Potential Breakthrough in War on AIDS!

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Potential Breakthrough in War on AIDS!

Postby Le1bn1z » Tue Jul 20, 2010 2:22 am UTC

From the BBC, this:

Spoiler:
Scientists say vaginal gel cuts HIV-infections by half Women in the trial are said to have used the gel largely as directed A vaginal gel has significantly cut the rate of women contracting HIV from infected partners in an experiment in South Africa, researchers said.

They said the gel, containing Aids drug tenofovir, cut infection rates among 889 women by 50% after one year of use, and by 39% after two and a half years.

If the results are confirmed it would be the first time that a microbicidal gel has been shown to be effective.

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Such a gel could be a defence for women whose partners refuse to wear condoms.

New ways of curbing the spread of HIV are badly needed, particularly in sub-Saharan Africa, where nearly 60% of those infected with the virus are women.

Many women are often forced to take part in unsafe sex, and are biologically more vulnerable to HIV infection than men, making a gel they apply an attractive option.

Welcoming the results, UN agencies said they would convene an expert consultation in South Africa next month to discuss the next steps with the product.

'Just pennies'

The results of the three-year study, which was completed by the Centre for the Aids Programme of Research in South Africa (Caprisa), are being presented at an international aids conference in Vienna and were published on Monday by the US magazine Science.


The gel was found to be both safe and acceptable when used once in the 12 hours before sex and once in the 12 hours after sex by women aged 18 to 40 years.

Salim Abdool Karim, one of the two leading co-researchers, told reporters in Vienna that the 889 women involved in the trial, conducted in the coastal city of Durban and a remote rural village, had largely used the gel as directed.

They were also given condoms and advice about sexually transmitted diseases, and tested for HIV once a month.

After 30 months, 98 women became infected with HIV - 38 in the group that got tenofovir in the gel and 60 in the group that got placebos.

"We showed a 39% lower incidence of HIV in the tenofovir group," Dr Karim said.

Tenofovir, he added, lowered the risk of infection by 50% at 12 months but then the efficacy declined.

Women who used the gel more consistently were much less likely to be infected, he said.

He added that he did not know how much each dose would cost but said the applicators and gel cost "just pennies".

"Boy, have we been doing the happy dance," Dr Karim, from the University of KwaZulu-Natal in Durban, said.

'Hope for women'

"It's the first time we've ever seen any microbicide give a positive result that you could say was statistically significant," said Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

The researchers say women who used the gel also showed a significant reduction in genital herpes, a common sexually transmitted infection, which itself increases the risk of HIV infection.

The UN's HIV/Aids agency noted that nearly 20 years of research had gone into microbicides that can be controlled by a woman, independent of her partner.

"We are giving hope to women," said Mr Michel Sidibe, executive director of UNAids.

"For the first time we have seen results for a woman-initiated and controlled HIV prevention option."

A microbicide, he said, would be a "powerful option for the prevention revolution and help us break the trajectory of the Aids epidemic".

Dr Margaret Chan, director-general of the World Health Organization, welcomed Caprisa's findings.

"We look forward in seeing these results confirmed," she said.

"Once they have been shown to be safe and effective, WHO will work with countries and partners to accelerate access to these products."

Analysis
Continue reading the main story

Richard Warry

BBC News

--------------------------------------------------------------------------------

An easy-to-use microbicidal gel proven to significantly reduce the risk of HIV infection would be a very important breakthrough in the fight to control the spread of HIV/Aids.

The best way to minimise the risk of infection during sex is to use a condom - but this is not an option for many women around the world who find it difficult to insist that a man take the necessary precautions.

As a result, women have become particularly vulnerable to infection in recent years and in Sub-Saharan Africa, where the Aids pandemic is most severe, they make up nearly 60% of those who are infected with the virus.

To compound the problem, science has shown that women are biologically more at risk of infection than men.

An effective gel would finally give women the chance to do something to protect themselves from infection - to take control of their own sexual health.

However, several earlier trials have produced disappointing results, and even the results of the latest trial - impressive though they are - underline that a gel is far from a fail-safe form of protection.

