San Francisco Chronicle - Wednesday, August 28, 2002
Sabin Russell, Chronicle Medical Writer

The grant ends an eight-year quest by UCSF researcher Nancy Padian to win funding for a never-tried approach that, in theory, could block the AIDS virus about as effectively as a much more expensive AIDS vaccine. The goal is to achieve at least a 33 percent reduction in new infections among women in developing countries.

Padian's project will get the lion's share of $48 million in new Gates grants, which also will support a study in Uganda to test whether male circumcision -- another low-cost intervention -- can cut the risk of HIV infection among males by at least 50 percent, as some earlier research suggests.

The concept of using a diaphragm to protect against HIV infection was first raised in 1989 by AIDS research pioneer Dr. Jay Levy of UCSF.

"I felt certain that if you could block virus-infected cells from the cervix, you could reduce transmission dramatically," he said.

The Gates Foundation already has committed $100 million to research on the elusive AIDS vaccine. Dr. Helen Gayle, director of HIV and tuberculosis programs at the Gates Foundation, said the grants complement that effort.

"There is a lot we can do with existing technologies while we search for a better vaccine," she said. "Even if we can reduce infections only by 30 percent, every life we save can make a difference."

The four-year diaphragm study, which will enroll 4,500 women in Zimbabwe and South Africa, was approved after Padian presented research at the 14th International AIDS Conference in Barcelona, Spain, showing that women in Zimbabwe who could not get their partners to wear condoms would use latex diaphragms as an HIV-prevention tool.

"The women are desperate there," said Padian, who divides her time between UCSF laboratories in San Francisco and Harare, Zimbabwe. "There is a 1 in 3 chance that their partner is infected. They would rather use something of hypothetical effectiveness that they can control than nothing at all."

No one expects a diaphragm to completely protect a woman against HIV, the virus that causes AIDS, but there is substantial biological evidence that protecting the cervix from infected semen could improve the odds significantly.

Padian called the cervix a "hot spot" of susceptibility to HIV infection.

Tissues there are targeted by the AIDS virus, though paradoxically, the tissues are richer in infection-fighting cells.

There also is some evidence -- currently being tested in unrelated trials -- that the diaphragm's protection of the cervix blocks some sexually transmitted diseases such as syphilis, which cause lesions that serve as gateways into the bloodstream for HIV.

Perhaps the most valuable attribute of the diaphragm is that women may often be able to use it without their sexual partner's knowledge. Padian insists that many of the women in the earlier Harare trial successfully used the devices clandestinely -- meeting the test of a long-sought "female- controlled" barrier to HIV.

All the women in the study will receive access to condoms and counseling to have their partners use them. Half the women will be given a diaphragm, which costs about $25; the other half will serve as controls.

The Gates Foundation also awarded a $5.8 million grant to Columbia University's Mailman School of Public Health to support a study of male circumcision under way in Rakai, Uganda. The Gates money will expand that study to test whether male circumcision, a simple operation which can be performed in Africa for about $4.50, also reduces other sexually transmitted diseases in both men and women.

Studies have shown that the male foreskin has up to six times the number of HIV-susceptible cells as the female cervix.

The Gates Foundation also awarded $11.9 million to the Eastern Virginia Medical School's Contraceptive Research and Development Program to test the effectiveness of microbicides that also would work as contraceptives.

E-mail Sabin Russell at srussell@sfchronicle.com.
020828
SC020814

Always watch for outdated information. This article first appeared in 2002. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2002. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .