ARHA: Australian Reproductive Health Alliance

Microbicides

"No matter where she lives, who
she is, or what she does,
a woman should never
need her partner's
permission to save
her own life"

- Bill Gates

The "invisible condom"

Microbicides, sometimes called "the invisible condom", are a virus-killing gel currently under development.

Although no microbicide is on the market yet, excitement is growing because they have the potential to change the world on a scale similar to that achieved by the contraceptive pill.

When the first microbicides are fully tested and cleared for market (which could be as early as 2010) humanity may have at its disposal a powerful new weapon in slowing or stopping the spread of HIV/AIDS.

"So desperately needed"

Microbicide Symposium
Thursday 10 May
2007

  ARHA, with five partners, hosted a one-day
symposium in Sydney on Thursday 10 May to
  discuss the importance of microbicides in   Australia, and consider proposals to
enhance support for and knowledge about   microbicides in Australia.

  The Microbicides Symposium was held
  with support from the Global Campaign for   Microbicides (GCM), AusAID, and Starpharma, an Australian company developing a microbicide
   gel, Vivagel. ARHA is also partnering with
the Australian Federation of Aids
  Organisations (AFAO), the Burnet Institute
and the National Centre in HIV Epidemiology
and Clinical Research (NCHECR).

The symposium involved all key stakeholders,
policy makers, and representatives from
industry, academia, government, and
community.For more information about the
symposium, please contact Tom Gosling

Microsoft founder Bill Gates and his wife Melinda are both passionate supporters of efforts to develop this new technology, which promises to give women a way of saving their lives without men needing to know what they are using.

Also referred to as "the molecular condom", microbicides are formulated as a gel, cream, emulsion, ring or suppository. They work by inactivating, blocking or otherwise disrupting the transmission of HIV to the epithelial surfaces - the skin or lining cells inside the body.

The unwillingness of men in many countries to use condoms is creating a desperate need for women to protect themselves against deadly infection.

"It's just so desperately needed, I can't put words to it," said Stephen Lewis, the former UN special envoy for United Nations special envoy for HIV/AIDS in Africa.

There are currently some 4.5 million new HIV infections every year, with women more heavily affected than men. In sub-Saharan Africa, women and girls make up 60 per cent of adults living with HIV.

Current prevention strategies are not feasible for many women, especially in developing countries. Women urgently need methods to protect themselves from infection with HIV and other STIs that are within their personal control.

While no product will address the underlying gender inequalities that constrain women’s ability to protect themselves from infection, making such products available could save millions of lives. Research suggests that a microbicide that is 60 per cent effective could prevent 2.5 million HIV infections over three years.

Microbicides can substantially reduce transmission of HIV and other sexually transmitted infections (STIs) when applied either in the vagina or rectum. They can take the form of a gel or cream, a film, a suppository, a sponge or vaginal ring slowly releasing the active ingredient.

Microbicides could work in different ways:

They can cover the surface of the vagina, thus preventing the virus from getting through;
They can boost the vagina’s natural defenses
They can attack the virus itself; and
They can stop the virus from replicating inside cells.

Would a microbicide protect against all sexually transmitted infections?

Since STIs are caused by different pathogens (some viral, some bacterial), a microbicide that works against one STI pathogen would not necessarily protect against another. Many of the microbicides currently being tested work against HIV and at least one other STI. Eventually, a product that combines different microbicides and mechanisms of action may offer a protection from a wide range of sexually transmitted infections, including HIV.

What is the current state of microbicide research?

Scientists are currently testing many substances to see whether they help protect against HIV and/or other STIs, but no safe and effective microbicide is currently available to the public. However, scientists are seriously pursuing dozens of product leads, including 10 that have proven safe and effective in animals and are now being tested in people. If one of these leads proves successful and investment is sufficient, a microbicide could be available by the end of the decade in a handful of settings in high prevalence countries.

Why are microbicides important?

Today's prevention options --condoms, mutual monogamy, and STI treatment-- are not feasible for millions of people around the world, especially women. Many women do not have the social or economic power necessary to insist on condom use and fidelity or to abandon partnerships that put them at risk. Because microbicides would not require a partner's cooperation, they would put the power to protect into women's hands.

Why are microbicides important for Australia?

Australia’s HIV epidemic is still concentrated on unsafe sex between men, which has accounted for more than two thirds of newly diagnosed HIV infections so far this decade. While current microbicides are being designed specifically for vaginal use, there is interest and a need for a rectal microbicide. In addition, microbicides could possibly be used as a contraceptive or to protect people from STI’s, which is on the rise in Australia.

Among Australia’s indigenous population, indigenous women are especially at risk for HIV infections: they are 18 times more likely to be HIV-infected than are non-indigenous women. There may be a role for microbicides to play in reducing infection rates among this particularly vulnerable population.

Outside of Australia, microbicides could become an important component of AusAID’s (the Australian government’s Agency for International Development) HIV/AIDS strategy in neighbouring countries like Papua New Guinea, for example.

According to UNAIDS (2005), Papua New Guinea has an adult national HIV prevalence of 1.8%, which implies that there are currently 57,000 people older than 15 years living with HIV. The epidemic continues to grow and shows no signs of abating.

High rates of sexually transmitted infections, early sexual initiation, a common practice of concurrent sexual partnerships, high rates of transactional sex, very low rates of condom use and widespread physical and sexual violence against women provide the epidemic with considerable potential for further growth. Young women are especially vulnerable: HIV infection levels among those aged 15-29 years are twice as high as among men of the same age. A recent study shows that 60% of infected females were married women. It is much more difficult to promote condom use in marital settings, even though married women are potentially at high risk of infection if their husbands engage in unprotected sex outside of marriage. Microbicides would allow women to protect themselves and their families.

Why are microbicides important to ARHA?

ARHA is committed to promoting public support for enhanced reproductive and sexual health in Australia and internationally, and to promote the advancement of the status of women and girls. Microbicides, when developed, will empower women with the ability to protect themselves and their families. It will potentially save the lives of millions of women and men.

As Bill Gates once said, “No matter where she lives, who she is, or what she does, a woman should never need her partner’s permission to save her own life.”

What is ARHA doing about microbicides?

ARHA is calling for a co-ordinated national advocacy plan to further the cause of microbicides. ARHA in partnership with the Australian Federation of AIDS Organizations (AFAO), Starpharma, Burnet Institute, National Centre in HIV Epidemiology and Clinical Research (NCHECR), and the Global Campaign for Microbicides (GCM) hosted a one-day symposium on Thursday, May 10, 2007 for all key stakeholders, policy makers, and representatives from industry, academia, government, and community. The symposium included discussions on the importance and potential of microbicides, and recent developments in microbicide research. Initial discussions was also held on working collaboratively to create an advocacy plan.