Monday, September 21, 2009

VOICES from the MSI network: Dr Badri N Saxena

VOICES from the MSI network

"India needs the technologies for meeting all the three important needs of an individual as well as for the country – i.e. prevention of unwanted pregnancies, prevention of non-HIV STIs as well as HIV" (Dr Badri N Saxena)

Dr Badri Saxena (read full text of his profile here) is an internationally and nationally known medical doctor in the field of reproductive health research. Before starting his professional career in India, Dr Sax
ena had already worked in three topmost medical academic institutions in the world (1. as a Fulbright Scholar at Harvard Medical School & Peter Bent Brigham Hospital, Boston USA; 2. as a Ford Foundation Fellow at Karolinska Institute & Hospital, Stockholm Sweden; 3. as a Senior Lecturer at Royal Postgraduate Medical School & Hammersmith Hospital, London, UK) . Dr Saxena also had the scientific research and management experience of having worked as United Nations (UN) Staff of World Health Organization (WHO)'s Special Programme for Research in Human Reproduction, Geneva, Switzerland.

Dr. Saxena has worked in India with the Indian Council of Medical Research (ICMR) for 21 years (from April 1977 to March 1998). Dr. Saxena had been primarily responsible for developing multi-faceted national programmes for research in human reproduction and nutrition and introduced the concept of Task Force Approach in India for biomedical research activities. To reduce the regional imbalances in a diverse country like India for the national research efforts, Dr. Saxena established a network of collaborating centres in the medical colleges in the different parts of the country - called as Human Reproduction Research Centres ( HRRCs)

From October 2001, Dr Saxena has been involved in the national and global research & development efforts on Microbicidal drugs with emphasis on the women-controlled methods for HIV prevention. From February 2004, He is also the Chair of the ICMR’s Experts Research Group on Microbicides Research. Dr. Saxena’s main focuss now is to develop a network of pre-clinical and clinical trial research centres for the microbicidal products and other HIV prevention technologies. Dr Saxena has been the Conference Co-chair for Microbicides 2008 International Conference. Recently , Dr Saxena has been elected as the President of the Microbicides Society of India (MSI).

Dr. Saxena is a rare individual of combining the first rate nationally and internationally recognized research capabilities, while also doing the science management and promoting collaborative research with several international & bilateral agencies as well the NGOs. MSI team spoke to Dr Badri Saxena this week:

1) Is Microbicides research and advocacy a priority in Indian context?

Dr Badri Saxena: According to the National AIDS Control Organization (NACO) in India, unsafe sex is the highest risk factor for HIV transmission in the country. About 86 percent HIV incidence in the country is from unprotected sex. Globally too, unsafe sex is recognized as one of the highest risk factors for disability and deaths worldwide. More people acquire curable sexually transmitted infections (STIs) other than HIV, than HIV globally. The data is shocking: every year, about 34 crore people (340 million) get infected with at least one of the four primary curable STIs: Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), and syphilis, and just under 30 lakhs (3 million) become infected with the human immunodeficiency virus (HIV). It is evident from clinical experiences in India, that a large number of people acquire chronic infections with pathogens such as the herpes simplex virus (HSV), a cause of genital ulcers, and the human papilloma virus (HPV), responsible for cervical cancer. According to the United Nations Population Fund (UNFPA) recent research estimates of 2005, over 200 million women in developing countries have an unmet need for effective contraception. Every life is invaluable so we need to advocate for prevention of HIV, non-HIV STIs, and effective contraception as well.

Despite considerable evidence of causal relationship between HIV and other STIs, there is – no oral or topical HIV prevention product, at present, which has yet produced clinical evidence of efficacy against non-HIV STIs, nor any new products under investigations which are highly HIV-specific, are expected to do so. Except for physical barrier methods like male or female condoms, which provide dual protection i.e. certain degrees of pregnancy protection besides HIV and non-HIV STIs protection when used correctly and consistently, none of the chemical microbicides investigated so far have shown any degree of acceptable pregnancy protection.

India needs the technologies for meeting all the three important needs of an individual as well as for the country – i.e. prevention of unwanted pregnancies, prevention of non-HIV STIs as well as HIV. It may be scientifically difficult to have one single product possessing all the pharmacological properties to meet the requirements effectively, for all the three preventive needs. However, it may be possible to develop combination products having only two of the preventive properties and use a newer drug delivery systems to combine the remaining third preventive pharmacological product, so that all these different products could be delivered concurrently, at the same time. The MSI would make efforts with the national and international agencies to focus their efforts and provide the required funds as well to develop interactive/ collaborative programs with the Indian scientists. If required, the MSI would develop the facilitatory mechanisms/ promote networking between the national and international scientists/ institutions.

2) Is there any Microbicides research and advocacy update you wish to give?

Dr Badri Saxena: The Microbicides Society of India (MSI) would advocate for the development of multipurpose technologies which would protect the individual from several or all of the health risks i.e. unwanted pregnancy, non-HIV STIs/ RTIs and HIV. The availability of such a product would be both the user friendly as well as the provider friendly, with improved accessibility.

The MSI would help to develop new communication strategies, stimulating the demand for new technologies while promoting the use of existing technologies to fill the gap, by integrating the new approaches with existing strategies.

3) Please mention your contribution to Microbicides research and advocacy?

Dr Badri Saxena: My own contribution as a "newcomer" to the field of microbicides research, has been to use my earlier reproductive health research experiences – both national and international ones, to promote the research in the field of microbicides in India as well as initiate international collaborative activities. The Indian Council of Medical Research (ICMR) has now got an Expert's Group on the Microbicides Research and Development (R & D) programmes, as well as the ICMR-CONRAD MoU for Microbicides Research. There is also a joint ICMR – Department of Bio-Technology (DBT) Programme as well as DBT-CONRAD MoU for Microbicides/ Reproductive Health Research.

4) As Microbicides research and advocacy goes ahead, what are some possible challenges you foresee in coming years?

Dr Badri Saxena: There would be regulatory challenges for the multipurpose technologies for providing the dual protection. Which means good basic science researches which would include better insights for vaginal and rectal physiologies, better biomarkers and in-vivo/ in-vitro testing methods as well as animal models. Better clinical trials would need to be designed to provide the answers rapidly and reliably. We must also realize that these technologies will not by themselves, achieve all the desired goals. It would be essential that these newer technologies need to be introduced with due care, and backed up by well-designed educational programs as well as community involvement with their grass roots leaderships.

5) What best can be done to address these possible obstacles? What should be the role of MSI in this context?

Dr Badri Saxena: Apart from promoting the basic and clinical researches as mentioned above, public health and socio-behavioural researches would be other areas for the MSI to be promoted equally well.

Despite the recent efforts by the Government of India and their respective state counterparts, sexual and reproductive health (SRH) services and HIV/AIDS services are still functioning independently, in most of places. The need for service integration remains an important programmatic challenge for sexual and reproductive health and HIV care services. Eventually, new multi-purpose technologies will need to be delivered under the existing primary health care delivery system. Therefore, it would be necessary to use the multiple marketing and distribution channels from both public and private sectors, for existing and new methods. The innovative social science and market researches on optimal introduction and development of appropriate strategies for the positioning of the microbicidal products would be the important areas for the R & D activities, in India.


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