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Query: UMLS:C0019693 (HIV)
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A study in Boston, Massachusetts, and another study in New York City examined samples of pre ejaculate fluid from HIV seropositive and HIV seronegative men to determine whether HIV was or was not present in pre ejaculate fluid. The researchers found macrophages and CD4 lymphocytes in most samples, indicating that HIV was present. The more significant finding, however, was that most pre ejaculate samples did not contain any sperm and those that did had only small clumps of a very small amount of sperm which seemed to be immobile. A larger study is needed to verify these results. If these results are confirmed, they may dispel the myth that pre ejaculate fluid contains sperm. An ongoing WHO/USAID study shows that the pregnancy rate caused by men with 3 million sperm/ml/ejaculation is very low; fertility clinics consider men with a sperm count of no more than 5 million/ml to be infertile, particularly if is there is low motility. The average ejaculation has about 100 million sperm/ml, but about 10 million sperm pass through the cervical mucus, about 1 million make it to the top of the uterine tract, and just about 100,000 sperm reach the fallopian tubes. Thus, only a couple of sperm, assuming motility, would reach the fallopian tubes in the case of the pre ejaculate samples with some sperm, which tended to be immobile (sperm levels only in the 1000s). Thus, the probability of pregnancy is very low if pre-ejaculate fluid enters the vagina. Pre-ejaculate fluid of 6 of the 9 HIV seropositive donors in Boston and 6 of the 14 HIV seropositive donors in New York contained HIV, regardless of symptom status or antiretroviral therapy status. Thus, the risk of HIV transmission may be higher than unplanned pregnancy, so people should use condoms before the penis enters the vagina, mouth, or anus.
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PMID:Researchers find no sperm in pre-ejaculate fluid. 1228 5

The World Health Organization's Global Program on AIDS's (GPA) Chief of clinical research and development reports on the rationale and recommendations of an international meeting in which the GPA called for the urgent development of antimicrobial products capable of preventing HIV infection when inserted in the vagina. The meeting took place in Geneva, November 11-13, 1993. It was attended by more than 70 people and organizations including scientists, drug company representatives, research funding agencies, drug regulatory authorities, nongovernmental organizations, and women's health advocacy groups which reviewed data on barrier methods against the sexual transmission of HIV and laid out the necessary steps to develop the microbicides. Participants at the meeting recommended studying the safety and efficacy of existing spermicides with antimicrobial activity in preventing HIV transmission; developing new products for intravaginal use capable of preventing the sexual transmission of HIV; researching nonirritating compounds; conducting animal studies; launching phase I-III clinical trials; fostering collaboration in research and other activities; and continuing to promote condom use as central to the prevention of HIV and other STDs.
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PMID:Experts call for urgent development of microbicides. 1228 35

FEMIDOM is a polyurethane sheath approximately 17 cm long manufactured by the Chartex company in the United Kingdom for intravaginal application as a device to protect against unwanted pregnancy and the transmission of sexually transmitted diseases. Its effectiveness can be favorably compared with that of the male condom. Unlike traditional erection-dependent, penis-applied condoms, FEMIDOM may be inserted into the vagina by the woman prior to coitus with or without the knowledge and cooperation of the male sex partner. FEMIDOM is therefore a device which allows women to protect themselves against sexually transmitted diseases. Described as successful by Dr. Elizabeth Musaba of the University Teaching Hospital, it is being given freely to HIV-discordant couples. Many couples have reported their satisfaction with the method. At about US$3 each, however, FEMIDOMs are far more expensive than traditional condoms. Some women have also complained that FEMIDOM is ugly, messy, hard to insert, unfamiliar, and too big. Men had mixed feelings about them. Dr. Musaba, however, counters that the device has been carefully designed to fit women of all ages and sizes. Users of FEMIDOM simply must grow accustomed to the method. She also notes that FEMIDOM conforms to the body temperature of the user, and that used devices should be burned or buried instead of flushed in waterborne toilets; the sewage system may become obstructed. Finally, since each FEMIDOM may be used only once, researchers are investigating the feasibility of cleaning them for reuse.
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PMID:Femidom -- a woman's condom. 1228 81

