Microbicides and sisterhood Editorial
Stabroek News
February 10, 2007

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Little is known in Guyana about microbicides or the research that has been ongoing with them. But these drugs have been the cause of great optimism among the people trying to find a way to halt the spread of the Human Immuno-deficiency Virus (HIV) and recently some amount of despair.

In layman's language, a microbicide is a chemical formulated to kill microbes and in this case the microbe is HIV. The current research involves using gels, creams and thin films developed using this chemical to protect women from contracting HIV. Women would be protected by applying the product in the vagina before sex and therefore the challenge was to find a chemical tough enough to repel or kill HIV, yet gentle enough to spare the female genital tract from corrosive chemical effects that have the effect of favouring infection.

It has been established that women are at greater risk for contracting HIV from men than men from women. Among the reasons why this is so is that women are far more susceptible to bruising - and the virus can easily enter the body through an open bruise - and that women are still too often disempowered to demand and insist on their partners using condoms. The female condom is not as accessible as it should be, particularly in developing countries, and it has not "caught on" the way its makers had hoped it would.

As a result, once developing microbicides seemed viable, the research was given much support from governments, advocates and philanthropists who understand the need to put women's protection in their own hands. The Bill and Melinda Gates Foundation, an active sponsor of HIV and AIDS and other medical research, invested US$125 million into developing microbicides.

After years of study, scientists believed they had found the right combination and developed several different products. One which uses a chemical called cellulose sulphate was taken to India and Africa, where HIV infection is the highest in the world and volunteers were invited to join trials. Though there was much hope when these trials were initiated no one knew for sure whether microbicides would actually work.

This raised an ethical dilemma. On the one hand, it effectively made the women who signed up for the trials guinea pigs. But on the other hand there was no other way of determining the efficacy of the drug. And then what of the women who volunteered for the trials. One can't but wonder why they would have entered the study which from the get-go was an obviously risky one. Did they believe that they would have been at risk for HIV anyhow?

Whichever it was is now beside the point as the Wall Street Journal reported on February 1 that independent safety monitors had halted a study being undertaken by Conrad, a non-profit outfit based in Arlington, Virginia, which had received a US$12 million grant from the Gates Foundation. The study involved 1,300 women and it was found that those using the gel developed more infections than those who were using a placebo. Of the 1,300 women 35 were infected overall. As a result, Family Health International, which had been conducting a similar study in Nigeria among 1,644 women called a halt to it as well, although it had not seen the increases found in the Conrad study.

As the news filtered down 350 volunteers in a study being conducted in Zambia began to air concerns about their own fates. However, since the product on trial there is unrelated to cellulose sulphate a decision was taken not to halt it.

If microbicides work, and scientists seem to think that they will, they would be a major breakthrough in reducing the transmission of HIV. If women can have in their hands a product which effectively protects them from contracting the virus, mother to child transmission of HIV will eventually become a thing of the past.

This is the basis for tremendous hope and explains why microbicides research will continue to receive funding and attention despite the recent setback. One hopes that the scientists' faith in this product is not misplaced. If it works, those who developed it stand to receive much acclaim. However, the real heroes are the volunteers who have and still continue to place themselves at risk for contracting HIV for the purpose of finding a product that can benefit women the world over. They may not now be aware of it, but their sacrifice is true sisterhood.