Statements on Introduced Bills and Joint Resolutions - S. 859

STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

Mr. DURBIN. Mr. President, I am honored to be a cosponsor of the Microbicides Development Act of 2003. The legislation calls for a redoubling of the effort at the National Institutes of Health and the Centers for Disease Control to develop microbicides, a class of products that can prevent transmission of HIV and other sexually transmitted diseases in women and their partners.

As this Congress continues to fight AIDS, taking tiny steps in pursuit of a challenge racing away from us, I see the development of microbicides as another "tiny" step forward. I believe microbicides are an important addition to the arsenal to fighting AIDS, and indeed the Global AIDS bill I introduced, The Global CARE Act of 2003, S. 250, includes microbicides among the preventative measures the U.S. should support.

I, and the other cosponsors of this important legislation, see a real need and urgency to expand the range of preventive interventions for HIV transmission. The ABC options for preventing HIV infection, which remain a key part of our response and contribute to the world's ability to slow the spread of HIV/AIDS, have not changed since the 1980s: A, abstinence when it comes to sexual activity; B, be faithful to one partner; C, if you are going to ignore the other two, use a condom. Despite the effectiveness of the ABCs in many areas, HIV/AIDS continues to spread. We urgently need more
prevention options.

Microbicides, defined as antimicrobial products that can be applied topically for the prevention of sexually transmitted diseases, STDs, including HIV, may offer one of the most promising preventive interventions. They could prove to be safe, effective, inexpensive, readily available, and widely acceptable. Microbicides will add to the range of options available. Most importantly, microbicides offer an additional method of prevention that can be controlled by women.

Notwithstanding the knowledge of successful HIV prevention strategies—condom use, reduction in the number of sexual partners, diagnosis and treatment of sexually transmitted infections—HIV continues to spread at an alarming rate especially among women in developing countries.

In sub-Saharan Africa, the area hardest hit by the pandemic, women and girls account for 58 percent of those living with AIDS. Worldwide, women represent 50 percent of those infected, an increase of 9 percent in five years. In some of the hardest hit countries in southern Saharan Africa, HIV prevalence among girls aged 15 to 19 is four to seven times higher than among boys their age. Attitudes, beliefs, and taboos surrounding sex, the status of women and children, and the source and causes of AIDS also complicate attempts to control transmission and provide appropriate prevention and treatment.

In the United States, more than 30 percent of newly reported HIV cases diagnosed are occurring in women, according to the most recent data collected by the Centers of Disease Control. As in the rest of the world, the majority of these reported HIV infections among U.S. women result from heterosexual transmission, and the data suggest that younger women are disproportionately at risk for acquiring HIV.

Microbicides will be particularly attractive to those who do not wish to draw attention to the fact that they are using a prevention method. Unlike male or female condoms, microbicides are a potential preventive option that women can easily control and that does not require the cooperation, consent or even knowledge of the partner. Microbicides are likely to be cheaper than condoms and, in the future, microbicides could be used to prevent mother-to-child transmission of HIV.

Microbicides have been under development for more than a decade. Yet, it is unlikely that they will be available before 2007, which leads to the general perception that there has been insufficient progress in this area. Three versions are currently in the final stages of clinical trials to determine whether they are safe and effective. Many factors contribute to this slow progress. The National Institutes of Health, NIH, reports that microbicide research requires huge and complex efficacy and effectiveness studies that must be conducted in areas with high HIV incidence rates. Such rates occur predominantly in developing countries where the research infrastructure is underdeveloped. Given this dependency on poorer, developing nations, it is not surprising that no large pharmaceutical company is interested in funding microbicide development. A second obstacle lies in the ethical obligation to provide counseling and make condoms available to the study subjects, which adds to the complexity and size of the trials. As a result, NIH explains, few Phase III efficacy trials have been completed.

Of those completed, few have yielded promising results.

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Reflecting on the reality of the global epidemic, United Nations Secretary General Kofi Annan stated that the face of the HIV epidemic is that of a woman. "If you want to save Africa," Annan says, "you must save the African woman first. It is they who care for the young, the old, the sick and the dying. It is they who nurture social networks that help societies share burdens."

Lack of access to treatment and care means that for the majority of HIV-positive women throughout the world, HIV infection is a death sentence. In Haiti, for example, AIDS is now the leading cause of death for women of childbearing age.

Microbicides will never become a viable option for prevention unless a serious amount of money is invested in their development. Senator Corzine's legislation will make microbicide research a priority, calling for the expansion and coordination of microbicide activities at the National Institutes of Health and other agencies working in this field. The bill requires the Centers for Disease Control to implement a 5-year topical research plan and requires the U.S. Agency for International Development to develop and implement a microbicide agenda.

I am proud to join Senator Corzine as a cosponsor of this legislation and hope that my colleagues will join us as we determine the next steps in our battle against AIDS, including the development of prevention efforts that may help women take control of their lives and their survival.