Contraceptives of the future in the light of HIV infection
Short, R.V.
Australian and New Zealand Journal of Obstetrics and Gynaecology 34(3): 330-332
1994
ISSN/ISBN: 0004-8666 PMID: 7848210 DOI: 10.1111/j.1479-828x.1994.tb01083.xDocument Number: 289243
The most common mode of HIV transmission in the world is heterosexual transmission. New and more effective preventive efforts are needed to stem the HIV/AIDS pandemic. Simultaneously, there is a pandemic of sexually transmitted diseases (STDs). HIV infection and STDs exacerbate each other. Most effective modern contraceptives do not protect against HIV or STD transmission. The male condom, the most effective means to protect against transmission of STDs and HIV, has a high failure rate. Deterioration of the latex over time, as a result of incorrect storage, and use of an oil-based lubricant are the main reasons for condom rupture. Many men do not use condoms because they reduce penile sensitivity. Loose-fitting plastic condoms could increase condom use. Some plastic condoms should reach the market soon. A plastic female condom allows women to be in control, but clinical trials show that many women do not like it and it has a high one-year failure rate (15%). They are expensive. A levonorgestrel-releasing IUD has a lower rate of pelvic inflammatory disease and endometritis than the copper IUD; thus, the levonorgestrel-releasing IUD reduces susceptibility to HIV infection. Since it reduces menstrual blood loss and maintains a cervical mucus plug, its use by HIV positive women would reduce infectivity for their partners and the women's susceptibility to ascending opportunistic infections. Postcoital penile treatment with bactericides and virucides may be a way to prevent STD or HIV infection for men. Women also need topical chemical methods that will protect from STDs or HIV infection. Cholic acid, in high concentrations in the uterus during the luteal phase, exhibits strong spermicidal and antiviral activity. It inhibits the reverse transcriptase enzyme in HIV and reduces the ability of HIV to infect lymphocytes. An already developed vaginal sponge with cholic acid that protects against pregnancy, HIV, and STDs would be a great breakthrough.