Women and Anal Sex: Yet Another Reason for Rectal Microbicide Advocacy

Save the Date!

IRMA's next global teleconference
July 10, 2008 at 10:00 am Eastern

Kate Morrow, PhD, Assistant Professor of Research, Centers for Behavioral & Preventive Medicine, Department of Psychiatry and Human Behavior, the Warren Alpert Medical School of Brown University and the Miriam Hospital, Providence, Rhode Island, USA will present, “Women and Anal Sex: Yet Another Reason for Rectal Microbicide Advocacy” on July 10, 2008. Please save this date!

Dr. Morrow will discuss formative research exploring women’s anal sex practices and their implications for HIV/STI prevention.

IRMA is very grateful to the Centers for Behavioral & Preventive Medicine, the Warren Alpert Medical School of Brown University and the Miriam Hospital for hosting this call and for providing call-in capabilities to our members. THANK YOU! IRMA would not be able to provide this caliber of timely and informative teleconferences without the support and collaboration of institutions and organizations like these.

More detailed call-in information will be sent out to IRMA members via our highly active listserv in the coming weeks. Want to join IRMA and be included in our listserv? Click here.

Dr. Morrow's presentation slides will be made available on the IRMA website in the Teleconference section in advance of the call - so you can download them and be prepared to follow along when the call begins July 10. The IRMA list will be notified when those slides have been posted.

The plague is over, let's party

by Elizabeth Pisani in Prospect

Pisani is an epidemiologist and the author of The Wisdom of Whores (on the IRMA reading list - look to your left). Check out her blog by the same name here.

This blog featured Pisani in this post - "The unspoken truths about Aids" - and she has been stirring the pot on the IRMA listserv lately with some of her commentary.

Below is another provocative essay, this one about HIV/AIDS and gay men in Britain.

What do you think?

-------------------------

An HIV diagnosis in Britain is no longer a death sentence—
thanks to costly new drugs.
But as the spectre of death fades, so do the
most visible reasons to avoid risky behaviour.

Now the Aids prevention industry has a whole new set of problems .

I'm in a bar in Soho. A message flashes up on the plasma screen on the wall behind me: "Tom, I want to nibble your biltong." A guy leaning against the banisters makes a show of putting his mobile phone away while making eye contact with a cute blond boy at the bar. Cute blond blushes. Soon, they're smooching in a corner. How Tom's biltong fared that night I don't know, but I can guess.

This is London's gay scene in a world without Aids. Since treatment for HIV became available in the mid-1990s, Aids has all but evaporated in rich countries. Annual deaths among gay men in Britain have crashed from a peak of over 1,162 in 1994 to just 153 in 2007. "Aids? I've never met anyone with Aids," says Tim, an engineering undergraduate who's sitting under the plasma screen, nursing a nasty pre-mixed drink. When I ask how many of the guys around us might be infected with HIV, he looks shocked. "That's not a nice thing to talk about. I don't know, 4 or 5 per cent?" Actually, the government estimates that around 9 per cent of gay men in London are HIV-infected, against 5 per cent elsewhere. But we're not looking at all gay men in London. We're looking at guys in a pick-up bar at 1am on Friday night; I'm probably the only person here who will leave without being propositioned. Many of the men eyeing each other up are in their 30s; they've had plenty of time to get infected. My guess is that 25 per cent of the men in this room have HIV, possibly a lot more. In 2006, 2,640 gay men were diagnosed with HIV—making up nearly two thirds of the total diagnoses of HIV infections that were acquired in Britain.

You don't have to be an epidemiologist to work out that if 2,640 people are diagnosed with an incurable disease and only 153 die, the number of people known to be living with the disease will rise. The number of gay men living with HIV in Britain is probably around 31,000.

But these days you never see a cadaverous looking 35 year old in an armchair surrounded by friends trying not to notice that his face is covered by the black splotches of Kaposi's sarcoma, a cancer that feeds on people weakened by HIV. And as Aids disappears, so does the most visible reason to avoid unprotected sex. Just under half of gay men say they had some unprotected anal sex in the last year, up from under a third in 1996, when treatment became widespread. But if HIV isn't fatal any more, does it really matter if lots more people get infected?

