A study of Hartford women at high risk for HIV infection found that these women would like to use a microbicide - a vaginal cream, foam or gel - to help prevent HIV infection during sex. The only problem is that there is no such product yet available.

At a daylong conference Thursday at Trinity College, more than 100 participants discussed the impact of the three-year study by Hartford's Institute for Community Research and heard from experts on the prospects for a safe and effective microbicide.

"It's a political issue because there is not enough money to test these products," explained Anna Forbes of the Global Campaign for Microbicides.

Microbicides have been gaining ground as a prevention strategy among HIV/AIDS advocates and researchers in the past several years. Most acknowledge that an AIDS vaccine is at least a decade away. The thought is that it would be relatively easy for scientists to come up with some kind of virus-killing or virus-blocking barrier that would be used vaginally and also for anal sex. Such a product would provide additional protection, especially for women who find it difficult to initiate condom use with their partners.

Because microbicides are not expected to be 100 percent effective, they are not intended to replace condoms as a way to prevent HIV and other sexually transmitted diseases.

Forbes noted that there is little interest in microbicides among big pharmaceutical firms because of the high costs of human tests, liability issues and the need to create a product price low enough to be of use to women in the developing world, where AIDS is hitting hardest. As a result, tiny biotech firms, nonprofit labs and public institutions are doing most of the work. One prominent early candidate - the spermicide nonoxynol-9 - proved to be ineffective.

Reviewing a chart of microbicides under development, Polly Harrison, director of the Alliance for Microbicide Development in Silver Spring, Md., noted that only one such product is in final-stage human trials. Most of the nearly 70 products have yet to be tested on humans. About 17 are in some stage of human testing.

"That's a great, big, sad story," said Harrison, pointing to a projected slide reflecting the sluggish product development.

Hoping for a happier ending, activists have focused on getting Congress to increase federal spending on microbicides, which was $56 million in fiscal year 2002, according to Forbes, or 2 percent of Washington's AIDS research budget.

Of course, these efforts are all for nothing unless those at highest risk for HIV are willing to use a microbicide. Institute for Community Research scientists brought together focus groups of 58 Hartford women and 30 men to find out about attitudes and experiences about contraception and about HIV prevention. Most women had little experience with vaginal products, such as gels, films, foams or creams.

Those conducting the study then invited 464 Hartford women to complete a survey. The group was made up of women involved in activities - drug use and multiple sex partners - that put them at high risk for HIV and other sexually transmitted diseases. Fewer than half of the women (45 percent) reported using either a male or female condom during sex in the previous month. Most said that the characteristics of a possible microbicide were mostly appealing.

In a final step, the institute group asked 92 of the women in the survey group to participate in a two-week trial meant to simulate the use of a microbicide. They were asked to use an over-the-counter vaginal moisturizer, Replens, before having sex, and to record information about each sexual encounter. They also agreed in advance to use a condom when having sex during the two-week period.

Participants used Replens in 84 percent of their sexual encounters, and all but one participant said that they would like to use a microbicide if it becomes available.

"We were really surprised how willing and able they were to use it," said Margaret R. Weeks, associate director of the institute and principal investigator for the study. She said that her group would try to publish some scholarly articles on the findings in the hope of building a stronger case for public support for microbicide development.

"We really want to push that forward with some science," she said.

Copyright 2003, Hartford Courant