The Case for Microbicides: Arming women in the battle against HIV/AIDS.
Friday, February 2, 2007
HIV/AIDS is the pandemic of our time. The statistics are staggering: 22 million people have died from AIDS, 42 million are living with AIDS, and there are 14,000 new infections every day. It is estimated that the number of children living with HIV today is 1.2 million and that by the year 2010 there will be 25 million AIDS orphans. Sub-Saharan Africa, the region hardest hit by the epidemic, is home to 21.5 million adults and 1 million children living with HIV.
Although women are biologically more vulnerable to HIV infection than men, the stark differences between male and female susceptibility are not widely understood. Reasons for this disparity in biological susceptibility include the fact that semen contains more HIV particles than do cervical or vaginal secretions, and it remains in the vaginal tract for a longer period of time than vaginal fluids remain on the penis.
In societies with deeply rooted sexism, the inferior social position of women creates a vulnerability that compounds the problem of biological susceptibility: Women are afflicted by a proliferation of misinformation about HIV/AIDS and by a lack of access to reliable information and prevention services. Unfortunately, they sometimes face these problems even in the United States, so the lack of any female-controlled prevention tool is one of the largest problems contributing to the epidemic today, leaving many women all over the world defenseless and desperate for a method to protect themselves from HIV.
While there is no single solution to this crisis, there are options that can restore hope and agency to women at risk. The development and distribution of microbicides would be a major victory in the ongoing battle against new HIV infection.
The term "microbicides" describes a range of products that, when applied topically, help prevent the sexual transmission of HIV and other sexually transmitted diseases (STDs). For women who do not have the social or economic power to demand fidelity and condom use, microbicides would provide an effective prevention and protection tool that does not require consent from their partners. Moreover, microbicides can be contraceptive or non-contraceptive, allowing women who desire to get pregnant to do so without risking the chance of contracting HIV. It has been estimated that the use of even a moderately effective microbicide in lower-income countries could prevent 2.5 million HIV/STD infections in just three years.
So why aren't microbicides available?
Microbicide research and development has slowed dramatically because of a lack of funding and interest from the large pharmaceutical companies, who can make more money selling drugs like Prozac and Viagra to affluent consumers in the developed world. To these companies, microbicides represent a traditional "public health good," a product that could yield tremendous benefits for society, but from which there is no promise of a high profit. Because microbicides are not in the economic interest of these companies, it is left to the public sector and civil society to fund all microbicide development and clinical trials. To date, the Bill and Melinda Gates Foundation has supplied the greatest amount of money for this research. Public funding is scarce, with only 2 percent of the National Institutes of Health's AIDS research budget devoted to microbicide development.
A microbicide candidate is proven safe and effective in large scale clinical trials when it decreases the likelihood of becoming infected without causing any significant side effects. It will then go through the regulatory approval process in each country where it might be distributed. By nature, these complex trials take a considerable amount of time, but if any of the "frontrunner" products that are now in large-scale efficacy trials prove to be effective, a microbicide could be available in some countries before the end of this decade.
Around the world, people are becoming more aware of the importance of finding a prevention method, like microbicides, that would put women in control of their own bodies. On World AIDS Day in 2004, Kofi Annan, the former United Nations Secretary-General, said, " What is needed is real, positive change that will give more power and confidence to women and girls.... Change that will allow women to play to the full their role in the fight against HIV/AIDS.... Empowering women in this struggle must be our strategy for the future.... It is among them that the real heroes of this war are to be found.... It is our job to furnish them with hope."
Annan's insight into the widening gap of HIV prevention options for men and women has motivated many individuals and organizations to give high priority to the legalization and distribution of candidate microbicides. In order to empower women to defend themselves against AIDS, the world community must advocate for microbicide funding, research and development, and equitable distribution and access. The development of a microbicide is not strictly scientific; the very absence of the product symbolizes an outright social injustice against which all health and social justice advocates must fight.
Advocacy is at the heart of the microbicide effort, and it is vital that students take on this pressing issue. It is today's students who will be tomorrow's doctors, lawyers, and epidemiologists, and who will have the ability to devise and ensure equitable distribution for the women most in need.
Leah Katz is a co-founder of S4M: Students for Microbicides at Wesleyan University in Middletown, CT. Katz is working with the Global Campaign for Microbicides to enhance campus advocacy efforts across the United States.