HIV prevention must address women' needs: microbicides offer an added ray of hope/La prevention du VIH doit aborder les besoins de la Femme: les microbicides offerent une lueur supplementaire d'Espoir.

• Author: Ramakant, Bobby

Global HIV/AIDS statistics tragically confirms what women's health, rights, and social justice advocates have said for a decade. Social, economic, and sexual vulnerability of women, particularly young women and girls, harms their health and increases their risk of HIV/ AIDS and other sexually transmitted diseases (STDs). Existing prevention strategies have Largely failed to address this vulnerability, focusing on abstinence, mutual monogamy and male condom use- none of which are easily controlled by women. The faces of HIV and AIDS in the world today are increasingly those of young women, many of whom are married, many of whom contracted the virus during adolescence.

Predictably HIV/AIDS is rapidly becoming a woman's epidemic. Approximately 14,000 people become infected with HIV everyday. Half of them are women. A vast majority of women had only one mode of exposure to HIV--sex with their male partners. Women are biologically more vulnerable to STD including HIV/AIDS. Women are twice as Likely as men to contract HIV from unprotected intercourse. Vaginal membranes are exposed to infectious fluids for hours after sex. Younger women are at greater risk because the immature cervix is more vulnerable to damage and infection. STD often go undetected, and therefore untreated, in women. STD increase women's vulnerability to HIV. In addition, untreated STI can Lead to infertility, ectopic pregnancy, infant mortality and cervical cancer.

Gender inequalities prevent many women from being able to protect themselves. Millions of women Lack the social and economic power to insist on HIV prevention measures such as condoms, abstinence or mutual monogamy. Male and female condom use requires the tacit cooperation, if not outright participation, of a woman's male partner. HIV risk escalates among adolescent girls because of their physical vulnerability and susceptibility to rape, forced marriage, trafficking, economic dependence and coercion. Violence, coercion, and economic dependency render millions of women of all ages unable to 'negotiate' condom use or to abandon partners who put them at risk. Millions Live in societies that permit them no role in sexual decision making, condone male infidelity and assign to women the burden of shame and stigma associated with infectious disease.

But there is always hope that not only gender inequity might change for the better, and women and men will recognize, appreciate and respect the rights of each other, but women will have more meaningful role to play in decision making, and will be empowered enough to access, afford, use and negotiate the use of STD/HIV prevention options with their partners. This struggle shall indeed be a long one. Some dedicated advocates, scientists and donors are working to develop microbicides--gels, tablets, or other intravaginal products a woman could use to reduce her risk of getting HIV through sex. Microbicides are still being researched, and will require significant political will, public investment and popular demand before they become available.

Microbicides are substances that can substantially reduce the transmission of HIV and other sexually transmitted infections (STI) when applied vaginally and, possibly, rectally. Epidemiological models suggest that a...