A Lot of Help From My Friends

By Mark Hubbard
Nashville, Tennessee

The Event

Wednesday night(May 21, 2008), in what I think of as semi-urban Nashville, Tennessee, U.S.A., a whopping 80 people gathered to address the future of HIV prevention ("Beyond Condoms.") The audience consisted of prevention, treatment, and care professionals, administrators, health department staffers, persons living with HIV/AIDS, and other community members. Three gifted researchers spoke briefly about their research and then frankly answered questions from the rest of the “experts” in the room.

One has spent much of his life focused on learning how HIV gets into cells, and refers to microbicides as “chemical condoms.” Another is a renowned behavioral scientist who works for the United states government and uses the pronoun “we” when he talks about black gay men who have sex with men. The third is involved in countless prevention projects globally and recently led efforts to convince the United States to fund two foundational domestic prevention trials.

Dr. James E.K. Hildreth talked about creating the Meharry Center for AIDS Health Disparities and how its mission exists at the confluence of biology, behavior, and community. Emphasizing safety as his number one priority as he works to develop his product, he described the compound as

§ very inexpensive to produce

§ already in use in humans in 1000s of products

§ not having N-9-like surfactant properties at the concentrations used

§ blocking other STIs such as the herpes virus

§ unlikely to be vulnerable to mutation based resistance

Greg Millet led us through the data he is so brilliant at analyzing like a field guide whose most important priority is to convey the humanity in what is being described. After thoroughly establishing that reported sexual activity and substance use does not explain the marked disparity in HIV/AIDS among black men who have sex with men, he proclaiming that it is time to move from facts to action. He categorized potential strategies as biological, interpersonal, and structural, exploring a number of ideas including

§ biomedical interventions including microbicides

§ the roles of sexual networks and influencing factors

§ the role of low income both as a risk factor for infection and low healthcare access.

Dr. Sten Vermund summarized “wins” and “losses” in terms of new infections and recent research progress. Citing current reports, Dr. Prevalence-Incidence, as I’ll now think of him, went on to show that black men and older black women in the U.S. suffer prevalence rates comparable to those in countries like Cambodia, Ghana, and Haiti. As the principal investigator of the HIV Prevention Trials Network, he outlined two planned multi-site domestic U.S. HIV prevention trials. HPTN061 will test the feasibility of a community level multi-component intervention for black men who have sex with men. HPTN061, or ISIS will address the extraordinarily high rate of infection in women of color, including those who reside in geographic “hot spots.”

Breaking It Down

The Q & A session was extremely lively. Written and verbal questions moderated by yours truly were met with frank answers and the occasional polemic. Dr. Hildreth waxed pessimistic when asked about rectal products, referring to work at Hopkins by a former colleague that found simulated ejaculate traveled as far as the transverse colon. [Based on my own lay person’s enthusiasm about his agent’s safety profile, I’ve referred him to rectal douche acceptability research that I learned about through IRMA.] All three presenters emphasized trust and cultural understanding, and their impassioned discussions of injustice foreshadowed my next planned conference.

The Birth of An Idea

Last year, when a deadline was extended, I applied for a scholarship to the U.S. Centers for Disease Control National HIV Prevention Conference, which I received. The application asked how I would use what I learned, and I committed to identifying important topics and experts and organizing two community forums. This is the first and will be the more elaborate of the two. I confess that when I invited our speakers, I had no idea that their presentations would be so synergistic, but it seems to prove a belief I have that when you get the right people in the room, regardless of the details, good things will happen.

Allies-based approach

OUR success occurred without endless committee meetings, conference calls, or a formal organizational structure. The cost was quite small but significant, yet I never had to handle a single check. How did we do it?

I use a natural, almost ecological approach that is based on listening to what is on the minds of numerous regional organizations, maintaining flexibility, and leveraging existing infrastructure and a network of established relationships. While I handle a chunk of the planning and most of the marketing, these supporters help with all aspects of the project, including obtaining presenters and funding, lending prestige, and helping to get the word out.

The list of thank-yous is quite long, but they are heartfelt. I couldn’t have done it without a lot of help of my friends.

==========

Mark Hubbard, 46, is a member of IRMA and the chair of the Tennessee Association of People With AIDS and has lived with HIV/AIDS for over two decades years. Mark first volunteered in 1987, and began engaging in prevention education and appearing publicly in 1997. He became active in community planning for care and prevention the next year. Mark has served three Vanderbilt University affiliated research and treatment Community Advisory Boards since 2001. He has assisted with registered dietician, nursing, and medical school student training at Vanderbilt and Meharry Medical College. Mark travels across the region and nationally to work with, present to, and learn from persons living with HIV/AIDS as well as the professionals and organizations that work in prevention and treatment research and services.

