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Gel helped women in study block HIV infection

Cash incentives also promising in Africa research

By Celia W. Dugger
New York Times / July 20, 2010

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VULINDLELA, South Africa — With an AIDS vaccine still out of reach, two rigorous new studies have found different ways to sharply cut HIV infections among women and schoolgirls, who make up a majority of the newly infected in sub-Saharan Africa.

After two decades in which researchers searched fruitlessly for an effective vaginal microbicide to block HIV, South African scientists working in two AIDS-devastated communities of South Africa, one rural and one urban, say they have finally found something that shows real promise.

Women who used a vaginal microbicidal gel containing an antiretroviral medication widely used to treat AIDS, tenofovir, were 39 percent less likely overall to contract HIV than those who used a placebo. Those who used the gel most regularly reduced their odds of infection 54 percent, in a 2 1/2-year study of 889 women by Caprisa, an AIDS research center in Durban.

Broader trials are needed to confirm the results, and it will probably be years before the product is publicly available, but if produced on a large scale the gel would cost less than 25 cents per application, the lead investigators estimated.

Dr. Bruce Walker, a Harvard Medical School professor who was not involved in the study, said a cheer erupted when researchers unveiled their findings to a small group of scientists last month in Durban.

“This is the first time that there’s been a tool that women can use to protect themselves from becoming infected,’’ he said. “It’s a game changer.’’

In Vienna, where the meeting of the International AIDS Society just opened, leaders of the global fight against AIDS said they found the results of the microbicide trial impressive.

“This is very encouraging,’’ said Michel Sidibe, executive director of UNAIDS, the UN AIDS agency. “It can be controlled by women, and put in 12 hours earlier, and that is empowering. They do not have to ask the man for permission to use it. And the cost of the gel is not high.’’

Gilead Sciences, the California biopharmaceutical company that produced the active ingredient in the gel, has relinquished any royalty claims on the gel if it is distributed in Africa and poor countries in other parts of the world.

In another piece of progress against AIDS, a separate, large study in Malawi found that if poor schoolgirls and their families received small monthly cash payments, the girls pushed back the age at which they first had sex, and had it less often and with fewer partners.

A year and a half after the start of the program, which was sponsored by the World Bank and made public Sunday, the girls were less than half as likely to be infected with the AIDS or herpes viruses than were girls whose families got no payments. The likelihood that the girls would agree to sex in return for gifts and cash declined as the size of the payments from the program rose, suggesting the central role of poverty in sexual choices.

“Maybe we can combine these behavioral and biomedical interventions,’’ said Dr. Tim Farley, a scientist with the World Health Organization involved in HIV prevention research. “We need to pursue both avenues.’’

At a time of intensifying competition for global health dollars, when the number of people who contract HIV is outstripping those who are put on treatment each year, pressure is mounting on African countries and donors to focus more on prevention. Male circumcision is one method that has proved to at least halve a man’s odds of HIV infection.

Scientists say the success of the $18 million microbicide trial, largely paid for by the US Agency for International Development, and the study on cash payments offer hope to girls and women in Africa, who have higher rates of HIV infection than their male counterparts and often less power in relationships.

There have been other signs of progress. A new UNAIDS study found that HIV prevalence among young people had declined by more than 25 percent in 15 of the 21 countries most affected by AIDS. In eight countries, the agency found evidence of positive changes in sexual behavior among young people, for example delaying having sex, having fewer partners, and the increasing use of condoms.

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