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Update on Microbicides: the search for a new method of HIV prevention

Update on Microbicides: the search for a new method of HIV prevention. Lori Heise, Director Global Campaign for Microbicides. Microbicides: new hope for HIV prevention.

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Update on Microbicides: the search for a new method of HIV prevention

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  1. Update on Microbicides: the search for a new method of HIV prevention Lori Heise, Director Global Campaign for Microbicides

  2. Microbicides: new hope for HIV prevention • Any substance that can substantially reduce transmission of sexually transmitted infections (STIs), including HIV, when applied vaginally or rectally • User/woman-initiated • Some leads effective against HIV and other STIs • Contraceptive and non-contraceptive • Likely to offer some protection to a woman’s partner should she be infected • Early products will be partially effective • Goal is inexpensive, over-the-counter product

  3. Eventually, microbicides could come in many forms First generation products will be gels applied with an applicator Future formulations could include vaginal rings or sponges that could be left in for weeks at a time

  4. 2. boosts vagina’s natural defenses 3. surfactants 1. physical barriers 5. anti-retrovirals 4. entry inhibitors

  5. Other important uses • Rectal microbicides • Limited work underway • Scientifically much more difficult • Vaginal microbicides tested for rectal safety • HIV positive women • Help prevent re-infection and STDs • May protect partners; requires separate trials

  6. Research Pipeline in 2006 6 products 4 products 4 products 15+ products Laboratory Testing 2-6 Years Phase 1 (safety) 1 Year Phase 2 (Expanded safety) 2 Years Phase 2b/3 (effectiveness) 2 to 4 years Phase 1 and 2 HIV+, penile & rectal studies 10+ Years 10 + Years

  7. When could we expect a microbicide? • The current set of phase III trials will be yielding results in early 2008 through 2009. • Assuming one of these shows efficacy, a microbicide may be available in a handful of countries in the next 5 years • Initial availability will most likely be via “introductory studies” prior to actual registration in country. • If the current set of products does not prove effective, the time horizon will be longer (although remember, there are several second-generation leads already in human safety testing)

  8. Condom Migration ?

  9. A Balancing Act to Minimize HIV Risk condoms Reduce transmission 80 to 90% ? consistency of use microbicides Reduce transmission 40 to 60% ?consistencyof use

  10. The Prevention “Trade-Off” • A low efficacy method used consistently can achieve the same protection as a high-efficacy method used less consistently • A 90% efficacious method (like condoms) used in 20% of sex acts, provides less protection than a: • 70% efficacy used> 30% of the time • 50% efficacy used> 40% of the time • 30% efficacy used> 60% of the time

  11. What do we know about likely use? • Multiple studies document widespread interest • Substantial acceptability literature based on actual use • 2 market studies: one global and one US • In clinical trials and acceptability studies where women have experience using products, they articulate clear advantages to microbicides: • Easier to use than condoms • Allows skin on skin intimacy • Woman initiated

  12. Acceptability & Use Dynamics • Covert use was an early premise of the microbicide field • Recent research suggests that most women would tell their partner • some women afraid to risk • others want partners involved • “Passive acquiescence” versus “active involvement” • Can be “negotiated” once rather than at every act of intercourse • No need to talk about sex • Allows skin to skin intimacy • Can enhance pleasure

  13. Microbicides: Where Gender, Technology & Sexuality Meet Microbicides can begin the discussion about sex and power. But, it can’t end there. Changing the power balance between men and women is essential for real and sustained change.

  14. Percent of ever-partnered women reporting physical and/or sexual violence by an intimate partner Source: WHO Multi-Country Study on Domestic Violence and Women’s Health

  15. Sexual Autonomy? Percent of women interviewed who believe that a man is justified in beating his wife if… Source: WHO Multi-Country Study on Domestic Violence and Women’s Health

  16. Girls’ and Women's Protection Strategies Social Power Protection Economic Opportunities Technology Brady, Martha. Population Council, Conceptual Framework. 2005.

  17. With condoms safer sex is his decision, We want to make it yours To download facts sheets & original reports visit: www.global-campaign.org

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