The latest results also need to replicated in a much bigger trial.

But provided a gel could be made widely accessible to women in some of the world's poorest countries, where it is needed the most, it could help to transform many lives for the better.


Read all about it here

If this isn't just some wild/impossible fluke, this is probably the greatest win yet in the war on AIDS, and could point the way for greater things yet to come.

Jubilation.
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Re: Potential Breakthrough in War on AIDS!

Postby Kyrn » Tue Jul 20, 2010 2:39 am UTC

Maybe it's just me, but 50% doesn't sound very effective in groups where women are forced to have unsafe sex, especially if multiple times.
Then again, if the percentage was higher, it wouldn't be called unsafe sex..

(seriously though, only way to fight AIDS is to eliminate/drastically reduce unsafe sex.)
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Re: Potential Breakthrough in War on AIDS!

Postby meatyochre » Tue Jul 20, 2010 2:44 am UTC

I am not a scientist. Can someone explain why or how the microbicide works against the hiv virus, and why we can't extrapolate that technology to kill the hiv virus inside of already-infected people?

Using the gel is better than not having it, it seems, but unfortunately... this is just prevention. I was hoping someone had come up with a cure based on the thread title (nothing against you, OP, just a fleeting thought of mine).
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Re: Potential Breakthrough in War on AIDS!

Postby Le1bn1z » Tue Jul 20, 2010 3:11 am UTC

meatyochre wrote:I am not a scientist. Can someone explain why or how the microbicide works against the hiv virus, and why we can't extrapolate that technology to kill the hiv virus inside of already-infected people?

Using the gel is better than not having it, it seems, but unfortunately... this is just prevention. I was hoping someone had come up with a cure based on the thread title (nothing against you, OP, just a fleeting thought of mine).


This is a big breakthrough for several reasons:

1.) The only way to not have AIDS is to not get it in the first place. Most of the power here has laid with men, especially in hard-scrabble areas where women don't have the same options to refuse advances as elsewhere. For the first time, women have something they can do to help themselves.

2.) Most of the progress we've made on AIDS has come from antiretroviral drugs -- basically drugs that slow the reproduction of the AIDS virus. We've been unable to kill it. This breakthrough is important because its a drug that seems to effect AIDS in a differnt way -- by messing with its ability to infect in the first place. As ARVs stall, to some extent, this drug offers a new avenue of advance.

3.) As a new discovery, this is just a begining. In its brand new form this stuff is 50% effective. Yes, it will need to get better. But in addition to already helping to slow the spread of AIDS, almost like a national scale ARV (a HUGE boon to countries like South Africa cracking under the sheer scale of the problem), it opens the door to hope for even more substantial advances in the future.

4.) As implied above, it buys places like SA time, if it works out and can be distributed. A big part of the impact of AIDS is the social impact: Governments can't keep up with the needs of victims. Having fewer victims, even if the final number ends up being 10% over 10 years or whatever, is still a lot of badly needed breathing room for social services.

5.) We already have the social-scale "vaccine" for AIDS: Condoms. To date, the blame for the spread of the disease has to rest with men, at least in the third world, who won't take the proper measures to stop AIDS. Generally, men are prone to resist condoms far, far more than women, as they see it as unmacho. (As opposed to AIDS, which is so macho, F--ing idiots.)

Now we introduce a research vector which empowers women to stop or slow the spread of the virus. This gel, though less effective than condoms, is aimed at people far more likely to use it, at least we can hope.

That's why this is huge, huge news.
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Re: Potential Breakthrough in War on AIDS!

Postby Diadem » Tue Jul 20, 2010 10:14 am UTC

Somehow I can't see many women getting enthusiastic about having to rub products on their vagina every time you have sex. How exactly is this a breakthrough when condoms are easier to use and much more effective?

I suppose condoms aren't an option when you're forced into sex. But this gel has to be applied before as well as after, right, so that's not really a solution then either.
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Re: Potential Breakthrough in War on AIDS!

Postby skeptical scientist » Tue Jul 20, 2010 10:58 am UTC

Diadem wrote:How exactly is this a breakthrough when condoms are easier to use and much more effective?

