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For Women: Safer Sex

As HIV infections rise sharply in females, scientists are researching microbicides, chemicals that could offer greater options in the battle against STDs.


With cases of AIDS soaring among women, health experts are taking a hard look at an old question. When a woman's partner won't wear a condom, is there another way for a woman to protect herself from HIV and other sexually transmitted diseases?

Researchers at dozens of U.S. organizations are working on a safe-sex solution for women, focusing on a promising group of chemicals called microbicides. The effort is being given high priority by women's health advocates, AIDS researchers and public-health officials as experts acknowledge that education programs don't hit home with everyone.

"Our prevention program message has been condoms, monogamy or abstinence," says Anna Forbes, U.S. field organizer for the Alliance for Microbicide Development, a consortium of international health experts. "But for some people, that just doesn't work. Not all women can insist on condom use."

While "microbicide" may sound like something sprayed on crops or kitchen counter tops, it is a catchall term for substances that could be used topically by women to kill a variety of viruses and bacteria. A woman would apply the substance, in the form of a gel or foam, to her vagina before sex.

In developing microbicides, researchers are building on their knowledge of spermicides--the foams, jellies and creams that are usually used with condoms for birth control. These easy-to-use sperm-killing chemicals do not harm vaginal tissues.

"We're looking for something that instead of killing sperm, kills or immobilizes HIV" as well as bacteria and viruses, says Forbes. Sexually transmitted bacterial infections include gonorrhea; viral STDs include herpes and hepatitis B.

Microbicides aren't likely to be available on pharmacy shelves any time soon. Reproductive health experts estimate that the products could become available within five years, provided that there is adequate research spending.

While most of the research focuses on preventing various STDs, the increased incidence of HIV infection in women has catalyzed the field, Forbes says. "We're seeing the worldwide rates of HIV infection among women going through the roof," she says. "Women are now becoming infected faster than men." In sub-Saharan Africa, more women than men are now infected with HIV, according to the World Health Organization.

In the United States, HIV infection among women is also rising quickly. This year, women will make up 30% of all new infections, according to the Centers for Disease Control and Prevention. About three in four new infections among U.S. women come from heterosexual sex.

Women are also the fastest-growing group of people with full-blown AIDS. AIDS in women increased from 7% of newly diagnosed cases in 1985 to about 24% in 1998.

Research on microbicides has also gained momentum as scientists have recognized that it may take longer than originally thought to develop an effective and safe AIDS vaccine. "It's going to be substantially easier to develop a microbicide than an HIV vaccine, although we need both," says Forbes.

While STDs generally are not life-threatening, they take a huge toll on Americans, experts say. About 15 million new STD cases occur each year, according to the Alan Guttmacher Institute, a reproductive health group in New York City.

Women tend to suffer disproportionately from the effects of STDs because the lack of symptoms in women (as compared to men) can lead to lingering infections. The human papilloma virus, for example, can cause cervical cancer; other STDs can lead to pelvic inflammatory disease and infertility.

"HIV is not a prime concern of most American women. But we have an epidemic of STDs here that women are worried about," says Anne-Marie Corner, president of Biosyn, a Philadelphia company that is developing a microbicide called Savvy.

In a survey conducted in 1999 by the Alan Guttmacher Institute of women ages 18 to 44, 40% said they would be interested in an alternative method of STD protection that would give the woman control over usage.

The most popular forms of birth control are the pill and sterilization, but neither prevents STDs. When used correctly, condoms can stop transmission of many STDs--although they do not always protect against herpes and human papilloma virus. But many Americans are ambivalent about condom use.

A 1998 survey by the Kaiser Family Foundation found that only about half of adults had talked to sexual partners about their history of STDs. Only 34% of women and 28% of men who had STDs said they informed their most recent or current sexual partner of their condition prior to having sex.

"It is a problem for women everywhere, at different points in their lives and in different relationships," said Polly Harrison, a reproductive health expert who founded the Alliance for Microbicide Development in 1998. "We also know there is attrition in condom use, and we know use is imperfect."

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