Jessica Cohen is taking aim at AIDS. Along with activists and researchers around the globe, she is in hot pursuit not of a vaccine, but of a means to prevent the spread of HIV. You’ve probably never heard of it, but this little-known beacon of hope is a kind of canary in an epidemic coal mine. It’s called a microbicide, and it’s designed to help people, especially women, all around the world.

Through her work at PATH, a widely lauded international nonprofit organization dedicated to improving global health, Jessica is part of a coalition known as the Global Campaign for Microbicides, a broad-based group with hundreds of supporting nongovernmental organizations from Southeast Asia to Africa to Canada—and beyond.

R: So. Microbicides. What are they?
JC: Microbicides are products that could be inserted before sex to prevent the transmission of HIV—and possibly other sexually transmitted infections. When we talk about microbicides, we are talking about a class of products—vaginal and rectal gels and creams—that would be inserted with an applicator, like a spermicide. There are no microbicides on the market today; they are all products in development.

R: So they’re considered more a product than a drug?
JC: They’ll be reviewed by the FDA as a new drug. But the goal is that they’ll be available over the counter without a prescription. They’d be low cost, and you’d be able to just pick them up at a drugstore, for example, in this country, or at clinics around the world.

R: How long has this work being going on?
JC: For over 20 years, scientists have been investigating microbicides. But the impetus really came from women around the world voicing a need for a user-controlled HIV-prevention method.

R: Is the research centralized somewhere?
JC: Not really. There’s not one university or one lab that’s working on this. There are a lot of universities and NGOs involved, along with the NIH [National Institute of Health], the CDC [Center for Disease Control and Prevention] and US AID [US Agency for International Development]. The Gates Foundation and other private funders have also been strong supporters. But one major distinction between microbicide research and other drug development is that no large pharmaceutical companies are heavily involved in microbicide research today.

R: Because it doesn’t appear to have a lucrative future?
JC: Yes. That’s one of the main reasons. There are also questions about liability—would there be a return on the investment if it isn’t 100 percent effective? So that’s a big difference, and it really affects the speed at which these products are being developed. Where a large pharmaceutical company could invest million dollars at a time for large clinical trials—instead there has been much slower progress because of a shortfall in funding.

R: How does the Global Campaign for Microbicides work?
JC: They’re a coalition—a network—that supports much of the advocacy going on in the global north and the global south. The Global Campaign is housed at PATH, of staff who work for it. They provide resources and assistance to support local advocacy activities going on in North America, Europe and the global south, primarily in the countries where the clinical trials are taking place. The goal of the Global Campaign is really to build support among policymakers and the general public. We want to increase investment in microbicides and other user-controlled prevention methods, and we want to protect the needs and interests of users throughout the development process.

R: What are the stakes?
JC: We think microbicides could have an enormous impact on the spread of the epidemic—especially for women who are, at this point, the fastest group becoming infected with HIV through heterosexual transmission—and many of whom are getting infected through sex with their primary partner. So microbicides would be a critical option for millions of women worldwide who cannot insist on condom use or mutual monogamy or abstinence for HIV prevention—because of cultural reasons, because they’re married or because of social, economic or gender-based inequalities.

R: Is the slow pace of all of this ultimately a gender equality issue?
JC: I think gender equality is a primary push behind this work. A lot of people who are mobilizing around this want to give women additional prevention options that are under their control. It’s a critical gap that we need to address, and it’s one of the main things missing from the arsenal of HIV-prevention methods. It helps just to acknowledge that the current HIV-prevention options are not successful enough often enough. Fourteen-thousand people become infected every day, over half of those are women, and over 95 percent of those infections are in developing countries. We clearly need more options.

R: What kind of impact do microbicides stand to have? What are the numbers?
JC: Even if a 60 percent effective microbicide were introduced in a number of countries that have high HIV rates, and was only used by a portion of people, we could actually avert 2.5 million infections over three years. That would be tremendous.

R: What’s the catch?
JC: The trick is having something people can use consistently and effectively. Even if you have male condoms—which are almost 100 percent effective—if you can never use them or get your partner to use them, they’re providing zero protection for you. But a microbicide is in a woman’s control. She can insert it an hour before sex, and it doesn’t have to be a conversation every time. She can use it when she wants to use it. So even if it’s not as effective as a condom, if used consistently, it could still provide important protection.

R: So who stands to benefit?
JC: Microbicides would benefit people everywhere. And some of the microbicides may also prevent other STIs, such as chlamydia and gonorrhea. Some of them may also prevent pregnancy.

R: But you’re not trying to eliminate the condom in any way, shape or form?
JC: Absolutely not. This is about options. For sexually active people who can use condoms, they should continue using condoms. Microbicides and condoms may very well work together in the future. And for people who cannot use condoms—male or female condoms—they should have additional options, such as microbicides.

R: So these would be inexpensive to buy and relatively easy to distribute. What’s the cost to produce these products? What needs to happen to bring this to market?
JC: Money is a major impediment. All of these products are in clinical trials or preclinical trials. To get a product from a Phase I trial, a small safety study, through a Phase III clinical trial, which involves thousands and thousands of people in numerous countries and can last several years, costs millions and millions of dollars. Just a Phase III trial for one product can cost $50 million. And ideally you want to be testing and pushing several products through trials at the same time. That way, if some fail, you will find others that might be successful. A recent study found that roughly $280 million is needed annually over the next five years to ensure the successful development of at least one microbicide.

R: How do you go about getting that funding?
JC: That’s what the advocacy is about, especially in the U.S., Europe and Canada—basically in countries where there are resources for research and development. Advocacy groups are putting pressure on their governments to fund microbicide research. For example, the Microbicide Development Act is a piece of legislation that has been introduced in the U.S. House and the Senate with bipartisan support. Its goal is to improve coordination and expand funding for microbicide research and development at the three federal agencies that work on microbicides.

R: What can people do to help?
JC: They can go to the global campaign Web site [www.globalcampaign. org], type in their region or state, and find a local coalition to get involved with. Here in Washington state, we have a local microbicides coalition, and we have a long list of things people can do. One is to get involved with lobbying and outreach. People can certainly write to their congressperson, organize a discussion in their community or arrange for a screening of a film we made about the importance of microbicides.

R: Who belongs to the Northwest Microbicides coalition?
JC: We have about 10 member organizations: Aradia Women’s Health Center, Planned Parenthood, PATH, Lifelong AIDS Alliance, the HIV Vaccine Trails Unit, Gay City Health Project, I-Tech, Rosehedge, the UW Center for AIDS and STD as well as individual community members. And we always welcome new members.

R: Are microbicides the sole focus of your individual work?
JC: No, but many of my projects focus on new HIV-prevention methods. I’m also working on the development of a new female condom that would be low cost and acceptable. I’m also working on a new cervical-barrier device and on new rapid, inexpensive diagnostic tests for sexually transmitted infections.

R: How did you first get interested in health issues?
JC: I spent time working before graduate school on the Navajo reservation. That was the first time I got a firsthand look at health disparities and unequal access to health and health-care information—and the impact that can have.

R: What has been the biggest achievement for microbicides so far?
JC: We do have five different products in the last stage of clinical research—Phase III clinical trails—and the results of those should be coming in within the next year or two. That’s very exciting. It would be another year or two for these products to go through the regulatory approval process at the FDA. If all goes well, a microbicide might be available and on the market five to seven years from now.

R: In the meantime, what is the wind in the sails?
JC: People, including our members of Congress, are getting familiar with microbicides. They’re talking about this. We are gaining momentum.

For more information about microbicides, visit www.globalcampaign.org.