Can nonoxynol-9 (N-9) prevent HIV infection? CDC UPDATE from the National Center for HIV, STD & TB Prevention (April 97) Although laboratory studies show that N-9 kills HIV in test tubes, available data on the efficacy and safety of N-9 spermicide to prevent sexual transmission of HIV in real life situations are inconclusive and inconsistent. For this reason, CDC does not recommend the use of N-9 alone to prevent the sexual transmission of HIV. CDC recommends the use of male latex condoms, with or without spermicide. Nonoxynol-9 has been shown to provide some protection against two bacterial STDs, gonorrhea and chlamydia. from Questions and Answers about Male Latex Condoms to Prevent Sexual Transmission of HIV
What We Know about Nonoxynol-9 for HIV and STD Prevention CDC UPDATE from the National Center for HIV, STD & TB Prevention (April 97) Nonoxynol-9 (N-9) is a detergent-like chemical that has been used for over 30 years in vaginal products to prevent pregnancy. In the United States, N-9 is available in a variety of concentrations and formulations, including gels, creams, foams, suppositories, and film. In addition, N-9 is used in some vaginal and rectal lubricants and in the lubricant used in some prelubricated male latex condoms. In laboratory and animal studies, N-9 has been shown to destroy bacteria and viruses that cause STDs, including herpes, gonorrhea, chlamydia, and HIV (the virus that causes AIDS). Even so, clinical studies (of humans in real life settings) have been inconsistent and inconclusive as to N-9's efficacy and safety. These clinical studies have used different formulations and different concentrations of N-9; making it complicated to make comparisons or draw conclusions across studies. Studies have shown that some formulations of N-9 provide women some protection against two bacterial STDs, cervical gonorrhea and chlamydia. In a review of studies, women who used N-9 without male latex condoms had a 24 to 89 percent lower risk of becoming infected with cervical gonorrhea and a 22 to 40 percent lower risk of becoming infected with cervical chlamydia than women who did not use either N-9 or condoms. There is no evidence to date that N-9 provides protection against HIV in real life situations. In one randomized, controlled trial among Kenyan female sex workers, no protective effect against HIV infection was observed among those using a vaginal sponge containing N-9 compared with those using a placebo suppository. However, lack of comparability between sponge and placebo users may have distorted study results. One small observational study found that women who consistently used N-9 vaginal suppositories had a significantly lower risk of acquiring HIV infection compared with less consistent users. However, the effect of N-9 use independent of condom use could not be measured and risk of HIV infection among suppository users compared to non-users was not assessed. An additional observational study in Zambia on condom and N-9 use among HIV discordant couples found no strong evidence that consistent use of N-9 provided protection against HIV when condoms were not used. A recent two-year study in Cameroon conducted by Family Health International (FHI) and the Cameroon Ministry of Public Health, with partial funding from the National Institutes of Health {NIH), found that vaginal contraceptive film containing 70 mg of N-9 provided no additional protection against HIV and other STDs when provided in conjunction with male latex condoms as part of an overall HIV/STD prevention program including counseling, condom promotion and distribution, and STD treatment. In addition, there are some questions about the safety of N-9 when used for HIV prevention. Several studies have shown that it may cause genital irritation. This is important because genital ulcers have been associated with an increased risk of HIV infection. Previous studies assessing the safety of N-9 have been inconsistent. A study conducted in the Dominican Republic found that use of suppositories containing 150 mg of N-9 once every other day did not cause genital inflammation; whereas, use once or more per day did cause genital inflammation. In addition, this inflammation increased with frequency of use. A study of the safety of N-9 film in Thailand showed that use of film containing 72 mg of N-9 two to three times per day was not associated with genital ulcers. In the recent Cameroon clinical trial, researchers did detect a slight increase in genital ulcers among the group of women using N-9 film when compared to placebo group users. The data are preliminary and other analyses need to be done to further assess the safety issue of N-9 film. CDC will continue to review new information and to work closely with investigators for this study to determine whether or not any of our current recommendations need to be revised. CDC Recommendations for Preventing Sexual Transmission of HIV and Other STDs CDC recommends sexual abstinence or sexual contact only with a partner known to be uninfected as the best methods of protection against the sexual transmission of HIV and other STDs. In addition, CDC recommends that male latex condoms be used consistently and correctly, with or without a spermicide. If for some reason it is not possible to use male latex condoms, CDC recommends using female condoms. CDC does not recommend using spermicide alone to prevent HIV infection. Scientific data about the effectiveness of latex condoms in preventing transmission of HIV is very clear. Male latex condoms are highly effective barriers to HIV and many other STDs when used consistently and correctly. Carefully designed studies among heterosexual couples, in which one partner is HIV positive and the other is not, demonstrate that latex condoms provide a very high level of protection against HIV. Ongoing Need to Develop Safe and Effective Female-Controlled HIV Prevention Methods Women account for an increasing proportion of newly reported AIDS cases in the United States. The proportion of female adult and adolescent AIDS cases increased from 7% of the annual total in 1985 to 20% of total adults reported with AIDS in 1996. Women at high risk of HIV and of acquiring other STDs must depend on the willingness of their male partners to use condoms consistently and correctly if they are to reduce their risk of infection. It is critical that research dedicated to finding new protective methods for women be accelerated. CDC is committed to developing prevention methods that can be controlled by women, such as virus- and bacteria-killing products that women can apply intra-vaginally before having sex. Known collectively as topical microbicides, these products could give women the means to protect themselves from HIV and other STDs. CDC researchers are working with scientists worldwide to develop effective topical microbicides. As with any new prevention tool, developing the product is only part of the solution. It must be determined what influences people's willingness and ability to use these methods. CDC behavioral scientists are simultaneously working to evaluate the factors that will contribute to a woman's use of topical microbicides In addition, CDC scientists are working to explore factors that will contribute to an HIV prevention counselor's understanding of how new prevention methods can and should be presented in concert with existing prevention options.
Nonoxynol-9 Film Ineffective In Reducing HIV Transmission WESTPORT, Apr 04 (Reuters) - Preliminary results of a large two-year study indicate that a vaginal contraceptive film containing nonoxynol-9 had no effects on the rate of HIV transmission, according to a press release issued yesterday by the National Institute of Allergy and Infectious Diseases (NIAID). The NIAID-sponsored study was conducted by investigators at the U.S.-based Family Health International, a non-profit health research organization, and researchers at the Cameroon Ministry of Public Health. Nearly 1,000 female sex workers in the central African country were followed for over 12 months. The subjects were given contraceptive film and instructions to use it prior to sexual intercourse. The film contained nonoxynol-9 or a placebo. The women also received male latex condoms and safe sex counseling. The researchers report that the overall rate of HIV transmission was 6.7%, which is half the rate previously estimated for this population. However, when the subjects who used nonoxynol-9 film were compared with subjects who used the placebo, the HIV transmission rates were the same. The overall HIV intervention program appears to be successful, according to Dr. Rodney Hoff of the NIAID. However, the nonoxynol-9 film was not effective in reducing rates of HIV transmission. "We had hoped that the N-9 [nonoxynol-9] film might increases a woman's available options for HIV and STD protection," said Dr. William Cates, Jr. of Family Health International. ©1997 Reuters Health Information Services, Inc. From AMA HIV/AIDS News - April 4, 1997
[ Home Page ][ Site
Map ][ Links ][ Feedback
][ Submit ][ HIV Prevention
Services ]
[ Berkeley Free Clinic ][
Confession Box ][ Counselor
Resources ][ Relationships ][ Theorizing Desire ]