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Microbicide and PrEP trial deemed a failure

Tuesday, 12 March, 2013

One of the largest trials ever conducted on pre-exposure prophylaxis (PrEP) and microbicides was deemed a failure at a presentation last week at the Conference on Retroviruses and Opportunistic Infections (CROI) in Atlanta.

The VOICE (Vaginal and Oral Interventions to Control the Epidemic) trial included over 5000 women from South Africa, Zimbabwe and Uganda, and was investigating two different oral contraceptives for PrEP, and a vaginal microbicide gel to prevent HIV transmission. It was found that none of the prevention methods reduced HIV incidence among the women, with adherence being the major contributing factor to their ineffectiveness. PrEP and microbicides proved most ineffective in young and unmarried women, adding to further evidence from other trials, including among young gay men, that adherence is a major risk factor for young people. Further research needs to be conducted to see among which populations PrEP and microbicides might be a effective HIV prevention tool.

Women are disproportionately affected by the HIV and AIDS epidemic, and gender inequalities within society often mean they are less likely to be able to negotiate condom use. Female-initiated HIV prevention technologies are limited to female condoms; it was hoped that PrEP and microbicides would give women and girls another HIV prevention tool that they could control. The failure of this trial means that it is even more important to focus on structural interventions such as promoting positive gender roles and women’s human rights.