Increase in serodiscordant casual sex among Sydney gay men at a time when HIV diagnoses have not increased

via Aidsmap

Between 2003 and 2006, there was an increase in the numbers of HIV-negative gay men in Sydney who reported having unprotected anal intercourse with casual HIV-positive partners, report researchers in the online edition of AIDS and Behavior. However the researchers do not believe that these men form "a core group of high risk men".

Iryna Zablotska and her colleagues from the University of New South Wales analysed data from two cohort studies among Sydney gay and bisexual men: the Positive Health cohort of 760 HIV-positive men, and the Health in Men cohort of 1427 HIV-negative men. Both studies asked identical questions about sexual behaviour in annual surveys from 2003 to 2006, including questions on sex with partners of a different HIV status (rather than, as in some other studies, sex which could have been with a partner of a different HIV status).

Among the HIV-negative men, whilst the number having sex with casual partners decreased from survey to survey, there were small but statistically significant increases in the numbers having serodiscordant sex. Those having sex with casual partners they believed to be HIV positive rose from 11% to 13%, and the number specifically having unprotected anal intercourse with those men increased from 3% to 4%.

The number of HIV-positive men reporting serodiscordant casual partners did rise, but there was no statistically significant rise in unprotected anal intercourse with them.

The study examined a number of behaviours that have been previously found to be associated with sexual risk-taking, and confirmed that serodiscordant unprotected anal intercourse with casual partners was more common among men with higher numbers of sexual partners, men who met partners online or in sex clubs, Viagra users, those who injected drugs, men who used 'party' drugs regularly and those having ‘esoteric’ sexual practices (fisting, sex toys, water sports, bondage etc).

However the researchers note that men who had risky sex did not do so consistently. Over 85% of the men who reported having serodiscordant unprotected anal intercourse only reported it at one of their annual interviews, and they typically reported that behaviour with just one or two partners in the previous six months.

Read the rest on Aidsmap.

Barebacking: A Review of Literature

Arch Sex Behav. 2009 Jan 22. [Epub ahead of print]

Berg RC.

Norwegian Knowledge Center for the Health Services, Box 7004, St Olavs plass, 0130, Oslo, Norway, rigmor.berg@nokc.no.

This article synthesizes the peer-reviewed literature about barebacking, an HIV risk behavior that is generally understood as intentional unprotected anal intercourse between men where HIV transmission is a possibility.

Of the 42 academic reports identified in the Anglophone literature, the greatest attention is given to U.S. publications and empirical projects.

The variable nomenclature about barebacking is recognized and it is concluded that although epidemiological data suggest prevalence of barebacking varies across regions, time, and serostatus, the majority of men who have sex with men (MSM) do not intentionally seek out condomless anal sex.

Findings show that macro-, meso-, interpersonal-, and intrapersonal level factors, such as homonegativity, community norms, partner intimacy, and drug use, converge to influence the likelihood that an individual will bareback. A conceptual framework to examine the reciprocal and dynamic relationships sustaining barebacking is proposed.

In examining the theoretical and methodological limitations of the research about barebacking, the atheoretical nature of the studies, failure to report analyses conducted, and suboptimal measures are included among the study constraints.

Furthermore, in research to date, the majority of participants have been white, urban, and gay-identified; thus, more research is needed to capture the viewpoints of diverse MSM communities. There has also been an overly individualistic focus on barebacking which needs to be tempered by greater consideration of the impact of macro- and meso-level factors upon MSM's behavior. With respect to programmatic responses, more culturally bound strategies are called for.

PMID: 19160033 [PubMed - as supplied by publisher]

2009 Annual Letter from Bill Gates: Progress on AIDS

[Note from the IRMA chair - while IRMA is very happy the Gates Foundation is deeply supportive of microbicide research, in addition to other new prevention technologies, it is very disappointing that Mr. Gates defines a microbicide as "a gel a woman can use to protect herself from getting infected." Of course, we all know that microbicides are being developed for use by gay men and men who have sex with men. Why is this fact ignored?]


[excerpted from his full letter]

On the AIDS front, you have probably read articles talking about failed trials of vaccines and microbicides. (A microbicide is a gel that a woman can use to protect herself from getting infected.) Although these results are setbacks, in each case we are learning and moving ahead with improved approaches. I am quite hopeful that in the next four to six years we will have either a pill or a microbicide that people can use to protect themselves temporarily from getting HIV. When used on a large scale they will dramatically reduce the annual rate of infection, which is currently 2.7 million. I feel a huge sense of urgency to make sure a pill or microbicide is developed as soon as possible. There are some great scientists working on this, and I am spending lots of time asking them what the bottlenecks are and understanding how we can make faster progress. The intensity reminds me of my time at Microsoft, when we were competing with other companies to make the best database or word processor. However, in this case the competitor is a virus and all of humanity is on the same team, wanting to work together to defeat the virus.

