Researcher sees female side of global AIDS fight

PITTSBURGH -- This is what motivates Sharon Hillier.

As she was leaving Durban, South Africa, recently, she encountered a young woman in a store who noticed that Dr. Hillier was carrying a bag with the word "microbicides" on it.

The woman knew what microbicides were -- medications that can target HIV, the virus that causes AIDS.

"I wish I had a microbicide," she told Hillier, a University of Pittsburgh professor who runs one of the world's largest research trials into using the substances to prevent HIV infections.

"I asked her why," Hillier recounted. "She said, 'Well, my sister's just gotten sick. Her husband died last year, and we think he had AIDS, and now my sister's sick and she has four children, and I can't get married because I know I'm going to have to take two of her children and my mother will take two."

These are the kinds of issues that face thousands of women around the globe, Hillier said, and it is what spurs her on in her search for a substance that will reliably prevent HIV infections and can be put into a vaginal gel, a pill, an injection or a contraceptive ring.

As much as any HIV prevention trial being funded by the National Institutes of Health, the microbicide effort is aimed at women, addressing what she calls "the feminization of the HIV epidemic" that has been under way for more than a decade.

Around the world, the United Nations estimates, half of those living with AIDS are women. And in sub-Saharan Africa, which accounts for most new cases, there are 13 million women with HIV, compared with 9 million men.

One of the persistent myths about the global epidemic, Hillier said, is that most women with HIV are prostitutes or promiscuous.

But the typical victim in Africa or India, she said, is a woman faithfully married to one man -- a man who has had sex with other women while they were married, or who was already infected when they were betrothed. For those women, she said, "the old prevention mantra of abstinence, being faithful and using condoms just doesn't work."

That's why she hopes to develop a reliable microbicide that can give women control over their own destinies.

It's been a difficult challenge so far.

Four trials have failed. Three involved spermicides and one involved a substance designed to block the entry of viruses into cells.

It's a different story for another substance that the network is now investigating, an antiviral agent called tenofovir. It's already known to work against HIV and is part of the three-drug cocktail that many patients take to hold the disease in check.

The network is about to launch a prevention trial to see whether the drug is more effective as a pill or a vaginal gel, she said, and hopes to get solid results in three to four years.

A recently finished trial in the United States and India with 200 women showed that the gel was safe and that none of the women got an HIV infection.

If a daily pill or application of gel is feasible, Hillier said, it will take away one of the main problems with any prevention method that has to be used right before sex.

"I think there are a substantial number of people at high risk of HIV who aren't going to use something right before they have sex because it interrupts the moment and because it says (to a partner) I don't really trust you, whereas if you use something every day it's not that I don't trust you, but I just don't want to get burned."

The main reason fewer women have HIV in America is that the overall prevalence is so much lower. The HIV prevalence among adults in North America is less than 1 percent. In sub-Saharan Africa it is eight times higher.

Sexual practices in those two parts of the world are not that much different, though, Hillier said, even though many Westerners mistakenly and condescendingly think they are.

Hillier feels her group's work is crucial because it now appears it will be a long time before there is an effective HIV vaccine.

"We used to say we need microbicides until we have a vaccine, but my view is that we really need to invest a lot of resources into coming up with prevention methods, because in 25 more years we're still not going to have an effective vaccine."

E-mail Mark Roth at mroth(at)post-gazette.com

(Distributed by Scripps Howard News Service, www.scrippsnews.com.)