Women Taking Control of Their Own AIDS Risk: Is a New Medicated Gel the Answer?

Twenty-four-year-old Slindile, who lives with her parents and seven siblings in the Vulindlela district of South Africa, first became involved in a study of a new vaginal gel at a local health clinic because of the money: she was paid 150 rand (about $20) for each visit. As part of the Caprisa AIDS Research Center trial, Slindile was instructed to use a microbicide gel spiked with the AIDS drug tenofovir up to twelve hours before and after sex. She was cautioned to use a condom as well since the gel might not prevent the spread of HIV. This was a precaution that Slindile took seriously. She lives in an area where one in five pregnant women has AIDS by age eighteen, one in three by twenty, and one in two by her age. But like women all over the world, she does not always have control over whether her sex partner uses a condom. This was the advantage of the anti-AIDS gel, Slindile told the South African newspaper City Press: “I didn’t have to ask for permission—I just used it myself.” For years, trials of such gels have produced disappointing results, showing microbicides to be ineffective or, worse, to increase a woman’s risk of infection. So when the results of the Caprisa trial were announced at the XVIII International AIDS Conference in Vienna in July, the scientists and health workers burst into applause. “Today we celebrate the proof of concept of microbicides,” announced Gita Ramjee, head of the South African Medical Research Council HIV prevention research unit. “This gives hope to thousands of women in South Africa and elsewhere.” The gel cut the risk of HIV infection by 50 percent after one year of use and 39 percent after two and a half years, said Quarraisha Abdool Karim, associate scientific director of the study. Karim thanked “all the gender activists and scientists who have been part of this process of trying to protect women.” Is a medicated gel that women can apply themselves, with or without their partner’s cooperation, consent, or even knowledge, the future of reducing heterosexual HIV transmission? Such a method could be useful for women, especially in the developing world, says Emory Professor of Medicine Jeff Lennox, chief of infectious disease at Atlanta’s Grady Memorial Hospital, since a gel would be inexpensive, easy to distribute, and is “self-applied and self-controlled.” “I’m glad to have a preventive therapy that looks like it’s working, but before we say it’s the be-all, end-all we have to look at oral medications,” Lennox says. “If we can find a therapy that’s successful 90 to 95 percent of time, that will be a real game- changer.” “This is great news from an early stage point of view, but the jump from that to making it available as a public health intervention in Africa is a big one,” says Susan Allen, a physician, AIDS researcher, and professor of global health at Rollins. “If you have to use this each and every time before you have sex, it’s a bit like vaginal spermicides, which proved cumbersome and not as efficacious as other methods of birth control.” Most AIDS therapies, no matter how effective, will continue to be out of reach for those who need them most desperately, since they live in countries where about $4 a head per year is spent on health care. With about 33.4 million people infected with HIV/AIDS worldwide, and nearly three million people per year continuing to develop the virus, mostly in sub-Saharan Africa, one thing remains certain: “Prevention is key,” Allen says, “because treatment will always be too expensive.”

Volunteers who participated in a study on reducing the risk of HIV infection in women listened as the test results were announced during a meeting in Vulindlela, Kwazulu-Natal,
South Africa.

Credit: Joao Silva/The New York Times/Redu

By Mary J. Loftus

Twenty-four-year-old Slindile, who lives with her parents and seven siblings in the Vulindlela district of South Africa, first became involved in a study of a new vaginal gel at a local health clinic because of the money: she was paid 150 rand (about $20) for each visit.

As part of the Caprisa AIDS Research Center trial, Slindile was instructed to use a microbicide gel spiked with the AIDS drug tenofovir up to twelve hours before and after sex. She was cautioned to use a condom as well since the gel might not prevent the spread of HIV.

This was a precaution that Slindile took seriously. She lives in an area where one in five pregnant women has AIDS by age eighteen, one in three by twenty, and one in two by her age. But like women all over the world, she does not always have control over whether her sex partner uses a condom. This was the advantage of the anti-AIDS gel, Slindile told the South African newspaper City Press: “I didn't have to ask for permission—I just used it myself.” 

For years, trials of such gels have produced disappointing results, showing microbicides to be ineffective or, worse, to increase a woman’s risk of infection. So when the results of the Caprisa trial were announced at the XVIII International AIDS Conference in Vienna in July, the scientists and health workers burst into applause. “Today we celebrate the proof of concept of microbicides,” announced Gita Ramjee, head of the South African Medical Research Council HIV prevention research unit. “This gives hope to thousands of women in South Africa and elsewhere.”

The gel cut the risk of HIV infection by 50 percent after one year of use and 39 percent after two and a half years, said Quarraisha Abdool Karim, associate scientific director of the study. Karim thanked “all the gender activists and scientists who have been part of this process of trying to protect women.”

Is a medicated gel that women can apply themselves, with or without their partner’s cooperation, consent, or even knowledge, the future of reducing heterosexual HIV transmission?

Such a method could be useful for women, especially in the developing world, says Emory Professor of Medicine Jeff Lennox, chief of infectious disease at Atlanta's Grady Memorial Hospital, given that a gel would be inexpensive, easy to distribute, and is “self-applied and self-controlled.”

“I’m glad to have a preventive therapy that looks like it’s working, but before we say it’s the be-all, end-all we have to look at oral medications,” Lennox says. “If we can find a therapy that’s successful 90 to 95 percent of time, that will be a real game-changer.”

“This is great news from an early-stage point of view, but the jump from that to making it available as a public health intervention in Africa is a big one,” says Susan Allen, a physician, AIDS researcher, and professor of global health at Rollins. “If you have to use this each and every time before you have sex, it’s a bit like vaginal spermicides, which proved cumbersome and not as efficacious as other methods of birth control.” Allen continues, "The most important piece of information an African woman can have is her HIV test result, along with that of her steady partner. Joint HIV testing reduces new infections in couples by half to two-thirds. The ideal program would combine couples testing with access to affordable biomedical strategies, including male circumcision and microbicides."

Most AIDS therapies, no matter how effective, will continue to be out of reach for those who need them most desperately, for they live in countries where about $4 a head per year is spent on health care.

With about 33.4 million people infected with HIV/AIDS worldwide, and nearly three million people per year continuing to develop the virus, mostly in sub-Saharan Africa, one thing remains certain: “Prevention is key,” Allen says, “because treatment will always be too expensive.”

Mary J. Loftus is the associate editor of Emory Magazine and writes often about health topics.