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Our host country: Female Condoms and Microbicides in

India

Paramita Kundu

Global Campaign for Microbicides

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Some Statistics

• 40% of the 2.5 million people living with HIV/AIDS in India are women (NACO, 2006) • A concentrated epidemic: Prevalence among general population : 0.36% Prevalence among FSW : 5.38% Prevalence among MSM : 5.69 % Source: NACO,2006

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Setting the Scene: India and New Health Technologies

• Participation in international and national HIV/SRH technologies clinical trials.

• Strong capacity for manufacturing new technologies.

• Long gap between development and access

• Influential NGO networks that could be allies in accelerating access to new technologies.

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Why has Civil Society in India Been Concerned?

• India a “hot spot” for research

• Past unethical research practices- especially around reproduction

• Legacy of population control ideology and contraceptive R&D

• Suspicion of “magic bullet” solutions

• Historically has played the watchdog role to protect the rights and interests of communities

• Well-honed skills in protest politics & public interest litigation

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What have Been Some of the successful advocacy campaigns?

• 1999-2000: Campaign against unethical introduction of Depo Provera and NET-EN in National Family Planning Programme by women’s groups

• 2002-2007: Access to affordable AIDS treatment advocacy campaign by HIV/AIDS groups

• 2003 onwards: Development of the HIV/AIDS draft bill was a collaborative effort of a wide range of stakeholders including civil society

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Advocates’ Voices

“Women in India and worldwide are still left out of equation. The issueof trust and violence against women increases their vulnerability toHIV/AIDS. Look at the current tools for women’s protection. Usageof condoms is in men’s hands and women lack the power to take thiswith their primary partners. I wish we could have a product likemicrobicides yesterday in the hands of women” (A leading HIV/AIDSactivist, India)

“Why a choice in contraception alone? Why shouldn’t women be givenchoices in employment, education, access to health care and at the most tohave equal rights as men in the family or society or to not be killed in thewomb?” (unveiled realities, SAMA,1999)

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FEMALE CONDOMS

FC Female Condom®

• Only female condom

approved by USFDA

• Acceptable to women

and men

• Main limitations related

to cost and usability

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Female Condoms in India : the beginning

• Available world wide since early 1990s

• Introduction of FC female condom in India in 2001

• Acceptability studies in Andhra Pradesh, Kerala and Maharashtra

• Operations research study in West Bengal and Gujarat

• Pre programme assessment through 61 NGOs in 8 states for FSW population under NACP3 and in 2 states for general population under RCH2

• FC 2 manufacturing facility in Kochi as a Joint Venture between Female Health Company and Hindustan Latex Limited

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Advocacy Successes

• 450,000 of the 500,000 FCs distributed to NGOs in various states for pre programme assessment

• Consistency in repeat purchase reported by 40-60% of sex workers

• 100% use of 100,000 FCs procured by FSWs in Andhra Pradesh and Operations Research studies

• Piloting through NACP III

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Advocacy challenges

• Long drawn process: FC not even in consideration in NACP I and most of NACP II

• High price remained a barrier for a long time

• Initial pilot among female sex workers associated FC with sex work

• Initially no available user experiences

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MICROBICIDES

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The Genesis of Microbicides

“ The whole notion of microbicides was articulated by women, rural women, urban women, people all over the world way before it sparked the imagination of scientists…and it was women saying look, we need this and we want you to work on this, really mobilizing and galvanizing the community”

Lori Heise, Global Campaign for Microbicides

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Microbicides research in India

Phase 3

Product Status No of trials Research institution

Cellulose Sulfate Discontinued 1 YRG Care,Chennai St Johns, Bangalore

Phase 2

Praneem completed 1 NARI, Pune

Tenofovir 1% completed 1 NARI, Pune

Phase 1

Cellulose Sulfate Completed 1

N-9, Today pessary

Completed 1 NARI, Pune

BufferGel Completed 1 NARI, Pune

Praneem Completed 1 NARI, Pune

Praneem Completed 1 PGI, Chandigarh

PRO 2000/5 Completed 1 NARI, Pune

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Microbicides research in India

• Preclinical research of products like NIM 76,Basant,NISIN,Maganin A, Haemolymph of Indian crab

• Currently there are no phase 3 trials in India because of less than expected HIV incidence to conduct such research

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Microbicides advocacy : India

• 2000: Raising awareness to civil society by international advocacy groups like Global Campaign for Microbicides (GCM) in collaboration with local groups like Indian network of NGOs (INN)

• 2002: Community stakeholders meeting

• 2003: National policy meeting

• 2003: Formation of the National Working Group

2003-2007:More engagement with civil society: Women’s groups, gay rights groups and HIV/AIDS groups.

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Advocacy successes

• Increasing visibility of microbicides

• Successful collaborations with key local groups

• Steps towards bringing together civil society and researchers

• Microbicides 2008 has provided an excellent opportunity to strengthen relationships with civil society and build relationships at policy level with National AIDS Control Organization

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Advocacy challenges

• Not perceived as a priority; other competing priorities

• Not perceived as a rights issue

• Technology not yet available

• Not enough awareness among SRH groups

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Lessons learnt Lessons from female condoms

Lessons for microbicides

Capacity building is pivotal to FC acceptance

Education on use will be key – start now!

Outreach by Peers sustains use

in difficult settings

Peer outreach could be a successful strategy in introducing microbicdes

Community involvement is a key to successful programmatic strategies

Community involvement is and will continue to be important

FC was expensive Examine pricing strategies now

Social marketing has been effective

Social marketing could be effective in increasing access and use of microbicides