Thursday, December 2, 2010

The 411 on microbicides

via ONE, by Todd Summers

There’s exciting news coming from researchers working on HIV prevention technologies about a gel that women can use that reduces significantly their risk of acquiring HIV from vaginal intercourse. Called a microbicide, it’s particularly exciting because it offers women more control over HIV prevention –- and this is important because AIDS impacts girls and women disproportionately (I blogged about this earlier, but it’s so exciting, I’m doing it again!)

Yesterday, I had a chance to attend a workshop at the US Agency for International Development hosted by its administrator Dr. Raj Shah (disclosure: I worked with Raj at the Gates Foundation and he’s a friend). USAID helped finance the microbicide study in South Africa that generated these results, and yesterday’s workshop was to come up with an action plan to get it approved by regulatory agencies and into the hands of women that need it.

It was smart to get this planning underway, as there are too many examples of good health technologies that go unused. It was also exciting for those attending, most of whom had been working in various ways for years to get to this point. Indeed, the first generation of microbicides didn’t work, and this second generation, now using AIDS drugs, was probably the last chance to keep the research going.

Raj started off the conference by sharing his trademark optimism: “I’m incredibly enthusiastic about today!” he exclaimed, noting that this research finding “changes the fundamental equation of how we address HIV around the world.” At the same time, he made clear what we all know, that “AIDS prevention requires a broad range of tools…all of which have some roll to play.”

Put simply, this is a great additional tool, especially for women, but it’s no silver bullet. Microbicides don’t protect from all infections, and will only work for women who can access it, afford it and use it every time they have intercourse -– all of which are significant challenges. There’s also a lot of work needed to get products necessary to regulatory approval in the donor world and in the affected countries, and to come up with strategies for integrating microbicides into broader HIV prevention strategies.

Raj urged the group to take a market-based approach, using lessons from the business world to look carefully at what’s needed to get the product out quickly and widely. Sometimes the public health world can learn a lesson from the business world, and this is one of those moments.

Also providing introductory remarks was Ambassador Melanne Verveer, a senior adviser to Secretary Clinton on gender issues (she worked with former First Lady Clinton in promoting US efforts on global HIV back in the late 1990s). She provided a sober reminder that HIV risk for women was about more than just the virus. Lack of economic opportunity and inadequate education, combined with longstanding cultural degradation, put women and girls at heightened risk for HIV –- and may very well inhibit their access to microbicides. So, she urged that planning for accelerating uptake of microbicides take these broader systemic challenges into account, and committed to full support from Secretary Clinton in that effort.

There’s lots of work ahead, and additional microbicides being studied, so expect to hear more from us on this. I’m particularly excited about microbicides that use impregnated rings that can stay inserted for long periods of time and therefore don’t require use of gels each time there’s a potential exposure. I also hope that work can begin to look at potential applications for rectal microbicides, which can protect women and men. Hats off to the researchers, the donors, and especially the women that volunteered to be part of the study!


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

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