Monday, May 5, 2008

A Spade is a Spade - "Anal Sex is a Public Health Risk"

[IRMA received permission to re-print this e-mail correspondence from Dr. Ruben F. del Prado, the UNAIDS Country Coordinator for Guyana and Suriname (left), calling on his global colleagues to address unprotected anal sex as a public health risk.]

Dear UNAIDS colleagues, members of the Global Forum on MSM and HIV, The Johns Hopkins Bloomberg School of Public Health, and The Royal Tropical Institute colleagues… fellow workers towards universal access for all,

Seizing the opportunity to reiterate my appeal to ‘call a spade a spade,’ please check this out.

More than ever before, UNAIDS and its partners must strongly advocate for establishing unprotected anal sex as high risk behaviour and a public health risk, and not as conduct that typifies ‘marginalised’ groups and ‘sexual minorities.’ This would make good public health sense, and immensely benefit HIV prevention through broader community prevention messages that might more usefully fit overall HIV prevention objectives.

By continuing to use euphemisms in the HIV arena such as ‘MSM’ and ‘gender’ we actually undermine gay and transgender rights activism by further stereotyping men who have sex with men and transgender people.

There continues to be an urgent need for activism, for instance by demanding medical and nursing training colleges and HIV counseling and prevention programmes to address sexual health related pathology and psychology of sexual minorities in their curriculums and training programmes. There is no doubt about that!

I hold and intensify my firm stand on the importance of identifying unprotected anal sex as a public health risk.

It is not without reason and common sense that extensive consultations throughout India have resulted in the key recommendation to address male-to-male sexual transmission of HIV by "Mainstreaming ‘unprotected anal sex’ as a public health risk: As a key public health measure, advocate for and put emphasis on unprotected anal sex as a mode of HIV transmission in all relevant health programmes; not just those for MSM or Hijras but also for other populations."

[Click here for the full report, organized by NACO, supported by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Resource Centre for Sexual Health and HIV/AIDS (RCSHA), June 21st – July 5th 2006]

I am an advocate and international civil servant working towards HIV prevention, treatment care and support for all, but first and foremost I am a public health professional. If we want to make an impact in our time and be seen by the next generation as successfully establishing solid HIV prevention practice, we must address unprotected anal sex head on with full force as a public health and sexual health issue of great concern. Religious, cultural and societal dogma notwithstanding, we can and we must.

Uniting the world against AIDS
Dr. Ruben F. del Prado
UNAIDS Country Coordinator for Guyana and Suriname


Dr. Ruben F. del Prado said...

I have had quite a few comments following my appeal for an honest public health approach to addressing unprotected anal sex.

I insist that we as public health professionals must work diligently towards generating more evidence that the behaviour of unprotected anal sex exists beyond men who have sex with men, transgendered people and other sexually marginalised persons, including ‘heterosexuals’ as the below referred study indicates: "HIV Prevention Studies in Africa: It's Important to ask about Anal Sex."

We need, as scientists, to reshape heterosexist dogma and hypocrisy-perpetuated and ‘religiosity-’ influenced tunnel-visioned science and epidemiology, and work towards mainstreaming and including unprotected anal sex in hiv prevention messages.

It is a fact that unprotected vaginal sex far surpasses unprotected anal intercourse, but does this mean that unprotected anal intercourse must continue to remain unmentioned in general hiv prevention messages throughout the world, while it remains to be [conveniently] equated with sexual acts of small groups of ‘deviants’ such as MSM and TGs, instead of calling a spade a spade?

It is precisely to share our already understanding and accepting unprotected anal sex as a risk for hiv transmission that this evidence must now find its way into the mainstream of hiv prevention messaging, alongside vaginal sex, and not be packaged as belonging only within the realm of men who have sex with men.

It would benefit the world greatly, especially in such places where sex between men is vilified and transgendered people are looked down upon, that the behavior that puts people at risk for hiv transmission is delinked from poorly defined and stigmatised high-risk groups.

As a scientist, a public health professional and epidemiologist I cringe more and more when I read countries’ epidemiology reports, that continue to refer to ‘hetero sexual’ transmission as the main and oftentimes sole mode of transmission, when many heterosexuals also engage in anal sex. The word ‘hetero sexual’ may need to be scrutinsed before future publications?

The comments I received also reminded me that much needed support must be given to action research to generate evidence that young people are increasingly enjoying unprotected anal sex; not just for the fun of it – but also to avoid pregnancy.

And where have I read that they remain virgins that way…?

Ruben F. del Prado, MD, M.P.H.

Jim Pickett said...

Thank you so much for your dialogue around these important issues Dr. del Prado!

Jim Pickett
Chair, IRMA

Gail Broder said...

Well said, Dr. Del Prado! Somehow we never hear about the fact that women also engage in anal sex with their male partners. As you noted, young people may view this as another means of avoiding pregnancy as well. I'm with you - let's call a spade a spade!

Gail Broder
Seattle, Washington

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