You have to get the guy to wear the condom. The gel is something you use yourself.
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Re: Potential Breakthrough in War on AIDS!

Postby Marquee Moon » Tue Jul 20, 2010 11:17 am UTC

skeptical scientist wrote:
Diadem wrote:How exactly is this a breakthrough when condoms are easier to use and much more effective?

You have to get the guy to wear the condom. The gel is something you use yourself.

There are condoms that women put "in themselves". See here.

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Re: Potential Breakthrough in War on AIDS!

Postby Jesse » Tue Jul 20, 2010 12:01 pm UTC

And guys can then remove, whereas a gel is a lot less obvious.

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Re: Potential Breakthrough in War on AIDS!

Postby Le1bn1z » Tue Jul 20, 2010 12:05 pm UTC

Marquee Moon wrote:
skeptical scientist wrote:
Diadem wrote:How exactly is this a breakthrough when condoms are easier to use and much more effective?

You have to get the guy to wear the condom. The gel is something you use yourself.

There are condoms that women put "in themselves". See here.


The problem is that the men feel that condoms are unmany and don't want to sacrifice sensation. This sidesteps this problem, again, especially in places where women don't have the same power to refuse advances.
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Re: Potential Breakthrough in War on AIDS!

Postby Gellert1984 » Tue Jul 20, 2010 12:16 pm UTC

Le1bn1z wrote:
Marquee Moon wrote:
skeptical scientist wrote:
Diadem wrote:How exactly is this a breakthrough when condoms are easier to use and much more effective?

You have to get the guy to wear the condom. The gel is something you use yourself.

There are condoms that women put "in themselves". See here.


The problem is that the men feel that condoms are unmany and don't want to sacrifice sensation. This sidesteps this problem, again, especially in places where women don't have the same power to refuse advances.


Also that whole 'condoms are bad' line from the vatican.
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Re: Potential Breakthrough in War on AIDS!

Postby Ishindri » Tue Jul 20, 2010 2:02 pm UTC

Le1bn1z wrote:2.) Most of the progress we've made on AIDS has come from antiretroviral drugs -- basically drugs that slow the reproduction of the AIDS virus. We've been unable to kill it. This breakthrough is important because its a drug that seems to effect AIDS in a differnt way -- by messing with its ability to infect in the first place. As ARVs stall, to some extent, this drug offers a new avenue of advance.

To be precise, tenofovir is an antiretroviral - a reverse transcriptase inhibitor. But using it as a gel provides a new vector by which it can combat the virus. Previously, it was taken orally. (And seemed to cut the risk of infection in that case, as well)
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Re: Potential Breakthrough in War on AIDS!

Postby Le1bn1z » Tue Jul 20, 2010 2:05 pm UTC

Ishindri wrote:
Le1bn1z wrote:2.) Most of the progress we've made on AIDS has come from antiretroviral drugs -- basically drugs that slow the reproduction of the AIDS virus. We've been unable to kill it. This breakthrough is important because its a drug that seems to effect AIDS in a differnt way -- by messing with its ability to infect in the first place. As ARVs stall, to some extent, this drug offers a new avenue of advance.

To be precise, tenofovir is an antiretroviral - a reverse transcriptase inhibitor. But using it as a gel provides a new vector by which it can combat the virus. Previously, it was taken orally. (And seemed to cut the risk of infection in that case, as well)


How right you are. My bad. Finished reading more about it recently.

Still, dirt cheap gels which can cut transmition ristk by 50% is not a bad step forward.
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Re: Potential Breakthrough in War on AIDS!

Postby skeptical scientist » Tue Jul 20, 2010 4:53 pm UTC

I'm looking forward to the day when the SNES emulator on my computer works by emulating the elementary particles in an actual, physical box with Nintendo stamped on the side.

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Re: Potential Breakthrough in War on AIDS!

Postby (╯°□°)╯︵ ┻━┻ » Tue Jul 20, 2010 5:30 pm UTC

I am tremendously heartened by this news. This is like, the best invention ever.
Marquee Moon wrote:
skeptical scientist wrote:
Diadem wrote:How exactly is this a breakthrough when condoms are easier to use and much more effective?

