Washington Blade - October 4, 2002
Mike Fleming

The medical coalition, led by the Global Campaign for Microbicides, called on condom and personal lubricant manufacturers to discontinue products that contain nonoxynol-9 following a warning to consumers by the World Health Organization and the national Centers for Disease Control in Atlanta.

Other high-profile supporters of the call to pull products that contain nonoxynol-9 include amfAR, Planned Parenthood and the Gay & Lesbian Medical Association.

As part of its involvement, the GLMA released a Sept. 26 "urgent message to gay and bisexual men."

"Nonoxynol-9, often used in the manufacture of lubricants and lubricated condoms, does not protect against HIV transmission and may actually increase vulnerability to transmission in some cases," said Christopher Harris, GLMA president. "We need to get the message out there right now.

"When you buy condoms or lubricants, look at the label," he said. "N-9 offers no benefit to men who have sex with men."

Nonoxynol-9 was never fully tested or proven, but was suggested in an effort to offer consumers a product immediately amid AIDS fears, said Lori Heise, director of the Global Campaign for Microbicides.

"The evidence one way or the other about N-9 effectiveness against STDs and HIV was not very strong," Heise said. "It wasnÆt until the microbicide field came along that people began to seriously evaluate N-9Æs safety and effectiveness as a possible anti-HIV agent.

Microbicides are anti-infective substances that are currently being developed as gels and other contraceptive products. Gay health and AIDS advocates, including the Global Campaign for Microbicides, have been calling for a step up in microbicide research against HIV for years, though no such product has hit store shelves or pharmacies to date.

Rectum weakness cited

The call to discontinue nonoxynol-9 products was specifically intended for rectal users because while the vagina is some 40-cells thick, the rectum is covered only by one layer of cells, making it far more susceptible to toxic damage by nonoxynol-9. But even vaginal use has proven damaging.

"N-9 appears far more toxic to the lining of the rectum than anything that we had seen vaginally," she Heise. "Even small doses of N-9 when used rectally cause almost total sloughing of the rectal cell lining, exposing underlying tissues to HIV."

Hard evidence emerged in a 2000 study by the United Nations Program on AIDS that showed female sex workers in Africa "who used nonoxynol-9 had become infected with HIV at about a 50 percent higher rate than women who used a placebo gel," said David Salyer, an AIDS educator in Atlanta as well as the co-chair of the Georgia branch of the Global Campaign for Microbicides.

"Women who used N-9 also had more vaginal legions, which probably increased the chances of HIV transmission," he said. "As a result of that study, the CDC issued a warning about nonoxynol-9."

The same would be incrementally true for rectal use, he said.

Some manufacturers of nonoxynol-9 products have already committed to voluntarily stop adding the ingredient to their products, including manufacturers Johnson & Johnson, makers of KY Plus; Trimensa, manufacturers of ForPlay and ForPlay Plus; Bcummings Company, makers of Elbow Grease and Mayer Laboratories, distributor of AquaLube Plus and Kimono and Maxx condoms.

Westridge Laboratories, makers of ID-Plus lubricant; Armkel LLC, makers of Trojan, Ansell, makers of Lifestyles and SSL International, makers of Durex did not agree to get on board with the ban by press time.

"The big three condom manufacturers have all balked, arguing that N-9 on condoms back up protection against pregnancy," Heise said. "But both the WHO and CDC have said that there is no evidence that the amount of N-9 available on a condom lubricant is sufficient to provide meaningful protection against pregnancy.

"If removing N-9 from condoms were a real affront to women, why have all the major womenÆs health groups signed onto our statement?" Heise asked. Representatives at Westridge, Armkel and SSL did not reply to interview requests by press time.

Global Campaign for Microbicides

1800 K St., Suite 800

Washington, DC 20006 - 202-822-0033

www.global-campaign.org

Gay & Lesbian Medical Association

459 Fulton St., Suite 107

San Francisco, CA 94102

415-255-4547 - www.glma.org

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