Microbicides: Who, what, where, when and how Rebekah Webb Global Campaign for Microbicides © Salam Dahbor, Courtesy Doubleshots Studio

What is a microbicide? A substance that can reduce the transmission of HIV and other STI pathogens when applied vaginally and, possibly, rectally. They do not yet exist… First generation: Gels and creams In the future: Sponges, vaginal rings Gels with barrier devices

Why We Need Female Controlled Methods Biology –Women are 2-4 times more likely than men to get HIV from unprotected sex Economics –Women are often dependent on men for income –Selling sex is a way of life Social & cultural traditions –Male entitlement to sex, female innocence about sex –Gender based violence Current methods (abstinence, fidelity and condom use) often require male consent, knowledge, or cooperation

Potential advantages Easy to use Allows intimacy and improves sex Contraceptive and non-contraceptive versions Reduces risk of other serious STIs Likely to be inexpensive and available over the counter Could be used without partner’s cooperation (or possibly even awareness)

3. surfactants 4. entry inhibitors5. anti-retrovirals 2. boost vagina’s natural defences 1. physical barriers How microbicides work… Source: Dr. R. Shattock

How would they benefit HIV+ people? Reduce risk of re-infection with other HIV strains Help protect both partners Reduce risk of other STIs, yeast and bladder infections Allow conception while protecting partner

How effective will they be? First microbicides may be 40-60% protective Second generation may be 60-80% Should be promoted as a “back-up” to condoms, not as a replacement –Use a male or female condom every time you have sex; if you absolutely can’t use a condom, use a microbicide –Use a microbicide with your condom for added pleasure and protection

Potential public health impact If a 60% effective product Offered to 73 lower income countries Is used by 20% people reached by health care During half of unprotected sex acts… = 2.5 million HIV infections could be averted in 3 years including women, men and children

How close are we? Ability to prevent HIV transmission from men to women is being tested Five candidates in final stages First results expected late 2007/early 2008 Likely to be only partially effective (if at all) Proof of concept possible by time of next AIDS Conference Ability to prevent HIV transmission from women to men, and during anal sex will be a next step

5 Products Furthest Along

The Product Pipeline in 2006 Source: Alliance Pipeline Update

Clinical trial sites Source: Alliance for Microbicide Development

Public funding is essential Why aren’t large pharmaceutical companies investing? –Perceived low profitability –Liability concerns –Lack of in-house expertise –Uncertain regulatory environment Public Sector, 87% Philanthropic Sector, 13%

Annual funding needs Annual funding needs to double! All combined: Need $280M $3M

Imagine a full spectrum of interventions Prior to exposurePoint of transmissionTreatment Male and female condoms and lube PMTCT Clean injecting equipment Vaginal and rectal microbicides Cervical barriers PEP Anti-retroviral treatment Treatment for opportunistic infections Basic care/nutrition Prevention for positives Education and behavior change Therapeutic vaccines Rights-focused behaviour change VCT STI screening and treatment Preventative Vaccines PREP Male circumcision

The Global Campaign for Microbicides A broad international coalition of 250 organisations and over 50 partners Our Goals: Accountability - ensuring that as science proceeds, the public interest is protected Mobilise demand and investment for research and development of new prevention technologies Policy advocacy for development, introduction, and use

GCM Global Partners United States: CA, CT, DC, IL, NY, MA, OH, PA, WA African: Kenya, Ghana, Nigeria, Uganda, and South Africa. Europe: UK, Ireland, Netherlands, Scandinavia, Spain, Portugal, Germany, France, Belgium, and Russia North America: Canada Asia: Thailand and India.

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