Sunday, March 1, 2009

The good/bad news about vaginal microbicides

I join everybody in applauding the news that the microbicide people are making progress in their quest to find a better female-controlled HIV-prevention device. But no one yet has answered the deeper and harder question: How do you get people to use it?
Elizabeth Pisani nails the happy side of the development announced last month at the CROI Conference in Montreal:
But at least as valuable is this piece by the gang at CADRE in Johannesburg, where they have watched the rise and fall of many of the supposed solutions to the AIDS crisis. Take a look at their reservations about microbicide research:
I fear that microbicides, and the one-a-day prevention pills that also are showing signs of technical success, amount to just building a better condom. Sure they stop HIV, but only if people use them almost constantly, with all sex partners, in every interaction. Microbicides certainly have the advantage of more female control, though I'm skeptical that men won't know that their sex partners suddenly are inserting a new substance in their vaginas. I can recall interviewing couples in Durban a couple of years back about Microbicide use during trials, and the men definitely could tell the difference. In most cases, they liked the extra lubrication, which might be a secret marketing advantage for microbicides IF you can get people to start using them.
In any case, the technological problems will not be the hardest ones to solve for Microbicides. As with most everything having to do with AIDS in Africa, the solutions are going to have to mesh with cultures almost totally unfamiliar to the Westerners in charge of the AIDS war.
What do you think?

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