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Microbicides and Men

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Microbicides are often heralded as an important breakthrough in women's reproductive health. But this does not mean that microbicides are just a "women's issue". The need for an expanded array of prevention options is one of supreme importance for men as well.

Consider the reasons:

  • The protection of many microbicides will be bi-directional --i.e. capable of reducing infection risk for the insertive as well as the receptive sex partner;
  • The AIDS pandemic is not a "men's issue" or a "women's issue". It's a human issue;
  • Many men are unwilling to negotiate around condom use each time they have sex and perceive condoms as a barrier to intimacy;
  • Men who have sex with men may also need non-condom tools with which to protect themselves; and
  • Men are involved in microbicide trials.

Would a microbicide also protect the male partners of HIV positive women?

Many candidate microbicides currently being tested are widely anti-microbial and may provide protection against a range of sexually transmitted infections, including HIV.  By neutralising pathogens in both semen and vaginal secretions, these products will provide bi-directional protection; that is, will help protect men as well as their partners. This will give HIV positive people a way of reducing their partner's risk of HIV exposure during sex --as well a way of reducing their own risk of re-infection.

Microbicides will also offer valuable back-up protection to couples who use them with condoms. If the condom slips or breaks, the microbicides can give both partners added protection from possible infection.

Why would a man want to use a microbicide instead of a condom?

Many men dislike using male condoms, despite the fact that they are excellent barriers against infection and unintended pregnancy. Objections include perceived decrease in pleasure, difficult maintaining an erection, interruption of spontaneity and loss of the intimacy associated with skin to skin contact. Even before the spread of HIV/AIDS led to heightened concern about STIs, these factors influenced men's attitude towards condoms. In large part, they account for the popularity of non-condom methods of birth control.

Unfortunately, non-condom methods of STIs prevention do not yet exist. Even when microbicides reach the market, it is unlikely that they will match the efficacy of male and female condoms for HIV prevention. Logically, it is safer to keep a virus from coming into contact with one's body than it is to try to disable it once it is there.

But, for men and women who don't use condoms consistently, microbicides will offer an important risk reduction alternative. Using even a partially effective microbicide will provide substantially more protection than using nothing at all.

Will men who have sex with men be able to use microbicides for anal sex?

Anal intercourse is practiced by both heterosexuals for pleasure and as a way of having intercourse without risk of pregnancy. Receptive sex partners (whether women or men) are at higher risk of HIV infection than insertive partners during unprotected anal intercourse.  Both partners can be exposed to other sexually transmitted infections (STIs) including anal warts, hepatitis B, syphilis and gonorrhea.

Condoms provide the best barrier against rectal infections but, obviously, only work when they are used.  Rectal microbicides could offer protection in the absence of condoms as well as giving back-up protection when condoms are being used. As such, they are essential if we are to address the full spectrum of prevalent sexual practices and the basic human need for accessible, user-controlled HIV and STI prevention tools. Click for more on microbicides for rectal use.

Have men been included into the research and development of microbicides?

Although most of the clinical microbicide trials now underway focus on vaginal use of the products, men are involved in microbicide research in a number of ways. Once a product is determined to be safe for vaginal use, men are enrolled in "male tolerance" trials to see if the product causes irritation to the penis or the male urethra. Obviously, such irritation would be a serious problem for the couple even if the product is safe for vaginal and/or rectal use.

Products are also tested to see if they cause rectal irritation, for two reasons:

  1. any product that goes on the market for vaginal use will probably be used rectally by some people (men and women) who are looking for non-condom ways of protecting themselves during anal intercourse; and
  2. gay and straight couples who have anal intercourse need a microbicide that has been specifically tested for safety and effectiveness during rectal use.

Male tolerance studies are now being done on several of the leading candidate products that have passed preliminary safety trials for vaginal use.

The third way in which men are participating is microbicide research is as partners of women enrolled in vaginal microbicide trials. Most trials require the participation of sexually active women. In these studies, data are also collected from the women's male partners about their attitudes toward the product, what impact (if any) it had on their experience of sex during the trial, and whether the product is something they would consider using on an ongoing basis. Men's responses form an important part of the acceptability data gathered from all study participants.

Why should men care about microbicides?

No one strategy or technology will solve the AIDS pandemic. We must employ all existing prevention strategies --such as behaviour change, voluntary counselling and testing, STI diagnosis and treatment, broad access to male and female condoms, and anti-retroviral interventions-- as well as expand our repertoire of tools and technologies.

For people who cannot or will not use condoms consistently, for whatever reason, using a microbicide could be lifesaving. Safe, effective microbicides would also have a substantial impact on the HIV epidemic. A mathematical model developed by researchers at the London School of Hygiene and Tropical Medicine demonstrates that if even a small proportion of women in lower income countries used a 60% efficacious microbicide in half the sexual encounters where condoms are not used, 2.5 million HIV infections could be averted over 3 years.

In these calculations, the modellers included not only the numbers of women who would be directly protected by a vaginal microbicide but also the men and children who would be protected by the fact that the women were able to remain HIV negative.

HIV/AIDS, the largest pandemic in the history of the world, affects us all as human beings. Microbicides are a men's issue as well as a women's issue because stopping the spread of HIV/AIDS is a human issue. For reasons of personal protection and for reasons of moral responsibility, it's time for men and women to demand increased public investment to expedite the development of safe, effective microbicides.