Tuesday, July 20, 2010

Some good news for HIV prevention

A randomized controlled trial in South Africa has revealed a microbicidal gel spread inside the vagina to be effective at reducing HIV transmission by 39%.  Women who complied closely with the treatment recommendations, to use the gel before and after sex, experienced a 54% reduction in transmission.  What's so revolutionary about the gel, versus orally taking anti-retrovirals as prophylaxis, is that it acts on site, so doesn't flood the body with powerful medications that aren't safe for long-term use.  This means both that the user won't experience side effects and, as reported by ERV, the virus itself is unlikely to become resistant to the particular anti-retroviral used in the gel, since it is not present throughout the body where HIV multiplies.

Unfortunately, 39% is a far cry from the virtual 100% protection proper use of a condom offers.  I have the same concerns about this drug as I have about circumcision, that it may make people feel protected when they are not, and therefore actually decrease or fail to adopt condom usage.  The first thing I'll say (in response to my own concerns) is that as much as we'd like "just wear a condom, darnit!" to be the solution, studies show that people simply like sex without condoms, and so there will continue to be a market for products or treatments (circumcision) that reduce risk without condom use.  Much of this aversion to condom may be social, and that's why I hope there continues to be just as much focus on upping the sex appeal of condoms as there is on finding alternatives.  The second important thing to keep in mind is that this gel is for use specifically by women, and can be used without her partner's knowledge or approval.  This is incredibly important, given that men are more likely to report experiencing a decrease in sexual pleasure with condom use, and therefore may be the ones objecting to prevention practices.  This gel allows a woman to protect herself if she is in a violent or unequal relationship, or simply if she wishes to have sex with someone who refuses to wear a condom.

I'll be interested to see further trials on the gel, and how marketing materials are developed to encourage use with condoms (I hope it's been tested for compatibility!) rather than in place of.

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