Women and HIV-AIDS: Disappointing News

This week’s medical news brought a report about the disappointing results of one of the (thought to be) most promising weapons in the small arsenal against HIV-AIDS: a vaginal gel microbiocide, Carroguard. The gel was being tested in a large-scale trial in South Africa and Botswanna. This clinical trial had been ongoing for three years, but unfortunately, the number of women who became infected with HIV during the trial from the group who used Carroguard was very similar to the number of women in the control group who also seroconverted. Essentially, this means the drug did not work.

Granted, there are some questions about the results since it is always difficult to calculate whether the women in the study used the drug regularly and correctly. Did they faithfully insert the gel before having sex? If not, the results of the study may not reveal the entire picture.

Why is this news significant? There are currently about 33 million people infected with HIV-AIDS. Over the years, we have heard of many failures in the various HIV-AIDS agents and therapies, although there have also been some major successes. But the drugs that have been shown to fight the stubborn and infinitely clever HIV virus have not, thus far, prevented infection. Instead, therapies like Zidovudine (AZT) and Nevirapine (which prevent the HIV virus from replicating inside infected human cells) and the HIV protease inhibitors (which stop mature new viruses from being produced) interfere with the HIV virus’s activity after it has already infected its victim. Such agents, usually used in combination with each other, have given life and hope to millions of people infected with the HIV virus. But they do not cure AIDS, nor do they prevent the virus from entering human cells and beginning its deadly siege of the human immune system.

The microbiocide gels work in an entirely different manner. The goal for this type of drug is to prevent the transmission of the virus by blocking its initial entry into human cells. The point here is not to cure the disease, but to prevent a person being infected in the first place.

According to a 2004 report of the Joint UN/World Health Organization, a microbiocide, even if only 60 % effective, could result in a major reduction of new HIV infections among women. If applied vaginally prior to intercourse by 20 percent of women in 73 low income countries, it could prevent 2.5 million new infections over a three year period.

This assumes, of course, that the microbiocide works. Different microbiocides use different methods to achieve their goals – for more on this topic see WHO’s website.

Such an approach is urgently needed. During sexual intercourse, the receptive partner is more susceptible to the virus than the penetrative partner, meaning that women are more likely to acquire the virus from men than vice versa. Since power dynamics in relationships often make it difficult for women to insist upon the use of condoms, the development of a topical agent that women could apply prior to intercourse is vital.

There has generally been a failure by public health officials to recognize that gender inequality all too often deprives women of the right either to decline sex or to insist upon the use of condoms. This situation is worse in some countries than in others, and is related not only to the status of women in a particular nation, but also to their age, level of education, and personal power within their sexual relationships.

If effective microbiocides can be researched and developed, and if women can be taught to use them regularly, they could potentially prevent millions of new infections in the years to come. This would greatly benefit women at risk for AIDS, an important goal since women now represent 50 percent of the global total of AIDS-infected individuals. It would also benefit children, since it is believed that 97 percent of infants with AIDS acquire the virus from their mothers.

More info on microbiocides

Paper written by Linda Barlow on macrobiocides