It’s hard to use a condom without having to interrupt the
middle of your adventure. It’s even harder to use some sort
of contraception that protects you from sexually transmitted
infections but still allows you to conceive a child. These
scenarios may seem unlikely, but a new product that could make them
realities is on its way.
Microbicides are a variety of products designed to protect
against HIV and other sexually transmitted infections, and some
varieties will also act as a contraceptive. They usually come in
the form of a gel or a cream that is applied topically to the
vagina or anus.
They’re a completely user-controlled form of STI
protection and sometimes birth control, and, more specifically,
they are completely female-controlled when a female is
involved.
When I first learned about microbicides I immediately assumed
they would be reserved for women in poorer countries who were at
risk for HIV. But microbicides are much more than that.
While they’re most needed in populations that are at high
risk for HIV, microbicides are simply another form of protection
against STIs ““ a form that allows privacy. Specifically,
women can use them without the knowledge of their partners, so they
can both protect themselves if they think their partner is
infected, or protect their partner if they think they themselves
are infected.
People should be open about sex; they should communicate freely.
You should be able to ask your partner to use a condom or dental
dam and your partner should reply, “I’m one step ahead
of you, honey.”
But as perfect as that sounds, it simply isn’t reality.
Even if everyone in the world had access to as many condoms as they
wanted, even if every woman had free access to birth control pills,
and even if everyone was educated about the benefits of birth
control and STI protection, perfectly open communication still
wouldn’t exist.
That’s why microbicides are such an important invention.
They place the power to control physical and reproductive health in
the individual’s hands.
Currently the only really effective way of protecting against
STIs is to use a condom. But I think most of us can agree that
they’re a nuisance.
I often hear complaints about how annoying condoms are from both
men and women. Some people see them as an obstruction to intimacy.
For some men they are uncomfortable, and they may inhibit the
man’s ability to maintain an erection.
This doesn’t mean condoms shouldn’t be used ““
they are the most effective form of STI protection available
““ but more options are always better.
Not only would microbicides be another option, but for some
people they could be a better option. According to Baylee DeCastro,
co-founder of the UCLA chapter of the Feminist Majority Leadership
Alliance, microbicides may be easier to sell than condoms because
they are less intrusive. Since they can be used without anyone
else’s knowledge and don’t disrupt the moment, it may
be easier to overcome cultural barriers.
At the moment there are 15 different microbicides undergoing
clinical trials, and four of these are entering stage three of the
process. The microbicides that are being developed will hopefully
provide options that vaginally and rectally protect against STIs,
and will also come with the option of being a contraceptive.
“The ideal situation would be a microbicide cocktail that
provides all three,” DeCastro said.
Microbicides work in a variety of ways. They can immobilize
pathogens, enhance the body’s natural defenses, or prevent
infection by blocking the pathogen from the cells or keeping the
infection from spreading from one cell to the next.
Just because microbicides would be a
“female-controlled” form of contraception and/or birth
control does not mean they would only benefit women. HIV is a human
issue and needs to be treated as such.
Microbicides would not only allow women with HIV to protect
themselves against other types of infection (which for them may be
deadly), but would also protect their partners and their
family.
These products could also help keep children safe. It is
possible that microbicides could be used to “wash” out
the vagina before giving birth, thereby reducing the risk of a
child being born to an HIV-positive woman contracting the virus.
Also, even though most microbicides are meant to be applied
topically, there are thoughts that a microbicide could be developed
that would deactivate HIV in breast milk. Mother-to-child
transmission of HIV is the most common cause of HIV in children, so
if this became widely used, it could potentially greatly reduce the
number of children infected with HIV.
Once the microbicide clinical trials finish, the issue will turn
toward educating people and distributing the microbicide. The
Rockefeller Foundation has formulated an ambitious plan for
research and action to try and ensure that the people who need
microbicides will have access to them. The document concludes with
“it is inefficient, and even unethical, to repeat the
mistakes of the past that have forced individuals in the developing
world to wait years, sometimes decades, to gain access to
much-needed drugs or vaccines.”
Microbicides seem like the perfect answer to so many problems.
Unfortunately, a lack of funding may delay their development. This
funding absolutely needs to come from the government or
philanthropies, because pharmaceutical companies simply don’t
believe it is in their economic interest to invest in microbicides
““ mainly due to the belief that they are only really useful
to women in poorer countries with a high prevalence of HIV.
“Microbicide Development” is a topic heading in the
new President’s Emergency Plan for AIDS Relief. But this plan
is still disproportionately in favor of abstinence-only programs.
And, with a product such as microbicides in the making that could
benefit people worldwide, this seems a little ridiculous.
There should also be a market for microbicides in the United
States. According to Paula Shulman, a second-year medical student
at UCLA and the co-coordinator of Medical Students for Choice,
while it may be difficult to assess what would be popular here in
the United States, microbicides would ideally be available to any
sexually active person.
From my experience, many people have issues with communicating
properly about their needs and concerns when it comes to sex. And
while microbicides would not replace condoms, they would provide
another option. If provided to the right people, they could save
thousands of lives.
E-mail Lara at lloewenstein@media.ucla.edu. Send general
comments to viewpoint@media.ucla.edu.