Women and HIV. Microbicides for HIV prevention.

Abstract

We all know about the "feminization" of AIDS. Approximately 8000 women and girls are infected with HIV daily, the vast majority by their husbands or boyfriends. In Africa, women make up 60% of all people living with HIV/AIDS, and girls make up 6% of HIV positive African youth. While fewer than half of all new HIV infections in the United States occur among women, the transmission pattern is similar. Heterosexual contact is the source of at least 78% of all new infections among U.S. women. Biologically, a woman is at least twice as likely as a man to contract HIV from a single act of unprotected vaginal intercourse. Even with the "female condom," a woman cannot protect herself during heterosexual sex without the cooperation of her partner. The "ABCs" (abstain, be faithful, use condoms) fail millions of women who lack the social and economic power to negotiate when and how sex occurs and whether protection is used. Microbicides could change this picture with just a simple cream, foam, or gel that can be inserted vaginally to protect women condom use isn't possible. Five candidate microbicides are now in large-scale efficacy trials and dozens more are in the preclinical and clinical trial pipeline. Research to develop rectal microbicides is also finally underway. We now have the scientific means and the public health motivation to put the first totally new HIV prevention technology into the hands of receptive sex partners--male and female--in the very near future.