The relationship between HIV treatment and prevention in the gay community is not straightforward. Virology, psychology, drugs and gay activist ideology play their part. Let's start with the virology. HIV is not very infectious. It is only easily transmitted when there's a high "viral load"—lots of free virus in the blood or genital fluids—and that is usually only for the first couple of months after a person gets infected, and then, years later, once they get sick. That means that people who have unprotected sex with several people in a three-month period are far more likely both to contract and spread HIV than people who have the same number of partners over a longer period. And gay men are far more likely than straight people to have lots of partners at once. A recent study of people who go drinking and clubbing in nine European cities found that gay or bisexual men were four times more likely than even out-to-have-fun heterosexuals to have had five or more recent partners.

Read the rest.

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!

News of IRMA-ALC Spreads Around the Globe!

da la bienvenida a

In its latest issue of GC News, which reaches an audience of nearly 1,000 people from around the world, the Global Campaign for Microbicides spreads the good news about the creation of IRMA-ALC (América latina y El Caribe).

Check the GCM web site to read the latest issue of GC News and to get microbicides resources in Spanish.

Visiten la página web de GCM para leer la última edición de GC News y para obtener algunos recursos en español sobre los microbicidas.

From GC News:

Advocacy in Action: New Rectal Microbicides Network in Latin America and the Caribbean

International Rectal Microbicide Advocates (IRMA) is very excited to share an important development for global rectal microbicides advocacy efforts. A new sister network has been created - IRMA-ALC (América Latina y El Caribe) - which will focus on rectal microbicide advocacy and research efforts in Latin America and the Caribbean.

IRMA-ALC has been formed by members in Peru, Ecuador and Brazil, who are co-chairs of the new network, including:

- Jerome Galea from the UCLA Program in Global Health in Peru and IRMA Steering Committee member
- Dr. Javier and Dr. Jorge Sánchez from Investigaciones médicas en salud (INMENSA), a health research institute in Peru
- Beatrice Grinsztejn, Valdilea Veloso and José Henrique Pilotto from FIOCRUZ, a public health institute in Brazil
- Orlando Monotya from EQUIDAD, a gay, lesbian, bisexual organization in Ecuador

"Although there is evidence of high frequency of anal sex among both men and women in Latin America, there is little interest in implementing clinical trials for rectal microbicides in the region", according to IRMA-ALC co-chair Dr. Jorge Sánchez. "The Latin American chapter of IRMA will advocate for a critical look at various opportunities for rectal microbicides research and push for its development in the region. We also want to facilitate the process for integrating these HIV prevention research efforts at a regional level, while instigating South-South collaboration." (original quote in Spanish can be accessed here.)

IRMA-ALC has a logo and new page on the IRMA web site. They will disseminate information in Spanish, and perhaps eventually in Portuguese. There is now a Spanish-language listserv that members can join from the web site.

"In all of Latin America and the Caribbean, there are only two microbicide clinical trials underway, one in the Dominican Republic and the other in Puerto Rico; both are for vaginal products. These studies represent important steps in the advancement of microbicide research", said Jerome Galea. "Together with IRMA, IRMA-ALC provides a framework for citizens, advocates and scientists from countries throughout Latin America and the Caribbean to put rectal microbicides on the regional map by disseminating information in local languages and promoting their culturally competent research and development."

"This wonderful development is another indication of the success IRMA is having collaborating with researchers and advocates around the world to spur global advocacy for rectal microbicide research and development. I am delighted that IRMA has a new sister, and love watching our family grow," said Jim Pickett, IRMA Chair.

News item: Community to discuss the future of HIV prevention

[this event, scheduled for May 21 in Nashville, Tennessee is being put together by IRMA member Mark Hubbard. Check out the flyer here.]

Gay and bisexual men continue to be in the forefront of HIV risk

“We now take evidence-based medicine for granted,” Dr. Sten Vermund of the Vanderbilt Institute for Global Health said last month. “We need evidence-based prevention programs just as much.”

Vermund is one of three prominent researchers scheduled to speak at “Beyond Condoms: Communities, Disparities, and HIV Prevention” at 6 p.m. on Wednesday, May 21, at the Hotel Preston in Nashville. According to organizer Mark Hubbard, the forum will have an interactive format.

Read the rest of this article in Out & About.

[Please share with IRMA information about your forums, workshops and events - and let us help publicize them here. It is so so so inspiring for all of us to see what is happening all over the world!]

"Beginning to Cross the Rectal Rubicon"

Join IRMA for a Global Teleconference

Thursday, May 29, 2008

Dr. Peter Anton will present a summary review of the data presented at M2008 on the first IND-supported rectal microbicide Phase 1 trial (using UC781). The talk will highlight explanations of the various mucosal assays currently in use, the design issues confronted and blinded results, now that the subject portion is complete. Data lockdown and unblinding is planned for 6/1/08. Dr. Anton will also briefly describe the study design of the upcoming rectal microbicide trial using tenofovir (gel vs. oral.)