==========

Pictured left to right are Dr. James Hildreth, Mark Hubbard, Dr. Sten Vermund, and Greg Millet

Perception that teens frequently substitute oral sex for intercourse a myth

PERCEPTION THAT TEENS FREQUENTLY SUBSTITUTE ORAL SEX FOR INTERCOURSE A MYTH Oral Sex “Epidemic” Not Supported by Facts Slightly more than half (55%) of 15–19-year-olds have engaged in heterosexual oral sex, 50% have engaged in vaginal sex and 11% have had anal sex, according to a new Guttmacher Institute study. However, both oral and anal sex are much more common among teens who have already had vaginal intercourse than among those who have not, suggesting that teens initiate a range of sexual activities around the same time, rather than substitute one for another. “There is a widespread belief that teens engage in nonvaginal forms of sex, especially oral sex, as a way to be sexually active while still claiming that technically, they are virgins,” says study author Laura Lindberg. “However, our research shows that this supposed substitution of oral sex for vaginal sex is largely a myth. There is no good evidence that teens who have not had intercourse engage in oral sex with a series of partners.” Some teens may first experience oral sex immediately prior to vaginal intercourse, while others may initiate vaginal intercourse shortly before having oral sex. While only one in four teen virgins (26%) have engaged in oral sex, once teens have had vaginal intercourse, the proportion increases incrementally. By six months after first vaginal sex, more than four out of five adolescents (81%) have also engaged in oral sex, and by three years after first intercourse, nine in 10 (92%) have done so. “The study has clear policy implications,” says Lindberg, a senior research associate at the Guttmacher Institute. “While oral and anal sex carry no risk of pregnancy, engaging in these behaviors can nevertheless put teens at risk of sexually transmitted infections (STIs). Counseling and education should take into account total STI risk by addressing the full range of behaviors that teens engage in, including oral and anal sex. It is crucial that teens receive evidence-based education and counseling about STI risks and protective behaviors for all types of sexual activity. The federal government’s exclusive emphasis on abstinence-only-until-marriage programs does not give teens the skills and information they need to be safe.” “Non-Coital Sexual Activities Among Adolescents,” by Laura Lindberg et al., is currently available on the Journal of Adolescent Health’s Web site and is scheduled to be published in the July 2008 issue of the journal. The study analyzes data on 15–19-year-olds from the 2002 National Survey of Family Growth. Although this is the first time the federal government has measured the prevalence of both oral and anal sex and so no direct trend data are available, comparisons of these data with those from other nationally representative surveys (such as the National Survey of Men, the National Health and Social Life Survey, and the National Survey of Adolescent Males) find little change in oral sex among opposite-sex partners in the past decade.

[Delhi Dynamos] Nesha Z. Haniff of Ypsilanti, Michigan

Part of a Movement

to Change the World

It's a Long Road...

Correspondence from IRMA advocates

by way of India

M2008 memories and the path forward

by Nesha Z. Haniff
via Durban, South Africa
May 19, 2008

For the last two weeks I have been in South Africa doing work at the University of Zululand and in the township of Cato Crest in Durban. Both of these places are in Kwa-Zulu Natal where the epidemic in HIV rages on. The work I do with my students from the University of Michigan centers around an oral methodology to teach HIV prevention to low literate populations. I developed this method in the Caribbean about 18 years ago and brought it to South Africa in 2007. The objective was to train my students at Michigan to teach this methodology and then have them teach their peers at the University of Zululand, who then develop it in Zulu and teach their communities. So far these students have taught over 10,000 people in their rural communities. I talk about this because unlike Jamaica, where the epidemic is concentrated in segments of the population, the epidemic here confronts you everywhere, in the long lines waiting for ARVs (anti-retroviral therapies), in the numbers of students who die every term at the University of Zululand, in the numbers of children made vulnerable in the Cato Crest Primary school in the township of Cato Crest. This reality of my work in South Africa and the reality of my work in Jamaica (Jamaica AIDS Support for Life) where the HIV infection rates among MSM are astronomical, are the drivers of my commitment to microbicides. Despite the recent failures in the microbicide trials and the arduous struggle for rectal microbicides, I continue its advocacy where the constant questions are - where is it, when can I get it? The international Microbicides 2008 came at a time when I felt that my enthusiasm was beginning to wane and my microbicide advocacy speech would indeed seem like a far-away dream.

Where everyone knows its name

The conference was overwhelming - so many people all over the world gathered to discuss and inform each other about microbicides. I say to myself - so many people are here and so few people even heard about microbicides. When I speak about it in Jamaica and to my students in the U.S . who are in Women’s Studies or in the School of Public Health, no one has heard of microbicides, so to be in a place where everyone knows about it and debates it made me feel less lonely and part of a movement to change the world.

