In the market there are four non-hormonal, female-initiated methods of contraception: the diaphragm, the sponge, the female condom, and the cervical cap. These represent about 2% of the targeted population or 9.6 million women worldwide using these products. There are currently no contraceptive products available that provide contraception and prevent HIV infection except for condoms (male and female), and none offering protection from transmission of STDs, including HIV, via vaginally administered drugs.
In 2007 the World Health Organization (WHO) reported that over 340 million new cases of STDs occurred with 50% of these in women. There are currently 33 million people living with HIV/AIDS with 2.7 million new cases per year, over 50% of whom are women. The key priority of international health agencies is to find an effective microbicide to control the sexual transmission of HIV/AIDS and a female-controlled mechanism for the delivery of the microbicides that at the same time is an effective contraceptive. The 8th, 9th, and 10th International AIDS Conferences have introduced the idea of cervical caps to prevent AIDS transmission from men to women and caps have been used as contraceptives for many years.
The HIV preventive market in conjunction with the contraceptive market offers an important opportunity. This market will expand dramatically with the approval of vaginal antiretroviral drugs (ARTs) for HIV prevention. The real market opportunity focuses attention on the over 500 million women in developing countries at risk for HIV/AIDS as well as unintended pregnancies.
Momentum is building. The US National Institutes of Health, US Agency for International Development, the Ministry of Health of China and other public and private donors are currently supporting efforts to advance multipurpose prevention strategies, including preclinical research, effectiveness trials and pre- and post introduction studies on a range of potential multipurpose prevention products, both coitally dependent and longer acting.
“Globally, failure to provide women with high-quality sexual and reproductive health information and services, combined with factors that prevent them from negotiating protection from HIV or other sexually transmitted infections, unwanted pregnancies, and unwanted sex, are the leading causes of death and disease in women of reproductive age” (Germain and Dixon-Mueller. Lancet May 2010). The contribution of unwanted pregnancy to female mortality worldwide, along with the devastating consequences of the HIV epidemic to women of reproductive age, urges a convergence in pregnancy and HIV prevention. A multipurpose technology that allows for a self-administered, discreet method of contraception that limits systemic exposure to hormonal contraceptives, allows ongoing ovulation, reduces the risk of HIV acquisition without systemic exposure to antiretrovirals, and could be translated quickly into an approved product, will meet a great and growing demand globally.