UCLA hosts this call at the following times. (Dial-in info is coming soon.)
8am - Los Angeles
10am - Chicago and Lima (home of IRMA - ALC)
3pm - UTC
5pm - Cape Town
8:30pm - New Delhi

Join IRMA by subscribing to our listserv. Dial-in info will be distributed via our email list for members.

Click here for presentations from previous IRMA teleconferences.

Be Kind to Your Behind

[click to enlarge images]

[posted by Jim Pickett]

[Delhi Dynamos] Lanre Onigbogi of Ibadan, Nigeria

More Grease to Your Elbows!
Proud Member of IRMA Puts Rectal Microbicides
on the African Map

Correspondence from IRMA advocates

by way of India

M2008 memories and the path forward

by Lanre Onigbogi

I had always wondered what it would be like visiting the Asian continent and M2008 provided that opportunity. As a rectal microbicide advocate and an IRMA scholarship recipient, the challenge could not be bigger because there was so much to look forward to about the conference. The excitement was further heightened by the fact that my exposure to rectal microbicide sessions at M2006 had generated my venturing into research related to rectal microbicides. I wondered whether my exposure to the rectal microbicides sessions in this meeting will heighten my curiosity about the subject or totally dampan my enthusiasm. In summary, I was not disappointed and could not have wished for a better conference. 

The apprehension about how the rectal microbicide sessions and how to combine that with the volunteer efforts at the advocate corner was too overwhelming to be hidden from colleagues who were also participants at the meeting. This was heightened by the fact that I had made up my mind to talk to some Nigerian delegates about the International Rectal Microbicide Advocates (IRMA), an area that was hitherto novel to many of my colleagues.

Anecdotal reports put it that many who came without ever hearing about rectal microbicides ended up signing up to be advocates.

The M2008 conference itself was a great success. If we can learn from this conference and support the development of research on microbicides and convince investors to invest more in these, it would be a great achievement. There were also many youths, especially really dynamic ones from Africa who I believe will grow up to become great advocates. Simply put, youths are the best investment in the future of our nations, as they are healthy and fresh workers. The rectal microbicide agenda was also a greater success. Anecdotal reports put it that many who came without ever hearing about rectal microbicides ended up signing up to be advocates. Quite an achievement bearing in mind the stigma that is still associated with homosexual relationships in many parts of the world.

We need to look at the research agenda of the conference so that African universities can do operations research and evaluate their rectal microbicide programs. I look forward to a cohort of researchers and advocates who will come out of Africa and will collaborate to get funding for rectal microbicide research and advocacy. 

Since coming back from Delhi, I have picked up the responsibility of editing the Quarterly Newsletter of the Nigeria HIV Vaccine and Microbicides Advocacy Group (NHVMAG) called the NHVMAG Echoes. We are in the final stages of producing the newsletter that will highlight activities at M2008, and the success of advocacy efforts by IRMA will be showcased. I also look forward to participating in the rectal microbicide sesions of the AIDS 2008 conference in Mexico City later in the year as well as further involvement in rectal microbicide research and advocacy.

My heartfelt gratitude goes to the steering committee of IRMA and the indefatigable Jim Pickett for working tirelessly to put the rectal microbicide agenda on the main table, thereby potentially saving many valuable lives of African women and men.

More grease to your elbows!

I am proud to belong to IRMA and will forever be grateful for this wonderful opportunity to attend M2008 and look forward to seeing you all in Pittsburgh!

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.

The unspoken truths about Aids

[Via Great Britain's The Sunday Times Online, epidemiologist Elizabeth Pisani says political correctness over criticising sexual practices such as multiple partners in Africa has prevented us finding an effective strategy to fight HIV. Check out Elizabeth's controversiall blog - The Wisdom of Whores]

After researching HIV for over a decade, I know that we now have the information, the tools and the money required to eradicate Aids in most of the world. But we’re not doing it – and that makes me very angry.

To be fair, Britain has been a world leader in sensible HIV prevention. Under Margaret Thatcher, we were the first country to fund clean needles for drug injectors at a national level, and to make methadone widely available so that heroin addicts could stop injecting. The result: fewer than one in 75 drug injectors in Britain is infected with HIV, compared with one in two in Indonesia, for example.

