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The International Community of Women Living with HIV/AIDS (ICW) and Positively Women
MICROBICIDES and HIV POSITIVE WOMEN
ICW and Positively Women strongly advocate for the development of female-controlled interventions, such as microbicides, that promote sexual and reproductive health and rights. Although we aim for the ideal of sexual relationships based on mutual respect and responsibility, we recognise that many women need methods that gives them greater power to protect themselves and their male sexual partners.
What are microbicides?
Microbicides are substances that can be applied to the vagina before having sex in order to reduce the risk of HIV and other sexually transmitted infections. They do not exist yet but approximately 60 products are at different stages of research. They could be produced in a variety of forms, including gels, creams, films, suppositories, or vaginal rings. Some would be contraceptive, while others would allow women to get pregnant whilst reducing their risk of infection. Other possible variations of a microbicide include: 1) a vaginal wash that can help prevent mother-to-child transmission of HIV during childbirth, 2) a compound that can be added to expressed breast milk to make it safer for infant feeding, 3) a substance for use during anal or oral sex.
Microbicides could help us:
Have healthy, pleasurable, sexual relationships.
Gain greater control over protecting ourselves from re-infection, STIs, and vaginal infections, especially if we are unable to discuss safer sex practices with our partners, if we have not disclosed our HIV status, or if we are unaware of our own status.
Protect our HIV negative sexual partners, particularly if we want to conceive.
The power to control prevention will help challenge the erroneous view that women are vectors of disease, and therefore help counter discrimination against HIV positive women worldwide.
What are our concerns?
We are concerned that research and development of microbicides has not considered the implications of involvement, or non-involvement, of HIV positive women. There is, for example, no research on the vaginal physiology of HIV positive women. Therefore we have no understanding of how a microbicide can halt HIV transmission from an HIV positive woman. Microbicide trials need to consider this gap in research along with other concerns about involvement and non-involvement of HIV positive women.
If we are not involved in trials, the effect on our sexual, reproductive and general health will not be determined. Unwanted side effects, for example, interaction with treatment including ART, will not be recorded. It also means that there will be little.
Women who test HIV positive at any stage of trials will require support to deal with their diagnosis, however researchers rarely acknowledge their responsibility to participants on-going mental and physical health needs, including the provision of ART.
Rejecting women who test HIV positive from microbicide trials may be perceived by families and the community as confirmation of a positive diagnosis. Because of stigma, there is a danger that these women may then be subject to mistreatment.
Ensuring partner and community support for trials involves providing a level of information that may adversely affect participant confidentiality, specifically concerning who is, and who is not, HIV positive.
Microbicides are unlikely to be 100 percent effective. Trial participants and eventual users may have an unrealistic sense of security. HIV positive women may be subject to blame and abuse if their sexual partners test positive despite the use of a microbicide.
The development of microbicides does not significantly change social and economic inequalities that impact on a womans ability to decide when, with whom, and how to have sex. Yet policy-makers and programme managers may believe that in promoting microbicides they are satisfying gender concerns.
ICW and Positively Women call for:
More political commitment and resources to develop microbicides.
International commitment to mainstream the development of microbicides into the broader prevention and treatment agenda.
Long term studies on the potential side effects of microbicides on womens reproductive and sexual health. This would include a commitment to study the vaginal physiology of HIV positive women.
The involvement of HIV positive women in microbicide research, development and advocacy, to include involvement at every level in developing ethical principles of involvement.
Trials to determine the effect of microbicides on the sexual, reproductive and general health of HIV positive women, our partners, and on mother-to-child transmission.
Commitment by researchers to ensuring that trial participants will benefit fully from any successes
The involvement of HIV positive women in the development of separate microbicides that 1) act as a contraceptive, 2) allow for conception, 3) that can be used by women and men in non-heterosexual relationships.
The confidentiality of all trial participants to be respected and support given to women who test HIV positive during any stage of trials to determine product effectiveness.
Provision of full information about trials to participants to ensure their informed consent.
Support for microbicides should not detract from the need for condom promotion programmes (including the female condom)
More programmes promoting the empowerment of women and transformation of gender and sexual relations.
Contact address Positively Women
347-349 City Road London, EC1V 1LR
United Kingdom
Tel: +44 (0) 20 7713 0444
Fax: +44 (0) 20 7713 1020
Email: HYPERLINK mailto:info@positivelywomen.org.uk info@positivelywomen.org.uk
URL: www.positivelywomen.org.ukContact address ICW
International Community of Women Living with HIV/AIDS (ICW) Unit 6, Building 1, Canonbury Business Centre, Canonbury Yard, 190a New North Road, London, N1 7BJ, United Kingdom Tel: +44 (0) 20 7704 0606, Fax: +44 (0) 20 7704 8070, Email: HYPERLINK "mailto:info@icw.org"info@icw.org, URL: www.icw.org
Thank you to Bridget Sleap from IFH for her comments.
There is little current research on these variations but they could be potential future applications of microbicides. At this stage the main research focus is on topically applied vaginal products for sexual transmission of HIV.
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