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We're getting an update now on a struggle to protect women in developing countries against sexually transmitted HIV. Men often will not agree to use condoms, so scientists are trying to develop pills and vaginal gels that women can use to block the virus. Hundreds of millions of dollars have been spent on this research, but it's still not clear how well the products work. NPR's Brenda Wilson reports.

BRENDA WILSON: To understand why so much is invested in finding a product that women in developing countries can use independently, Dr. Sharon Hillier at the University of Pittsburgh School of Medicine says put yourself in the mind of an 18-year-old Zambian woman who just got married.

Dr. SHARON HILLIER (University of Pittsburgh School of Medicine): I need to have children because my value as a woman is very much associated with my ability to have a baby, and I need to breast-feed that baby. I need to have sex with my husband, but if I ask him to use condoms, he'll think that I've been unfaithful or that I don't trust him. He might even beat me up. So I need something that I can use, perhaps even without my husband knowing, that will allow me to stay uninfected.

WILSON: But so far no one has come up with a gel or a pill that can prevent HIV. So the results from a microbicide study conducted in several African countries that was recently presented in Montreal was looked to with great expectations. Women in the study who were given a topical gel called PRO 2000 were 30 percent less likely to become infected with HIV.

Lorie Heise of the Global Campaign for Microbicides acknowledges that the results were statistically insignificant, but she wasn't entirely disappointed.

Ms. LORIE HEISE (Global Campaign for Microbicides): It means that we can't rule out the possibly that they happened by chance, but in this case there's a nine out of 10 chance that actually it was a real effect. To me, that's promising.

WILSON: She notes that the gel appeared to be more effective among the highest level of users, those who used it practically every time. But Dr. Tachi Yamada, the director of global health for the Bill and Melinda Gates Foundation, expressed dismay at the findings.

Dr. TACHI YAMADA (Bill and Melinda Gates Foundation): To me it was very unfortunate. In fact, there should be a little bit of concern that this is now the fifth or sixth trial that came out statistically insignificant.

WILSON: He's concerned that even if scientists could find a microbicide that would work reliably, women would not use it.

Dr. YAMADA: You know, they come in a paper packet, and then there's a plastic applicator, and then you have to apply the plastic applicator presumably around the sex act and then dispose of it. And in the bush you don't see waste disposals. So somehow it gets put out around your hut and then everybody in the village knows you had sex and that you suspect your husband has HIV.

WILSON: He has higher hopes for another prevention method, the pre-exposure pill, or PrEP, using an anti-AIDS drug. Some of the compounds being studied are longer acting so they could be taken once a day or once a month to block infection. The University of Pittsburgh Professor Hillier says that only people who don't face the same risk as women in developing countries would quibble over what prevention method was used.

Dr. HILLIER: Almost all the women I've talked to in this trial actually told me that their aunts had died, their brothers had died of HIV. They didn't care if it was a pill or a gel; they wanted something to help protect them from HIV. And so the notion that somehow a vaginal gel with an applicator is going to be too much trouble just doesn't make sense to them. They actually laughed when I asked them that.

WILSON: But scientists like Microbiologist John Moore at Cornell Weill Medical College have concerns about both approaches, because the gels and pills contain the same drugs that treat HIV.

Mr. JOHN MOORE (Cornell Weill Medical College): The use of antiretrovirals for prevention could create the spread of resistant variants that compromise treatment programs.

WILSON: Part of the problem, he says, is that too many different researchers and organizations are chasing concepts that are too similar, making the same mistakes that were made in HIV vaccine research.

Mr. MOORE: There are times when the vaccine and microbicide fields have almost acted like they're racing to be the first lemming off the cliff.

WILSON: In response to these criticisms, Hillier and other members of the Alliance for Microbicide Development say they are working to create greater coordination and to pursue the best scientific leads. What they cannot do, they say, is wait, because the need is too great.

Brenda Wilson, NPR News.

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