the blob: unlikely aids hero

 By Christina Scott (mail & Guardian)

May 3, 2006: Okay, so abstinence hasn’t worked very well, featuring more in conversations than in bedrooms. Male condoms mean trusting men both to display foresight and to eat the proverbial “banana with its peel on”, while female condoms are scarce, awkward and apparently noisy. A vaccine against that quick-change-artist, the Aids virus, is science fiction -- and likely to remain that way for a long time.

Enter an unlikely hero: The Blob.

The Blob is a microbicide, a smallish dab of transparent gel, cream or lotion, which comes in narrow plastic push-tubes, miniature toothpaste-type tubes or sponges and flexible plastic vaginal rings soaked in the stuff.

Many microbicides, including a traditional herbal medicine from India, are just at the beginning stages of an exhausting marathon of tests. Others drop out along the way. The lemon and lime juice profiled in last week’s Mail & Guardian, for example, only works at concentrations so strong that it damages the lining of the vagina, thereby opening the door to the Aids virus. You’d be better off making lemonade, while waiting for scientists to isolate the active ingredient and contain it in something less destructive.

The most exciting news is that five dramatically different microbicides have passed their laboratory and animal safety trials with flying colours. They’re currently undergoing the final hurdle: effectiveness tests among tens of thousands of women volunteers across Africa and Asia, many of whom have results due two years from now.

Some of these volunteers are illiterate. Many are poor. None are ignorant, because they have to survive an intensive educational campaign on the potential risks and dangers before giving their written informed consent and being enrolled in what is quite possibly one of the largest human experiments in history.

Some are married, some are single and some are sex workers. Some use it with a condom, others without. Some have children. Others don’t. They have to give up large chunks of time in order to travel to clinics repeatedly for testing and analysis, they often have to undergo embarrassing medical examinations and discussions and they can’t be paid to do the work for fear that they might then distort the information.

All the participants are brave, because they understand that if the science is to benefit others, not all of them will get the real thing. Some will be given a placebo -- a gel that looks like the real thing and does nothing to protect them from Aids. There is no other way to make absolutely sure of the results, which are double-blinded so that no type of well-intentioned bias from staff or volunteers can manipulate the outcome.

Interestingly, many of the women who fall pregnant claim to be using condoms as well, so either the condoms are not very successful or their recollection is at fault. Either way, as a result, researchers need to test The Blob on vast numbers of women.

Researchers have learnt from previous mistakes and are getting better at conducting ethically sound research in poverty-stricken areas where government health services may be patchy and residents desperate.

Many of the microbicides sound like robots in Star Wars movies: C31G, HPTN035 and PRO2000/5. Some of the research has progressed to the point where The Blob in question has a little trademark symbol after its name, like the seaweed-based Carraguard™, whose main ingredient is a stabiliser also found in ice cream and hand lotions. Carraguard used to be known as PC-515.

The names are clunky, but the actual experiment is relatively simple: insert, have sex with your partner, remove and discard applicator. Don’t wash your private parts immediately after sex. Do not use other products, commercial or traditional. Repeat every time you have sex.

It’s painstaking, time-consuming, horrendously expensive research to conduct. “You’ve got to be mad to be doing one of these,” Professor Janet Darbyshire of the United Kingdom Medical Research Council cheerfully admitted at this week’s Microbicides 2006 conference in Cape Town. “There are so many issues!”

Dr Salim Abdool Karim, director of the Durban-based Centre for the Aids Programme of Research in South Africa, agreed. “It’s a task of madness,” he told more than 1 000 delegates at the bi-annual meeting. And he smiled.

The scientists won’t admit it on record, but they’re getting excited by the possibility that some day soon we will have an inexpensive way to prevent Aids and many other sexually transmitted viruses and bacteria. And it’s something that will work for women who haven’t been tested and don’t want to know their HIV status. Prevention, for the disease with no cure, may soon be on the shelves next to the Sunlight soap and the Tampax.

Both the researchers and their volunteers persist in this crazy, Herculean task for a good reason.

“Women are falling in love,” said Symon Wandiembe of the Uganda Research Unit on Aids. “They are falling in love with microbicides. We should not let this love fail.”