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Future of PreventionMicrobicides
In response to this need, research is currently being conducted into the development of microbicides, products that can be used vaginally (and possibly rectally) to prevent transmission of HIV and, potentially, other STIs, by blocking transmission or killing the pathogen. Over the past 10 years, significant progress has been made in microbicide research and development. A number of promising new products are currently in different stages of development, and the results of marketing and acceptability research have been encouraging. Nonetheless, it is likely to be another decade before safe, effective, and affordable microbicides are readily available. In general, scientists are using two approaches to the development of microbicides: developing and testing new substances, and researching the potential microbicidal activity of existing spermicidal products. Today, approximately 38 small biotechnology firms, 28 nonprofit research institutes, and six public-sector agencies are working on microbicides. In 2000, about 60 product leads were in development, of which seven were in later-stage clinical trials. Almost three dozen potential products remain in some stage of testing. Although promising, initial results of Phase III trials of the Nonoxynol-9 spermicide, Advantage-S, have indicated that use of the product may actually increase HIV transmission. These trials were conducted among women who used the product with a high degree of frequency, some up to 20 times per day. It is thought that highly frequent use may irritate the mucosal surfaces in the vagina and cervix and create portals of entry for HIV. This may or may not occur with less frequent use. VaccinesResearch is currently being conducted on a variety of potential HIV/AIDS vaccines. Only one potential vaccine has entered Phase III human efficacy trials, and one is in Phase II trials. There are more than 60 Phase I trials with approximately 30 candidate vaccines. Although there has been significant progress and there is great promise, it is not likely that a highly effective vaccine will be available in the near future. It is worth noting that once a vaccine is developed, it may be only partially effective, and may only stop or delay progression of the disease or reduce infectiousness among people already infected, rather than prevent primary transmission. Shifting gender normsStemming the HIV/AIDS epidemic will require a long-term focus on shifting societal gender norms. Short- and long-term interventions are needed to address the underlying causes of vulnerability to HIV with efforts designed to raise awareness about gender norms and power relations, and to seek shifts in such norms. It is important to recognize that culture can and does change. Some interventions have shown much promise in changing both the way men and women relate to each other, as well as gender relations at the community level. Given the often slow nature of cultural change and the long-term implications of such change, it is especially important to work with young people, who are generally more adaptable and are also able to carry forward what they have learned into their lives as adults.
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Since
many women’s risk derives primarily from their partners’ behaviors
rather than their own, and the fact that the major current strategies
for HIV prevention—partner reduction, monogamy, condom use, and treatment
of STIs—are not feasible for many women, there has been a growing
call for the development of a means of protection against HIV that women
can control. 