The international Microbicides conference opened on Sunday in Cape Town, South Africa, with a focus on the vulnerability to HIV infection of women in Africa (and elsewhere) — and the need to find better ways so that they can protect themselves from infection.
“Asking women to simply abstain, be faithful, or use condoms is not practical. Nor is it enough — especially when... 75% of new infections are acquired from a spouse or regular partner,” said Mrs. Graça Machel who gave one of the opening addresses for the meeting .
Mrs Machel' s long list of the distinctions include being founder and President of the Foundation for Community Development, former Minister of Education and Culture as well as former first lady of Mozambique and the current wife of former South African President Nelson Mandela. She is also a renowned advocate for women’s health, and, more recently, for microbicide research.
Microbicides are products that could reduce the transmission of HIV and other sexually transmitted infections when used in the vagina or rectum. Microbicides can be formulated in a variety of ways, such as a gel, foam, cream, sponge, or intravaginal ring. Since they can be applied by a women before and, in some cases, even after sex — without the man being present — they are being touted as a female-controlled prevention method.
“Too many women, married or not, lack the social power to negotiate condom use with their partners or husbands,” said Mrs. Machel. “The development of vaginal microbicides is key to prevent more women becoming infected with HIV. Whether it be a gel, or a crème, or an intravaginal ring... regardless of the type, we need a microbicide now!”
Nowhere is this more true than in southern Africa where over 60% of the infected adults are women. One in four South African women aged 15-24 is infected with HIV, compared to one in fourteen of the young men of that age. But in some communities, the prevalence is much higher, with up to two-thirds of the pregnant women aged 25-29 now HIV-infected .
“Despite the huge investments we have made on HIV prevention little has changed,” said Mrs. Machel. “The existing methods to prevent HIV infection are failing women.”
However, according to projections presented at Microbicides 2002 by Dr. Charlotte Church, of the London School of Tropical Medicine, if a microbicide that was 60% effective reaches the market, and was used consistently by 30% of women at risk, it could prevent 3.7 million infections. Even a weakly effective microbicide could have similar effects if it reaches a higher percentage of women, and if affordable would translate into substantial savings for Africa’s over-stretched public health systems.
As a result of such modelling (and the apparently poor prospects for a vaccine against HIV), over the last several years, interest and funding for microbicide research has grown substantially. Currently, over six products are in advanced clinical studies in Africa involving over 25,000 participants (five are being studied in South Africa in at least 12,000 women). If found to be at least partly effective, one of these products could move towards licensing as soon as 2010.
The Microbicides 2006 conference
Notably the first time it has ever been held in a developing country, the Microbicides Conference has now become a major HIV/AIDS medical meeting, with over 1300 researchers, public health workers, advocates, and members of civil society organisations in attendance. (More than half of the delegates come from Africa, where the lion’s share of the clinical studies are being conducted).
The conference is divided into four tracks: a basic science track looking at issues such as mucosal immunology, transmission models, microbicide discovery and delivery mechanisms; a clinical track, including preliminary data from some of the large scale studies, as data on rectal microbicides; a third track focusing on the social and bioethical challenges conducting this type of research in vulnerable populations (with a host of sub-studies looking at issues such as product acceptability, and adherence issues); and finally, and for the first time, a community and advocacy track — in the hopes that greater engagement of the community would not only help in research implementation but help mobilise resources to move research ahead more rapidly.
“If we are to have a microbicide that will be accessible and affordable for poor women in rural and urban areas, we need to embark on a truly global effort - with political leadership, financial resources, and community mobilisation,” said Mrs. Machel. “I cannot think of a more worthy cause,” said Mrs. Machel “than finding a tool that will allow women to prevent HIV infection and empower them well. The future of a generation of African women depends on it.”