...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.

Following the results of this study, experts at the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) conducted a concerted review of the evidence and made a series of recommendations. Based on those recommendations, an ad-hoc coalition of individual experts and women's health and AIDS organizations called on manufacturers to stop adding N-9 to condoms and sexual lubricants. In accordance with the available evidence, however, the coalition stopped short of calling for the withdrawal of noncondom contraceptive products containing N-9 from the market. Meanwhile, anti-family planning activists have been using the N-9 issue to further their ongoing campaign to discredit condoms, and contraceptives in general, as a means of promoting abstinence outside of marriage as the only appropriate answer to STIs and unwanted pregnancy.

Expectations Unfulfilled

N-9 spermicides have been available over-the-counter in the United States since the 1960s and are used by approximately half a million women for pregnancy prevention. N-9 is found in a variety of vaginal contraceptive products, including creams, foams, gels and suppositories--used alone or in combination with the...

NOTE: All illustrations and photos have been removed from this article.



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