Special Edition, Spring 2002

CONTENTS

STI Prevention
Toward the Development of a Microbicide
The spread of AIDS and other sexually transmitted infections has created an urgent need for products that women can use to protect themselves. Developing one such product-called a microbicide-is the goal of research in the laboratory of David Phillips, a virologist at the Population Council's Center for Biomedical Research. This article reports the findings of Phillips and his colleagues in preliminary and more advanced testing of the microbicide compounds and the mechanisms by which HIV infects the body.

HIV Prevention
More Data Needed Before Male Circumcision Is Advocated
A growing body of research shows that uncircumcised men in certain parts of Africa are twice as likely as circumcised men to be HIV infected. These findings suggest that male circumcision may offer a measure of protection against HIV infection, and public health experts have begun to debate the possibility of encouraging male circumcision as an anti-HIV intervention. To explore this issue, the Population Council’s Horizons Project organized a two-day meeting of scientists from around the world. The meeting’s participants identified several cultural, medical, and ethical issues that should be explored before the procedure is recommended as an intervention.

Women's Health
Investigating Links Between HIV and Partner Violence
Encouraging clients to inform partners of their test results is an important component of HIV voluntary counseling and testing programs. Yet many clients do not disclose test results to their partners. Studies have found that many women fear their partners will react violently and that indeed HIV-infected women are at increased risk for partner violence. Researchers with the Population Council's Horizons program and Muhimbili University College of Health Sciences explored the links between HIV infection, the disclosure of test results, and partner violence among women attending the Muhimbili Health Information Center, a voluntary counseling and testing clinic in Dar es Salaam, Tanzania. (PDF in Arabic)

Immunology
Role of Dendritic Cells in HIV Infection Clarified
Population Council immunologist Melissa Pope has studied the action of dendritic cells during HIV infection for the past decade. In parallel with human studies, Pope uses rhesus macaques and the simian immunodeficiency virus (SIV) to model human HIV infection. Her findings have contributed to one of the widely accepted theories for the mechanism of sexual transmission of HIV. Positioned within the mucosa, dendritic cells are one of the first white blood cells that meet HIV following sexual or perinatal transmission and may be pivotal for the onset and spread of infection. Ultimately, Pope's work may identify ways to block the mucosal transmission of HIV with microbicidal formulations. This work may also provide clues in the search for a vaccine.

Biomedical Research
Nonoxynol-9 Rapidly Exfoliates Rectal Epithelium
New findings suggest that products containing the spermicide nonoxynol-9 (N-9) may increase the risk of HIV infection when used during rectal intercourse. David M. Phillips, of the Population Council's Center for Biomedical Research, and his colleagues found that N-9 caused the rapid shedding of epithelium when applied rectally. Surveys in the United States have shown that 41 percent of men who have sex with men try to use products containing N-9 as lubricants during rectal sex. This practice stems in part from a belief that such products may protect against HIV infection. While there is some evidence in support of this idea, there is also some evidence that N-9 may enhance HIV transmission.

Community-based Initiatives
Tools and Training Strengthen African AIDS Groups
In sub-Saharan Africa, AIDS has stricken some 21 million adults and children, according to recent estimates. In the early 1990s, many grassroots organizations sprang up in response to the devastation. Population Council researchers Ann Leonard and Esther Muia undertook four collaborative interventions to further strengthen such groups. The efforts demonstrated that providing simple, carefully selected forms of technical assistance can greatly improve the ability of grassroots organizations to achieve their goals.

Reproductive Health
Syndromic Method Poor at Detecting STIs in Women
Three recent studies conducted by Population Council researchers and their colleagues find that the syndromic approach is not an effective strategy for diagnosing or managing gonorrhea, chlamydia, and other reproductive tract infections among women. Syndromic management diagnoses infection based on the presence of vaginal discharge, lower abdominal pain, or other symptoms, signs, or risk factors, rather than on laboratory tests. Standard laboratory tests to identify some sexually transmitted infections are expensive and require equipment that is generally unavailable to clinics in developing countries. Clinics began using the syndromic method before it had been adequately evaluated.

Entire issue (PDF)

 

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