In 1993, the US Food and Drug Administration (FDA) approved the female condom Reality. It provides better protection against sexually transmitted diseases (STDs) than does the male condom. The polyurethane sheath is more resistant to tears and covers the vagina, cervix, and vulva. Since it does not depend on erection of the penis, the female condom protects women from STDs/HIV that can be transmitted through the pre-ejaculate. In light of the AIDS epidemic, FDA approved the female condom based on its contraceptive effectiveness rather than on its ability to protect against STDs. Annual contraceptive failure rates for Reality range 5-21%, which match those of other barrier methods for women and men. Incorrect or inconsistent use affects its contraceptive effectiveness. The female condom prevents passage of virus particles as small as the hepatitis B virus which is smaller than HIV. In a study, all women who correctly and consistently used Reality were protected from Trichomonas vaginalis, while sporadic users were not protected. Currently, less than 20% of US couples use male condoms, indicating a need for women to have options to protect their reproductive and genital health. The female condom provides women such an option since women are in total control of its use. Women with partners who do not want to use a male condom maintain that Reality will revolutionize sexual dynamics. Its visibility does not help women with violent partners, however. Educational efforts about all methods that can be used without men's knowledge need to reach these women. Family planning providers need to shed the old concept of women as incompetent users and set up counseling programs that promote women's methods. They should accept and provide the female condom. Basic sexual education and constant provider support and encouragement are crucial.
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PMID:The female condom: STD protection in the hands of women. 1228 50

In January 1994, a clinical trial was launched in Amsterdam, Antwerp, and Bangkok to study the side effects of 2 weeks of daily use of Nonoxynol-9. A total of 300 women will be examined for scars and other damage caused by the Nonoxynol to the vaginal linings. Nonoxynol is known to kill sperm, and it was found to kill HIV in vitro in 1985. The World Health Organization (WHO) intends to develop Nonoxynol as a vaginal microbicide for women's protection against infection with HIV during vaginal penetration. The WHO has charged three university hospitals with the study of the effects to the vagina of a daily dose of 50mc to ascertain if Nonoxynol is worth developing as a microbicide. In the Netherlands, nonpregnant women aged 18-45 were solicited to participate. They were told to continue using their regular contraceptive. However, nobody mentioned the possibility that these women could be at risk of contracting HIV, as only one of them claimed to use condoms consistently. Questions remain unanswered as to the use and development of vaginal microbicides. The method is meant to increase women's autonomy in the prevention of HIV infection and empower them regarding their sexuality. It is doubtful whether the method's availability, cost, and resistance to heat and humidity have been considered. The WHO insists the vaginal microbicides are not meant to replace condoms, but it is certain at this moment that women are again targeted in the battle against the spread of AIDS.
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PMID:Study of side-effects of vaginal microbicide. 1228 99

Between May 1993 and August 1994, only family planning and sexually transmitted disease (STD) clinics had the female condom available. The manufacturer is using a print and educational campaign to market the female condom. The print campaigns provide a toll-free number for consumers and health care providers. The educational component consists of community outreach programs for public health, family planning clinics, and university health centers. The single-use soft polyurethane sheath has a flexible ring at the closed end, which is used to insert the condom and holds it over the cervix. A flexible ring is at the outer end; it holds the condom over the labia. The female condom is prelubricated and comes with a bottle of lubricant. Adding extra lubricant on the penis or the inside of the condom can prevent invagination of the outer ring, the penis entering the vagina instead of the condom, or the condom riding the penis. The 1-year failure rate is 25% for average use and 5.1% for perfect use. Correct and consistent use determines the female condom's ability to protect against STDs and HIV. The female condom helps women protect themselves against pregnancy and STDs/HIV when their male partner refuses to use a latex condom. Since it is visible outside the vagina, some women might still find it difficult to negotiate its use. Drawbacks of the female condom are that it is cumbersome and challenges our traditional gender roles and ideas about sexuality. Education addressing how women feel about themselves, their sexuality, and their relationships is needed to increase female condom use and acceptance. Some couples prefer the female condom over the male condom because it is roomier and because the polyurethane creates a better sensation than latex.
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PMID:Female condom becomes available nationwide. 1228 70

