Lori Heise is Director of the Global Campaign for Microbicides.

Talk of microbicides was the pulse of the 2006 International AIDS conference in Toronto, Canada. Microbicides moved from the sidelines to center stage, a paradigm shift of bold proportions. All who have worked hard to articulate the need for user-controlled prevention should feel proud and savor this moment. Congratulations!

Reaching this tipping point also means that we now need to adjust our messages. For the past fifteen years, the microbicide movement has focused on building the enthusiasm and momentum necessary to gain the attention, respect, and commitment of world leaders. If we are concerned about the long term success of our enterprise, however, we must help individuals develop realistic expectations regarding this new technology. As advocates with advanced knowledge and training in the field, we have a critical role to play in shaping future discourse.

Our messages need to communicate clearly that microbicides will not be a magic bullet. The idea of a technological panacea is seductive and one we must discourage. Microbicides are a technology that cannot possibly make an impact without a simultaneous investment in access and women's empowerment. As advocates we are responsible for keeping this larger agenda in focus.

We must also focus attention on the inexcusable gap in access to EXISTING prevention tools: male and female condoms, harm reduction programs, etc. It is a travesty that less than 5 percent of women have access to the PMTCT (Preventing Mother To Child Transmission) services. Our commitment to widespread and timely access to microbicides will ring hollow unless we demonstrate our ability to deliver on the products that already exist.

We need to firmly establish a realistic picture of microbicides as one tool that can help stem the increase of HIV incidence among women – but only if we, collectively, work to assure social environments in which women can access and use them. This means working to empower women in their intimate relationships, addressing violence against women and expanding their economic opportunities. It also means working with men. We also have to encourage the media and advocates at all levels to be realistic about the complex nature of drug development. Public discussion of microbicides must be sensitive to the desperation and powerlessness that many women feel in the face of their current HIV risk and their lack of ability to protect themselves. In this environment, it is irresponsible and potentially exploitive to be overly optimistic about the characteristics and likely availability of microbicides.

What then are realistic, but inspiring, messages we can use to describe the potential for microbicides? And what other information must we incorporate in our advocacy and media work to help the wider public understand the realities of drug development?

Fact sheet #19: Managing Expectations Around Microbicides, contains several key messages that you can use to express clear and realistic expectations about microbicide in advocacy and outreach regarding:

• Timing of microbicide availability
• General drug development
• Nature of clinical trials
• Likely microbicide effectiveness
• Cost of a microbicide
• Attributes of a microbicide
• Current efforts to overcome barriers to making microbicides accessible.

The Toronto AIDS conference will always be remembered as a watershed event for microbicides. Let us celebrate our success, re-double our energy, and be thoughtful as we move forward in this new era.