Potential Impact of Vaginal Microbicides on HIV Risk Among Women With Primary Heterosexual Partners

Abstract

This paper explores the potential public health consequences of anti-HIV microbicide adoption among women in high-risk communities, using data from an exploratory study to illustrate key points. A brief quantitative survey was administered to 71 drug-using women with primary heterosexual partners in New York City. Only 37% of women reported recent condom use with a primary male partner. Eighty-six percent expressed willingness to use a microbicide with a primary partner. Among women using condoms, 50% believed they would decrease condom use if they started using a vaginal microbicide. While overall condom use was low and intended condom migration was low among women with HIV-infected partners, universal promotion of microbicides could nonetheless lead to an increase in HIV risk among specific subgroups of women, indicating the importance of promoting continued condom use. More research is needed to inform public policy decisions prior to the availability of the first commercial microbicide. Keywords condom migration; HIV infection; sexual risk behavior; vaginal microbicide; women's healthOver the past 2 decades women have increasingly shouldered the burden of the global HIV pandemic (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2004), with the majority of infected women acquiring HIV through sexual contact with a primary male partner (O'Leary, 2000). These trends are the result of multiple factors. Women may be CONFLICT OF INTEREST STATEMENT:The authors report no real or perceived vested interests that relate to this article (including relationships with pharmaceutical companies, biomedical device manufacturers, grantors, or other entities whose products or services are related to topics covered in this manuscript) that could be construed as a conflict of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. biologically more susceptible to heterosexual transmission of HIV than men, especially via receptive anal intercourse (Boily et al., 2009;Mastro & Kitayaporn, 1998;Padian, Shiboski, & Jewell, 1991). In addition, gender-based social inequalities limit women's options with regard to protective sexual behavior (Higgins, Hoffman, & Dworkin, 2010;Quinn & Overbaugh, 2005;Remien, Halkitis, O'Leary, Wolitski, & Gomez, 2005 While it is anticipated that the first generation of vaginal microbicides will be less effective at preventing HIV than latex condoms, the enormous potential of this new technology lies in its enhanced acceptability and usability by women. As our experience with the female condom has demonstrated, the importance of the acceptability of an...

Human Microbiome and HIV/AIDS

“…In immune-compromised women differences in the microbiome may be significant. There is emphasis in BV studies in understanding the shift in the vaginal microbiome [57, 58••, 60•, 61••, 62•, 63]. The bacterial diversity associated with BV may cause a functional imbalance with respect to mucosal permeability and lead to detrimental health effects.…”

“…There is no clear explanation for these failures, but one hypothesis holds that microbicides alter the vaginal microbial flora in ways that increase inflammation or activate potential HIV host cells, thus enhancing transmission. Alternatives to condom use in these inherently high-risk encounters have the potential to increase the risk for HIV [61••]. The human vaginal microbiota plays an important role in the maintenance of health of women, their partners, and newborn infants.…”

Condom migration after introduction of pre-exposure prophylaxis among HIV-uninfected adolescents in South Africa: A cohort analysis

“…In the past, the potential introduction of other HIV prevention technologies, such as vaccines, barrier methods, 13 antiretroviral treatment for prevention, male circumcision 14 and vaginal microbicides, 15 , 16 raised the same public health concern. Yet, previous research has not found evidence for sexual risk compensation in adults using PrEP 17 , 18 , 19 , 20 , 21 , 22 or post-exposure prophylaxis (PEP).…”

“…In particular there is potential concern that condom use may decrease in the short-term as a result of being substituted by another prevention intervention, also known as ‘condom migration’. 15 In this article, we aim to explore short-term changes in condom use among HIV-uninfected adolescents using PrEP in South Africa.…”

Women's Perspectives on Female-Initiated Barrier Methods for the Prevention of HIV in the Context of Methamphetamine Use and Partner Violence

“…While these trials demonstrated proof-of-concept for vaginal microbicides as a form of HIV prevention (Mayer & Krakower, 2012; Rosenberg & Devlin, 2012), experts have called for additional research into product acceptability and adherence among diverse populations at risk for HIV (Mantell et al, 2005). While interest in vaginal microbicides is generally high, acceptability may vary by ethnic group (Hammett et al, 2000), prior experience with vaginal products (Reiff, Wade, Chao, Kronenberg, & Cushman, 2008), and drug use patterns (Hammett et al, 2000; Weeks et al, 2004; Hammett, Norton et al, 2000; McMahon, Morrow, Weeks, Morrison-Beedy, & Coyle, 2011). …”