For all its sensible policies, though, Britain won’t give out needles in prison. Yet two-thirds of all injectors in Britain have been to prison at some point; and nearly a quarter of all male injectors in prison say they’ve shot up while inside. Meanwhile, taxpayers fund needle-exchange programmes in prisons in other countries through the Department for International Development. But in Britain, the Home Office dictates what happens in prison, and denial rules.

I call it the Three Monkeys approach to HIV: we close our eyes to people injecting drugs, to people buying and selling sex, to people getting plastered and getting laid. We close our eyes, in short, to all the things that do the most to spread HIV.

Yet we can’t close our eyes to the fact that nearly 60m people have been infected with a preventable, fatal disease. About 25m of those are already in their graves. It’s also hard to ignore the fact that two-thirds of people with HIV in the world are Africans. Yet few people ask why.

HIV is largely a sexually transmitted infection, so there must be something different about sex in Africa. Yet you can’t say that without appearing to be racist. So campaigners have come up with other reasons that HIV is worse in Africa: poverty, ignorance, men having more power than women. All politically correct, but not epidemiologically correct.

Read the rest.

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.

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

HIV prevention studies in Africa: it's important to ask about anal sex

[originally published on aidsmap, april 10, 2008]

Individuals enrolled on HIV prevention trials in Africa should be asked if they have had anal sex, suggest investigators in a article published in the online edition of Sexually Transmitted Infections. Their study found that 18% of women enrolled in their study had recently had receptive anal sex and that undiagnosed anal sexually transmitted infections were present in many of these individuals.

Studies into sexual behaviour in Africa have often neglected to enquire about anal sex, and sex between men. There has either been an assumption that such behaviour was not prevalent, or a sensitivity to cultural taboos and prejudices means that investigators are reluctant to enquire about such behaviour. But studies are now suggesting that anal intercourse is common in Africa in both heterosexual and homosexual contexts and is an important mode of HIV transmission.

The study also showed that relying on patient report of symptoms will lead to many sexually transmitted infections remaining undiagnosed, and that simple microscope examinations of genital and anal swabs can lead to more infections being diagnosed.

Read the rest on aidsmap.

For related analysis, read IRMA's new report - "Less Silence, More Science" here.

[Delhi Dynamos] Shaleena Theophilus of Ottawa, Canada

Renegade Daughter and Microbicide DIVA
Makes Subcontinental Advocacy Magic

Proves You CAN Go Home
And Walk the Talk

Correspondence from IRMA advocates

by way of India
M2008 memories and the path forward

by Shaleena Theophilus

Thanks to the generous funding by IRMA through the John Shaw Memorial Scholarship, I was able to attend the Microbicides 2008 conference that was held in New Delhi. For me, these conferences are so amazing because you not only get to attend sessions on the latest in the field of microbicides research, you also get to genuinely interact with people from all sectors invested in microbicides advocacy from around the globe. How amazing is that!

I did my usual conference routine of trying to attend at least one session from every track. I had to stretch my mind a bit for the basic and clinical sciences, but overall, the information that I brought back was useful and informative for the work that I will be doing here in Canada.

Now, being an Indo-Canadian, this conference held an added importance to me. I had not been back to India for 13 years (as my family who still live there reminded on every occasion possible) and seeing how it has changed and the impact that this disease has had was something that I find hard to describe. In Canada, there are a handful of us -- South Asians working in this field. I found it inspiring to be surrounded by other Indians who are not only committed to the cause, but who also have an interest in microbicides.

Heading off after the conference, I had wished that more delegates could have seen Delhi beyond the confines of the conference, and experienced India in all of its intensity. I left to visit the plethora of aunties and uncles in the south, and I found that attending Microbicides 2008 afforded me the opportunity to talk with many of my relatives about these issues. I secretly chuckle when I think of my mother finding out that I talked about sex to her childhood classmate. However, I guess it is the smallest things that can have the biggest impact, whether that be giving a renegade daughter a secret pleasure or changing a person’s perception and actions around this disease.

Back in Canada, I have already had the opportunity to share what I had learned with the Canadian Microbicides Action Plan steering committee, as well as the Microbicides Advocacy Network Group. I will also be incorporating this information into upcoming presentations, the next of which will be held for community members in Nova Scotia at their regional skills building conference.

I look forward to the next conference in Pittsburgh. More importantly, I look forward to one day showing community members what a microbicide looks like and how to use it both vaginally and rectally as the newest prevention option available to them!

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.