Potential Impact of Microbicides in Bagalkot District, Karnataka, India

Published by the International Family Health (IFH), this briefing note outlines a study which estimates the impact of a partially effective microbicide in three urban sub-districts in Karnataka, India.

The authors found that a 40 percent microbicide would avert 18 percent of infections among clients and non-commercial partners, and a 60 percent microbicide would avert 35 percent of infections. Findings also demonstrated that microbicides reduce infection for non-commercial partners of clients in two ways: directly, by their own use of microbicides; and indirectly, by reducing the rate at which clients become infected.

Conclusions from the study show that microbicides could be an important addition to existing HIV prevention options in the areas. However, condom migration (reduction in condom use following microbicide introduction) could be a concern, especially among groups, such as sex workers, who use condoms consistently. The impact of microbicides will depend upon the extent to which women find them accessible, and convenient to use consistently.

Recommendations include:

1. "Mechanisms to facilitate the regulatory review process and to help the rapid distribution of any efficacious microbicide product should be identified.
2. Methods to promote microbicides for use by people most vulnerable to HIV infection with their noncommercial sexual partners need to be investigated.
3. Different strategies to promote microbicides to different groups need to be considered. Strategies to promote the use of microbicides within primary partnerships need to ensure that their use is not associated with infidelity or lack of trust.
4. Hierarchical messages to separately promote microbicides for use in commercial sex as a fall-back to condoms, without undermining condom use, need to be explored.
5. While products are in development it is important to identify what programmatic and product-related characteristics may affect a microbicide's acceptability, price and ease of use.