When we get a vaccine it will be even more impactful than a pill or a microbicide, because a vaccine will protect people for much longer. But given the complexities involved, even with the great work being done, it is very likely to be more than 10 years before we have one in widespread use.

To stay alive, people with HIV need to start using anti-retroviral drugs before their immune systems become weakened, usually within five years of becoming infected. In 2003, only 400,000 people were being treated, and now some 3 million are. That is a phenomenal increase. The biggest reason for it is that the United States funded the President’s Emergency Plan for AIDS Relief and managed the effort very well. In addition the United States, along with a number of other countries, has funded the Global Fund for AIDS, Tuberculosis, and Malaria. This is a good example of how scientific innovations, in this case the invention of anti-retroviral drugs, can reach the poorest with help from governments, foundations, and drug companies. Although less than 5 percent of people with HIV/AIDS live in rich countries, it was the market demand from these wealthier patients that drove the large R&D investment in these drugs.

Read his full letter.

Martin Delaney - The accomplishments of people living with HIV/AIDS

by Mark Hubbard

Last Monday, the National Institute of Allergies and Infectious Diseases awarded a Director’s Special Recognition Award to Martin for his many contributions to the fight against HIV/AIDS

By now, many of you know that Martin Delaney (of Project Inform) died peacefully Friday morning surrounded by friends and family in San Francisco.

At last year’s Positive Living conference in Fort Walton Beach, Florida, Martin provided the annual treatment update. Martin only missed one meeting in the conference’s eleven-year history, having had a heart attack a week before the event. Positively Living is one of very few U.S. conferences remaining that are targeted specifically (and almost exclusively) to PLWHAs. A member of the audience was so inspired by Martin’s remarks concerning the role of activism in the history of HIV/AIDS that he approached Martin and conference organizer Butch McKay about creating a session on the subject for this year’s event.

As the gentleman and Martin began emailing back and forth, they copied Butch with the product of their efforts. For some reason the correspondence petered out in March of this year. Earlier this week, as a member of the conference planning committee, I volunteered to help format the rough document. This year’s Positive Living will feature a special tribute to Martin. I can’t think of a better way to honor his memory than to pass on this version of what Butch has deemed the “Delaney Declaration.”

The Delaney Declaration
(March 2008)

By Martin Delaney

The entire human population benefited from the way AIDS first struck the gay community. Many people wanted to blame the spread of AIDS on gay people, but the facts are exactly the opposite. The epidemic would have been dramatically worse if it had struck any other group than gay people.

Most diseases uniformly strike an entire population, spreading lightly across all economic, geographic, racial, and gender groups. As a result, nothing really unifies the patient population other than the disease itself. As a consequence, people do not bond together or organize to fight the disease because they have nothing in common that connects them.

You can see this in virtually all other major diseases. There may be millions of people who have a disease but they fail to organize to fight it. They don’t demonstrate, they don’t group together to influence the Congress, they don’t develop media strategies. They just go on with their various local groups and families and fight the disease simply as individuals.

In great contrast, when AIDS hit the gay community with unparalleled specificity, it struck a group that already identified itself as a community across the entire nation. It struck a group of people who were already organized politically with skills to influence both local and national government; it struck a population that that already knew it had to fight for its rights, even fight to survive. It knew how to use the media. It knew it had to take care of its own because no one else would. It knew it had to fight back or die.

We [the gay community] were in San Francisco, Los Angeles, New York and every other major country, yet linked together. Wherever, we were a part of a whole. We were in the scientific community; we were in the NIH (the United States’ medical research agency, the National Institutes of Health). We were in the drug companies and in Congress. Because of this unique situation, AIDS faced a far more formidable and organized enemy than had ever before been the case. Had AIDS simply hit across all the general segments of society, like other diseases, it would have encountered far less resistance. People getting the disease would have had nothing in common with each other, no underlying links or abilities, or any need to see itself as a fighting force. It would have been just another disease and it would have been treated like just another disease.

But we know it was not just another disease. It was far cleverer, more dangerous, and spread quietly because it acted slowly. It continued to spread for decades before society would even know it was there. In contrast when it struck the gay community, our underlying culture made it visible much more quickly. Within a few short years, we were able to see that it was sexually transmitted.

