[Press Kit, International Conference on AIDS (13th : 2000 : Durban, South Africa)]

microbicidal product. Moreover, there is a substantial middle class in developing countries ready and
able to use microbicides. In India the "middle class" consists of 158 million people, more than twice
the number of women ages 15-49 in the United States (69.9 million).
MYTH: Once one good microbicide enters the market, there will be no need for further research and
investment.
FACT: A first-generation microbicide will probably not possess all the characteristics of an "ideal"
product; the efficacy and acceptability of emerging products will evolve over time. Eventually, the best
products will likely combine several mechanisms of action in order to confer protection against a
range of STIs. In addition, women's preferences vary widely, and formulations and mechanisms that
are suitable in one setting may be inappropriate in another. In a five-country study of formulation
preferences,6 women in Zimbabwe preferred film as the delivery mechanism because it was nonlubricating, while older women in C6te d'lvoire liked the lubrication provided by the gel. While nearly a
third of the study participants in New York liked the suppository, women in developing country sites
found it inappropriate because it melted at higher temperatures. Microbicide users will prioritize
different product characteristics--such as surreptitious use, disposable packaging, lubricating
properties, ease of application, color and odor-- based on their individual situations. Multiple
formulations are the key, meaning that the market could bear many different products.
MYTH: Women from [fill in the blank] culture would not be comfortable inserting or applying a vaginal
product.
FACT: Women from many cultures have long practiced customs associated with vaginal hygiene and
sexuality. It is likely that the application of a microbicide would be analogous to using douches,
tampons, treatment for yeast infections, sexual lubricants, vaginal drying agents, herbs, or other
barrier contraceptive methods. Clearly, the promotion and distribution of a microbicide-- as for female
condoms-- must include culturally-appropriate instruction and support for correct use.
MYTH: If microbicides were available, women would stop trying so hard to use condoms, and would
end up being at HIGHER risk of HIV and STIs.
FACT: Concerns about "condom migration"-- the idea that current condom users will switch to the
potentially easier but less effective protection of microbicides, thereby increasing their risk--are neither
fully accurate nor inevitable. Successful condom users are not the intended beneficiaries of
microbicide technology; microbicides are meant as an alternative for individuals who are unable to
use condoms consistently and correctly. At the population level, the degree of protection provided by
a method is a function of not only its efficacy (how good it is at preventing infection on a perintercourse basis), but how consistently it is used within partnerships, and by what percentage of
couples. Mathematical models show that supplementing a highly effective but inconsistently-used
method (like the condom) with a lower-efficacy method that could be used by more people (like a
microbicide) would increase the total number of HIV cases averted.7 When provided with complete
and accurate information, individuals are capable of making personal decisions about their health.
The relative effectiveness of condoms versus microbicides should be made clear in all product
labeling and public health interventions. A hierarchical message that promotes condoms as the "best
choice" but suggests microbicides as a fallback option when condoms are not possible is consistent
with other "harm reduction" approaches to HIV prevention.
Coggins C. et al. A Study of Women's Preferences Regarding the Formulation of Over-The-Counter Vaginal Spermicides. New York, NY:

The Population Council. 1998.
SWatts CH, Thompson WA, Heise LL. 1998. The impact of microbicides for HIV prevention: Results of a mathematical modeling exercise.
Presentation at 12th World AIDS Conference, Geneva, July 1998.
Global Campaign for STI/HIV Prevention Alternatives for Women, Takoma Park, MD, July 2000. For info. contact [email protected]