Although women comprise less than 30% of all Americans living with HIV/AIDS, the number of new infections among women in some US populations exceeds that among men by a ratio of two to one. AIDS is the second leading cause of death in the United States among African-American women between the ages of 25 and 44, and the third leading cause among Latinas in that age group. To slow the rate of new infections, women need a non-condom alternative, a prevention method they can control and use without their partners' knowledge, if necessary. Microbicides -- products designed to be used vaginally or rectally to reduce the risk of infection during sex -- are such a method. Researchers have identified more than 60 potential microbicides and half of these are now in, or approved for, human trials. Despite their enormous promise for slowing HIV spread, public and private investment in microbicide research remains grossly inadequate.

According to the Alliance for Microbicide Development, the cost of bringing microbicides on to the market in the next five years will require spending of US$75-100 million per year. At present, US$35 million per year at most is spent globally on microbicide research. In response to the lack of funding for developing microbicides, women's health advocates created the Global Campaign for the STI/HIV Prevention Alternatives for Women, a broad-based, international effort to increase access to HIV/STI prevention technologies other than the male condom. The Campaign currently has more than 60 participating organisations worldwide that mobilise political will through public education, constituency building, legislative advocacy and a global petition drive. Advocacy for increased funding for microbicide research is an important function of the Campaign.

Expanding microbicide research

The US arm of the Global Campaign is working to increase US government funding for microbicide research. Just as the US government has provided the bulk of public funding globally for contraceptive research and development, so it must also assume the lead in underwriting microbicide research and development. The US government provides about US$25 million of the US$35 million spent globally on microbicides, only about 1% of the US AIDS research budget.
To increase the amount spent on microbicides, legislators introduced a bill --the Microbicide Development Act of 2000-- in Congress. If passed, this bill would increase federal microbicide research funding to US$50 million in financial year 2001, US$75 million in 2002 and US$100 million in 2003. This funding would be sufficient to get the first generation of microbicides through the research pipeline and into consumers' hands within the next five years. Winning congressional support for this low budget, non-controversial bill is difficult because most members of Congress have never heard of microbicides and their constituents have not raised the issue.

Mobilising demand

The Campaign is working to generate constituent demand by establishing a network of grass-roots Campaign sites in key legislative districts throughout the US. These sites educate constituents about the need for increased microbicide research funding and then assist them to communicate with their legislators about the issue. The Campaign selected its first ten sites in districts of Congress members with significant influence in the federal appropriations process.
In the first six months of this project (January - June 2000), the Campaign established sites in five of the ten target states. Relying on volunteers to staff the local sites, the Campaign looks for people who are passionate about microbicide advocacy and will commit time or pro-bono work to organise around this issue in their own regions. The Campaign approaches community-based HIV/AIDS organisations and women's health advocates and providers in target areas for volunteers.
Pairing smaller grass-roots organisations that are well-connected and trusted in their communities with larger, better-funded organisations is particularly effective. It enables the co-hosting organisations to generate a broader, more diverse list of community contacts than either could produce alone.

The Campaign reimburses local sites for pre-approved operating expenses (such as postage, photocopying and refreshments for meetings), provides educational materials ("action kits") for public distribution, and encourages sites to adapt and reprint materials for local use. A microbicide video will be distributed later this year and national Campaign staff members are guest speakers for local events. The Campaign's expectations for site activity vary widely depending on site capacity. The co-ordinator in eastern Iowa, for example, who is single-handedly running a rural HIV prevention organisation, cannot deliver the same results as the Los Angeles site co-ordinators who work in large, well-staffed agencies in an urban environment.

The Campaign asks sites to engage in the following activities, to the best of their individual abilities:

• hold local workshops and community forums;
• meet with their legislators;
• place information on microbicides in local media outlets;
• collect signatures for the Campaign's International Petition Drive; and
• develop a local contact list of individuals willing to respond quickly to Campaign Action Alerts.

Accomplishments

Although still in its first year, the Campaign is starting to see some positive results. As a direct result of the Campaign's advocacy, the National Institutes of Allergy and Infectious Diseases, a branch of the US federal government's National Institutes of Health, recently increased its microbicide research budget for fiscal year 2001 by US$7 million.
The most challenging aspect of organising the grass-roots Campaign sites is getting busy, over-committed people to take on the additional work of hosting a site. In virtually every area of the country, however, people are available who share the sense of urgency about getting safe, effective microbicides on the market as rapidly as possible.

In Europe, Asia, Africa, Latin America and elsewhere, women and men sign and circulate the Petition for Greater Investment in Microbicides and STI/HIV Prevention Alternatives for Women, raising awareness in their own communities of the need for topical microbicides. Although the Campaign may not be able to mobilise state-of-the-art treatment for the millions of people already infected with HIV worldwide, it can work to make non-condom prevention technology publicly available within the next five years by demanding adequate funding for microbicide research now.