Microbicides: Not a Silver Bullet

In Thailand, as in many parts of the world, socio-cultural and economic factors weigh heavily on women's ability to negotiate for safe sex.

"In Thailand, the persistence of patriarchal norms has resulted in women's lack of autonomy and increased risk to HIV/AIDS infection," reports United Nation's Population Fund (UNFPA) "Women have been socialized into passivity and taking a non-initiating role, acquiescing only to male demands."

Current prevention methods, such as condoms, tip the power balance heavily in favour of men when it comes to negotiating for safe sex. Consequently, there has been a growing need in recent years to develop tools that women can control to protect themselves from diseases.

Because microbicides can be used without a male partner's knowledge or consent, they have been proffered as a potential solution that could empower women to control their reproductive and sexual health.

However, microbicides—currently beset by trial failures that have lead to the cancellation of clinical trials in Benin, India, Nigeria, South Africa, and Uganda—are certainly not a magic bullet to protecting women against diseases.

"Microbicides are just an option—not a goal," said Ms. Thalaengkit, a representative of the Thai HIV/AIDS Women Taskforce (TAWT).

For microbicides to work effectively for women, issues such as accessibility, the subordinate status of women, and cultural and gender dynamics that define sex and sexuality will have to be addressed.

"Ultimately, history tells us that vaginas never belong to women as they have never had genuine power to decide on sexual matters and about their own bodies," said Ms. Kanchana Thalaengkit.

So, unless the fundamental inequalities between men and women are addressed, the microbicides will not be an effective barrier to HIV-infection for women. Women need to be empowered to see that they own their bodies and can therefore define their own sexual behaviour.

"Even though microbicides can be an effective tool, we cannot simply look at it just from the medical perspective. There's a social process too. We need to bear in mind the levels of management of sexual relationships by women", said Ms. Thalaengkit.

She also noted that it was critical to ensure right at the outset of clinical trials that women were interested in utilizing microbicides.

"Take for example, the female condom. Most women dislike using it not to mention it is expensive and not easily accessible. We have learned lessons from female condoms—they have been produced but women are not able to use them because of the limited power to negotiate and to assert their sexuality," said Ms. Thalaengkit.

So, unless the fundamental inequalities that exist between men and women are addressed, the introduction of new tools will not do much in turning the tide of infection of women. Also, society needs to be more sensitive to the sexual and reproductive health needs of women through ensuring affordability and accessibility of SRH products.

"The emphasis of microbicide trials should be placed on the management of power relationships between women and men. Microbicides will become meaningless should women still have no power to decide on their own sexual matters" said Ms. Thalaengkit.

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