AIDS TREATMENT NEWS #381, June 28, 2002
John S. James
On June 25, 2002 the World Health Organization published a 27- page report summarizing what is known about nonoxynol-9 (N-9) -- the failed microbicide that actually increases risk of HIV transmission. They concluded that N-9 should never be used for preventing HIV transmission, has no value in preventing other sexually transmitted diseases, and should never be used rectally, where the problem may be much worse than with vaginal use. (The report acknowledges that women at *low* risk of HIV infection may use N-9 occasionally as a moderately effective, female-controlled form of birth control, when better means are not available to them.)
Condoms should not include N-9 for any use. However, if the only condom available has N-9, it is better than no condom.
On May 10, 2002 the U.S. Centers for Disease Control and Prevention updated its GUIDELINES FOR THE TREATMENT OF SEXUALLY TRANSMITTTED DISEASES(MMWR, May 3, 2002 / 51(RR06);1-80) also warning against using N-9 (MMWR, May 10, 2002 / 51(18);389-392) for STD prevention.
N-9 kills HIV in the laboratory. But it also causes irritation in the vagina or rectum that can allow HIV to infect. A major clinical trial in women, reported two years ago at the International AIDS Conference in Durban, South Africa, studied over 800 sex workers randomly given either an N-9 or placebo gel, and found 48% more new HIV infections among those using N-9.
No one has done such a study with rectal use. But in both humans and animals the irritation is worse, with "sloughing of sheets of epithelium." The damage is later repaired, but by then HIV could have been transmitted.
A recent survey found that about 40% of condoms sold in the U.S. are lubricated with N-9, and about 40% of gay men look for it. Manufacturers of condoms and lube have no incentive to include N- 9, except for this mistaken public demand; and all of these manufacturers also market parallel versions of their products without N-9. Now that there is a clear, official consensus that N-9 is harmful, especially for rectal use, it is likely to start disappearing from condoms and lubes.
The community will need to help get the word out, since no one has a commercial incentive to do so, and government agencies are reluctant to speak about anal sex.
1. WHO/CONRAD TECHNICAL CONSULTATION ON NONOXYNOL-9, WORLD HEALTH ORGANIZATION, GENEVA, 9 - 10 OCTOBER 2001, SUMMARY REPORT. (This is the report published June 25, 2002; the October 2001 meeting brought together experts to examine the evidence and prepare recommendations.)
As we go to press the report is available through http://www.who.int/reproductive-health/rtis/index.htm (PDF) and also through: http://www.conrad.org (HTML).
2. "World Health Organization/Conrad Report Warns Against Use of Nonoxynol-9 As Microbicide," press statement issued June 25, available at the Web sites above.
020628
ATN38101
Copyright © 2002 - AIDS Treatment News. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used. Subscription lists are kept confidential. AIDS Treatment News, Subscription and Editorial Office: 1233 Locust St., 5th floor Philadelphia, PA 19107 800/TREAT-1-2 toll-free email: aidsnews@critpath.org http://www.aidsnews.org
Subscription Information: Call 800/TREAT-1-2: Businesses, Institutions, Professionals: $270/year. Includes early delivery of an extra copy by email. Nonprofit organizations: $135/year. Includes early delivery of an extra copy by email. Individuals: $120/year, or $70 for six months. Special discount for persons with financial difficulties: $54/year, or $30 for six months. If you cannot afford a subscription, please write or call. Outside North, Central, or South America, add air mail postage: $20/year, $10 for six months. Back issues available. Fax subscriptions, bulk rates, and multiple subscriptions are available; contact our office for details. Please send U.S. funds: personal check or bank draft, international postal money order, or travelers checks. VISA, Mastercard, and purchase orders also accepted. ISSN # 1052-4207
AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, iMetrikus, Inc., the National Library of Medicine, and donations from users like you. 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. .