Trials show microbicide not effective for social reasons

Photo by ΟΆКІ Clinical trials have found that anti-HIV vaginal microbicide gel Carraguard is not effective, it was announced last week.

The trial results are the latest in a string of disappointments for people hoping to develop a cream or gel to help protect women against the transmission of HIV through sex.

Carraguard, made from carrageenan seaweed, has been deemed safe by the US Food and Drug Administration “for oral and topical use”. During clinical trials however, just 10% of female participants used the gel as instructed, rendering the product ineffective.

All trial participants received information on HIV, safer sex practices and how to reduce the risk of contracting a sexually transmitted infection (STI). Care and support services were provided to female participants, who were given male condoms as well as an inactive gel or placebo.

But the women used the gel less than half the number of times they had sex, calling the practicality of microbicides into question. While the development of anti-HIV creams and gels is seen as a key step towards empowering women in the fight against HIV, the use of such preventative measures requires the cooperation of a woman’s partner.

Gender inequalities prevent many women from being able to protect themselves against HIV. Millions of women lack the social or economic power to insist on preventative measures such as condoms, abstinence or monogamy. So while the development of microbicides is appealing in theory, in reality, and during clinic trials, the gels are not proving effective.

Women who took part in the Carraguard trials were expected to use the gels during social interactions that allowed them little power to negotiate issues related to sex and their sexuality. Outside the laboratory, other social situations further reduce the women’s likelihood of using the product.

Millions of women live in societies that permit them no role in sexual decision-making, condone male infidelity and assign the shame and stigma associated with infectious diseases to women.

Existing preventative strategies have largely failed to address this vulnerability, focusing on abstinence, mutual monogamy and male condom use, none of which are easily controlled by women.

Vaginal microbicides are also likely to fail until men understand and respect the need for women to protect themselves against HIV and other STIs. Not only do women need preventative options that they can choose to use freely but the gender inequalities that make it harder for women to insist on safer sex must be addressed.

Hopefully delegates at the International Microbicides Conference 2008 in Delhi, India will address these issues and can help produce effective strategies to reduce gender inequalities as well as promising microbicide products.

Bobby Ramakant-CNS

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