You have to get the guy to wear the condom. The gel is something you use yourself.

There are condoms that women put "in themselves". See here.

Female condoms are great but if the gentleman in question doesn't want to wear one, esp. in the cases of rape, there's generally little to be done about that. The gel is an improvement over something the man can remove at will, or even see.
In some parts of Africa there are myths that having sex with a virgin can cure HIV. Not only do they probably not have a choice in the matter, but the myth insists on no condoms. If it will keep women safer, it's better than condoms.
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Re: Potential Breakthrough in War on AIDS!

Postby Kyrn » Wed Jul 21, 2010 12:09 am UTC

One other advantage: unless I'm reading it wrong, it can be used 12 hours AFTER sex, something which condoms can't provide.
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Re: Potential Breakthrough in War on AIDS!

Postby Qaanol » Wed Jul 21, 2010 5:47 am UTC

I would like to comment on some mathematics. From the abstract of the study, we see the results listed as infections per woman-year. For the gel this was 38/680.6 = 5.6/100 woman-years. For the placebo it was 60/660.7 = 9.1/100 woman-years. If we believe the study itself did not alter typical behaviors, then the gain from the gel can be viewed as a woman going from about 90.9% sure she will not get HIV in the next year, to about 94.4% sure she will not get HIV in the next year.
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Re: Potential Breakthrough in War on AIDS!

Postby phlip » Wed Jul 21, 2010 6:09 am UTC

Qaanol wrote:If we believe the study itself did not alter typical behaviors, then the gain from the gel can be viewed as a woman going from about 90.9% sure she will not get HIV in the next year, to about 94.4% sure she will not get HIV in the next year.

Are you trying to give the impression that the change isn't that much? (Honest question, I can't read properly what tone you're aiming for there...)

Well, of course if you take a timespan where the numbers are close to either 0% or 100%, the change is going to look small... they tend to bunch near both extremes. Pick a longer timespan, and the numbers are much further apart... say, over a course of 5 years, the chance of being infected drops from 50% to 25% (give or take a lot - I'm only going to work with approximations because I'm not certain on the best way to turn "number of infections" to "chance of getting infected"... I'm not even sure what "infections per woman-year" is supposed to mean... it's probably a standard term I'm unfamiliar with, but I don't think the naive defintion is well-defined, since 100 women for 1 year could have a heap of infections, but 1 woman for 100 years can only be infected once... but enough tangent, time for the closing paren...). Since the choice of the the timespan makes a huge difference as to whether the resulting difference appears large or small, I'm not convinced that it's a useful clarifying measure at all.

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Re: Potential Breakthrough in War on AIDS!

Postby Goldstein » Wed Jul 21, 2010 9:33 am UTC

Mathematically, it sounds great. I know we can't really take the 50% or even 39% reduction at face value, but even a small reduction in the rate of transmission of a disease can have a huge impact. 39% less infections in a given time span means that many less infectees in round 2 and if, as a result of this gel, the number of people you're sleeping with that have HIV is reduced by 39%, your chances - and consequently the chances of those you're sleeping with - of catching HIV are significantly lower even before you personally start using the gel.

I tried to avoid throwing in '39% less' in places where I just meant 'less', but it was hard. I think I did okay.
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Re: Potential Breakthrough in War on AIDS!

Postby Diadem » Wed Jul 21, 2010 2:22 pm UTC

Meaux_Pas wrote:I am tremendously heartened by this news. This is like, the best invention ever.
Marquee Moon wrote:
skeptical scientist wrote:
Diadem wrote:How exactly is this a breakthrough when condoms are easier to use and much more effective?

You have to get the guy to wear the condom. The gel is something you use yourself.

There are condoms that women put "in themselves". See here.

Female condoms are great but if the gentleman in question doesn't want to wear one, esp. in the cases of rape, there's generally little to be done about that. The gel is an improvement over something the man can remove at will, or even see.
In some parts of Africa there are myths that having sex with a virgin can cure HIV. Not only do they probably not have a choice in the matter, but the myth insists on no condoms. If it will keep women safer, it's better than condoms.

