Nonoxynol-9, a widely used spermicide, may increase the risk of catching HIV
rather than lower it, as many assumed, according to research released at the XII International AIDS conference.
The spermicide, called nonoxynol-9, is widely used as a
sperm-killing cream and as a coating for condoms. Test-tube studies
suggest it can kill HIV, and many believed it helps prevent the
spread of the virus.
However, a new study surprised researchers with the finding that
women who use it often have a higher risk of AIDS than those who do
"It is an understatement to say that we were extremely
disappointed," said Dr. Lut Van Damme of the Institute of Tropical
Medicine in Antwerp, the study's director. She presented the
findings at the 13th International AIDS Conference.
The study was conducted on 990 prostitutes in Africa and Asia.
Fifteen percent of those using a nonoxynol-9 cream became infected
with HIV, compared with 10 percent of a comparison group using a
Scientists theorized that the increased risk could be related to
vaginal irritation caused by the spermicide.
Experts said the long-term safety of nonoxynol-9 as a
contraceptive should also be re-evaluated.
In another report Wednesday, researchers said that scattered
successes around the world show that government prevention programs
can slow and reverse the AIDS epidemic, even in the poorest areas,
researchers said Wednesday.
The explosive spread of AIDS, especially in sub-Saharan Africa,
has surprised even those who warned several years ago about the
continent's vulnerability to HIV.
However, Peter R. Lamptey of Ghana, an official of Family Health
International in Washington, said examples of declining AIDS
incidence in several countries in Africa and Asia show the
situation is not hopeless.
Many of these prevention programs are underfunded and small, and
there is no way to accurately monitor their impact. Still, he said,
"I have no doubt that many of them are saving lives and that the
epidemic would have been far worse without them."
He noted that Thailand and Uganda have already reversed broad
epidemics, and Senegal is the only sub-Saharan African country to
prevent one from occurring. He said there are encouraging signs
that the epidemic may be stabilizing in Cambodia, Zambia and the
Democratic Republic of the Congo.
Lamptey said money spent on these programs is still relatively
small. In 1990, developing countries spent about dlrs 600 million
on both AIDS prevention and care. By comparison, the United States
spent dlrs 800 million on domestic HIV prevention and dlrs 7
billion on AIDS care and assistance programs.
Key ways of preventing AIDS spread are education programs that
promote condom use, treatment of other sexually spread diseases and
treatment to prevent mother-to-child transmission.
"We know that HIV prevention can work," Lamptey said. "How
many more people must die before we find the will and the resources
needed to make prevention and care work for everyone?"
In presentations at the meeting Tuesday, doctors described a new
approach to treatment _ taking patients off their AIDS drugs for a
few weeks at a time to see if breaks in therapy are safe and
perhaps even more effective than giving the grueling treatment
The new approach departs from the commonly held dogma that even
a brief interruption in drug treatment will allow the AIDS virus to
come roaring back in a mutant form that is impossible to control.
Intentionally interrupted therapy is still considered
experimental. But doctors say it potentially has several important
advantages, including lower cost, fewer side effects and temporary
relief from a demanding pill schedule. Furthermore, it could make
AIDS therapy more practical and affordable in poor parts of the
world, where the sophisticated combinations of medicines are simply
beyond the reach of most people with HIV.
Dr. Anthony Fauci, head of the U.S. National Institute of
Allergy and Infectious Diseases, noted at least a dozen teams
around the world are studying the approach _ which he calls
structured intermittent therapy _ and it will be at least a year
before doctors know whether it is safe. Until then, he cautioned
against interrupting treatment outside carefully conducted studies.