Sunday Times (Johannesburg) - April 30, 2006
Claire Keeton

A GEL or cream offering sexually active people protection against HIV infection could be on the market by 2010, when South Africa hosts the soccer World Cup.

Such creams ought to be made as easy to use as toothpaste in order for them to be popular, the CEO of the International Partnership for Microbicides, Dr Zeda Rosenberg, told the Sunday Times this week.

She said: "We need to design these products so that women and their partners enjoy them, and want to use them every day for the rest of their lives."

Rosenberg told the Microbicides 2006 conference in Cape Town this week that trials taking place around the world - involving about 25000 women - would influence the products' development.

Globally, six "phase III" trials, or final tests, are taking place to test how effective the products are, as well as to gather HIV-infection and pregnancy data.

The trials have also been used to collect information on sexual behaviour - some of which raised an eyebrow or two at the conference.

An overworked HIV doctor and Aids activist joked how colleagues had felt inadequate after hearing that women involved in a trial in Ghana reported that they had sex on average 6.9 times a week.

The safe sex counselling provided to women signing up for the trials appeared to have reduced the rate of new HIV infections at some sites.

But elsewhere, pregnancy rates were very high: between 12 and 60 pregnancies per 100 "women years" (that is, 100 women participating over one year). This indicated that participants were not using condoms.

Rosenberg said: "The reason this epidemic is out of control is that condoms are not a tool many women can use. The ABC tool [abstinence/ be faithful/ condomise] does not work for so many women. This is why we are developing microbicides."

She said that a microbicide that was only 50% effective would still "make a huge impact on the epidemic among women".

Recognising the potential benefits - which may include blocking sexually transmitted infections, or stopping HIV, but not fertility - the South African government has thrown its weight behind microbicides, both politically and by funding research.

Conference co-chairman Professor Gita Ramjee, director of the South African Medical Research Council's HIV Prevention Research Unit, said this development was very positive.

She said it would accelerate access to microbicides in South Africa once an effective candidate was identified.

She said another major ethical advance was that trial participants had access to the best care if they were found to be HIV-positive or became positive during the trial.

"Two years ago standards of care were not sorted out. The reasons that they are now include government buy-in," said Ramjee.

Preliminary results from trials of the current products are expected to be released at the next global conference in India in 2008.

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