Advances in New Technologies and Issues
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One promising product under development
are microbicides, which can be used vaginally or rectally
to decrease microorganisms causing sexually transmitted
diseases, including HIV.
Microbicides could provide direct
prevention of HIV infection and indirect protection
by preventing STIs that increase the propensity for
HIV infection.
An important feature of microbicides
is their potential for use in contraceptive and non
contraceptive forms, unlike barrier methods such as
condoms.
Microbicides would thus be ideally
suited for ouples who wish to have children but without
risk of the transmission of HIV infection.
Or, for dual protection from unwanted
pregnancy and STI, condoms could be used in conjunction
with microbicides for increased efficacy.
In communities where condom use
is low or inconsistent, microbicides may offer a beneficial
alternative, especially for women. Women are often limited
in their ability to employ or insist that their partners
employ many of the known strategies for preventing HIV,
such as male condoms. Although microbicides afford women
a weapon against HIV that they can control to some extent,
microbicides protect both women and men. Some microbicides
may have the ability to be used for vaginal washing
in HIV-positive women prior to vaginal delivery and,
thereby reduce transmission to infants. Reinfection
of HIV-positive persons would also be theoretically
reduced with microbicides.
Microbicide research involves developing
and testing new products, and assessing the microbicidal
properties f existing spermicidal products.
More than 50 microbicides are currently
under development, about a fifth of which are in clinical
trials (in Benin, Cameroon, Cote d’Ivoire, India, Malawi,
South Africa, Thailand, Uganda, the United States and
Zimbabwe, among others).
Most of the current research on
microbicides is being supported by public-sector funding.
Impediments to the private sector’s becoming active
in microbicide development include regulatory uncertainty,
unclear market potential, safety and liability issues,
and skepticism over whether microbicides are effective
in preventing HIV and other STIs.
To address these issues, an International
Working Group on Microbicides was organized in 1993,
with participation by UNAIDS, WHO and other international
and national organizations.
The working group has produced guidelines
on the development of microbicides and is active in
coordinating efforts to produce a safe, effective, affordable
and acceptable product.
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