A new defense against sexually transmitted diseases. (Microbicides).

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PREFACE

For more than 30 years, The Alan Guttmacher Institute (AGI) has focused its attention on research and programs to improve the reproductive health of individuals and couples, both in the United States and around the world. While the prevention of unintended pregnancy has been, and continues to be, a major goal of the Institute's work, AGI is increasingly looking at other important aspects of reproductive health. One of these is the prevention of sexually transmitted diseases (STDs).

Even though STD prevention has been a serious epidemiological issue for years, most laypeople have not been very comfortable discussing or even thinking about the topic. In the 1980s, as awareness of HIV and AIDS grew, the stakes were raised, and people were forced to start talking more openly about both HIV and other STDs. Despite increased public attention, however, STD prevention remains a difficult objective, since no aspect of it is simple.

STDs can result from numerous pathogens and can be transmitted in many ways. For example, they can be spread through vaginal, anal and oral sex. HIV and some other STDs also may be transmitted if an infected individual shares needles for injection-drug use or if blood used for a transfusion is tainted. In addition, STDs do not affect only adults. Infants and children whose mothers are infected can acquire some of these diseases in the womb, during delivery or through breastfeeding. These considerations make the prevention of STDs extremely complex--for physicians, health counselors, research scientists, policymakers, and the average man and woman.

Worldwide, prevention is being pursued mainly through efforts to reduce risky sexual practices. These efforts involve encouraging sexually active individuals to limit intercourse to one uninfected partner or to use condoms every time they have sex--particularly if they do not know their partner's risk status or if they know that their partner is infected. In addition, prevention is being approached on other fronts: needle exchange programs for injection-drug users; the screening of donor blood supplies; and the use of drug therapies and, sometimes, cesarean section to avoid transmission from infected women to their infants. Moreover, work continues on the development of vaccines, including one that would provide immunity from the most deadly STD--HIV.

Still, efforts to promote primary STD prevention through safer sexual behavior have been hampered by the limited options available. The surest courses of action are abstinence from intercourse, except in a completely monogamous relationship with an uninfected partner, total avoidance of sex with an infected person, and correct and consistent condom use. At best, these practices require considerable self-discipline. For women, they are not always feasible. Many women are unable to insist that their partner use a condom every time they have sex and do not know about or do not like other methods that might offer some protection. And some women who believe that they are in a mutually monogamous relationship with an uninfected partner do not know that he actually has other partners or is infected with an STD.