Women have become especially vulnerable to the dangers of the AIDS epidemic, spurring research for a protective gel or cream. But availability on the market is still five years away, even if all goes well, a leading researcher said on Wednesday.
Women make up nearly 60 percent of all HIV infections in Africa and their infection rates in many regions are climbing much faster than men, experts say. Because being young, married and faithful is no protection against infection, the need has never been greater.
“There could be a product on the market in five years if the current products in large scale trials work,” Dr. Zeda Rosenberg, of the non-profit International Partnership for Microbicides, told Reuters at a global AIDS conference.
“If they do not, then it will be seven to nine years.”
No vaccine in sight
AIDS experts estimate that even a partially effective microbicide -- a cream, gel, foaming tablet or a vaginal ring that acts like an invisible condom -- could prevent 2.5 million deaths from AIDS over three years.
Across the world, 17 million women are infected.
With no AIDS vaccine likely to be on the market for years, a microbicide offers one of the best chances to thwart the global pandemic, experts say.
Last year alone, almost three million people died and five million were infected with the virus. The most vulnerable group are poor, young women and, increasingly, married women whose husbands refuse to use condoms.
Many cultures deny women the power and confidence to demand that partners wear condoms — regarded as the key prevention tool.
U.N. Secretary General Kofi Annan, in his opening address to the 15th International AIDS Conference, stressed the importance of helping women.
“We must ensure they have full access to the practical options that can protect them from HIV -- including microbicides, as they become available,” he said.
Three ways of attacking the virus
Not only does biology make women more vulnerable to HIV infection, but the current prevention policies are often not working for them, experts say.
The woman is the one giving up work and school to care for a sick husband, brother or child. Poverty, discrimination and violence make her more vulnerable to the disease.
“The cultural challenges that face her are so huge that we’ve got to look at the issue of women’s rights when we are talking about HIV and AIDS,” said Ludfine Anyango, a Kenyan mother who was infected, then widowed, by her husband. “If it doesn’t happen, we are going to lose a whole generation
“All those are in the context of a man,” said Anyango, who came to the Bangkok conference to campaign for women’s access to HIV prevention and care. “We are talking about the girl-child. How will she abstain when she is raped? What about 'be faithful?' I was infected in the family environment. I was faithful, but 'be faithful' did not work for me.”
Among new HIV prevention strategies being discussed are vaccines, diaphragms, anti-HIV vaginal gels, and a daily prescription of HIV drugs to prevent infection.
Scientists hope that within five years, the first batch of broad-spectrum, HIV-killing vaginal products could be available. A second generation — more specifically targeting the HIV virus and expected to be more potent and longer-lasting — is in early testing.
These products would include gels or creams, slow-release sponges, dissolving films or long-wearing vaginal rings.
While they are no substitute for condoms, they could profoundly affect how well the world’s most vulnerable women can fight HIV even if the products turn out to be no more than 30 percent effective, said Rosenberg.
Rosenberg said there were many products in different stages of clinical trials. Two have begun efficacy testing and four more are due to follow soon. The trials will involve 20,000 women over the next three years.
The microbicides would either kill HIV in semen, block the attachment of the virus to its target cell, or prevent HIV from multiplying if the virus enters the cell.
“You keep it at a local infection and stop it locally before the virus spreads throughout the body. The ideal microbicide eventually may be one that combines all three stages,” Rosenberg said.
'Feminization of the epidemic'
The IPC, which receives funding from governments and foundations, is developing its own microbicides and is working with other groups which have promising candidates.
The ideal product would be easy to produce so companies around the world could make them as rapidly as possible to ensure wide use and availability.
IPC reached a royalty-free agreement with Tibotec, a Belgian subsidiary of U.S. healthcare group Johnson & Johnson, in March to develop a drug known as TMC120 for use as a microbicide in developing countries.
“Microbicides will help give women control over their reproductive health and that will help in easing the inequity, but we need education for women,” Rosenberg said.
“We need them to be economically independent. There is a lot that needs to be done to help women, and microbicides are one tool,” she said.
“The feminization of the epidemic has brought the need for a microbicide clearly into the limelight.”
Experts predict they most likely will be used in combination with diaphragms or other techniques.
Interest in microbicides intensified in the last two years as AIDS increasingly afflicted women and as hopes dimmed for a vaccine anytime soon, Rosenberg said.
Also, many experts are now concerned that AIDS vaccines will only be partially effective — also an initial concern over microbicides.
“When you can have a partially protective vaccine in 15 years or a partially protective microbicide in 5 years, it makes a whole lot of sense now to focus on microbicides,” Rosenberg said.
