To reduce the spread of HIV around the globe, leading researchers and health experts at a symposium sponsored by the American Foundation for AIDS Research (amfAR) have urged the development of gels and other natural substances that they say both women and men can use to block HIV transmission.

Called microbicides, these substances could be applied vaginally or rectally to prevent HIV infection. Now that women account for 43 percent of the HIV/AIDS cases worldwide and most of them were infected through sexual contact, there is an urgent need for a prevention tool that women can control. Microbicides are such a tool.

"In some parts of the world, women can be at risk of violence or abandonment if they try to negotiate safer sex," said Dr. Mathilde Krim, Founding Co-Chair and Chairman of the Board of amfAR. "This fact makes it imperative that we develop more methods to prevent infection, especially methods that put women in control. Microbicides would do just that."

"Safe, effective microbicides will provide protection for women and men alike," said Dr. Penelope J. Hitchcock, Chief of the Sexually Transmitted Disease Branch at NIH and a speaker at the symposium. "Microbicides that will prevent infection and permit pregnancy are needed. Some of the new, non-detergent products offer this potential and are also likely to be less toxic."

Currently, no microbicides have proven safe and effective in preventing HIV and STDs. Spermicidal gels and foams containing nonoxynol-9 or other detergent-based products have inactivated HIV in the test tube, but the harshness of the chemicals can exacerbate genital ulcers and may facilitate HIV transmission. The challenge is to develop natural "biotherapeutics" that block HIV and other STDs without destroying sensitive mucosal tissues and aggravating the ulcerations that promote HIV transmission. The ideal microbicide would be a gel, cream, suppository, or film that is applied or inserted prior to sex and lasts several hours after application. It should also not affect sperm. There are currently 23 microbicide products in clinical testing, with at least two candidates expected to enter final-phase testing soon.

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In August, amfAR announced a new basic research grants initiative in biomedical methods to prevent the sexual transmission of HIV. Letters of intent have been reviewed and full proposals for research in microbicides have been invited.