Female-controlled methods to prevent sexual transmission of HIV

Abstract

THE NEED FOR PREVENTION: Women throughout the world face a growing risk of infection with HIV. Consistent condom use, one cornerstone of primary prevention strategy, is not always feasible for many women. Consequently, women urgently need infection prevention technology that is within their personal control.

Methods: This session will review current efforts to develop and test female-controlled methods for preventing sexual transmission of HIV and other sexually transmitted pathogens. Both physical and chemical methods will be summarized, including recent findings concerning the efficacy and acceptability of the vaginal pouch (female condom), as well as an overview of research on vaginal microbicides. Data from studies of existing over-the-counter spermicides will be reviewed. The wide range of novel microbicidal products currently being evaluated in the laboratory and early clinical trials demonstrate the breadth of possibilities presented by chemical barrier methods. However, formidible challenges face public and private sector research and development efforts. This session will conclude by highlighting several issues related to the clinical evaluation and introduction of female-controlled prevention technology.

PIP: This article presents a literature review of contraception research on female-controlled methods that prevent transmission of HIV infections and other sexually transmitted diseases (STDs). The review includes efforts to develop and test new methods in laboratory and clinical trials. The main research challenges are a better understanding of reproductive biology pertaining to STD and HIV transmission, better animal models for determining safety and efficacy of candida microbicides, improved methods for conducting HIV and STD incidence cohort analyses in communities at risk, and improved understanding of the determinants of vaginal product use. Product development challenges include testing a range of new products that evolved or will evolve from a better understanding of the role of mucosal immunity, normal flora, and other aspects of vaginal ecology. Funding for research and development of female-controlled methods is low. Private pharmaceutical companies have a low investment in these methods due to liability, regulatory uncertainty, and the perception of marginal profitability. Clinical trials are costly. Alliances must be formed across disciplines within the scientific community, between scientists and the communities at risk, and with industrial partners. Women living with HIV infection should be involved. HIV infection is a greater risk to women in developing countries, particularly poor countries. Data reveal that HIV infections among women are transmitted through vaginal intercourse, and the presence of STDs often facilitates transmission. Female-controlled methods are not a substitute for male condoms but a form of protection for women who are unable to negotiate for safer sex and an option for increasing choice. This review includes new barrier methods (diaphragms, cervical caps, and female condoms), vaginal microbicides, existing spermicides, and novel vaginal microbicides.