I get that. But unless I read that article wrong, this gel has to be applied before intercourse to be fully effective, right? What makes you think rapist who wouldn't use a condom will allow women the time to apply this gel?

Unless the idea is to apply this gel every day all the time?
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Re: Potential Breakthrough in War on AIDS!

Postby skeptical scientist » Wed Jul 21, 2010 3:07 pm UTC

You may get some effectiveness from applying the gel afterwards. Also, the issue is not just a violent attack by a stranger, but any circumstance when a woman may not be in a position to refuse advances, or to make the man wear a condom. In some of those circumstances, the woman may well be able to foresee contact and use the gel.
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Re: Potential Breakthrough in War on AIDS!

Postby Heisenberg » Wed Jul 21, 2010 4:52 pm UTC

Or if the woman doesn't want to wear a condom.

If you want to procreate with your parter, who may have HIV, this gel may offer some protection against the virus while not preventing pregnancy.

While I imagine there are folks who advocate against this due to the very real risks, I'm sure the women who are right now trying to get pregnant while crossing their fingers would appreciate any help they can get.

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Re: Potential Breakthrough in War on AIDS!

Postby Le1bn1z » Wed Jul 21, 2010 5:01 pm UTC

Heisenberg wrote:Or if the woman doesn't want to wear a condom.

If you want to procreate with your parter, who may have HIV, this gel may offer some protection against the virus while not preventing pregnancy.

While I imagine there are folks who advocate against this due to the very real risks, I'm sure the women who are right now trying to get pregnant while crossing their fingers would appreciate any help they can get.


Considering the sheer idiocy that goes into the spread of AIDS as it is, this is not so inconcievable. Even if it is pretty stupid in its own right.
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Re: Potential Breakthrough in War on AIDS!

Postby (╯°□°)╯︵ ┻━┻ » Wed Jul 21, 2010 7:40 pm UTC

Diadem wrote:
Meaux_Pas wrote:I am tremendously heartened by this news. This is like, the best invention ever.
Marquee Moon wrote:
skeptical scientist wrote:
Diadem wrote:How exactly is this a breakthrough when condoms are easier to use and much more effective?

You have to get the guy to wear the condom. The gel is something you use yourself.

There are condoms that women put "in themselves". See here.

Female condoms are great but if the gentleman in question doesn't want to wear one, esp. in the cases of rape, there's generally little to be done about that. The gel is an improvement over something the man can remove at will, or even see.
In some parts of Africa there are myths that having sex with a virgin can cure HIV. Not only do they probably not have a choice in the matter, but the myth insists on no condoms. If it will keep women safer, it's better than condoms.

I get that. But unless I read that article wrong, this gel has to be applied before intercourse to be fully effective, right? What makes you think rapist who wouldn't use a condom will allow women the time to apply this gel?

Unless the idea is to apply this gel every day all the time?

Well, that's the idea behind Rapex, so why not? In places like refugee camps in Sudan and remote locations, women are raped when they so much as go out to look for firewood. If they have the access to this before they even leave the camp, they are better off.
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Re: Potential Breakthrough in War on AIDS!

Postby Levelheaded » Fri Jul 23, 2010 7:29 pm UTC

Heisenberg wrote:Or if the woman doesn't want to wear a condom.

If you want to procreate with your parter, who may have HIV, this gel may offer some protection against the virus while not preventing pregnancy.

While I imagine there are folks who advocate against this due to the very real risks, I'm sure the women who are right now trying to get pregnant while crossing their fingers would appreciate any help they can get.


In Africa, women in their teens are regularly forced into arranged marriages, and there is nothing to protect women against spousal rape or other abuse. In some places in Africa, women who resist their husbands can be beaten, whipped, burned with acid, or worse - and there are no consequences to the husband.

Just think about this...the first state to outlaw spousal rape was South Dakota in 1975 and the last was North Carolina in 1993. 1993. That law can't even vote yet and that's in the United States of America.

There are so many African women who have no way to refuse their HIV-positive husband's advances or protect themselves. It's not a question of 'want' - 'wanting' to wear a condom, 'wanting' to procreate'. It's women whose husbands are forcing them to play HIV Russian Roulette that would probably appreciate any help they can get.

