What people working with AIDS, know about Microbicides? A poster presentation by Maria Ines from FEIM Argentina made a striking remark to the focus and recognition which potentially powerful prevention options like microbicides get in the AIDS community. Argentina which has three times more HIV positive women than men and the highest rate of MTCT in Latin America (6-9%), has a poor level of awareness and commitment towards female controlled prevention options like Microbicides, says Maria.
She interviewed delegates at the 5th National Congress on AIDS in Argentina. 61.4% of the interviewed participants had a university degree and 33.3% of them worked in public hospitals as health care providers.To her question "Do you know any AIDS prevention method exclusively for woman'?s use?" 2.4% of women and 5.4% of men respondents, named Microbicides. When specifically asked "Do you know Microbicides?" 24% of women respondents and 29.7% of men respondents, replied in the affirmative.
Dr.Charles J.N.Lacey, Faculty member of the Imperial College, London, had a poster presentation on "PRO 2000 achieves potentially protective levels against HIV in cervico-vaginal secretions." He said that there was no evidence of systemic absorption of PRO 2000. He also marked out the caveats in his research and said that participants were healthy women who were neither sexually active nor menstruating, and whether systemic absorption can take place in other contexts is not known. He also pointed out the factors that may affect or alter the concentrations of Microbicides required for effective prevention during vaginal coitus. He said more research is needed to evaluate microbicide efficacy during female arousal, which may cause additional dilution effects. The mechanical effects of coitus in removing microbicides bearing vaginal secretions needs to be looked at further, although there was a MRI?? study presented at Microbicides 2002 in this regard, recently in Antwerp, Belgium.
Another interesting poster presentation was of Dr. JM Brown titled "The Acceptability of Vaginal Microbicides Use and Study : Men and Women in Malawi and Zimbabwe".One of the Malawi male participants said, "I notice a increase in vaginal fluid, and feel good having sex when vagina is wet. I thought vaginal passage was tight and with more fluid. It increases friction, which enhances sexual act. Sexual pleasure while using gel is much more than while using condoms because gel facilitates body to body contact? Another female Malawi participant said "gel increases the heat during penetration and makes sex more enjoyable".
Addressing a big debate on intravaginal practices among women in Malawi and Zimbabwe, Dr.Brown said that most of the female participants agreed "It is unhygienic not to finger cleanse". She quoted a women participant who said "I broke the rules when it came to finger cleansing because if I don't finger cleanse, I won?t even be able to go anywhere. I feel as if everyone can see that I didn't wash, as if I am having discharges. So I didn't agree with it and broke the rule!?
There was another poster presentation on intravaginal practices (IVP) by H.Jones of the Population Council - Intravaginal practices by Phase II Carraguard trial participants in South Africa. Jones reported what IVP can mean to trial participants - cleansing the inside of the vagina, wipe/dry??, tightening or warming during sex, lubrication during sex, control of menstrual flow, treatment of infections, prevention of pregnancy or STI's or the induction of abortions.
Cleansing, drying and tightening practices are common in 11 countries in Africa, Indonesia, Thailand, Qatar, Dominian Republic, Haiti and US. IVP are most likely more widespread than currently documented, said Jones.
Commenting on the relationship between HIV/STI's and IVP, Jones said that there are three potential mechanisms for IVP that affect the risk of contracting STI's which include that IVP's may dry or irritate cervical and vaginal mucosa increasing the likelihood of epithelial disruption (but there is no evidence), they may interfere with healthy vaginal flora like lactobacilli (studies have shown douching increases the risk of BV (bacterial vaginosis) and BV is linked to HIV, and lastly they may interfere with the acceptability and efficacy of barrier methods including microbicides.
Therefore Jones recommended that Phase III trials must explicitly instruct the women participants not to insert anything vaginally between the insertion of gel and sexual intercourse. Marianne Callahan of CONRAD and Lee Claypool of USAID who had a poster presentation on C31G and Carraguard microbicide product leads also spoke on male tolerance of Microbicides. Marianne said that they have conducted four studies involving men, and the fifth one is underway currently. The previous four studies were with microbicide candidates PRO 2000, buffer gel, cellulose sulphate and C31G. The fifth one, which is currently going on, is with polystyrene sulphonate. There was no major or serious side effect of microbicides reported by men, and only minor irritations including tingling and stinging were reported.
