Microbicides By the Bedside

Although the name sounds more like an infection than anything else, microbicides may just be the next wave in HIV prevention.

By Ngoc Nguyen

Bethany Young Holt wishes microbicides had a catchier name like Va-gel or Foam-med. Then, she thinks, she could convince more people to use them.

"When I tell women about microbicides, they all say, 'Oh great, where can I get it,'" says Holt. "Then I have to tell them that they haven't been developed yet."

As the director of Microbicides as an Alternative Solution (MAS), Holt is one of many researchers and activists at the forefront of HIV/AIDS prevention research. But rather than pushing for an HIV vaccine, Holt is part of a movement advocating for the development of microbicides.

No, they're not bugs that infect your drinking water. Actually, microbicides are topical antimicrobial agents that, when applied vaginally or rectally, can kill or inactivate infectious viruses, such as HIV or those that cause STDs. Like condoms, microbicides provide a barrier method to prevent HIV and STD transmission. But, unlike condoms, they can take many forms — gels, foams, creams, suppositories, jellies — and, most importantly, they can be used without a partner's knowledge.

In the past few years, the rate of HIV infection has grown rapidly among heterosexual women, especially among poor women of color in the U.S. and worldwide. So far, their only real protection against infection is either abstinence or a condom. But the reality is, often times, a woman is not able to get her partner to use a condom, thus putting both people at risk.

"[Microbicides are] one way to empower...people who don't have the luxury to negotiate safe sex or for those who don't like condoms," says Holt, Ph.D., an epidemiologist at the Center for Family and Community Health, affiliated with the UC Berkeley School of Public Health.

This is when an odorless, colorless and HIV-blocking "goop" would come in handy.

Some scientists view microbicides as kitchen-sink science that uses essentially low-grade detergents. But, according to Polly Harrison, Ph.D., Director of the Alliance for Microbicides Development, microbicides are "revolutionary."

The fact that there are substances that can kill or inactivate HIV and STD viruses is not news. In fact, some quite ordinary sources such as toothpaste, yogurt, tears and saliva have been shown to have antimicrobial properties. What makes microbicides revolutionary is not their function, but their form.

According to Holt, "People should start thinking outside the box. Microbicides can have different formulations — some with spermicidal properties, some without...it doesn't have to stop with gels, foams, creams. There could be other forms no one has ever thought of before."

The Alliance for Microbicides Development reports that there are currently 60 microbicides in development, and 63 research facilities working to develop antimicrobial products. And they've come a long way from toothpaste.

"Some really innovative things are being done in academic labs and in a handful of start-up pharmaceuticals," says Holt.

One approach hinges on maintaining the natural acidity of the vaginal area, which is naturally hostile to HIV and other STD-causing microbes. During intercourse, semen makes the vaginal area less acidic and thus more vulnerable to infection. A crop of buffering gels is currently in development.

"Another cool thing that is being looked at are plantibodies," Holt explains. "They're extracting amino acids from corn and using them to produce antibodies against HIV and Herpes, and they're rigging them up to work in the body."

On the edge of microbicides research is the work being done around the concept of "mucosal immunity." Researchers at Harvard and the University of Washington are looking at a way to isolate the HIV virus in the vagina, where the local immune system is able to contain and manage the infection.

According to Holt, the holy grail of microbicides research would be to develop a safe, effective and bi-directional microbicide — one that could protect against infection but allow a woman to conceive, and one with both antimicrobial and spermicidal properties.

All research indicates that one may be just around the corner, so why aren't pharmaceuticals or federal agencies paying attention?

According to a report put out by the Journal of the American Medical Association HIV/AIDS Information Center, "Big Pharma...has not become involved in microbicides development in any significant way. All of the microbicide candidates currently under investigation are being developed in academic and government laboratories, and by small biotechnology firms."

The federal government is not helping either. In a recent press release, it was announced that the Global AIDS Prevention Act of 2000 will authorize $2 billion in funding for HIV vaccine development initiatives, and offers $1 billion in tax cuts for pharmaceutical companies working on vaccine technology.

Currently, the government is spending barely one percent of the federal HIV budget on microbicide development. According to Holt, to take one microbicide candidate from the beginning stages (in vitro) to phase three of clinical research could cost between $20-30 million.

While the federal government may pour billions into vaccine research without any guarantee that there will be one, microbicides could offer a good interim solution and help stop the spread of HIV and STD infections for mere peanuts.

"It's not an either/or question...vaccines or microbicides," says Holt. "It's so hard to make a vaccine, and many people are skeptical. We should keep trying...but it makes sense to really start paying attention to other prevention methods."

Aside from tax breaks and complicated regulatory issues involved with microbicide research, it all boils down to the bottom line.

"[Pharmaceuticals] think there isn't a lucrative market for microbicides...and that no one will use them but poor women in third world countries," says Holt. "But they're very wrong about that."

Three years ago, while speaking at the Women and HIV/AIDS Conference in Pasadena, Calif., Holt was struck by a comment made during a microbicides symposium that there were "no grassroots organizations or voice from the people" advocating for microbicides development. She went back to Berkeley, Calif. and started MAS. Now, she and other MAS members spend their days promoting awareness of microbicides to policy-makers, health professionals and women in the community. And they're trying to show "Big Pharma" that there is a huge market for microbicides.

While talking to focus groups of college-aged men and women, Holt found that the potential market for microbicides might be quite far reaching. It impacts anyone — college students, middle-aged men and women, gay men — who wants to protect himself or herself from HIV, STDs and/or unwanted pregnancy. And with the rising divorce rate, there will be many more people out there for whom these issues will be big concerns.

What Holt is realizing is key: It's not just poor women of color in third world countries who may not be able to negotiate safe sex. Many factors in our contemporary life including decreasing condom use and the rising incidence of date rape, are making it harder and harder for young women to negotiate safe sex.

"These are empowered women we're talking about," says Holt.

It's clear that microbicides could offer alternatives to women worldwide.

"It's an issue that transcends socioeconomic boundaries," says Holt. "Not being able to negotiate sex does not happen to you if

Ngoc Nguyen is a managing editor at savvyHEALTH.com.

Related Article(s)...

• The Body Politic: Mandatory HIV Testing of Newborns
  
• Twice Bitten
  
• Mindful Medicine: Yoga and HIV