The Global Campaign for Microbicides has launched a public 'Call to discontinue nonoxynol-9 for rectal use' (available here. This is based on concerns, set out by the US Centers for Disease Control and Prevention and the World Health Organization, that this widely-used spermicide causes damage to the lining of the rectum when used for anal sex, significantly increasing the risk of HIV and other STI transmission.
The call has been backed by leading scientists in the field and by many HIV, AIDS, gay and women's organisations including all of the main microbicide advocacy groups, the American Foundation for AIDS Research (amFAR), the Family Planning Association (UK), International HIV/AIDS Alliance, International AIDS Vaccine Initiative, National AIDS Trust, Terrence Higgins Trust, and the US Gay and Lesbian Medical Association.
The call demands that manufacturers discontinue the sale of condoms and sexual lubricants containing nonoxynol-9, while continuing to supply over-the-counter spermicides containing nonoxynol-9 in forms designed for vaginal use. The argument is that a public education campaign, to persuade individual consumers to check the labels and avoid products containing nonoxynol-9, would not be as effective in bringing about change as a simple change to the products.
While gay men may generally be at the highest risk of HIV transmission through anal sex, there are many heterosexual couples who sometimes have anal sex and therefore many women who are also potentially at risk.
At least one condom company, Mayer Laboratories, has agreed to remove nonoxynol-9 from Kimono condoms, and Planned Parenthood is going to do the same with the condoms to which it gives its name. On the other hand, leading international companies such as UK-based SSL International plc (Durex) and Australia's Ansell (Mates, Lifestyles) have so far resisted the call.
SSL International has issued a statement on Durex, arguing there is a continuing demand for such condoms and that nonoxynol-9 has been 'used safely for 30 years as a contraceptive'. They also say they are revising the labelling on their condoms to stress that condoms which are spermicidally lubricated should not be used for frequent sex or for anal sex. They maintain this should be an issue of consumer choice.
Alternative condoms are available without nonoxynol-9, although at most retail outlets only a limited range of products are stocked. Also, not all shapes are available in spermicide-free versions.
Some might argue that the proposed labelling changes in relation to anal sex are of limited value, since the condoms currently on the market carry warnings that they may be less effective 'for non-vaginal use' and say nothing about how best to use them for anal sex. It might also be problematic to expect people to act on such instructions, traditionally written in small print, after having bought the (wrong) product.
Easily accessible commercial websites offering condoms for sale do not currently carry warnings about the hazards of spermicides, while many claim that nonoxynol-9 provides additional protection against pregnancy. However, as WHO has pointed out, there is no published scientific evidence to support the claim that pregnancies can be prevented by the inclusion of small amounts of nonoxynol-9 in the lubricant for condoms. A further point made by the campaigners is that effective emergency contraception is now available, in the event of a condom breakage or slippage, and women should be encouraged to make use of it rather than rely on any spermicide with which condoms are lubricated.