"Her Own STD Barrier"

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US News & World Report (06.02.03)::Katherine Hobson
     "Women deserve more options than begging their husbands to
use a condom," says Sharon Hillier, a scientist at Magee-Women's
Research Institute in Pittsburgh. But begging is too frequently a
woman's only defense against STDs, and these pleas are often
ignored - one reason more than 19 million women in the world have
AIDS. But women soon may have the power to prevent HIV and other
STDs on their own.
     Microbicides - gels and ointments applied directly to the
vagina - aim to provide this protection. Carraguard, a
microbicide expected to enter clinical trials later this year, is
just one of nearly 60 products in development. The Bill and
Melinda Gates Foundation just granted $60 million to microbicide
research, and if all goes well, a product could be on the shelf
by 2007.

     Carraguard is a gel made from seaweed. Applied no more than
an hour before sex, the gel is chemically attracted to proteins
on pathogens like HIV and herpes. Other compounds take different
approaches. Some can boost the vagina's natural pathogen-killing
acidity, while others strip viruses of their protective shield or
prevent a virus from replicating inside a cell. Human studies
have shown that Carraguard is safe, and animal research and other
compounds shows that it works. Effectiveness in humans is harder
to prove. It is unethical to intentionally expose people to HIV,
so trials must track thousands of women who are already at risk
of contracting the virus to learn if those who use gels escape
infection. A product does not have to be foolproof: Investigators
would be thrilled with a 30 percent to 50 percent reduction in
infections.

     The biggest obstacle to microbicide research is the cost of
the trials. The largest demand for the products is from poor
women in AIDS-besieged areas of Africa and Asia. With a few
exceptions, nonprofit and government spending has financed
research and early testing. For long-term development, however,
"the western world is important because that's where the money
is," said David Phillips, senior scientist at the Population
Council, which is developing Carraguard. To win over western
customers interested in birth control, a microbicide might
include a spermicide - an approach that would not work in
developing nations, where fertility is highly valued.