Microbicides: the next sexual revolution?

Date: 20/04/06

By 2010 the world may see the start of a revolution in sexual health to match the arrival of oral contraceptives in the 1960s.

If optimists such as UK Development Minister Hilary Benn are correct and clinical trials go well, then microbicides - substances that kill or disable sexually transmitted pathogens - will be available by the end of the decade.

Supporters say the potential is enormous to save millions of lives and reduce poverty in many parts of the globe.

In societies where the use of condoms is prohibited or socially taboo, it is hoped that microbicides will be effective enough to tackle infections such as HIV/AIDS, gonorrhoea and chlamydia.

While condoms do prevent HIV infection, their use depends on the co-operation of the male partner and they are also contraceptives. Microbicides need not be contraceptive and need not depend on male co-operation.

Campaigners hope that in places such as Zimbabwe, where condoms are rarely used, or in places where birth control is restricted by religious teaching, then microbicides, which are not necessarily spermicidal, could become more widely accepted.

According to estimates from the London School of Hygiene and Tropical Medicine, if microbicides were only 60% effective and were used in half of all sexual encounters, over a three-year period 2.5 million lives would be saved.

The problem is that they do not yet exist and funding research has proven difficult. The largest markets for microbicides are likely to be poor, developing countries in Africa and Asia, where major pharmaceutical firms see little return for their investment, leaving research to non-governmental organisations, institutes and small firms.

In the EU, public funding was slow to arrive. In 2000 Europe was the source of around 2% of money being spent on microbicide research around the world.

But things are changing: by 2004 that figure had risen to 25%.

In 2004 the Commission launched the EUR 19m European Microbicides Project to bring products to advanced clinical trial.

The European and Developing Countries Clinical Trials Partnership Programme, funded by the EU, has attempted to cover some of the high costs associated with full-scale drug trials, although some projects have found it difficult to meet tough criteria for EU tenders, including the use of European scientists.

"We would like to see more flexibility," said Rebekah Webb of the Global Campaign for Microbicides.

Other problems remain. Research by the Guttmacher Institute in Zimbabwe has shown that, while microbicides might empower women, overcoming male fears and cultural sensitivities will be essential to promoting widespread use.

"We need to be thinking about access issues now," said Webb. "It can be the perfect solution but if you cannot get it to people then it doesn't work."

With microbicides still unproven, some in the health community are urging caution. They fear that over-hyping microbicides will erode some of the work done in promoting condoms.

Article takes a look at scientific progress on microbicides, substances that kill or disable sexually transmitted pathogens, which were thought to be available by about 2010 and could help in the global fight against sexually transmitted diseases such as HIV/AIDS, gonorrhoea and chlamydia. Microbicides are seen by some as a way of female empowerment in the field of contraception.
Article is part of European Voice Special Report, 'The EU and women'.

European Commission: DG Research: Health: Poverty-related Diseases https://ec.europa.eu/health/sti_prevention/hiv_aids_en

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