Abstract

PIP: Women are the fastest growing group of people with AIDS (about 80,000 women 15-44 years old) in the US. HIV transmission continues even though many people know how HIV is spread. The power dynamics of sexual relations and gender inequities keep women from convincing their partners to use a condom. Research and development of microbicides are ongoing. Microbicides delivered via suppositories, dissolving films, creams, or sponges can destroy HIV and sexually transmitted diseases. Women would be able to control their use. Microbicides would likely be acceptable to women. Existing chemicals which have already exhibited virucidal properties are the spermicides nonoxynol-9 and octoxynol; benzalkonium chloride; menfegol; and chlorhexidine. 26 of 56 new spermicidal products recently screened by USAID's Contraceptive Research and Development Program are active against HIV in vitro. Behind the delay in the development of and interest in HIV-destroying agents was the perception that women were not at significant risk for HIV infection. Microbicides first became of interest in the late 1980s. Part of the medical community still resists research and development of microbicides. These people fear that availability of microbicides will keep women from using condoms. Yet, high rates of HIV infection are occurring despite condom availability. The harm reduction model provides a series of options other than the ideal. Deeply ingrained sexual norms affect scientific research and microbicide development. For example, medical professionals use the words normal and regular for sexual behavior, which suggests that other behaviors are abnormal. Manufacturers are unlikely to support research, development, and marketing of microbicides for a variety of reasons, such as the low profit level, since low income women need them most.