We may soon have the Plan B of HIV prevention. A study published this week shows promise for women being able to successfully combat HIV transmission even after a sexual encounter.
This time, hope comes in the form of a vaginal gel. In the first step towards its clinical development, when the gel was applied to macaque monkeys within three hours after exposure to the virus, five out of six primates remained HIV-free.
Unlike previous vaginal gels or microbicides that have been shown to work when applied prior to exposure, this one relies on utilizing a drug from a class that interferes at a later step in the HIV transmission process.
The study’s lead author, Walid Heneine of the Centers for Disease Control and Prevention (CDC), explained that the researchers used raltegravir, an antiretroviral that inhibits the later integration stage of HIV transmission. “It is a more suitable product to allow prevention not only before sex but also after sex,” he says.
Should the gels eventually prove effective in humans, they may revolutionize the fight against HIV/AIDS. Women would have the chance to protect themselves from the virus even if their partners refused or failed to wear a condom.
The gels can potentially can be used “after sex in privacy when you are freshening up after sex and, the partner does not have to know,” says Heneine, and, thus “provides an advantage.”
Vaginal gels are only the latest exciting new development for women looking to take control of protecting themselves from sexually-transmitted diseases such as HIV. Vaginal films, rings, and tablets are all on the horizon to empower women, especially in parts of the world where they have fewer rights and less sexual freedom.
“What do you say when a man says he won’t use a condom? That’s the problem women have,” says Anna Forbes, an independent HIV/AIDS health consultant who has worked in the field since 1985. “In a domestic violence situation, it gets a fist in your face. But it’s more common than that. If a man says he doesn’t like condoms, she might sidestep. It triggers questions, like ‘Don’t you trust me?,’ or ‘Are you sleeping with five other people?’ It introduces a lot of potential conflict, and what tends to happen is that women back away from the conflict.”
Even American women can attest to the difficulty of getting male sexual partners to wear condoms. It’s not for nothing that the Bill and Melinda Gates Foundation has spent over $1 million on the development of more innovative and comfortable condoms to increase their usage.
“Condoms are great and really effective, but they are controlled by men,” says Patrick Kiser, a biomedical engineer at Northwestern University. “In societies where we don’t have parity [between the sexes] it’s very hard for women to negotiate condom use.”
For this reason, Kiser and his team have patented a vaginal ring that promises to simultaneously prevent both pregnancy and HIV transmission. The first study on it was published last week, and researchers hope clinical trials will begin soon.
“The idea came from the overlap of the unmet need for HIV-prevention technology and family planning. The needs coincide in low income countries, especially sub-Saharan African,” says Smith. Once inserted, the ring will release levonorgestrel, a contraceptive, and tenofovir, an antiretroviral drug, and it will only have to be changed every 90 days.
There are other forms of female-focused prevention currently being developed and tested to empower women to have full control of their own sexual health.
Last week at the Conference on Retroviruses and Opportunistic Infections (CROI), one of the main innovations on display was a vaginal film that could potentially help prevent HIV transmission. Smith described the films as comparable to “Listerine mouth strips” in terms of texture. Obviously, they don’t leave your mouth feeling minty fresh, and they aren’t inserted orally but vaginally.
Even the rarely used and often maligned female condom is on the verge of making a comeback. It has been over 20 years since the FDA approved a female condom, and it had a rather unceremonious launch that led to few women using it—and few stores carrying them.
The FC2, a revamped version of the only female condom approved for use in the U.S., launched in 2007 with some major changes. Instead of being made of latex like traditional male condoms, FC2 female condoms are made of nitrile, which is what surgical gloves are made of. Overall, it’s less noisy and transmits heat better.
Female condoms are being pushed in other parts of the globe, as well. PATH introduced a female condom in China in 2008 that is inserted via a dissolvable gel capsule, says Forbes. “The whole bag is wadded up in a capsule and the size of an O.B. tampon. You insert it the way you would with a tampon, and the gel dissolves within 30 seconds,” says Forbes “This might be a much easier proposition.”
And although they are called female condoms, men who have sex with men can also benefit from them. While the FDA hasn’t approved them for anal sex, Forbes says they can be inserted rectally and, thus, serve as a barrier to HIV transmission during anal sex.
While Forbes is excited by the new advancements in female condoms, she believes it’s critical to see a general expansion of female-focused HIV prevention methods. She believes HIV prevention must be treated like contraception. “Like we learned with birth control, the more options you give, the more likely someone is to use something. When you add new options, the number of unprotected sex acts goes down,” she says. “The challenge is making tools women can use. We still have a long way to go.”