http://allafrica.com/stories/200812020511.html

As the world celebrates the World AIDS Day which fell yesterday, December 1, it is important to recall that the pandemic broke out 20 years ago and a lot of efforts and finances have gone into research studies for a cure which has culminated into interventions to prevent new infections from occurring.

Although global figures still remain high coupled with a gloomy picture of many lives that have so far been claimed especially in the most productive group, it is delighting to note that Zambia has in the past few years recorded a decline in prevalence rates from 16 per cent to 14.3 per cent.

The Government in committing itself to the fight against the pandemic states that more funds will be pumped into the exercise to halt the pandemic.

Hence, the on-going sensitisation programmes which are targeting mostly the vulnerable people in society.

In addition, prevention messages have continued to be resounded at most fora with the aim of reducing the scourge in conjunction with other interventions while people are being urged to seek Voluntary Counselling and Testing (VCT) services for them to know their status.

It is common to note that condom use is one such intervention that has been developed although it has come under heavy criticism from some quarters for being in conflict with some religious beliefs.

The pandemic affects everyone regardless of sex, creed and status and so if one is not infected, they are affected in a way and it is for this reason that the condom was developed to act a barrier against HIV and not that it should promote promiscuity.

But from the information availed by scientists, it puts women more at a greater risk of the infection because of their biological make-up as well as lack of control over their sexuality.

Women lack the power to negotiate for safer sex with either their spouses or partners and this puts them at even a greater risk of infection than their male counterparts.

There is also another transmission mode through mother-to-child transmission wich can affect the unborn child.

There are also issues of poverty. Women who lack economic empowerment find themselves engaging in unsafe sex as a means of earning an income or obtaining favours from their male counterparts for either a promotion or a job, thus endangering their lives.

At the same time, some girls have been victims of defilement and violent rape that puts them in a precarious situation of contracting HIV.

It is for this reason that research is being done in an effort to empower the woman with a tool that would protect her from being infected by HIV.

Interventions such as the female condom, abstinence and faithfulness are already being practised by activists side-by-side in an effort to reduce the scourge, but still, the statistics of infections are high, especially in the sub-Saharan region coupled with increased poverty levels.

Stakeholders argue that the battle against the pandemic cannot be fought in isolation but requires a multi-sectoral approach to combat it.

AIDS activist and medical practitioner, Mannaseh Phiri, cites multiple concurrent partners, alcohol and substance use and bad cultural practices as some of the drivers of the HIV pandemic in Africa.

While this is true, another initiative is still being developed in the form of Microbicide gels.

Microbicides are agents that can prevent the transmission of HIV and other sexually transmitted diseases when applied in the vagina or rectum.

The successful development of the gels would provide a critical adjunct to male and female condoms as well as a needed complement to existing efforts to develop a therapeutic or prophylactic HIV vaccine.

The Centre for Infectious Diseases Research in Zambia (CIDRZ) has been conducting a randomised clinical trial on two different microbicide gels at the Kamwala study clinic in Lusaka for two-and-a-half years.

This HIV prevention research study is aimed at seeing if a microbicide gel is effective in preventing HIV infection in women.

Similar studies have been carried out simultaneously in South Africa, Malawi, Zimbabwe and the United States of America as part of the HIV prevention trials.

In Kamwala, this study called the Well Woman and Partner Study, occurred over the last two-and-a-half years.

According to principal investigator of the Kamwala site, Muzala Kapinga, the gels have been proved to be safe for use and do not cause any adverse effects on those participating in the study.

The gels being used are Buffer gel, which maintains acidity of the vagina, and 0.5 per cent PRO 2000 gel P that prevents viral entry into CD 4 cells.

Dr Kaping'a was, however, quick to point out that although the study had reached an advanced stage, as the safety, a report would have to be compiled early next year to ascertain the gels' efficacy.

"Gels are safe for use by women but the question of their effectiveness as to whether they can prevent HIV is what remains to be answered. Results will be early next year," she said.

Dr Kaping'a revealed this recently in Lusaka at the University Teaching Hospital (UTH) during a media briefing to create awareness on the ongoing research.

Dr Kaping'a said the study population involved a total of 3,100 HIV uninfected women with 320 coming from Lusaka, aged between 18 and 30 years old.

In one of the documentaries shown to the participants to illustrate the impact of the pandemic on women and the need to develop a safer intervention method other than the already existing ones, former United Nations (UN) special envoy for AIDS Stephen Lewis was quoted as saying that if the barrier on HIV/AIDS prevention could not be broken through behavioural change, then the best thing to do was to empower women with microbicide gels.

"Unless we confront it in a fashion that is uncompromising, we are going to lose more women. That is why microbicides are important," he said.

And Clementine Mumba, representing Treatment, Advocacy and Literacy Campaign (TALC), said the research into microbicides was a good initiative, particularly designed for women for the following reasons:

-That most women are not in a position to negotiate for safer sex with either their spouses or partners as they lack asertiveness

-Microbicides will help most married women who are currently in the high risk group of infection to protect themselves against infections, and

-Female condoms are readily available in Zambia but only a few women can afford them as they are costly while those who have used them before complain of discomfort and noise during sexual intercourse.

Ms Mumba said, however, that caution must be exercised to ensure that only the best interventions were brought into the country for use by the local people.

She made this suggestion in the wake of the pharmaceutical regulatory authority's lack of equipment to ensure transparency and non-coerciveness.

It is believed that once proved effective, the gels should be made readily available and affordable to all ordinary citizens as an effective method of empowering women against the HIV pandemic than having to look for expensive female condoms which are rare to find.