The Future of Preventing HIV and STDs

There is currently only one product that can prevent HIV transmission during sex - condoms. But the race is on to create an alternative. And one of the biggest developments, microbicides, may be the favorite that will help reduce the spread of HIV and other sexually transmitted diseases (STDs) worldwide.

How Microbicides Would Work

Unlike condoms, which create a physical barrier to prevent the transfer of disease from one body to another, microbicides would form a chemical barrier inside a woman's vagina. This barrier could prevent both bacteria and viruses from spreading in various ways: by blocking the virus before it enters the body, preventing the virus from replicating, boosting the vagina's natural defenses or by directly killing the bacteria or virus before it infects the body.

No matter their mechanism of action, microbicides could be developed to target only HIV or a broad spectrum of STDs, both bacterial and viral, including herpes, chlamydia, gonorrhea and syphilis. Additionally, microbicides may also include a spermicidal property to help prevent unwanted pregnancy.

They may be developed in the form of creams, gels, films or suppositories that are applied directly to the vagina. Just like condoms, early studies indicate that they will protect both sexual partners from disease transmission.

For American women, microbicides would offer an alternative to condoms and more protection than diaphragms, the pill or other forms of birth control, which do not offer any disease prevention. In fact, it seems that they will be just as effective when used in combination with these other types of birth control.

"We expect that a lot of women who are on the pill will use this as well to protect against sexual disease transmission, said Ann Marie Corner, Senior Vice President of Cellegy, the manufacturer of Savvy, one of the microbicides in development, "But it seems that women will also be likely to use it with a condom, as it is also a lubricating gel."

Microbicides, however, will offer much more to women overseas.

The Spread of HIV
Even with numerous efforts to curb the spread of HIV, rates of the disease continue to grow, mostly notably in women around the world. The World Health Organization estimates that half of all people with HIV are women and third-world nations have been the hardest hit.

Women in these regions are often uneducated about sexual diseases and subjected to sexual violence. And while resources may be scarce, there are many programs that offer condoms to these women. But they don't always help, as the man has to be willing to wear it. Making matters worse, a woman is almost twice as likely to be infected by HIV after sex with an infected man than vice-versa.

"[Microbicides] are a way for a woman to control HIV and other disease transmissions without a man's knowledge," said Dr. Christine Mauck, senior medical advisor at Conrad, a leading institution in testing various microbicides.

The Contenders
There are three microbicides currently in late-stage studies for FDA approval.

One gel, Savvy (C31G), created a buzz after being put on the FDA's fast-track system for approval in 2003. It works by preventing the infectious cell from entering the body. Early tests show that the gel is "highly potent" in fighting viruses and bacteria, and it is about 85 percent successful in preventing pregnancies with minimal side effects. Two other products, Carraguard and cellulose sulfate (also known as UsherCell), are also currently being tested for their effectiveness.

As of yet, all three microbicides have shown promise for use against HIV with minimal side effects. Only time will tell if these products prove to be just as effective in long-term tests and against other STDs. Still, while some experts may disagree, Mauck estimates that at least one of these products will be approved for use in three to four years.

Even though government approval may be far off, manufacturing companies have already established agreements with USAID, an American organization dedicated to helping underdeveloped nations, to provide microbicides to women in the most affected countries at an incredibly reduced cost.

"The hope is to give women something that doesn't need a partner's knowledge that will reduce rates of HIV to not only them, but their children as well," said Corner.

And while microbicides probably won't be provided at a reduced cost to American women, they would still be an inexpensive option to help make sex safer for everyone.

Karen Barrow is a copyeditor/writer for Healthology. She obtained a master's degree in biomedical journalism from New York University and a bachelor's degree in biology from Cornell University.