The normal rules for people with life threatening illnesses didn’t work very well. Usually such people are too sick to do anything about it. We saw our entire community under siege; we knew we had to change the rules or we would all be dead.

We hollered about it in the media, we went to the FDA (the United States’ Food and Drug Administration) and the NIH, we marched in Washington, got people on committees and proposed new ideas and new ways of thinking about science and the treatment of people with terrible diseases. WE changed the rules, first for ourselves but ultimately for everyone facing a life threatening disease. WE wouldn’t just listen to our doctor either. We recognized that they worked for us, that we were in charge of our lives and our bodies. We taught each other to demand that our doctors act as partners, not as dictators. We changed the doctor patient relationship. We realized that patient education was ultimately going to be done either by drug companies or by the patient community itself; we organized ourselves to teach ourselves.

We became a voice that could counter, when necessary, the messages of the drug companies, drug company advertising, and everything the companies did that affected us. As activists, we formed teams to speak up for our community regarding clinical trials.

The accomplishments of people living with AIDS:

1.Having an instrumental role in changing the rules for drug discovery, development and approval for life threatening illnesses

2.Greatly speeding up access to new drugs, both in and outside of clinical trials.

3.Changing the mindset of researchers about the wisdom of providing early access to experimental drugs.

4.Patient empowerment - helping people understand that they don’t have to be victims of a disease, but can instead be leaders in the fight against it.

5.Changing the patient mindset from hopelessness to hope; helping people see that there is always something you can do.

6.Demonstrating that you don’t have to be a scientist to influence science and have it serve people.

7.Discovering how to be taken seriously by scientists, academics and government bureaucrats, and how to influence them with without making them the enemy.

8.Learning how to organize to influence government policy.

Gay men likely to be highly sexually experienced before they are willing to 'come out' to obtain HPV vaccine

via Aidsmap

Gay men will have a high level of sexual experience before they are willing to disclose their sexuality to healthcare providers so they can obtain a vaccine for human papilloma virus, an Australian study published in the online edition of Sexually Transmitted Infections has shown. This could mean that many gay men would already have been infected with human papilloma virus (HPV) before they were willing to come forward for vaccination, meaning that its protective effect for these individuals would, at best, be extremely limited.

Earlier research has suggested that there is a high prevalence of genital and anal infection with human papilloma virus amongst gay men, with particularly high levels of infection seen amongst gay men with HIV. Infection with human papilloma virus increases the risk of anal cancer, which occurs with greater frequency in gay men, most notably HIV-positive gay men.

Two vaccines that offer a high level of protection against the strains of human papilloma virus most associated with cervical (and anal) cancer have recently been approved. Their use is currently restricted to women, and to ensure that they have the maximum possible protective effect, UK guidelines state that they should be given to girls aged between twelve and 13 before they become sexually active.

Studies are currently evaluating the safety and effectiveness of these vaccines in men (and people with HIV).

Researchers in Melbourne, Australia, wanted to see how acceptable gay men would find a vaccine for human papilloma virus (assuming the results of trials were favourable). Furthermore, they wanted to gain an impression of how useful the vaccine would be at preventing infection with human papilloma virus.

Read the rest.

New study claims 16% of Iranian men have had gay relationships

via pinknews.co.uk

A sociologist at an Iranian university has presented a new study that shows high levels of homosexual experiences among the country's population.

Iran has strict laws against sex outside marriage and other sexual acts such as masturbation. Adultery and same-sex acts are punishable by death.

Startling new research from sociologist Parvaneh Abdul Maleki found that 24% of Iranian women and 16% of Iranian men have had at least one homosexual experience.

73% of men and 26% of women surveyed said they had masturbated.

Ms Maleki presented her findings at the Third Conference on Well-being in the Family and the story has been reported in the Iranian press, albeit as a report on sexual deviance in need of treatment.

The report also revealed that more than 75% of those who grew up in a conservative religious environment have watched pornography, 86% have had a heterosexual relationship outside of marriage and just over 4% have had gay or lesbian relationships.

Since Iran's Islamic revolution in 1979, human rights groups claim that between 3,000 and 4,000 people have been executed under Sharia law for the crime of homosexuality.

In September the President of Iran admitted in an interview that there may be "a few" gay people in his country, but attacked homosexuality as destructive to society.

In an interview with US current affairs TV programme Democracy Now, Mahmoud Ahmadinejad also rejected criticism of the execution of children in Iran.

