Contraceptives of the future in the light of HIV infection

Abstract

The AIDS and sexually transmissible disease pandemics have helped to focus the world's attention on the need for good protection against transmission of infections during sexual intercourse. Most of the highly effective modern contraceptives provide only limited protection against STD transmission, although recent progress with the development of loose-fitting plastic male condoms and new spermicides gives some hope. Urgent attention must continue to be given to contraceptives with STD protective qualities which are under the woman's control. Refinements of the female condom and vaginal sponges with new spermicides and microbicides may be a step in this direction.

PIP: The most common mode of HIV transmission in the world is heterosexual transmission. New and more effective preventive efforts are needed to stem the HIV/AIDS pandemic. Simultaneously, there is a pandemic of sexually transmitted diseases (STDs). HIV infection and STDs exacerbate each other. Most effective modern contraceptives do not protect against HIV or STD transmission. The male condom, the most effective means to protect against transmission of STDs and HIV, has a high failure rate. Deterioration of the latex over time, as a result of incorrect storage, and use of an oil-based lubricant are the main reasons for condom rupture. Many men do not use condoms because they reduce penile sensitivity. Loose-fitting plastic condoms could increase condom use. Some plastic condoms should reach the market soon. A plastic female condom allows women to be in control, but clinical trials show that many women do not like it and it has a high one-year failure rate (15%). They are expensive. A levonorgestrel-releasing IUD has a lower rate of pelvic inflammatory disease and endometritis than the copper IUD; thus, the levonorgestrel-releasing IUD reduces susceptibility to HIV infection. Since it reduces menstrual blood loss and maintains a cervical mucus plug, its use by HIV positive women would reduce infectivity for their partners and the women's susceptibility to ascending opportunistic infections. Postcoital penile treatment with bactericides and virucides may be a way to prevent STD or HIV infection for men. Women also need topical chemical methods that will protect from STDs or HIV infection. Cholic acid, in high concentrations in the uterus during the luteal phase, exhibits strong spermicidal and antiviral activity. It inhibits the reverse transcriptase enzyme in HIV and reduces the ability of HIV to infect lymphocytes. An already developed vaginal sponge with cholic acid that protects against pregnancy, HIV, and STDs would be a great breakthrough.