Tonight, you or someone you know may have sex without a condom. Maybe you'll decide it's not worth pissing off your husband to bring it up. Maybe you'll want someone so bad you just won't want to risk the rejection. Or maybe you'll want someone so bad, period. Every day, in thousands of places, women and men are getting infected (or reinfected) because they can't or don't use a condom.
Spending more money on prevention education is the usual prescription -- and it can't hurt. But we can lower the odds of HIV infection even without upping condom use. We could have safe, effective vaginal and rectal HIV killers in the near future if we care enough to kick up a fuss.
Microbicides -- creams or gels applied topically to reduce the risk of infection during sex -- aren't "pie in the sky" anymore. Of the more than 60 potential products, half are already in, or on the verge of, human trials. The Global Campaign for STI/HIV Prevention Alternatives for Women, an international coalition of microbicide advocates, estimates that just $75 to $100 million a year for the next five years would move one or more of these products through the pipeline and on to market.
But the money isn't there. Right now $35 million a year at most is being spent globally on microbicide research. This underfunding means potentially effective microbicides will sit on lab shelves, going nowhere fast because their developers (small, often university-based research groups) simply can't afford to test them.
The problem is that the pharmaceutical conglomerates that support most AIDS research do not yet perceive microbicides as profitable. Wake up! Several microbicides-in-waiting could be safe, effective against HIV without a condom, unobtrusive enough to use without a partner's knowledge, and inexpensive. Some may block HIV but allow conception. Others may be bidirectional, disabling the virus in an HIV positive woman's vaginal secretions and thus enabling her to protect her partner from infection -- as well as herself from reinfection. A number in the pipeline will probably be appropriate for rectal use, though it will take some agitation to break the not-so-polite silence surrounding this topic. With so many promising leads, research in this area should be racing forward. Instead, it's close to stalling.
Big Pharma shells out most of the $56 billion spent per year worldwide on health research. To them, the $100 million needed for microbicides is pocket change. But rather than invest now, they are waiting for publicly and philanthropically funded research to yield products with proven effectiveness and, in the words of Alan Stone, MD, of the British Medical Research Council, "convincing evidence of profitability."
This leaves the microbicide research engine running mainly on the $25 million a year supplied by the U.S. government -- 1 percent of the feds' AIDS research budget. The Microbicides Development Act of 2000 proposes to correct this. Written by microbicide activists and supportive House staff, the bill increases microbicide research funding at the National Institutes of Health (NIH) to $50 million in 2001, $75 million in 2002 and $100 million in 2003 -- enough to grease the pipeline for the first microbicides.
The House version of the Act, H.R. 3891, was introduced by Reps. Connie Morella (R-MD) and Nancy Pelosi (D-CA) last March and assigned to the House Commerce Committee's Subcommittee on Health and the Environment. It has gained the support of both the Congressional Women's Caucus and the Congressional Black Caucus. Tragically, no one has yet stepped forward to introduce the Senate version. Even the House version has only 25 cosponsors as of this writing -- too few to guarantee passage. Morella introduced micro-bicide funding bills in the two previous Congresses, and both times they died in committee due to lack of support.
Noncontroversial and low budget, this bill deserves the support of Congress members on both sides of the aisle. But few can even tell the difference between microbicides and microwaves. We can change that. If AIDS activists make the Microbicides Development Act a high priority between now and late December, we can force their hands. Otherwise, the bill will die in committee again, delaying access to microbicides by a few more years. So call your senators and rep, and tell them to sign on to the Microbicides Development Act of 2000. It's time to make a fuss. Silence still equals death.
To reach your senator or rep by phone, call 800.648.3516. For info, or to sign a petition calling for more microbicide research, contact the Global Campaign for STI/HIV Prevention Alternatives for Women at 301.270.1182 or http://www.genderhealth.org/.