Microbicide Awareness, Investment and Demand: Advocacy and Networking to Accelerate Microbicide Development and Availability

This 12-page paper examines the epidemiological and economic analysis of microbicide based on five papers by the London School of Hygiene and Tropical Medicine. The paper explores findings and the patterns of condom use in different forms of partnership; impact projections from South Africa, India and Benin; and the delivery of new technologies.

The findings confirm that the widespread use of even a low efficacy microbicide could have an important impact on HIV transmission. According to the paper, this raises questions regarding assumptions that support microbicide impact projections. For instance, "how realistic are reports of condom use?; how realistic are assumptions about microbicide coverage and use?; and to what extent should the impact of microbicides on HIV transmission from women to men be explored?" The paper also highlights the need for a review of the potential risks and benefits of microbicide distribution to sex workers.

Based on findings presented, the paper suggests that potential risks and benefits of microbicide distribution to groups such as sex workers needs to be carefully reviewed. The modelling highlights that "among sex workers with high levels of condom use, any small reduction in condom use could result in an increased risk of HIV infection to sex workers (although the benefits to the overall sexual populations are still positive). Where condom use is high, migration is particularly a concern if the efficacy of the microbicide is low, and/or the consistency of use is low."

The paper also notes that the more in-depth analyses from each site show that "a microbicides impact in a particular setting will depend upon the levels of coverage achieved, the consistency of use in different forms of partnership, and the persex act efficacy of the
microbicide against HIV and other STI, and the level of migration." The paper indicates that the greatest gap in HIV prevention options is within primary partnerships where abstinence is described as not an option, where women are often at risk from their partner’s behaviour, and where condom use seldom exceeds 10%.

The paper suggests that recommendations for further research include: analysis of post-intervention levels of condom use; promotion of microbicides without stigma; integrating distribution with primary level health services; and assessing the feasibility of different introduction strategies in different contexts. The paper notes that distribution channels and target groups must be researched further. One key aspect to public sector intervention is the role they play in the event that
markets fail and are unable to achieve social goals.