TREATMENT REVIEW 32 - 33 - Fall/Winter 2000

Nearly 1,000 HIV-negative women in several sites in Africa enrolled in a study to see if using condoms and a vaginal gel called nonoxyl-9 or N-9 (known as Advantage-S in the United States) would prevent HIV transmission during sexual intercourse. All the women who participated in this study were commercial sex workers. N-9 is an approved spermicide designed to help prevent pregnancy. It was hoped that this gel would also prevent the transmission of some sexually transmitted diseases, including HIV. According to the Centers for Disease Control and Prevention (CDC), the N-9 gel definitely does NOT prevent HIV transmission. Using the N-9 during anal or vaginal intercourse may actually increase the chances that HIV will be transmitted. Some brands of lubricated condoms contain N-9. Condom use is still strongly recommended as a way to prevent HIV transmission, although condoms that have N-9 should be avoided.

All women in the study were asked to use condoms every time they had sexual intercourse. In addition, half of the women were asked to use a vaginal gel that contained N-9. The other half of the study participants were given a placebo - gel that did not contain N-9. Women who used the N-9 gel became infected with HIV at a 50% higher rate than women who used the placebo gel. The more frequently women used the N-9 gel, the greater their chance of becoming infected.

The CDC states that using N-9 is NOT an effective way to prevent HIV transmission. Although using a condom that has N-9 is still much better than not using a condom at all during anal or vaginal intercourse, the N-9 does not offer any additional protection against HIV. The CDC also states that, "this study suggests that the use of N-9 for HIV prevention may be harmful." As this issue of Treatment Review went to press, the manufacturer of Wet Lube lubricants announced that they were removing nonoxyl-9 from all of their products.