The 411 on microbicides
This is the second in today’s five-part series on innovative prevention efforts in the fight against HIV/AIDS for World AIDS Day. Be sure to follow along throughout the day.
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!
- Previous Post What We’re Reading: AIDS activism on the college campus
- Next Post Get ready — the new young guns are in town!
Blog Contributors
Hot Topics
-
The FY2013 Budget: Protect Funding that Saves Lives
As Congress weighs in on the FY2013 budget, they need to protect funding for poverty-fighting programs. -
Big oil. We won't be bullied.
Right now, some of the world's biggest oil companies are fighting to keep some of their deals with foreign governments secret. Let's tell big oil we won't be bullied. -
Canadian Aid
Cuts to poverty-fighting programs won't balance the budget, but they will set back progress on Canada's development priorities and risk jeopardizing existing investments. -
The Beginning of the End of AIDS
2011 marks 30 years since the first cases of AIDS were documented. Take a closer look at the specific, achievable goals we must hit by 2015 to make this year the beginning of the end of AIDS.
From Our Members
-
Sowing the ‘seeds of change’ at Des Moines’ Downtown Farmers Market
May 10th, 2012 | Posted by Libby Crimmings -
Thrivin’ in Pennsylvania with Rep. Charlie Dent
Apr 26th, 2012 | Posted by Brian Sweeney -
Working together as ONE at Loyola Academy
Apr 25th, 2012 | Posted by Field
From Our Partners
-
Coffee? Or lunch? You choose.
May 18th, 2012 | Posted by Guest Blogger -
A human yardstick
May 15th, 2012 | Posted by Guest Blogger -
UN report calls for a realignment of agricultural reform
May 8th, 2012 | Posted by Guest Blogger
December 2, 2010 at 9:06 am
Thanks for this great post Todd, and as chair of IRMA – International Rectal Microbicide Advocates – special thanks for mentioning rectal microbicides!
Because unprotected anal intercourse is not only a common human behavior but also very efficient at transmitting HIV – at least 10 to 20 times more efficient compared to unprotected vaginal intercourse – this is an area of the field that must be urgently pursued for men, women, and transgender individuals around the world who need options beyond condoms.
Rectal microbicide science is about a decade behind vaginal microbicides for a whole host of reasons – including institutionalized homophobia, stigma around anal intercourse, and denial that this behavior occurs among heterosexuals.
However, those attitudes are shifting, and the science is moving along – thanks to strong advocacy and visionary scientists – and of course the amazing leadership of the National Institutes of Health.
The world’s third rectal microbicide trial launched in Pittsburgh, Boston, and Birmingham in mid-October. The study, being conducted by the Microbicide Trials Network, is testing the rectal safety and acceptability of tenofovir gel. Depending on the outcome of this new study, tenofovir gel could be further evaluated to determine if it can reduce the risk of HIV among both men and women who engage in receptive anal intercourse.
At the beginning of 2010, a multicenter research team led by the University of Pittsburgh received an $11 million, five-year grant from the National Institutes of Health to develop microbicides specifically designed to prevent rectal transmission of HIV, with the further aim of assessing their safety and efficacy in lab and early clinical studies. The Combination HIV Antiretroviral Rectal Microbicide (CHARM) program includes a project that will reformulate existing antiretroviral drugs into topical preparations that can be applied to the rectum.
While the rectal microbicide field has gained significant momentum, more focus and resources are necessary. In 2010, U.S. $7.2 million is being spent globally on rectal microbicide research. IRMA has calculated that annual investments must increase by 40% from 2011 – 2014, to U.S. $10 million/year and must increase further to U.S. $44 million (a six-fold increase) in the years 2015 – 2020 to ensure a minimum of candidate products are moving through the research pipeline into advanced testing for effectiveness.
For more info on rectal microbicide research and advocacy, I encourage readers to visit the IRMA website and read “From Promise to Product: Advancing Rectal Microbicide Research and Advocacy” – a report we published in May of this year, and which provides a great summary of current scientific and advocacy activities.