During a visit to the US in 2007 he said in reply to a question posed about homosexuality during his speech at New York's Columbia University:

"In Iran we don't have homosexuals like in your country… In Iran we do not have this phenomenon, I don't know who has told you that we have it."

In his TV interview in September he condemned American acceptance of gay people.

"It should be of no pride to American society to say they defend something like this," President Ahmadinejad said.

"Just because some people want to get votes, they are willing to overlook every morality."

Heterosexual Anal Sex in the Age of HIV

People are inundated with “safe sex” messages and condom advertisements, but heterosexual penetrative penile-anal sex is rarely, if ever mentioned in these, leaving a gaping hole in people’s knowledge and awareness.

by Zoe Duby University of Cape Town

Research on sexual transmission of HIV consistently finds unprotected anal intercourse to be a highly predictive risk factor for sero-conversion. Despite this, most AIDS prevention messages targeted at heterosexuals continue to solely emphasise vaginal (and increasingly but still only occasionally oral) sexual transmission without mention of anal sex. This omission is influenced by the deeply entrenched taboos surrounding this sexual practice, as well as a lack of acknowledgment of its prevalence and significance as a heterosexual behaviour.

Partly as a consequence of this omission, the potential health risks of unprotected anal sex continue to be severely underestimated in the heterosexual community. Although knowledge seems to be high amongst the gay community, this appears not to be the case amongst heterosexuals. Evidence of this lies in the reportedly universal lower use of condoms for anal sex than for vaginal sex by heterosexuals. Data suggests that some people choose to practice anal sex due to misconceptions about the risks it poses. Anal sex is sometimes not considered to be “real sex” and evidence suggests that young girls choose anal sex as a means of preserving their virginity and as a form of contraception.

Evidently there are significant gaps in knowledge and awareness of the risks of unprotected anal sex amongst heterosexuals; many people choose to have anal sex as a “safe” alternative, thinking that it is not possible to transmit HIV through anal intercourse. This is largely due to the lack of information available that explicitly depicts and differentiates all potential sexual transmission vectors – vaginal, anal and oral. People are inundated with “safe sex” messages and condom advertisements, but heterosexual penetrative penile-anal sex is rarely, if ever mentioned in these, leaving a gaping hole in people’s knowledge and awareness.

The censure and stigmatisation of a commonly practiced sexual behaviour not only puts people at greater risk but also creates an atmosphere of shame and disgust around what for many people may be a desirable, pleasurable and consensual part of sexual relationships and intimate interaction.

Why do heterosexuals have anal sex?

i. Virginity
Virginity maintenance is one of an array of reasons given for young people electing to have oral and anal sex over penile-vaginal penetrative sex; the substitution of non-vaginal sexual activities for vaginal intercourse is a means of maintaining “technical virginity.”

Religion and culture play a key role in condoning or prohibiting certain sexual practices. Ample data supports the assertion that young girls in Christian, Islamic and traditional societies throughout Africa practice anal sex in order to protect their vaginal virginity. In many cultures, a high value is placed by the family and society on safeguarding girls’ virginity until marriage. In addition, evidence shows that young people in the United States who pledge to remain virgins are more likely to have engaged in ‘alternative sexual behaviour’, in order to preserve their virginity. Research shows that among those who have not had vaginal intercourse, pledgers have shown to be more likely than their non-pledging peers to have engaged in both oral and anal sex. In communities with a higher proportion of virginity pledgers, overall STI rates are actually higher than in other settings. Reasons for this may lie in the lack of sex education that young people in conservative religious communities receive.

…a lot of my religious friends… who are trying to hold on to some sort of sanctity of waiting until they’re married to have sex – feel that oral sex and anal sex are sex that they can have that’s still not full sex in their eyes… I think that the youth… today… are searching for these things that don’t make them lose their virginity – but allow them to still sort of engage in sexual activity… like they think all their peers are.. It’s like a loophole – it’s like they’re desperate to hold onto their virginity – but they’re not scared to engage in other acts so that they look cool... [Respondent 1, Duby, 2008]

In some communities virginity until marriage is less an established religious issue than a traditional cultural preference. In some communities “virginity testing” is practiced. Young girls are examined before marriage to ensure that their hymen is intact. Discovery of a ruptured hymen brings shame to a girl and her family, and can jeopardise her eligibility for marriage. As a result of the high value placed on virginity and hymen maintenance (a falsity as the hymen can be ruptured in non-sexual activity such as tampon use or physical exercise) it appears that young people choose to have oral and anal sex instead.

