In an epidemic short on good news, it is surprising that more people are not aware of the recent advances made in developing topical microbicides. Microbicides are substances that when used intravaginally can prevent the transmission of HIV and other sexually transmitted pathogens. A safe, effective microbicide could make a tremendous difference in the lives of the millions of women who must now rely on their partner's good will and cooperation to protect themselves from disease.

So far, no microbicides are yet on the market, but scientists believe that effective microbicides could be available in less than five years. Already more than 50 product leads are under development, and 23 of them have entered human trials. Microbicides could be available in a variety of forms - as gel, suppository, cream, film or sponge. The goal is to develop something that could be inserted many hours before intercourse and still offer protection.

Many of the leads being explored build on the body's natural defence mechanisms and are broadly microbicidal, meaning that they would provide protection against a wide range of sexually transmitted pathogens, not just HIV. In many parts of the world "traditional" STDs are responsible for more ill health - in terms of infertility, pregnancy complications, and cancer  than HIV. Therefore, STDs and HIV need to be addressed in the same package.

Some product leads are contraceptive and some are not. This leaves open the possibility of a product that would protect women from infection but still allow pregnancy. This could also be important to lift opposition of certain groups that oppose contraceptives. Just as there are many brands of condoms, a range of microbicides capable of meeting women's varying needs and preferences must be developed. In addition, there is every reason to believe that if a future product protected women, it would also protect their male partners during vaginal sex.

Although acceptability studies around the world have confirmed women's strong interest in microbicidal products, they have likewise confirmed that women's preferences regarding formulation varies among women and across settings. A recent review of existing acceptability research confirms that women want a safe, affordable and efficacious product. Beyond that, they are willing to tolerate a wide range of product types and formulations as long as they are not too messy.

As microbicides can be considered a public good, leadership must come from the public sector - from governments and donors  willing to invest in microbicide research, to compensate for the market's failure to do so. Unfortunately, the current level of investment is nowhere near what is necessary to ensure an effective product reaches the market. Scientists estimate that it costs upwards of $50 million to test just one compound for its safety and efficacy against HIV. The US government is investing roughly $22 million a year in microbiciderelated research, less than 1% of what the US National Institute of Health invests in AIDS research every year.

With donor funding, the campaign has developed action kits that include information on women and HIV, background data on microbicides and the female condom, and ideas for incorporating the petition and other campaign materials into ongoing work at the community level. The campaign is seeking cosponsors and others interested in linking their local activities to an international initiative.

For more information about how to get involved, contact: Megan Gottemoeller at mgottem@genderhealth.org.