Microbicides 2000: report of an international conference, 13-16 March, Washington DC.

'Microbicide' is the name for a number of new products currently under research which could become a new class of barrier method for use in the vagina and rectum for protection against HIV, prevention and/or treatment of other sexually transmitted diseases and/or act as a contraceptive. This is a summary report of this scientific conference, at which basic science, clinical trial efficacy and design, and ethical, behavioural and public health issues were on the agenda. There are many potential products but few have yet got beyond Phase I clinical trials. There is not likely to be an approved and available product for 5-10 years at best; finding a balance of low toxicity with high efficacy is the major challenge, given how rapidly HIV infection actually infects tissue. Phase III clinical trials of these products require new protocols and procedures. It was urged by many, and underscored by HIV positive women who were present that clinical trials must be treated as an opportunity to promote a total prevention package--STD treatment, voluntary HIV testing and counselling, condom use, practising safer sex--plus microbicides and contraception. Identifying effective products and making them available as soon as possible were obviously also a priority. How to do this--ethically and scientifically--were the main subject of the meeting.