African Woman and Child Feature Service

Numerous microbicidal products, designed to be inserted into the vagina and or rectum prior to sexual intercourse for the prevention of HIV and other sexually transmitted infections are still being developed.

A few years ago women had been given hope of protecting themselves from HIV infection by use of microbicides.

In 2007, the microbicides Cellulose Sulphate, also viewed with optimism, was stopped because it weakened the compact space between cells thus increasing the possibility of infection.

It is for these reasons, coupled with years of endless research, that has the discourse on microbicides taking a pessimistic turn.

The big question being asked is why the research does not seem to be moving forward. However, not everybody is pessimistic. For some the scenario could not be brighter. According to East Africa’s coordinator for Global Campaign for Microbicides, Pauline Irungu, there is hope from some products. She says: “Early this year, a product called PRO 2000 showed, for the first time the possibility that effective vaginal products could be developed to protect women against HIV infection.”

She adds: “When assessing how useful a product can be used against HIV infection, two things are factored, the safety of the product as well as its effectiveness.”

According to Irungu, some previously tested products have been found to be safe but have not shown effectiveness.

This is why in PRO 2000, scientists have found renewed hope because it proves to have both components although at a relatively low effectiveness percentage.

Dr John Ong’ech, a gynaecologist in Nairobi who is also a HIV specialist emphasises that it has been a challenging process. “We still have a long way to go towards achieving a successful microbicides product just as it has been with the HIV vaccine largely because the HIV virus has remained a mystery.”

Explains Ong’ech: “Once scientists study a concept in the lab and it has shown evidence that it can prevent HIV infection, the virus assumes a different shape and completely renders the concept ineffective. Those are the dynamics of the virus.”

He says the female body is not homogenously vulnerable. This means that a number of women are vulnerable for a number of reasons which further complicates the research process because all these issues must be factored in if microbicides are to be deemed effective.

But these are just some of the issues that have plagued the success of the microbicides and its research thereof, thus fueling a feeling of “microbicides fatigue”. Expectations of success have been raised over a long period of time with no signs of success.

“It was in the mid-1990s when I first heard that although it may be years before an HIV vaccine can be developed, there was talk of another product — microbicides — in the offing which would give women the much needed protection against the virus,” says Waithera Mwangi, a businesswoman in Gikomba.

She adds: “Years later and thousands of new infections in Kenya with women bearing the burden of infection and care, and there seems to be little hope that the product will be in the market soon.”

However, what to many might appear a long time in the quest towards achieving an effective microbicides product could actually be the way to success.

Irungu explains the delay has been driven by a number of issues. She says: “Apart from the fact that microbicides are an entirely new concept, funding has also been a major challenge.”

New territory of microbicides development has never been driven by pharma, the engine of drug development, which has shown a reluctance to invest in microbicides even though there is a large market hungry for its breakthrough.

“This is because the said market has little money and it’s a distinctively female market based in the Third World which offers little potential for profit hence the lack of interest by pharmaceutical companies to drive the progress of the research,” explains Irungu.

Other than money, there are tremendous scientific challenges. It takes a long time to develop a product from a concept, taking the concept to the lab then to trials until its effectiveness can be proven. As has been the case with vaccines, it is a long and winding road for the microbicides to come to the table.

In addition, divisions in the scientific world have further clipped the research process. Irungu says: “There are scientists who do not believe in microbicides, they would rather we treated ourselves out of the epidemic.”

But what has remained a major research impediment is indicated in the continued misunderstanding of the vaginal environment. It was initially believed that infection occurs through vaginal cuts and abrasions but science can now prove that the HIV virus can squeeze in between cells.

Although it continues to be a long wait, Dr Mary Amuyunzu, an anthropologist in Nairobi says that the need for microbicides cannot be further emphasised.

“Human sexual behaviour is confounding. Over one million Kenyans are living with the virus yet risky sexual behaviour has remained high and many women are still unable to negotiate for safe sex,” says Amuyunzu.

She adds: “It is for these reasons that microbicides excite us even though after years of research there is still no product that has conclusively proven to be effective against HIV infection.”

Amuyunzu says the beauty about microbicides is that it is a women initiated HIV prevention, which in itself might not be an indicator for success based on other ventures such as the female condom. However, she says, if used as intended, the ability to slash down new infections can be significant.

In the meantime, we can only hope that PRO 2000, which is currently under another phase of a bigger trial, will give us a safer and more effective package against the HIV virus. It’s hoped that the current trials on PRO 2000 will be much more conclusive than the previous one with the results expected between November and December.

There is even more reason to remain hopeful since public health experts say that in a period of three years, effective microbicides against HIV could prevent 2.5 million infections.