Bobby Ramakant-CNS
She interviewed delegates at the 5th National Congress on AIDS in Argentina. 61.4% of the interviewed participants had a university degree and 33.3% of them worked in public hospitals as health care providers.To her question "Do you know any AIDS prevention method exclusively for woman'?s use?" 2.4% of women and 5.4% of men respondents, named Microbicides. When specifically asked "Do you know Microbicides?" 24% of women respondents and 29.7% of men respondents, replied in the affirmative.
Dr.Charles J.N.Lacey, Faculty member of the Imperial College, London, had a poster presentation on "PRO 2000 achieves potentially protective levels against HIV in cervico-vaginal secretions." He said that there was no evidence of systemic absorption of PRO 2000. He also marked out the caveats in his research and said that participants were healthy women who were neither sexually active nor menstruating, and whether systemic absorption can take place in other contexts is not known. He also pointed out the factors that may affect or alter the concentrations of Microbicides required for effective prevention during vaginal coitus. He said more research is needed to evaluate microbicide efficacy during female arousal, which may cause additional dilution effects. The mechanical effects of coitus in removing microbicides bearing vaginal secretions needs to be looked at further, although there was a MRI?? study presented at Microbicides 2002 in this regard, recently in Antwerp, Belgium.
Another interesting poster presentation was of Dr. JM Brown titled "The Acceptability of Vaginal Microbicides Use and Study : Men and Women in Malawi and Zimbabwe".One of the Malawi male participants said, "I notice a increase in vaginal fluid, and feel good having sex when vagina is wet. I thought vaginal passage was tight and with more fluid. It increases friction, which enhances sexual act. Sexual pleasure while using gel is much more than while using condoms because gel facilitates body to body contact? Another female Malawi participant said "gel increases the heat during penetration and makes sex more enjoyable".
Addressing a big debate on intravaginal practices among women in Malawi and Zimbabwe, Dr.Brown said that most of the female participants agreed "It is unhygienic not to finger cleanse". She quoted a women participant who said "I broke the rules when it came to finger cleansing because if I don't finger cleanse, I won?t even be able to go anywhere. I feel as if everyone can see that I didn't wash, as if I am having discharges. So I didn't agree with it and broke the rule!?
There was another poster presentation on intravaginal practices (IVP) by H.Jones of the Population Council - Intravaginal practices by Phase II Carraguard trial participants in South Africa. Jones reported what IVP can mean to trial participants - cleansing the inside of the vagina, wipe/dry??, tightening or warming during sex, lubrication during sex, control of menstrual flow, treatment of infections, prevention of pregnancy or STI's or the induction of abortions.
Cleansing, drying and tightening practices are common in 11 countries in Africa, Indonesia, Thailand, Qatar, Dominian Republic, Haiti and US. IVP are most likely more widespread than currently documented, said Jones.
Commenting on the relationship between HIV/STI's and IVP, Jones said that there are three potential mechanisms for IVP that affect the risk of contracting STI's which include that IVP's may dry or irritate cervical and vaginal mucosa increasing the likelihood of epithelial disruption (but there is no evidence), they may interfere with healthy vaginal flora like lactobacilli (studies have shown douching increases the risk of BV (bacterial vaginosis) and BV is linked to HIV, and lastly they may interfere with the acceptability and efficacy of barrier methods including microbicides.
Therefore Jones recommended that Phase III trials must explicitly instruct the women participants not to insert anything vaginally between the insertion of gel and sexual intercourse. Marianne Callahan of CONRAD and Lee Claypool of USAID who had a poster presentation on C31G and Carraguard microbicide product leads also spoke on male tolerance of Microbicides. Marianne said that they have conducted four studies involving men, and the fifth one is underway currently. The previous four studies were with microbicide candidates PRO 2000, buffer gel, cellulose sulphate and C31G. The fifth one, which is currently going on, is with polystyrene sulphonate. There was no major or serious side effect of microbicides reported by men, and only minor irritations including tingling and stinging were reported.
Bobby Ramakant-CNS