I was in India again after 25 years ,when I was there as a very young woman. Even though I didn’t get a chance to do very much, I could feel the difference in the Delhi-then and the Delhi-now. I felt that it was a place on the move, on the cusp, a city modern with a culture so powerful that if it won’t rule the world, it is certainly at the moment profoundly influencing it. Everyone to me looked beautiful, even the poorest person was wrapped in color, I was constantly assaulted by the many beautiful sounds and sights. I was so appreciative to be in India and to drink it in.

The questions around adherence

The conference itself was a classroom and I loved particularly the D track sessions (on advocacy and community engagement.) These were people on the front lines of the epidemic and their insights and experiences were instructive and demonstrated the disconnect between the science protocols and ethics and the practitioners on the ground. I remember a great debate about adherence and the use of incentives. How do you encourage participants to adhere with token rewards instead of solid monetary incentives? The crux of this question is still troubling and at the center of the current debate around the trial of giving monetary rewards to people who do not become infected. For me this question must be resolved. How can scientists who are the greatest beneficiaries of trials and interventions, whether they succeed or fail, ask the poorest people to participate for the greater benefit of their societies while the scientists reap immediate benefits, publications, grants, travel, promotions? This was not the exact debate but it was a very lively discussion about the problems of practitioners achieving adherence to study protocols with incentives that are not enough to sustain adherence.

I was especially informed by the pre-meeting that covered the new research on rectal microbicides and learned a great deal from those sessions. The work being done at the University of Pittsburgh and UCLA is impressive and innovative, although I would like to see more women participating in anal intercourse studies since this population is also at risk but notat this stage as present in scientific research. We cannot assume that the anal intercourse event is the same for men and women even if the physicality appears the same, and even this physicality must be challenged.

Old school ≠ irrelevance

The sessions on gender and new technologies were disturbing for all the papers reiterated the severe disadvantages that women face in the epidemic. The male paradigm of science and how it affects women’s health was highlighted in Catherine Hankins presentation in one of the opening symposiums. I thought that the re-examination of the diaphragm as a choice for women was important in advocating for already available technologies. The redesign of the diaphragm and the female condoms are necessary and immediate priorities. This “old school” technology is not irrelevant.

I was struck by the priority given to the scientific presentations as opposed to the praxis and cultural presentations. The venues were better, the presenters were on stage, the rooms were larger. I think to some extent it represented the schism in current microbicide work - the disjunction between privileging scientific studies over behavioral cultural studies. Unless the social sciences are more incorporated in microbicide studies then the problems of adherence will continue and social scientists will continue to feel marginalized over the big important science.

The emergence of ARVs

Perhaps the most interesting thing I got from the conference was the emerging viability of ARVs as a method of HIV prevention . The implications of this research meant that now HIV positive people can become involved in the development of this new method since drug resistance becomes pivotal, and that the complexities and difficulties of the vagina in developing a vaginal microbicide can be circumvented. This still leaves us with a paucity of studies on the vagina and again reveals the sexist nature of the current state of science and women in 2008.

I appreciate the support of IRMA in attending this conference and becoming one of the first John Shaw scholarship recipients. I was honored to be selected. Last week I gave an open lecture at the University of Zululand on new prevention technologies and gender. It was very well received. It has occurred to me that perhaps now the word is no longer "microbicides" but "new technologies." Somehow I think this is a tacit acceptance that the microbicides struggle is a long haul and that new technologies simply mean now a reworking of old technologies and the hope that ARVs will come to the rescue.

It is indeed a long road and I when it gets lonely I remember India and that we are part of a movement to change the world.

Read other Delhi Dynamo entries.

Check out IRMA's photo set from the M2008 conference here.

Did you attend M2008 and want to add your photos to our growing collection? Send Jim Pickett of IRMA a note with your photos attached and they will be included.

Sentencing of HIV+ Man for Spitting - Open Forum to Respond

Dear Allies,

On May 14 Willie Campbell, a person living with HIV, was convicted and sentenced to a 35 year prison term for "harrassment of a public servant" - and spitting on a police officer - in Dallas, Texas. Since the jury determined his saliva to be a "deadly weapon," Campbell must serve half of his sentence before becoming eligible for parole.

As news of his conviction has spread, so has outcry from HIV/AIDS activists and advocates. Hundreds of national and international media organizations have already picked up the story (see links below).

Meanwhile, similar cases are pending elsewhere, including one in Philadelphia involving a man living with HIV who is being held in custody and awaiting trial for biting a person after disclosing he was HIV-positive. Past cases have resulted in convictions, including the 1990 New Jersey sentencing of Gregory Dean Smith to 25 years for attempted murder, assault, and terroristic threats following an incident in which he allegedly bit and spat on guards at the Camden County jail. Smith died while imprisoned in 2003.

