BRISBANE, AUSTRALIA – Multipurpose technologies such as vaginal rings, gels, and new types of diaphragms have the potential to address a gap in products that can prevent both unwanted pregnancy and sexually transmitted infections.
The emerging pipeline of new multipurpose technologies could deliver significant public health benefits, particularly to women, Dr. Vivian Black said at the World STI & HIV Congress 2015.
Dr. Vivian Black
“We know that each year there are over 74 million unintended pregnancies, and 36 million of these end up in abortions, many of which are conducted in unsafe environments,” said Dr. Black, director for clinical programs at the Wits Reproductive Health and HIV Institute in Johannesburg, South Africa. “Against this backdrop, we also are very aware of the HIV epidemic and how that impacts, particularly on women in the same resource-poor environments and in particular in the African region.”
Multipurpose technologies – which are generally initiated by women – can help address situations of power imbalance within relationships and sexual inequality that mean women may struggle to negotiate effective use of condoms.
One such multipurpose technology is the one-size-fits-all SILCS diaphragm, which is made of silicone and is sold under the brand name Caya diaphragm. The device has been approved for use in more than 20 countries and was granted market clearance by the Food and Drug Administration in 2014.
“End users have given feedback that it’s a comfortable product to use. Male partners find that it doesn’t impact on sexual experience, although some even claimed it might improve their sexual experience, which is a good outcome,” Dr. Black said.
The diaphragm can be combined with a topical contraceptive, and there is the potential to use it with a topical microbicide and other preventive agents.
Vaginal gels are another example of multipurpose technologies. A 1% tenofovir gel to prevent HIV and herpes simplex virus infection is currently in phase III trials, while phase I trials are being conducted to explore the impact of a gel combining nonnucleoside reverse transcriptase inhibitor MIV-150, zinc acetate, and carrageenan, Dr. Black said.
Several multipurpose vaginal rings are also in development, containing sustained-release formulations of contraceptive agents such as levonorgesterel in combination with an anti-infective agent such as tenofovir, or combining anti-infective agents to prevent both HIV and other STIs.
Work is also ongoing in the area of vaccine development.
“Currently we have very effective vaccines for human papillomavirus and hepatitis B, but we hope that in 20 years or so we might have a single vaccine that we could give that would prevent a whole host of STIs including HIV, gonorrhea, chlamydia, trichomoniasis, and herpes simplex virus,” Dr. Black said.
In the United States, the focus of multipurpose technologies has been less on HIV prevention and more on the prevention of unwanted pregnancies and STIs, Dr. Black said. But she stressed that the marketing of multipurpose technologies must be done carefully to avoid “tarnishing” their image by associating them with STI or HIV prevention.
“I think that’s a very important thing that when it comes to marketing, it’s not about STI prevention but about enhancing intimacy and things like that,” Dr. Black said in an interview. “The nice thing about multipurpose technologies is you can also switch use, so if, for example, you’ve got a woman whose partner is maybe unfaithful or [she] is not able to negotiate condom usage, she can use a product for contraception and vice versa.”
Dr. Black reported having no relevant financial disclosures.