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Talk:Lemon douches for HIV prevention
Controversial or widely accepted?
Wondering what the latest info was on this - I had the impression that there was strong encouraging evidence (including traditional use of limes as a contraceptive in Thailand and other countries, and this appearing, at least on the surface, to be associated with lower HIV rates) - but that it hadn't yet overcome the doubts of experts. It often seems to happen that initial results look very promising, certain even, but further testing (by different researchers and in different conditions) gives more disappointing results.
It would also be interesting to know what the effect was on other STD's.
Good point, Chris. New research was just published last month... "Lime juice up to 20% concentration has an acceptable safety profile for vaginal use. However, as new in vitro research shows that the effectiveness of lime juice to prevent HIV transmission in concentrations lower than >or=50% is unlikely and concentrations of 50% have been shown to be toxic, women should be discouraged from commencing or continuing the vaginal use of lime juice (my emphasis)" (Hemmerling A, et. al. Lime juice as a candidate microbicide? An open-label safety trial of 10% and 20% lime juice used vaginally. J Womens Health. 2007 Sep;16(7):1041-51.)
I haven't been able to find the studies on HIV transmission in concentrations lower than 50% and toxicity in levels greater than 50%.
So much for a magic bullet. I'm going to update the page with this new study. So now the question is: If something is found to be a potentially "inappropriate technology", do we keep it on Appropedia for learning and discussion or remove it to avoid any misunderstandings? I would think it would be the former as long as we make the current findings clear. Steve.mccrosky 11:10, 24 October 2007 (PDT)
- Hi Steve and Chris,
- Excellent work. I agree that as technologies are found to be inappropriate, they should be kept on Appropedia, but with the new findings made very clear. Eventually we will probably have templates that show the current state of development of projects similar to those at Demotech. Those templates should also show how appropriate something is for given situations - for many projects that will take a lot of debate and probably utilize a Delphi Matrix from experts in the field. Until then, let's just make the new findings clear.
- Thank you, --Lonny 11:26, 24 October 2007 (PDT)
- "If something is found to be a potentially "inappropriate technology", do we keep it on Appropedia for learning and discussion" - definitely keep it. Good work, and good thoughts on templates. --Chriswaterguy · talk 13:11, 25 October 2007 (PDT)
Sounds good. I have also invited Dr Hemmerling to review the page and join our discussion here. Steve.mccrosky 11:59, 24 October 2007 (PDT)
Methodology in the Hemmerling et al study
From the abstract:
- METHODS: Twenty-five sexually abstinent women were randomly assigned to apply a 10% or 20% concentration of lime juice or 0% (water-only) through a soaked tampon once daily for 14 consecutive days. Tests for genital infections, measurement of inflammatory biomarkers, and a colposcopy were performed before and after treatment.
It's not clear to me how long the tampon was applied for - if the solution was applied constantly for 14 days, then it tells us almost nothing about how irritating it would be when applied in a stronger concentration for a short period. Also, these were sexually abstinent women - I can understand the value of this from an experimental point of view, to control the variables, but it's actually not the group we're interested in. And there are significant differences between the groups when it comes to production of natural fluid that might (I'm speculating) protect the membranes, dilute the citrus juice, or expel the citrus juice more quickly.
- ...concentrations of 50% have been shown to be toxic...
No detail given in the abstract, so I can't comment.
I wonder what the concentration is when it's used traditionally? I've heard, anecdotally, that women in parts of SE Asia (Thailand?) traditionally use a slice or wedge (not sure which) of lime as a vaginal plug - so it's a barrier as well as having the anti-microbial agents. The barrier would reduce the extent to which potentially fluids enter the body, keeping it in a relatively small area, together with the microbicide. It might not be a sure thing from the point of view of Western medicine, especially with juice concentrations of less than 50%, but in terms of risk management, it does sound like it should (speculating again) reduce the risks significantly.
And if this is a cultural practice, and at each step in the risk of transmission between people, this risk is significantly reduced, that would have big implications for the epidemiology of HIV.
Risk, appropriate technology and free knowledge
Thinking more about the risk aspect and the idea of appropriate technology - the appropriate technology is that one that reduces risk in the given cultural and economic context. Risky and short-sighted behavior occurs everywhere, but presumably varies with culture, education, and factors such as mobility (e.g. transport workers). Particularly in a context of high-risk behavior, having the knowledge that there is another practice which may be preferable (due to dislike of condoms) but which reduces risk significantly, could be expected to have an overall positive effect.
An opposing view might be that endorsing practices which are less safe is not acceptable (and this is similar to the situation of organizations such as WaterAid, which feel they cannot endorse any practice or technology which does less than improve water to first world conditions - based on comments I heard from a water engineer working in aid). However, the perspective which hold more water in my mind is the idea that "knowledge wants to be free", that we should not be paternalistic and decide what people are allowed to know; rather we should give them the knowledge, all appropriate warnings (and there needs to be warnings about lemon/lime juice douche - at the very least saying it's unproven, at this stage), appropriate resources (i.e. other safe sexW aids) and let them choose how to act. --Chriswaterguy · talk 05:20, 29 October 2007 (PDT)
- In addition to Appropedia:General disclaimer I'd also suggest creating Appropedia:Medical disclaimer similar to wikipedia:Wikipedia:Medical disclaimer. The practice of medicine and the giving of medical advice are highly regulated in many countries, for rather obvious reasons, and Appropedia should specifically disclaim either one to avoid liability exposure. (I am not a lawyer, but on the Wikipedia Help deskW there are lots of medical questions and the answer is always to consult a physician.) --Teratornis 20:52, 9 February 2011 (PST)