Condoms contraceptives and nonoxynol-9: complex issues obscured by ideology.

During the 1990s as the AIDS crisis worsened and vaccine research faltered HIV prevention activists increasingly pinned their hopes on nonoyxnol-9 (N-9). Widely available in the United States for over 50 years as the active ingredient in spermicides N-9 was shown to kill the AIDS virus in the laboratory. A number of epidemiologic studies further suggested that N-9 conferred some protection against bacterial sexually transmitted infections (STIs) when used alone or in combination with a diaphragm. Researchers and advocates alike anticipated that it would be shown to prevent HIV in human trials as well clearing the way for a new and relatively inexpensive preventive option to be made available to people around the world living with or at-risk of HIV. Those expectations were dashed however when in 2000 a study of N-9’s effectiveness among sex workers in Benin Cote d’Ivoire South Africa and Thailand showed that HIV incidence was actually higher among the women using N-9 than among those using a comparison product. But in addition to being a disappointment for HIV prevention efforts the results also raised questions about the safety of N-9 when used for the purpose for which it was approved protection against unwanted pregnancy. (excerpt)