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The editorial by Professor Kotwal (January 2004 JRSM1) provides a very welcome commentary on South Africa's improved approach to HIV/AIDS. I am surprised, however, that he makes no mention of the potential role of vaginal microbicides in curbing the epidemic. These products are in an advanced stage of development and, like AIDS vaccines, are the subject of clinical trials taking place in several countries, including South Africa. Microbicides are gels containing selected anti-infective agents, for women to insert before sexual intercourse in order to protect themselves and their partners from HIV and other sexually transmitted infections.2 Some 20 microbicides have been successfully tested in human safety studies and several of them are scheduled to begin large-scale field trials this year to find out how well they protect women at high risk of HIV, with the results expected some 3 years later. Unlike condoms, they do not create a physical barrier to reduce sexual pleasure, and—crucially—they are controlled by the woman and will thus make a vital contribution to enhancing women's empowerment.
Microbicides are not intended to replace other vital prevention measures such as those based on health education messages, male and female condoms—or AIDS vaccines when they become available—but will give people a wider choice of potentially life-saving methods of protection.