On December 1st each year, the world comes together to commemorate World AIDS Day. Today, about 42 million people live with HIV/AIDS worldwide. Of the approximately 15,000 people who will be infected with HIV each day this year, the majority will not even know that they are infected and will continue to spread this disease for another several years before they realize they are ill. As the epidemic spreads, it is affecting more and more women; globally, it is estimated that women represent approximately 65% of all those infected with HIV/AIDS. In fact, the leading risk factor for HIV among women in much of the world is to be the monogamous wife of an unfaithful or polygamous husband. AIDS has now become one of the most serious women’s health issues globally and existing prevention methods for women at risk for HIV/AIDS are severely inadequate. While there have been significant advances in AIDS education, treatment and prevention efforts worldwide, the epidemic shows no sign of abating and increased efforts to find safe and effective prevention methods such as microbicides, vaccines and behavioral interventions are urgently needed.

Worldwide, more than 90% of all adolescent and adult HIV infections result from unprotected heterosexual intercourse. Condoms, if used correctly and consistently, can prevent a high level of HIV infections from occurring. However, male and female condoms are not always available or affordable. Even where condoms are accessible, social factors such as a desire to have children, or desire for sexual spontaneity, intimacy and trust, influences and restricts use. In addition, men often decide whether or not to use a condom during intercourse: it can be difficult or impossible for women (especially if they are young, married, and dependent on their spouse) to ensure consistent condom use. Lack of economic and social power prevents many women from negotiating safe sex: the risk of being stigmatized as barren is often feared far more than the risk of HIV infection. Hence, for many women, condom use, abstinence, or sexual fidelity are not sufficient strategies for reducing exposure to HIV and other sexually transmitted infections (STIs).

In California, women have become the fastest growing population infected with HIV, with African American and Hispanic women disproportionately affected. Other sexually transmitted infections are also a growing concern. In 2005, there were 1.1 million estimated cases of sexually transmitted infections (STIs) in young people; the total direct medical cost of these cases was 1.1 billion dollars. According to the California Department of Health Services, rates of chlamydia, gonorrhea, and early syphilis all increased in 2005 (the most recently reported available data) compared with 2004.

Microbicides are substances currently in development which are intended to improve sexual and reproductive health through the reduction or prevention of HIV and other STIs when applied vaginally (or rectally) prior to intercourse. In order for widespread use, such agents must be cheap, stable, easy to use, and acceptable to target populations. For example, most developers now design microbicides to be self-administered prior to sex or to remain in place for several weeks and provide continuous protection . These types of products would not interfere with intimacy or spontaneity, which eliminates the important concern about user friendliness. And while many of the first commercially available microbicides are also likely to be contraceptive, future microbicide development should provide women with a choice between contraceptive and non-contraceptive products. Among the more promising microbicides are those that are ‘multi-indication’ microbicides, meaning they may prevent a variety of sexual and reproductive health concerns, such as chlamydia, gonorrhea, HIV, and bacterial vaginosis; some may be contraceptive. Several multi-indication microbicide candidates are currently in (or soon will enter) clinical trials in California.

Without an effective therapy or vaccine against HIV/AIDS, microbicide development, in combination with other HIV and STI prevention strategies, will become a core part of global efforts to slow the spread of HIV/AIDS. Mathematical models have shown that even a moderately effective product used only some of the time could have a substantial impact on curbing the HIV/AIDS epidemic.

The California Microbicides Initiative (CaMI), a statewide collaborative, aims to facilitate the development of safe, effective, acceptable and accessible microbicides as a means to promote sexual and reproductive health for the benefit of Californians and people around the globe. For more information please contact: CaMI@CaMI-Health.com or consult the website www.cami-health.com.