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Re: Potential Breakthrough in War on AIDS!

Postby Manial » Sun Jul 25, 2010 2:57 pm UTC

Diadem wrote:Somehow I can't see many women getting enthusiastic about having to rub products on their vagina every time you have sex. How exactly is this a breakthrough when condoms are easier to use and much more effective?
To be fair, it's not an either/or situation. Using this gel in addition to wearing a condom would reduce the risk just that little bit more.

889 women involved in the trial ... After 30 months, 98 women became infected with HIV
I knew HIV was prevalent in South Africa but this really shocked me, over a 10% chance of getting HIV in 30 months?

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Re: Potential Breakthrough in War on AIDS!

Postby Marquee Moon » Sun Jul 25, 2010 10:42 pm UTC

Meaux_Pas wrote:
Diadem wrote:
Meaux_Pas wrote:Female condoms are great but if the gentleman in question doesn't want to wear one, esp. in the cases of rape, there's generally little to be done about that. The gel is an improvement over something the man can remove at will, or even see.
In some parts of Africa there are myths that having sex with a virgin can cure HIV. Not only do they probably not have a choice in the matter, but the myth insists on no condoms. If it will keep women safer, it's better than condoms.

I get that. But unless I read that article wrong, this gel has to be applied before intercourse to be fully effective, right? What makes you think rapist who wouldn't use a condom will allow women the time to apply this gel?

Unless the idea is to apply this gel every day all the time?

Well, that's the idea behind Rapex, so why not? In places like refugee camps in Sudan and remote locations, women are raped when they so much as go out to look for firewood. If they have the access to this before they even leave the camp, they are better off.
Sure, but how expensive will it be to apply this gel every single day?

I think this is a good invention, and anything that helps people who live in a) extreme poverty, b) places with high HIV rates, c) places where rape of women is prevelant, or d) all of the above, is a very good thing. However, the main "aids problem" isn't a lack of technology, it's distributing these technologies to people. So for example comdoms (especially ones that women control) if they were widely distributed and used would be great at stoping the spread of aids. There are huge gains to be made in effectively distributing current technologies. New technologies are good, but they may well face the same 'bottleneck' that comdoms face, and so won't do that much good.

tl;dr the important work in stoping the spread of aids will be in distributing things like comdoms in poor countries, not in the science labs of rich countries.

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Re: Potential Breakthrough in War on AIDS!

Postby podbaydoor » Sun Jul 25, 2010 11:37 pm UTC

Well, it can be both.
tenet |ˈtenit|
noun
a principle or belief, esp. one of the main principles of a religion or philosophy : the tenets of classical liberalism.
tenant |ˈtenənt|
noun
a person who occupies land or property rented from a landlord.

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Re: Potential Breakthrough in War on AIDS!

Postby Mittagessen » Sat Jul 31, 2010 5:39 pm UTC

Of course, it is great to have a after-sex solution for AIDS prevention, but wouldn't it be vastly more effective to indoctrinate students from a young age through an sex ed program to use condoms instead of letting the notion that condoms are unmanly prevail? Even the poorest of the poorest in South Africa have some amount of schooling, so removing the stigma of condoms shouldn't take more than one generation.

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Re: Potential Breakthrough in War on AIDS!

Postby skeptical scientist » Sat Jul 31, 2010 6:40 pm UTC

Mittagessen wrote:Of course, it is great to have a after-sex solution for AIDS prevention, but wouldn't it be vastly more effective to indoctrinate students from a young age through an sex ed program to use condoms instead of letting the notion that condoms are unmanly prevail? Even the poorest of the poorest in South Africa have some amount of schooling, so removing the stigma of condoms shouldn't take more than one generation.

Don't discount the effects of inertia. That generation might be getting one message from their schooling, but they will also be getting contradictory messages from parents, older siblings, peers who have been taught the other message, the catholic church, etc. etc. And that's assuming you can get sex ed classes taught the way you want them to be taught, when all of those same groups are likely to oppose it.
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