In 1951, Katherine McCormick and Margaret Sanger set in motion the ideas and funding that would revolutionize women's sexual and reproductive health for generations. Their groundbreaking work paved the way for today's standard oral contraceptives, known collectively as "the pill."
This was long before the advent of HIV/AIDS, but it is the same type of innovation AIDS advocates now hope to achieve with microbicides.
Microbicides are substances, typically in the form of a topical gels applied to the vaginal area, that currently are being tested as a way to reduce sexually transmitted diseases, including HIV/AIDS.
According to the International Center for Research on Women, both genders could benefit from microbicides, but the immediate target is women. For men, the most effective HIV-preventative product currently is the latex condom. Microbicides are considered a "woman-focused method of HIV prevention," ICRW officials said.
World AIDS Day, which was observed Dec. 1, this year focused on the growing infection rate of the disease among women and girls.
Long stigmatized as a homosexual disease, an African disease or a disease contracted only by prostitutes and intravenous drug users, new evidence shows the AIDS epidemic is heading in another direction. A recent report published by the Joint United Nations Program on HIV/AIDS -- also known as UNAIDS -- and the World Health Organization found nearly half of the 37.2 million adults ages 15 to 49 worldwide living with the human immunodeficiency virus -- the organism that causes AIDS -- are female.
"These latest trends firmly establish AIDS as a unique development challenge," said Dr. Peter Piot, the UNAIDS executive director. "The time of quick fixes and emergency responses is over. We have to balance the emergency nature of the crisis with the need for sustainable solutions."
The current education strategy used to reduce the number of AIDS cases in the world is called "ABC" -- for Abstinence, Being faithful and reducing the number of partners, and Condom use. However, at a recent news conference announcing World AIDS Day, members of UNAIDS and ICRW said for women in developing countries "ABC" simply isn't enough.
Piot said an improved policy called "ABC Plus" is needed to address, among other issues, violence against women, their lack of property and inheritance rights, improving access to information on HIV/AIDS and reproductive health education, providing technologies appropriate to women's needs such as microbicides and the female condom, and ensuring women's employment and economic opportunities.
ICRW's research shows a strong link between violence against women and HIV infection. Women are not only more vulnerable to HIV infection due to their position in society, but evidence also shows they are more physically susceptible than men. The organization said women's reproductive anatomy makes male-to-female transmission during sex twice as likely than female-to-male transmission.
Microbicides mark a critical point in the fight to prevent the spread HIV/AIDS among women, said Anna Forbes, Global North programs coordinator for the Global Campaign for Microbicides. She said over 60 potential microbicides have been tested. Of those, five have reached the final stage of human testing.
"The soonest we think anything can be available is between 2007-2010," Forbes told United Press International. "Microbicides are all about women's empowerment, as much as males are empowered by being able to use a condom."
Forbes added she would like to see "microbicides distributed as widely as condoms are now."
The number of people living with HIV/AIDS globally has reached an all-time high -- totaling an estimated 39.4 million people -- although the rate of infection varies among regions.
"Women are the backbone holding together the fabric of society," said Dr. Kathleen Cravero, UNAIDS deputy executive director. She said women's vital roles as food producers, mothers, and caretakers of the sick are at stake.
"The disproportionate infection of millions of poor women isn't merely an injustice; it is a socio-economic disaster," Cravero said.
Driven by poverty, hunger and dreams of a better life, many women and girls become involved with "transactional sex" -- using sex as a commodity in exchange for basic necessities, according to ICRW research. The organization cautions, however, that this is not the only way women contract the AIDS virus. In Kenya and Zambia, for example, ICRW research shows, married girls are up to 65 percent more likely to be HIV-positive than unmarried sexually active girls.
"The number-one risk in sub-Saharan Africa is marriage," Forbes said. In regions of the world where women under age 18 often marry men 10 or more years older, the risk of HIV/AIDS doubles compared to women who marry men only four years older.
"Instead of focusing on high risk groups like intravenous drug users or sex workers, we need to focus on all women if we are going to help them," said Dr. Khuat Thu Hong, co-director of the Institute for Social Development Studies in Hanoi, Vietnam. ISDS is a non-governmental, non-profit organization that conducts research and training in areas that include sexuality, gender, HIV/AIDS and reproductive health.
"We need to empower our women, we need to support our women," said Khuat, "Women suffer much more than others from this epidemic."
While many women's-rights and AIDS activists push for more funding for microbicides and other global gender-specific policy reform, there have been some small-scale success stories.
For example, in India in a district in the state of Maharashtra, ICRW and the Institute for Health Management developed a curriculum to provide life skills education to adolescent girls in hopes of delaying their age of marriage. By teaching skills such as how to fill out bureaucratic forms, find employment, and how to open a bank account, they increased the average marriage age by one year over a four-year period.
"There are lots of small projects scattered across the world by very good people with a lot of successes," Dr. Geeta Rao Gupta, ICRW's president, told United Press International. "Successes must be scaled up and repeated."
Gupta said the ABC approach does not work if all parts are not used together. Abstinence, for example, is not feasible in a married relationship or if a woman is raped. Also, due to double standards in gender rights, being faithful does not always apply to men, who in some societies are allowed to have up to four wives.
"HIV infection has spread the fastest among women worldwide," Gupta said, "largely due to AIDS policies and programs that fail to recognize and address the realities of millions of women and girls around the globe. Existing programs simply are not sufficient to meet their needs."
Gupta said microbicides are a key product for women, because many women are not in a position to negotiate condom use, particularly in marriages between older men and adolescent girls.
"We would like (microbicides) to be developed in a way so (they) can be available for men and women in the developing world," Gupta said. "The only political barrier in the developing world is in the way it's marketed because there is such a stigma about HIV/AIDS."
Forbes said resistance for microbicides comes in the form of under-funding, rather than direct opposition.
"We can't afford to let political agendas get in the way of protecting women against an infectious disease like AIDS," she said.
"Strategies to address gender inequalities are urgently needed if we want a realistic chance at turning back the epidemic," Piot said. "Gender inequality is, in fact, fatal."
Source: Feature: Fighting AIDS with microbicides
By Holli Chmela
UPI Correspondent
12-01-2004
