South Africa has largely led the world in the quest to create an effective and discreet HIV prevention method that could revolutionise power dynamics in the bedroom – and protect those most vulnerable to infection.
COMMENT
By the time you go to bed tonight, more than 1 000 women aged 10 to 24 will have contracted HIV, according to 2015 statistics from UNAids.
And just as with contraception, there is no one-size-fits-all approach to protecting young women — or the thousands of men who have sex with men and sex workers — who are at a high risk of HIV infection. In South Africa, as many as one in three gay men may be living with HIV, shows 2011 research published the journal Aids and Behavior. Among women sex workers, four out of five may be HIV positive, reveals a 2014 study by the South African national health department and US Centers for Disease Control.
Whether it’s preventing an unwanted pregnancy or HIV infection, people need options that work for them. They also need methods that can grow with them as, for example, their risk of contracting HIV changes.
The good news is that the world recently expanded our HIV prevention menu to include the HIV prevention pill, also known as the pre-exposure prophylaxis (PrEP).
Listen: Sex, condoms and the HIV prevention pill
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The bad news is the United States government could be on the verge of stopping some of our most promising options from ever making it on to this menu and into people’s lives.
Microbicides are gels, rings, films or other substances that often contain antiretrovirals (ARVs) — the same type of drugs used in the HIV prevention pill — and are applied to the vagina or rectum before sex to prevent HIV infection. In a world where women and men who have sex with men may not always be able to negotiate condom use, microbicides could help people take control of their HIV infection risk.
Much of the important microbicide research has happened in South Africa, including three major clinical trials among women and the first African trial of a rectal microbicide designed for men who have sex with men. This led to the creation of an ARV-containing vaginal ring for women that can be inserted monthly. The ring was found to reduce a woman’s chances of contracting HIV by up to 37%, revealed research presented at the 2016 Conference on Retroviruses and Opportunistic Infections.
As of July, this ring was being evaluated for use in Africa by the World Health Organisation European, and similar moves had been expected in South Africa by the end of this year.
And today, about a dozen new types of microbicides are in the research pipeline, including some that could protect women against not only HIV infection but also other sexually transmitted infections and unwanted pregnancies.
But this progress is in peril.
The US government has been the major funder for HIV prevention research, including that into microbicides, primarily through the US National Institutes of Health’s (NIH) Division of Aids. This department supports networks of people such as scientists, health workers and statisticians working on microbicide clinical trials globally and in South Africa.
The US is reviewing its funding to these networks and the NIH’s Aids division as indicated that it may shift its focus away from microbicide research to invest more in long-acting HIV prevention products such as injectable ARVs and HIV prevention vaccines.
In the coming months, the NIH’s Aids division will make its final decision whether to continue the kind of focus its had on microbicides research.
But the division is calling for public input before it decides the fate of much of the world’s microbicides research. Time is short to make our views heard. South Africa, where so much of the research takes place and where the need is great, must raise its voice now.
If funding for microbicides research and development goes, so too does one of our best chances of putting the power of HIV prevention back in the hands of those who need it most.
Yvette Raphael is the programme manager for the Advocacy for Prevention of HIV and Aids organisation. Manju Chatani is the director of partnerships and capacity strengthening at the Aids prevention lobby group AVAC. Submit comments to the NIH via its website to or sign onto to the campaign to protect microbicides funding.