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Nonoxynol-9 and Risk Reduction

Nonoxynol-9 (or N-9) is a sperm-killing ingredient in many widely available contraceptive creams, foams, jellies, films, and sponges. The following is a fact sheet on N-9 from the Global Campaign for Microbicides.

What’s Up with Nonoxynol-9?

I heard that Nonoxynol-9, the chemical used in over-the-counter birth control products, is dangerous. Is that true?

In 2000, researchers demonstrated conclusively that Nonoxynol-9 (N-9) was not effective in reducing HIV risk.  N-9 products are sold over the counter as contraceptive spermicides, not for the prevention of HIV or other infections.  Since N-9 kills HIV in a test tube, research was undertaken in the 1980s and 90s to see if these products would also work for HIV prevention.

The 2000 study data showed that a 52.5 mg. N-9 gel (the lowest dose product on the market) did not protect women from HIV infection.  In fact, when used more than once a day, N-9 contraceptive products may actually increase HIV risk slightly by irritating the vaginal membranes and causing disruptions that make it easier for the virus to enter the blood stream.  Other studies show that N-9 is even more irritating to rectal tissue than to vaginal tissue.

Does this mean that people shouldn't be using N-9 products at all?

In 2001, World Health Organization (WHO) experts came to the following conclusions:
  • N-9 is not effective at preventing the   transmission of HIV or other sexually transmitted diseases (STD). It shouldn't be used or promoted for disease prevention.

  • N-9 contraceptive products (used alone or with a diaphragm or cervical cap) offer an important option for women who chose not to use hormonal birth control methods.  But N-9 may also increase a woman's chances of getting infected, if exposed to HIV. So women at risk of HIV, especially those having sex more than once a day, shouldn't use N-9 for birth control.

  • Women who are not at risk of HIV can continue to use N-9 for birth control purposes safely.  

  • Condoms with N-9 provide no more protection against pregnancy or infection than plain lubricated condoms.  Since N-9 condoms may cause irritation, they should not be promoted for any purpose.

  • Products with N-9 -- including condoms, lubes and birth control products -- should never be used for anal sex.  The rectum is more fragile than the vagina.  Even the small amount of N-9 on condoms can damage the rectum, raising HIV risk.

What does this say about the feasibility of microbicides?

Microbicides (my-CROW-besides) are products designed to be used vaginally or rectally to reduce the risk of getting infected with HIV and possibly other STDs.  They are being formulated as gels, creams, suppositories, etc.  No approved microbicides are yet available.  But over 60 potential microbicides are in the research pipeline and 18 of them are already in human testing.

Unfortunately, the failure of N-9 has given some people the impression that developing a safe, effective microbicide is impossible. That isn't true!  Scientists are confident that microbicides can be developed.  But N-9 is not one of them. 

Right now, the National Institutes of Health spends only 2% of its AIDS research budget on microbicide research.  This investment urgently needs to be increased.

With adequate funding, an effective microbicide could be on the market within 5-7 years. It would provide a life-saving alternative to people who can't insist on condom use, a valuable back-up method in case of condom failure and a much-needed boost, in the form of a new tool, for ongoing STD and HIV prevention efforts.

Written by: Global Campaign for Microbicides. May 2004. Reproduction encouraged.
Last revised: March 2005

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