Important note: Information in this article was accurate in 2001. The state of the art may have changed since the publication date.
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Bay Area Reporter - February 2, 2001
Ed Walsh
"Studies have indicated that N-9 is not an effective tool in preventing the transmission of HIV," the letter said. "In addition there is some evidence that suggests that N-9 may increase the risk of HIV transmission during anal sex. While further research is indicated and is under way, we believe the prudent course of action is to reduce this risk.
"The consistent and correct use of condoms is an important tool in the prevention of HIV infection. If the only condom available has N-9, clients should be encouraged to use it. The protection provided by a condom against HIV far outweighs the risk of N-9. However, if given a choice, condoms without N-9 are the better option for HIV prevention."
The letter referred all questions about the new policy to Steven Tierney, DPH's director of HIV prevention.
Tierney told the Bay Area Reporter that DPH currently spends about $400,000 each year on condoms and lubricants. He said his department supplies the products to a number of organizations, including the Stop AIDS Project.
When asked how he would respond to those who may be critical of DPH for not nixing N-9 sooner, Tierney said his department makes decisions based on available science and with community input.
"We had a community meeting a couple of months ago and people were concerned from what we've been hearing about from the studies," said Tierney. "When a couple of more studies recently came out, it just seemed the time to take the safest possible approach."
The most widely publicized study on N-9 was presented to the International AIDS Conference in South Africa last summer. It found that women who used lubricants with N-9 contracted HIV at a rate 50 percent higher than those who used lubricants without the spermicide. The study was based on 1,000 prostitutes from several parts of Africa. That report prompted the Centers of Disease Control and Prevention to issue a letter to health care providers warning of N-9's potential for increasing the risk of HIV transmission.
The lubricants used in the African study had a much higher concentration of N-9 than the products commercially available in the United States, but other studies have shown that products containing lower concentrations of N-9 also are unsafe.
As the B.A.R. reported last week, a recent study of the lubricants ForPlay with N-9 and KY Plus found that both products could be dangerous if used for anal intercourse because they were shown to strip the rectum of its protective epithelial cells.
Ironically, the spermicide N-9 was once touted as an HIV preventive. It was added to lubricants and condoms and marketed to gay men. Now, some companies are promoting their products for being N-9 free.
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