CHAMP will open up a space for the community to convene and discuss possible responses. We encourage those outraged by the current injustice in Texas and elsewhere to join the call, share your ideas and discuss possible steps the HIV/AIDS community can take.

Open Forum

A space for the HIV/AIDS community to address the conviction of an HIV-positive man for spitting

Two time slots to choose from

Thursday, May 22:
9p-10p Eastern / 8p - 9p Central / 7p - 8p Mountain / 6p - 7p Pacific

~ or ~

Friday, May 23:
1p - 2p Eastern / 12p - 1p Central / 11a - 12p Mountain / 10a - 11a Pacific

Dial-in: 1-866-740-1260 access code: 4272302#


Please RSVP to:
Josh Thomas • josh@champnetwork.org • 401-427-7030


News Analysis:
Texas jury concludes saliva of HIV-positive man a 'deadly weapon', sentenced to 35 yrs jail, Aidsmap, 16 May 2008

News Coverage:
Spitting on Dallas officer gets HIV-positive man 35 years, The Dallas Morning News, 15 May 2008

Prison for Man with H.I.V. Who Spit on a Police Officer, The New York Times, 16 May 2008

New report claims 86 countries criminalise same-sex acts

[ILGA has published a map on LGBTI rights that can be used to raise awareness of people on the many laws affecting LGBTI people in the world. It is available on www.ilga.org.]

The International Lesbian and Gay Association’s 2008 report on state-sponsored homophobia says that to be lesbian or gay risks jail time in 86 countries and death penalty in seven.

The figure normally quoted is 77 countries.

The research deals only with legislation criminalising consensual sexual acts between persons of the same sex in private above the age of consent.

Laws dealing with such acts in public, with under aged people, with force or by any other reason are not included.

In addition to those 86 countries there are six provinces or territorial units which also punish homosexuality with imprisonment, said ILGA.

Read the rest.

Direct from Delhi - Microbicides 2008 Comes to Sweet Home Chicago

Direct from Delhi - Microbicides 2008 Comes to Sweet Home Chicago

Wednesday June 25, 2008

6:00-8:00 p.m.

University Center

525 S. State Street

Chicago, IL

Please join the Chicago Women and Girls HIV Prevention Coalition and the International Rectal Microbicide Advocates for this exclusive update from across the globe on the current developments in microbicide research and advocacy - direct from the Microbicides 2008 conference held in New Delhi, India. Microbicides are products currently in development that a person could use to reduce her or his risk from infection of HIV and other STDs.

RSVP - it's FREE.

This dynamic event will feature microbicide advocacy leaders:

Latifa Boyce
Alliance for Microbicide Development

Dázon Dixon Diallo
SisterLove, Inc.

Jim Pickett
International Rectal Microbicide Advocates
AIDS Foundation of Chicago

Hi Five!

I happily read about the five new advocates just featured in the Friendly Rectal Microbicide Advocates section of the IRMA site.

I'm impressed to learn about what others are doing worldwide and look forward to reading more.

I'm relatively new to the fold and it's inspiring to see how diverse a network of people are involved.

What's IRMA Reading?

Wild about Whiteside? Pissed off at Pisani? Happy about the Halperins - and delirious with delight about debating the merits of David H vs Daniel H?

IRMA has been ecstatic about the level of discussion on the listserv surrounding the ideas proposed in Elizabeth Pisani's latest book, as well as a recently published article by Potts, Halperin (Daniel), et al.


Therefore, we want to start our own suggested reading list. If you have any recommended reading, particularly focussed on the issues dear to IRMA's heart, then please submit them to us, and we will add them to our reading list right here on our blog. Better yet, if you'd like to write up a brief review, we would be eternally grateful.

PLEASE write to us now with your ideas!

Take a Spin...

... with some Friendly
Rectal Microbicide Advocates!

IRMA is now featuring, for your reading pleasure, five fresh bios of rectal microbicide advocates from around the world (India, Nigeria, Uganda, South Africa and Canada in the new batch) who are, like you, working to advance the research and development of safe, effective and acceptable rectal microbicides.

Now appearing here, in the "Meet IRMA Advocates" section of International Rectal Microbicide Advocates' website.

Be inspired!

Click 'n Learn - "Forward Thinking - the Future of HIV Prevention"

David Munar of the AIDS Foundation of Chicago recently presented "Forward Thinking - the Future of HIV Prevention" in Philadelphia. He has graciously shared them with IRMA. You may also find this slide set, and many, many others, at IRMA's website under the Resources tab.