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Arming Women in the Battle Against HIV/AIDS: The Case for Microbicides

HIV/AIDS is the pandemic of our time.

 

The statistics are staggering: 22 million people have died from AIDS, 42 million are living with AIDS, and there are 14,000 new infections every day.  It is estimated that the number of children living with HIV today is 1.2 million and that, by the year 2010, there will be 25 million AIDS orphans. Sub-Saharan Africa, the region hardest hit by the epidemic, is home to 21.5 million adults and 1 million children living with HIV.

The African woman is becoming the new face of AIDS.  At the recent International AIDS Conference in Toronto, the feminization of AIDS, especially in Sub-Saharan Africa, was the most pressing concern.  HIV is now the leading cause of death for African American women between the ages of 25 and 34 and the third leading cause of death for African American women between the ages of 35 and 44.

Although women are biologically more vulnerable to HIV infection than men, the stark differences in male and female susceptibility are not widely understood.  Factors for this disparity in biological susceptibility include the fact that semen contains more HIV particles than do vaginal fluids and remain in the vaginal tract for a longer period of time than vaginal fluids remain on the penis. Also, compared to middle-aged women, adolescent girls and menopausal women have thinner vaginal walls, providing a weaker barrier to the pathogen that causes AIDS.

In societies with deeply rooted sexism, the inferior position of women creates a social vulnerability that compounds the problem of biological susceptibility.  In such societies, women in particular are afflicted by a proliferation of misinformation about HIV/AIDS and by a lack of access to reliable information and prevention services. 

In many African societies, as in other societies throughout the world, it is unacceptable for women to negotiate for safer sex.  There is also no viable way for them to prevent the disease while still allowing for conception.  The lack of any female-controlled prevention tool is one of the largest problems contributing to the epidemic today, leaving women all over the world defenseless and desperate for a method to protect themselves from HIV infection.

While there is no single solution to this crisis, there are options that can restore hope and agency to women at risk.  The development and distribution of microbicides would be a major victory in the ongoing battle against new HIV infection.

The term “microbicides” describes a range of products that, when applied topically, prevent the sexual transmission of HIV and other sexually transmitted diseases (STDs). For women who do not have the social or economic power to demand fidelity and condom use, microbicides would provide an effective prevention and protection tool that does not require consent from their partners. Moreover, microbicides can be contraceptive or non- contraceptive, allowing women who desire to get pregnant to do so without risking the chance of contracting HIV. It has been estimated that the use of even a moderately effective microbicide in lower income countries could prevent two and a half million HIV/STD infections in just three years.
       
So why aren’t they available?

Microbicide research and development has been slowed dramatically because of a lack of funding and interest from the large pharmaceutical companies. To these companies, microbicides represent a traditional “public health good,” a product that could yield tremendous benefits for society, but from which there is no promise of a high profit. Because microbicides are not in the economic interest of these companies, it is left to the public sector to fund all microbicide development and clinical trials. To date, the Bill and Melinda Gates Foundation has supplied the greatest amount of money for this research.  However, public funding is scarce, with only two percent  of the National Institutes of Health’s AIDS research budget devoted to microbicide development.

A microbicide candidate is proven safe and effective in large scale clinical trials when it decreases the likelihood of becoming infected without causing any significant side effects.  It will then go through the regulatory approval process in each country where it might be distributed. By nature, these complex trials take a considerable amount of time, but if any of the “frontrunner” products that are now in large scale efficacy trials prove to be effective, a microbicide could be available in some countries before the end of the decade.

Around the world, people are becoming more aware of the importance of finding a prevention method, like microbicides, that would put women in control of their own bodies.  On World AIDS Day in 2004, Kofi Annan, the United Nations Secretary-General, said, “ What is needed is real, positive change that will give more power and confidence to women and girls…Change that will allow women to play to the full their role in the fight against HIV/AIDS…Empowering women in this struggle must be our strategy for the future…It is among them that the real heroes of this war are to be found…It is our job to furnish them with hope.”

Annan’s insight into the widening gap of HIV prevention options for men and women has mobilized many individuals and organizations to prioritize the legalization and distribution of the candidate microbicides.  In order to empower women to defend themselves against AIDS, the world community must accept the responsibility to advocate for microbicide funding, research and development, and equitable distribution and access.  The development of a microbicide is not strictly scientific; the very absence of the product symbolizes an outright social injustice against which all health and social justice advocates must fight.

Advocacy is at the heart of the microbicide effort and it is vital that students take on this pressing issue.  It is today’s students who will be the next doctors, lawyers, and epidemiologists, and who will have the ability to devise and ensure equitable distribution for the women most in need.

Microbicide advocacy, like the issue itself, can take on many forms and spreads across a multitude of languages, races, and nations. The one unifying and empowering principle is that all methods and forms of advocacy positively contribute to the global microbicide effort. For advocates today, the prospect of the successful microbicide and the potential for true progress in the struggle against HIV/AIDS sustain and inspire innovative campaigns to continue fighting for something that will oppose social injustice and save countless lives.

Leah Katz is a co-founder of S4M: Students for Microbicides at Wesleyan University in Middletown, CT. Katz is working with the Global Campaign for Microbicides to enhance campus advocacy efforts across the United States.