1987-97 : Building a Movement
Since 1987, advocates have been working to draw attention to the need for new HIV prevention tools to supplement the male condom. The first leaders came from the field of women's health and contraceptive research and development. They were joined by advocates working on HIV/AIDS, STIs, infectious diseases and international development.
In April 1990, South African epidemiologist and advocate Zena Stein published "HIV Prevention: The Need for Methods Women Can Use," in the American Journal of Public Health (80:460-462). Hers was the first voice to draw widespread public attention to the issue. In December, 1990, the demand was heard in a national public forum for the first time when delegates to the US National Conference on Women and HIV Infection included among their conference recommendations the "develop[ment] of better barrier/contraceptive methods and virucides which are effective, safe and acceptable to women", adding that “methods which are woman-controlled and may be used without detection by their sexual partners" are “especially needed”.
That same month, scientists within the UK’s Medical Research Council initiated plans to convene an expert group to discuss the challenges and prospects of developing such products. The group, involving experts from the US, Belgium and the UK, met three times over the following 18 months and their report led to MRC’s decision to establish and fund a program of microbicides research .
On the advocacy front, the first consultation on microbicides among women’s health and HIV/AIDS professionals was held in 1991 at the Population Council in New York. Also that year, the International Women's Health Coalition (IWHC) and the World Health Organization (WHO) sponsored a meeting of women's health advocates and scientists in Geneva to discuss contraceptive research priorities. The resulting report, "Creating Common Ground" called for greater attention to barrier methods of contraception that are user-controlled and help protect against infection as well as pregnancy.
In 1992, two small but significant streams of public funding for microbicide research began to flow. The UK Medical Research Council mounted its coordinated research and funding strategy to develop an “intravaginal virucide” . The US National Institutes of Health (NIH) put out its first Request for Application that year seeking investigators interested in studying vaginal ecology as it relates to disease transmission, its first step toward any consideration of microbicides.
By 1993, the stage was set for the birth of the first microbicide-specific advocates coalition. WHAM (the Women's Health Advocates on Microbicides) was a group of eleven women's health organisations and networks worldwide who came together to shape the Population Council's nascent microbicide research effort. This group met semi-annually for several years and influenced the Council's microbicide program by helping to design a multi-country study of women's formulation preferences, reviewing draft protocols, exploring ways to better monitor informed consent in clinical trials, and providing recommendations to Council management. WHAM's work culminated in 1997 with convening “Practical and Ethical Dilemmas in the Clinical Testing of Microbicides”, an international symposium that brought together 55 participants from 15 countries to build consensus on how best to conduct microbicide trials.
The scientific community also recognised the need to begin working in coalition to advance the issue. In 1994, the International Working Group on Microbicides (IWGM) was formed, with initial support from the WHO Global Programme on AIDS, to facilitate collaboration between research institutes working on microbicides.
The field’s rapid maturation between 1993 and 1997 made it impractical to continue to focus advocacy attention exclusively on one NGO. New microbicide actors had entered the arena and the locus of activity was shifting from the lab to the field, as different microbicide candidates began to enter clinical trials. So in 1997, WHAM formally disbanded in order to allow a more inclusive advocacy movement to evolve.
1998–2001 : The Global Campaign for Microbicides is born
In July 1998 at the XII International AIDS Conference in Geneva, the Global Campaign, the brain child of former WHAM members and other key players, this new entity committed itself to focusing world attention on the critical need for new HIV prevention options, especially for women. With start-up funding from UNAIDS, the Global Campaign took on the two part challenge of:
1. Generating political pressure for increased investment in microbicides--products that women and men could use vaginally or rectally to protect themselves and their partners from HIV and other sexually transmitted infections, and
2. Ensuring that the public interest is protected and the rights and interests of trial participants, users, and communities are fully represented and respected throughout every phase of scientific process required to develop these new products. formed by a number of key members of the women's health and HIV community was officially launched.
Under the guidance of its International Steering Committee, the Global Campaign set out to raise awareness about microbicides via the media, workshops, and outreach to policymakers; launch a major legislative strategy to increase US government investment in microbicide research and development; and supply grassroots activists with ‘action kits’ so they could start spreading the word. During this era, the Global Campaign was managed out of the ‘Center for Health and Gender Equity’ (CHANGE), a small woman's health NGO based in the US. Although its main secretariat is based in the US, the Global Campaign has sought from its inception to work with, and through, a broad range of partners internationally. By 2001, the Campaign had grown into a major global organising effort, with more than 70 partner groups worldwide.
In January 2001, the Steering Committee of the Campaign decided to hire a full-time Executive Director and move its secretariat to a larger organisation. Lori Heise, a founding member and long-time women's health advocate, stepped down as Co-Director of CHANGE and assumed full-time leadership of the Global Campaign.
In April 2001, the Campaign moved its secretariat to the Program for Appropriate Technology in Health (PATH), an international NGO with 19 offices in thirteen countries. PATH's president, Dr. Christopher Elias, is a leading expert of the issue of microbicides and has a long history of collaboration with women's groups to engage advocates in the process of technology development.
Between July 2000 and February 2002, the Rockefeller Foundation’s Microbicides Initiative convened an international group of scientists, research organisations, advocacy groups, pharmaceutical representatives, United Nations organisations, and donors to examine the field and recommend strategies to accelerate microbicides development. The Initiative invited Campaign Director Lori Heise to co-chair a working group on advocacy, public education, and resource mobilisation. Microbicides: A Call to Action was authored by Heise as the Working Group’s final report and offered a blueprint for advocacy action:
“Over the next two years, priority should be given to building the capacity of NGOs and their networks to advocate for microbicides and to participate actively in decision-making around research agendas and clinical trial implementation.”
2002 and onward : Expanding the “Umbrella”
The Rockefeller Initiative gave impetus to two major developments in the microbicides advocacy effort in Europe. Increased civil society activism from Campaign endorsers and matching commitment from the European Commission culminated in an EC award to International Family Health (IFH) for international networking and advocacy on microbicides over three years. The Campaign partnered with IFH to develop a strong presence in key European countries, seconding Anna Forbes to the London-based organisation for three months to build capacity. Simultaneously, the creation of the International Partnership for Microbicides brought renewed focus on European fundraising and provided an opportunity to redefine the role of the Global Campaign in Europe. At the Microbicides 2002 Conference in Antwerp, the Global Campaign, IFH and IPM held key meetings that formed the basis for the European mobilising effort. IFH and the Global Campaign came together to launch ‘Global Campaign Europe’.
The Campaign had succeeded in cultivating a strong grassroots base for the microbicides issue in the Global North among allied NGOs and the general public in the US, Canada and Europe.
In the Global South, in 2002, the Campaign launched a clinical trials/community involvement initiative designed to support researchers to engage communities in effective microbicides research. In 2004, a number of partner groups in Africa formed the Africa Microbicides Advocacy Group (AMAG), a collation of Africa-based advocates implementing a microbicides advocacy agenda for Africa.
The Campaign has also forged partnerships with many organizations in Asia, which are exploring the idea of developing a similar regional structure and agenda. The Campaign’s partners in the global South have worked to garner critical support among Southern civil society organizations, helping to build capacity in advocacy on the need for prevention methods that women can initiate, and a more gendered approach to the epidemic. They have also ensured that the voices of trial participants and grass-roots communities are heard at the national and international level.
The campaign has over 300 endorsers today working all over the world and continues to expand HIV prevention options, especially for women.