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Marvellous microbicides. Intravaginal gels could save millions of lives, but first someone has to prove that they work.
Lancet. 2004 Mar 27; 363(9414):1042-1043.Preventing AIDS is theoretically simple: encourage mutual monogamy or consistent condom use. But experts warn that if responsibility for protection stays with men, these interventions will produce only small gains in the fight against AIDS. The majority of women in some parts of sub-Sarahan Africa are in immediate danger of contracting HIV. But these women are powerless to protect themselves because most are dependent on men for economic security, and are often unable to negotiate safe sex. If a method of HIV prevention were available that women could administer themselves, the situation could rapidly become very different. Alan Stone, chairman of the International Working Group on Microbicides believes that microbicides —topical agents that stop the HIV virus being transmitted during intercourse— are the only realistic option. “There is absolutely nothing else on the horizon that could make a large-scale impact”, he says. (excerpt)
ECONOMIST. 1993 Nov 27 - Dec 3; 51.Promoting condom use alone is no effective against AIDS because many men do not like condoms and women, particularly adolescents, do not have the sexual bargaining power to demand condom use. WHO is calling for pharmaceutical companies to perfect microbicidal vaginal gels or sprays and to have them out on the market within 2 years. AIDS researchers have tended to ignore the potential of vaginal gels to protect against HIV. Vaginal gels have been available for decades. Most serve as contraceptive barriers, while others protect against sexually transmitted diseases (e.g., gonorrhea). Results of trials of the spermicide nonoxynol-9 in Cameroon and Zambia suggest that it protects against HIV transmission, but trials among prostitutes in Kenya suggest the opposite. In the Kenyan trials, nonoxynol-9 caused ulcers in some prostitutes, thereby facilitating HIV transmission. The president of the Society for Women and AIDS in Africa points out that a product that can separate the contraceptive function from the microbicidal function is needed to be acceptable. She adds that people in developing countries want protection against AIDS but not against pregnancy, WHO could further their cause by saying that the Pope also wants protection against AIDS but not against pregnancy. Microbicides are not very profitable for pharmaceutical companies and are less attractive for researchers than genetically engineered drugs. The president of the African women's groups believes that researchers and pharmaceutical companies have not taken microbicides seriously over the last decade because men oppose any woman-controlled method. If a woman used an easily available gel and it failed to protect against HIV/AIDS, the failure would be her death sentence and would expose pharmaceutical companies to litigation. WHO understands why pharmaceutical companies are wary: US lawyers. The companies' apathy is understood when one adds a legal suit to the quagmire suffering of sex and research trials in developing countries.
Geneva, Switzerland, WHO, 1987. vii, 80 p.This WHO manual on barrier contraceptives and spermicides covers all methods, their effectiveness, advantages and disadvantages, non-contraceptive advantages, uses in special cases, family program considerations, the logistics of supply, monitoring shelf-life and quality control, and application of condoms in AIDS prevention programs. Condoms and foaming tablets are the most appropriate methods for developing countries, especially those in the tropics. Other methods present problems such as expense (diaphragms, foams, sponges), unavailability outside the U.K. and U.S. (caps, sponges), bulk and expense (canned foams). Certain individuals are particularly good candidates for barriers and spermicides: lactating women, people using abstinence or natural family planning, adolescents, older women, women waiting to start using other methods, and those at risk for contracting sexually transmitted diseases. Program officials should consider providing supplies in their special environments, with limitations such as transport, reliability of shipments, storage requirements, cultural sensitivity, multiple outlets for supplies, and cost both to the program and to the users. Methods of insuring steady supply and techniques of testing condoms are described. Barrier methods, condoms in particular, help stop the spread of gonorrhea, syphilis, Chlamydia, Candida, Trichomonas and HIV. An appendix describes basic information about AIDS and the relevance of barriers and spermicides, as well as monogamy and abstinence, in preventing AIDS transmission. Other appendices list sources of supply for developing countries, addresses of manufacturers and sources of further information, techniques for using these methods, and teaching methods for illiterates and semi-illiterates.
London, England, International Planned Parenthood Federation, 1985. 48 p. (IPPF Medical Publications.)This booklet, published by the International Planned Parenthood Federation (IPPF), discusses the mode of action of barrier methods of contraception--their advantages, disadvantages, and effectiveness. Each method is dealt with in detail under the headings of 'application,' 'instruction to users,' 'advantages,' 'disadvantages and side-effects' and 'effectiveness.' Areas of research and safety issues are also discussed. The various types of barrier contraceptives are: 1) spermicides--creams, jellies, melting suppositories, foaming suppositories or tablets, and aerosol foams; 2) unmedicated mechanical barriers--vagnial diaphrams and cervical caps, including cavity-rim, Vimule and vault caps; 3) medicated mechanical barriers--vaginal sponges; and 4) condoms. When used properly and conscientiously, the contraceptive agents are both safe and effective, although their mode of action may be more complex than has been assumed in the past. The function of barrier contraceptives is to block the passage of sperm into the cervical mucus; the condom prevents sperm from being deposited in the vagina, whereas the vaginal barriers interfere with sperm transport after semen has entered the vagina. In addition to blocking the intial wave of sperm form entering the cervix, the spermicidal preparations also kill the sperm within the vagina; most products now in use contain a nonionic surface active agent as a spermicide. Favorable attributes of barrier methods are: 1) few local side effects, 2) no highly skilled medical intervention is needed, 3) they are applied locally in the vagina, 4) they may inhibit sexually transmitted diseases, 5) there are few medical contraindications to their use, and 6) most are available without prescription. Disadvantages are: 1) they are generally less effective than most hormonal contraceptive and IUDs, 2) strong motivation is required for successful use, 3) they require manipulation of the genitalia, 4) some types are inconvenient or messy, and 5) most must be applied at or near the time of sexual intercourse. New spermicides, custom fitted cervical caps, and enzyme inhibitors are some of the new methods being researched and developed. The appendix includes the IPPF policy statement on barrier methods of contraception.
London, International Planned Parenthood Federation, June 1971. 83 pThis is a comprehensive listing of available contraceptives worldwide compiled by the International Planned Parenthood Medical Dept. Contraceptives are listed by brand name and by country, and are categorized by: 1) caps, i.e. diaphragms and others; 2) condoms; 3) spermicides; 4) IUDs; and 5) oral contraceptives. Codes indicate the composition of all oral contraceptives. No assessment of quality has been made. Most oral contraceptives have been approved by the national governments. The IUDs have been clinically tested. There is 1 national standard for diaphragms, several national standards for condoms, and the International Planned Parenthood Federation test for spermicidals.