It's time to make microbicides more than a pipe dream

The Microbicide Development Act, in one form or another, has been introduced during eight different Congressional sessions. But now that the legislation has an unprecedented 74 cosponsors in the House and 18 in the Senate, advocates say the time is ripe to get it passed. More than 150 organizations, including Housing Works, Alliance for Microbicide Development, and the South Suburban HIV/AIDS Regional Coalition signed on to a letter to Energy and Commerce Committee Chairman Joe Barton, urging him to mark up and report out of committee the Microbicide Development Act, H.R. 1420. Illinois Rep. Jan Schakowsky (D-IL) introduced the most recent House version, and Sen. Barack Obama (D-IL) introduced the Senate version. (And for all you bird doggers out there, though Sen. Hillary Clinton (D-NY) is a cosponsor, Sen. John McCain (R-AZ) is not).

Microbicides are products that can prevent transmission of HIV and other infections when used in the vagina or rectum. They include gels, creams, and rings that release drugs slowly over days or weeks, and could give people -- particularly women -- control over HIV prevention, especially in situations where it is difficult or impossible to demand condom use from their partners.

In the 2008 fiscal year budget about $140 million was earmarked for microbicide research and development. The MDA asks for a coordinated unit devoted to microbicides within the National Institute of Health's National Institute of Allergies and Infectious Diseases. Currently, research and development is scattered throughout the U.S. Agency for International Development, the Centers for Disease Control and Prevention and the NIH, leaving open the possibility of duplication of work and resources.

"Such coordination, coupled with steady funding for microbicide development and the required clinical trials, is essential to ensure the efficient use of tax dollars to develop safe and effective microbicides," the letter reads.

Advocates hope that the MDA's passage would spur additional research and excitement around microbicides. "It would set precedent, and shows a commitment to doing microbicide research and development," said Jessica Terlikowski, policy manager at the AIDS Foundation of Chicago, who is involved with gathering support for the MDA.

"If the MDA passes, it will help to ensure that the U.S. government's commitment to microbicide research and development is substantially increased," said Adeyemi Oshodi the Policy and Advocacy Associate at PATH, an international nonprofit, which houses the Global Campaign for Microbicides.

Microbicides Desperately Needed

In recent years, there has been momentum behind developing microbicides -- with Bill Gates' a particularly effective cheerleader, speaking at length about the promise of vaginal microbicides at the 2006 International AIDS Conference -- but an effective microbicide has yet to be developed. There are currently two vaginal microbicides in phase three trials -- Carraguard gel, sponsored by the Bill and Melinda Gates Foundation, NIAID and the Population Council and Pro2000/5 gels, sponsored by Indevus Pharmaceuticals, the U.K Medical Research Council and Department for International Development. For a chart of all of the microbicides in the pipeline click here.

And though most of the emphasis has been on vaginal microbicides -- in fact the text of the MDA doesn't mention a word about men -- advocates stress the importance of including rectal microbicides for both men and women who have anal sex. This is particularly essential in the U.S. and other countries where men who have sex with men account for the majority of all new infections.

"It's highly unlikely a vaginal product could be used for anal sex," Terlikowski said. "It's important to make sure the funding is there for both."

For a list of Energy and Commerce Committee members to contact to urge to make the MDA a reality, click here.