Inter Press Service - July 16, 2000
Marwaan Macan-Markar

According to the New York-based Population Council, which is conducting the trials among these women, Carraguard, the Council's lead component in its microbicide tests, has displayed positive results during initial experiments. It "was found to block HIV infection in vitro."

But more tests need to be conducted to determine this method's safety, admits Charlotte Ellertson, the Council's chief investigator in these trials. "Microbicide efficacy testing is most urgent -- and most feasible in populations that have an annual rate of HIV that is greater than one percent."

And the choice of women from South Africa and Thailand for the "expanded safety trials" stems from the high incidence rate of HIV among women in those two countries.

Such high prevalence demonstrates "an acute need for a women- controlled HIV prevention method and provides sufficiently large sample sizes to detect differences between treatment and control groups," adds Ellertson.

These efforts by the Council - an international non-governmental organisation (NGO) specialising in biomedical, social science and public health research - are part of a larger drive, in fact, to develop a potent microbicide. Currently, there are 10 public agencies committed to such an objective under the International Working Group on Microbicides.

According to Dionne Patz, of the Pan American Health Organisation (PAHO), microbicides provide a beacon of hope for women, since such products will "empower women to protect themselves against infection not only from HIV but other sexually transmitted diseases."

In her view, furthermore, "It is one strategy of protection and control over a woman's sexual health that is not solely dependent on male co- operation. " The urgent need for such a gel or "invisible condom" has grown more acute in light of the devastating impact HIV and AIDS (acquired immune deficiency syndrome) have had on women, particularly in Africa and South and South East Asia.

Of the 33.6 million people living with HIV/AIDS, for instance, 14.8 million are women, states the World Health Organisation (WHO). In addition, of the 5 million adults who were newly infected in 1999, 2.3 million were women. And of the 2.1 million who died of AIDS last year, 1.1 million were women.

What is more, reveals the WHO in its assessment of this pandemic, women in sub-Saharan Africa, which is home to over 70 percent of the people with HIV or AIDS, have been worse hit than men -- "55 percent of adult infections in sub-Saharan Africa are in women."

In South East Asia, on the other hand, women make up 30 percent of the current adult infections.

And among the factors that have contributed to this dismal picture is a lack of recognition that women, too, have a right to "safe sexuality," notes the Geneva-based health body. "Women's right to safe sexuality and to autonomy in all decisions relating to sexuality is respected almost nowhere."

Often, it adds, women have been infected as a result of sex with a bisexual partner or drug-injecting partner, or as a consequence of coerced sex, where women have been compelled to "exchange sex for material favours, for daily survival."

Cultural taboos, too, have contributed to this upsurge in infections. "By and large, most men, however poor, can choose when, with whom and with what protection in any, to have sex. Most women cannot," affirms the WHO.

In addition, social and cultural constraints have also meant women not being expected to discuss or make decisions about sexuality, nor requesting any form of protection. According to WHO studies, if women refuse sex or request protection, "they often risk abuse, as there is suspicion of infidelity. "

Conversely, however, "For married and unmarried men, multiple partners (including sex workers) are culturally accepted."

Similar concerns have been expressed by the United Nations department for AIDS (UNAIDS) in view of the surge in the number of infected women.

"Gender inequality is a fundamental driving force of the AIDS epidemic," says Dominique De Santis, spokeswoman for UNAIDS.

Research done by her organisation has revealed that biological and social factors have made women and girls "more vulnerable to AIDS than men." This has been more so in adolescence and youth, where in many places HIV infection in young women has been three to five times higher than among boys.

Furthermore, she points out, "Violence -- or the threat of violence -- against women increases their vulnerability to HIV and reduces their ability to protect themselves against infection."

Such realities endured by many women, and the potency of microbicides to help them, was not lost on women's rights activists who attended the 13th International AIDS Conference, which ended in Durban, South Africa, last week. They argued that such a gel would serve vulnerable women well.

However, they expressed rage at the absence of such a product for women to access. "After 10 years of being nice about this, I think it's time we start acting up," said Lori Heise, of the Global Campaign for Women- Controlled Prevention Alternatives.

And such efforts would require activists like Heise to take on some of the obstacles that have come in the way of developing a potent microbicide. The lack of funding, according to Ellertson, is one of them.

Another, she pointed out, was the response to this "totally new" concept by the pharmaceutical industry -- "Pharmaceutical companies are not yet convinced that there is an adequate market."

So how long will it be before such an approved gel sees the light of day? At the current pace of research and development, "it is likely to be another decade before safe, effective and affordable microbicides are available," the Council estimates. (END/IPS/HE/mmm/da/00).
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