Can lemons stop AIDS?

An affordable widely obtainable prophylactic to prevent HIV infection? No not a condom, try a lemon. Dr Roger Short of the University of Melbourne has been researching the potential of lemon juice for preventing HIV transmission. Lemon juice which has been used traditionally to avoid pregnancy has been shown to immobilise human sperm and kill HIV in the laboratory. Lemon juice may be " nature's own microbicide" according to Dr Short.

Lemon juice was once widely used in the Mediterranean as a contraceptive, and remains in use in parts of Africa and South East Asia as a disease preventative and contraceptive device.

It is proposed that lemon or lime juice could be used as a natural microbicide by using the juice either as a douche (or wash) directly after sex or by using it directly in the vagina during sex. Approximately a teaspoon of lemon juice in a saturated cotton ball or sea sponge inserted into the vagina and removed after sex could be all that is needed.

Laboratory experiments have shown that a 20% concentration of lemon juice inactivates 80% of HIV in as little as two minutes. (1)

The AIDS pandemic is increasingly becoming an issue for women with them making up 75% of HIV positive Africans between the ages of 15 - 24. (2) Women frequently are not able to demand that male partners wear condoms so an affordable, accessible women-controlled product is a good option. Dr Short believes that condoms still represent the best current method for HIV protection, yet widespread production and promotion of condom use has yet to stem the AIDS pandemic. (3). In many parts of the world, there is entrenched cultural resistance to condom use. Dr Short and the professionals working with him call themselves the LemonAids and are seeking ways to put the prophylactic control into women's hands.

Pharmaceutical interest in HIV/AIDS

Funding for HIV/AIDS research comes from two main sources: the pharmaceutical companies, who stand to benefit from the discovery of HIV vaccines or HIV/AIDS treatment drugs and the large government donors, notably the U.S.

The difficulties the LemonAids trials are facing are indicative of the wider challenges faced in research for sexual and reproductive health.Funding for such research is difficult. Much of the funding for research into drug development comes from the pharmaceutical companies who profit from these discoveries.

Currently most of the research done in topical microbicides (an agent destructive to micro-organisms) is supported through organisations such as the Alliance for Microbicide Development, an organisation made up of biopharmaceutical companies working with research institutions.

Currently the Alliance is supporting trials in Ghana for a microbicide gel called Savvy. According to the manufacturer Cellegy Pharmaceuticals, the phase 111 trials which are to begin in the United States have been financed by $50 million (USD) in grants and contracts from organisations such as the Alliance and the US Agency for International Development. (4).

Contrast the experience of Dr Short's trial on Lemons, a natural product which cannot be patented and as such would be affordable and available to a much wider range of people in need. Dr Short's trial is seeking $250,000 USD to run a trial in Nigeria.

As the pharmaceutical companies have nothing to gain and may in fact have much to lose with the discovery of a successful product that can not be patented, there is no funding support available from the research organisations.

Additionally, Dr Short's trial has also run foul of US funding policy and is ineligible for most US funds as the trial design is to work with sex workers.

Trials

Research on lemon juice started with laboratory experiments on lemon juice's ability to kill the HIV virus in test tubes in the laboratory. The experiments found that as little as a 20% concentration of lemon juice kills 100% of spermazoa in less than 30 seconds. Research on the safety of lemon juice started in 2003 where primate trials in Indonesia found that lemon juice did not cause cervical or vaginal lesions.

This is important data as earlier studies found that existing microbicides such as nonoxynol-9 in some cases increased HIV transmissions as it causes small disruptions in the vaginal cell wall. A simple trial of 74 people found that lemon juice produced little or no discomfort for men and women who placed undiluted lemon juice on the genitals.

The next step[ is to begin clinical trials. The LemonAids have proposed two trials: one in Thailand, the other in Nigeria. The researchers found a group of female sex workers in Jos, Nigeria regularly use lemon juice as a spermicide for protection against STDs and pregnancy.

The Nigerian trial has completed a feasibility study which concludes there are sufficient numbers of willing participants and the local skill and capacity to carry out the field work for the trial to go ahead.

The trial represents an excellent opportunity for an ethical trial with women who are already using lemon juice as their sole form of protection. Despite receiving ethics approval from the University of California Berkeley and successfully recruiting participants, the trial has been put on hold due to lack of funding.

Funding HIV research

Individuals and organisations seeking funds for HIV/AIDS research or outreach work face an uphill battle with the largest funder, the US government. (5) The current requirement is that groups receiving US money must "have a policy explicitly opposing prostitution and sex trafficking" (6).

This contentious policy has been applied to different organisations in slightly different ways. The largest obstacle in applying this clause is the right to free speech which is protected by the US Constitution.

The US Administration is therefore able to enforce this requirement with foreign organisations but is unable to enforce this rule for US based organisations as they are protected under the US Constitution. Few, if any, of the organisations which have had funding restricted support or encourage prostitution or sex trafficking but many continue to work with at-risk groups such as sex workers.

There has been an outcry in the international development community over the enforcement of the US clause, many organisations argue that declaring opposition to sex work is unhelpful and likely to result in further stigmatising people with HIV (7).

As the Nigerian study is currently unable to tap into the two main funding sources, they have set up a special project to fund the research. The Mary Magdalene Project was launched last May to raise funds for the HIV prevention trials in Nigeria.

The Jos, Nigeria trials will contribute to the understanding of lemon juice as a preventative measure. It will also contribute to the understanding that the women currently using lemon juice have of potential negative consequences of the practice. These trials contribute to an understanding of the HIV/AIDS pandemic in the geographic area where research is most needed. The September 2005 BMJ found that "the relatively small number of HIV/AIDS trials conducted in Africa is not commensurate with the burden of disease" (8).

It is crucial that we continue to explore all methods for addressing HIV and AIDS around the world. Even if lemon juice proves not to be "nature's own microbicide" it is certainly worth examining.

It is important that the research agenda is set by more than personal values or commercial will. Health research needs to come from a variety of places and innovative ideas fostered to provide a true evidence base for health options and treatment.

Rererences

For more information see www.aids.net.au

1. Short,R.McCoombe,S.,Maslin,C. and S.Crowe (2004) Lemon and lime juice as potent natural microbicides 15th International AIDS Conference Bangkok, Thailand 2004 avail at http://www.aids.net.au/aids-lemons.pdf
2. Http://www.un.org/ecosocdev/geninfo/afrec/vol 18no3/183women_aids.htm
3. Short,R.(2004) The HIV/AIDS pandemic: new ways of preventing infection in men Reproduction, fertility and development 16:555-559
4. See Cellegy Pharmaceuticals' website http:// www.cellegy.com/products/savvy.html
5. OECD website
6. Washington Post 18/5/05
7. Washington Post 18/5/05
8. Siegfried,N.,Clarke, M and J. Volmink (2005) Randomised controlled trials in Africa of HIV and AIDS: descriptive study and spatial distribution. BMJ 331(7519):742-6.