It is estimated that 70% of the 3000 women who are infected with HIV each day are 15-24 years old. This pattern of increased prevalence among young women has been noted since a 1986 report that AIDS cases in Zaire were equally divided among men and women, but that the women were an average of 10 years younger than the men, and cases in women peaked at age 20-29. Despite this information, the HIV research and program agenda has failed to address the gender issues that place young women at risk of infection. Societies that do not provide young women with information about reproductive anatomy and sex or with reproductive health services, that allow men to have multiple sex partners, and that condone condom use only for illicit intercourse, leave young girls and women at risk of forced and unprotected sexual intercourse. Studies have also shown that early marriage practices also increase the risk of women becoming infected (usually by their older and more "experienced" husbands). In some parts of Africa, older men seek out virgins in the belief that having sex with a virgin will cure them of sexually transmitted diseases. Poverty also drives women to barter sex for money or goods. In addition to these social and behavioral risk factors, young women appear to have a greater physiological susceptibility to infection than more mature women. Possible factors for this increased risk include the facts that, in younger women, the lining of the vagina is thinner, vaginal mucus may be less profuse, ovulation (which seems to have a protective effect against infection) is infrequent, and a transition zone of cells ringing the cervical opening is more exposed. Thus, biologic, social, and behavioral factors increase the vulnerability of young women. To protect young women, societies will have to change cultural and sexual norms, values, and practices.
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PMID:Young women most vulnerable to HIV infection. 1228 34

The polyurethane female condom is stronger than the latex male condom. Thus, the single-use female condom is less likely to break and has a longer shelf life than the single-use male condom. The ring at the closed end of the condom helps women insert the condom and secures the condom inside the vagina. The outer ring remains outside the vagina and protects the labia and the base of the penis. Female condom use reduces the likelihood of transmission of infectious diseases. The female condom is as effective at preventing pregnancy as the male condom and the diaphragm. Its life-table pregnancy rate in a multicenter clinical trial in the US and Latin America was 15.1% (12.4% in US and 22.% in Latin America). The 6-month failure rate during perfect use was 4.3%. In laboratory studies, no sexually transmitted organism, including HIV, penetrated the female condom. In a human use study, 14% of controls and 14.7% of non-perfect users were reinfected with trichomonas while none of the perfect users were reinfected. Advantages of the female condom follow: allows for greater sensitivity and greater protection than the male condom, is controlled by the female, can be used with any lubricant (even oil-based lubricants), and can be inserted well before intercourse. Disadvantages include cost (5 times costlier than the male condom), unsightly coverage of female genitalia, noisy during use, and breakage (although breakage rates were lower than for latex condoms: 1% vs. 2-5%). Method acceptability studies among various populations show that the inner rings and movement of the female condom during use were the most common complaints. Many women liked the female condom and would recommend it to others. Only a few women complained about insertion problems, yet it took some women at least two tries to insert the female condom.
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PMID:The female condom: controlled by women. 1229 Apr 68

Frequently asked questions about the female condom include questions about its effectiveness as a contraceptive, which is as high as the other barrier methods and can approach 95% with perfect use. Its effectiveness in preventing transmission of sexually transmitted diseases and HIV infection is speculative but promising because the condom material is impermeable to the causative agents. The female condom is safe to use except by people who are sensitive to polyurethane or silicone. The condom is made in one size and has a closed inner ring and an open outer ring (which remains outside of the vagina during use). The condoms are prelubricated, and additional water-based lubrication can be used. The accepted shelf life of the female condom in the US is two years, but this may be extended. The female condom is impervious to normal changes in temperature, altitude, and humidity; however, it can be ripped by a sharp object such as a fingernail or jewelry. The female condom can be used with other nonbarrier methods but should not be used in conjunction with a male condom or in the presence of a tampon. Pregnant or menstruating women and women of any age can safely use the device, and it can be inserted several hours prior to use. Studies have shown that many women like the device and would recommend it to others.
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PMID:The female condom: frequently asked questions. 1229 Apr 69

Female genital mutilation (FGM) refers to a traditional practice involving the excision of external female genitalia. Taking place in several regions in Africa and practiced in 25 countries, FGM has serious adverse consequences upon women's health. FGM is often conducted upon young girls under unsanitary conditions and with only the most basic surgical tools. Death can result from hemorrhage and infection. Once the girl who has undergone FGM develops into a woman and begins to conceive and bear children, the almost fully closed vaginal opening impedes the natural flow of fluids from the vagina and bladder, making childbirth particularly difficult. Moreover, women who have undergone FGM are at increased risk of contracting HIV. The World Health Organization estimates that up to 80 million women and children undergo FGM. FGM has received growing attention in recent years, with action being taken at the national and international levels by governments and nongovernmental organizations to eradicate the practice. AIDoS has been involved in FGM eradication efforts for the past several years, expanding its involvement in 1990/91 in the campaign to eradicate FGM in Africa. The campaign to eradicate FGM in Africa and the Inter-African Committee are discussed,
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PMID:The eradication of female genital mutilation. 1229 88


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