Microbicide Q & A (2)

Who is working on microbicide research and development?
Virtually all microbicides research to date has been conducted by non-profit and academic institutions or small biotech companies. Research is financed by charitable foundations along with government grants. These public funds also support basic science, social and behavioural research, and clinical study infrastructure that contribute to microbicides research and development. Large pharmaceutical companies have not invested significantly in this area, this is mostly because their income would be minimal.

Why do we need microbicides if we will finally have an HIV-vaccine?
No method or technology will "solve" the AIDS pandemic. We must implement all existing prevention methods --such as behavior change, voluntary counselling and testing, STI diagnosis and treatment, extensive access to male and female condoms, and anti-retroviral interventions-- as well as extend our collection of resources and technologies. Microbicides will probably be accessible and available sooner than an HIV-vaccine. Even after a safe and effective vaccine is discovered, vaccines and microbicides will have different, complementary roles to play in an integrated, multi-faceted global HIV prevention strategy.

Would a microbicide also protect the male partners of HIV positive women?
Lots of candidate microbicides currently being examined are widely anti-microbial and may provide protection against a variety of sexually transmitted infections, including HIV.  By neutralising pathogens in both semen and vaginal secretions, these products will give bi-directional protection; that is, will help protect men and partners. This will give HIV positive people a way of minimizing their partner's risk of HIV exposure during intercourse --as well a way of reducing their own risk of re-infection.
Microbicides will also provide valuable back-up protection to couples who use them with condoms. If the condom slips or breaks, the microbicides can provide both partners added protection from possible infection.

Why would a man want to use a microbicide instead of a condom?
Lots of men dislike using male condoms, regardless that they are excellent barriers against infection and unintended pregnancy. Objections include perceived decrease in pleasure, difficult maintaining an erection, interruption of spontaneity and decrease of the intimacy associated with skin to skin contact. Even before the spread of HIV/AIDS resulted in higher concern about STIs, these factors influenced men's attitude towards condoms. Largely, they account for the popularity of non-condom methods of contraception.
However, non-condom methods of STIs prevention do not yet {exist|be found}. Even when microbicides reach the market, it is unlikely that they will meet the efficacy of male and female condoms for HIV prevention. Logically, it is advisable to keep a virus from coming into contact with one's body than it is to try to eliminate it once it is there.
But, for men and women who don't use condoms regularly, microbicides will offer an essential risk reduction option. Using even a partially effective microbicide will provide significantly more protection than using nothing at all.

Will men who have sex with men be able to use microbicides for anal sex?
Anal intercourse is practiced by both heterosexuals for pleasure and as a way of having intercourse without risk of pregnancy. Receptive sex partners (whether women or men) are at higher risk of HIV infection than insertive partners during unprotected anal intercourse.  Both partners can be in contact with other sexually transmitted infections (STIs) including anal warts, hepatitis B, syphilis and gonorrhea.
Condoms deliver the best barrier against rectal infections but, obviously, only work when they are used.  Rectal microbicides could  protection in the absence of condoms and giving back-up protection when condoms are being used. Therefore, they are essential if we are to address the entire spectrum of prevalent sexual practices as well as the basic human need for accessible, user-controlled HIV and STI prevention tools.

Have men been involved in the research and development of microbicides?
Although most of the clinical microbicide trials now ongoing focus on vaginal use of the products, men are included in microbicide research in a number of ways. Once a product is determined to be safe for vaginal use, men are enrolled in "male tolerance" trials to find out if the product causes irritation to the penis or the male urethra. Clearly, such irritation would be a serious issue for the couple even if the product is safe for vaginal and/or rectal use.
Products are also tested to see if they cause rectal irritation, for two reasons:
- any product that proceeds on the market for vaginal use will probably be used rectally by some people (men and women) who are interested in non-condom ways of protecting themselves during anal intercourse; and
- gay and straight couples who have anal intercourse need a microbicide that has been specifically tried for safety and effectiveness during rectal use.
Male tolerance studies are now being carried out on several of the leading candidate products that have passed preliminary safety trials for vaginal use.
The third way in which men are taking part is microbicide research is as partners of women participating in vaginal microbicide trials. Most trials require the participation of sexually active women. In these studies, information are also gathered from the women's male partners about their attitudes toward the product, what impact (if any) it had on their experience of sex during the trial, and whether the product is something they would consider using on an continuous basis. Men's responses form an essential part of the acceptability data collected from all study participants.

Why should men care about microbicides?
No strategy or technology will solve the AIDS pandemic. We must implement all existing prevention strategies --such as behaviour change, voluntary counselling and testing, STI diagnosis and treatment, broad access to male and female condoms, and anti-retroviral interventions-- as well as expand our collection of tools and technologies.
For people who cannot or will not use condoms consistently, for whatever reason, using a microbicide could be lifesaving. Safe, effective microbicides would also have an important impact on the HIV epidemic. A mathematical model developed by researchers at the London School of Hygiene and Tropical Medicine shows that if even a small number of women in lower income countries used a 60% effective microbicide in half the sexual encounters where condoms are not used, 2.5 million HIV infections could be averted over 3 years.
In these calculations, the modellers included not only the numbers of women who would be directly protected by a vaginal microbicide but also the men and children who would be protected because the women were able to continue to be HIV negative.
Microbicides are a men's issue as well as a women's issue because halting the spread of HIV/AIDS is a human issue. For reasons of personal protection and for reasons of moral responsibility, it's time for men and women to demand increased public investment to expedite the development of safe, effective microbicides.