In an era of abstinence and HIV prevention programmes advocating delayed sexual initiation, it can be argued that the social pressure to remain a virgin actually contributes to young women’s risk of infection, acts as a barrier to their adoption of preventive behaviours and encourages the subsitution of alternative non-vaginal sexual practices. Some young adults have unprotected anal sex unaware of the high risk of HIV and STI transmission it poses.

Research on adolescent sexual behaviour in the past has been largely limited to vaginal intercourse, thus accurate prevalence statistics for non-vaginal genital activity amongst adolescents are unavailable. Research and sexual health programmes have traditionally used the classification of an individual as ‘sexually active’ based on vaginal intercourse. This means that ‘technical virgins’ who are engaging in non-vaginal sexual activities are omitted from discussions on sexual risk, potentially excluding many sexually active young people and consequently placing them at greater risk.

ii. Contraception
In a similar vein to virginity maintenance, evidence suggests that heterosexual anal sex is also practiced as a means of contraception. Young women wishing to avoid pregnancy but still desirous of sexual activity choose anal sex as an alternative means of attaining sexual pleasure without fear of conception.

…the main reason for having anal sex, other than it just being nice for the guy – is ejaculation. He can come inside you and there’s no risk. [Female respondent, Duby, 2008]

Sexual partners wanting to have non-reproductive “flesh to flesh” sex without the presence of any form of contraception and without the physical barrier of a condom, may choose to have anal sex so that there will be no chance of conception if the male ejaculates inside the female.

…it’s a nice way because then there’s no stress if he comes inside you… [Female respondent, Duby, 2008]

iii. Misconceptions: Misinformed and Unaware
Sadly, available evidence suggests that anal sex is sometimes practiced as a form of “safe sex”, ironically as a means of avoiding HIV transmission. Due to the silence around the topic of heterosexual anal sex and its omission from discussion on safe sex, the assumption is made that it must be safe. Health care providers themselves are also often unaware of the risks of anal sex. The false impression created that anal sex is safer than vaginal sex may be due to its lack of address in health education. Safe sex promotion and HIV prevention strategies unwittingly encourage misperceptions that anal sex is a ‘safer’ form of sex. Evidence from anecdotal reports suggest that some people practice anal sex (either with a female or a male) because they believe it will protect them from STIs/HIV. The reason for this is because they have heard no discussion about the risks of infection through anal sex.

Condom Use and Anal Sex
Despite anal sex having been identified as the most predictive risk factor for sero conversion in heterosexual HIV transmission, its risks are still underestimated by the vast majority of sexually active heterosexuals. This is illustrated by data showing that reported rates of condom use are universally lower for heterosexual anal intercourse than vaginal, and that far more women engage in unprotected anal sex than gay men. The male homosexual population are more sensitised to condom use for anal sex than heterosexuals. This can be attributed to the fact that HIV and STI programs targeted at the general population do not specifically address anal sex, whereas prevention programmes aimed at the gay population do. Another reason may be that condoms are primarily used by women for contraceptive purposes rather than protecting against STIs. Due to the failure of prevention programmes to sensitise heterosexuals to the high risk of infection of HIV and other STIs through unprotected anal intercourse, the widespread assumption that HIV transmission between heterosexuals is synonymous with penile-vaginal penetrative sex is inadvertently reinforced. Most literature on HIV and AIDS does not pay heed to heterosexual anal sex, although contrary to the popular association of anal sex with homosexual men, numerically more heterosexuals engage in anal sex than homosexuals. But due to the highly stigmatised and hidden nature of heterosexual anal sex as a topic, both male and female heterosexuals are less likely to discuss and negotiate safe sex approaches to anal intercourse than homosexual men.

iv. Peer group pressure: “because everyone else is doing it”
In contrast to the pressure to maintain virginity exerted by religious and traditional communities, the power of the peer group should not be underestimated. Young people are subject to the powerful force of wanting to conform, of needing to be accepted into social groups. In ‘school yard’ discussions about sex prestige may be gained through sexual prowess and sexual experience. Some youths, in an effort to win respect and admiration from peers may exaggerate and boast about sexual experiences, in order to appear ‘mature’. Banter about adventurous and exciting new sexual positions, that may only be entirely theoretical, may exert pressure on more inexperienced teenagers to try out ‘what everyone else is doing’. Sexual prowess, expressed in terms of numerous sexual partners or claimed wide sexual experience, is linked to both peer and general social recognition, especially of a masculine profile.

v. Menstruation
Anal sex is sometimes used as an alternative form of penetrative sex when a woman is menstruating. Anal sex can constitute a more ‘convenient’ form of penetrative intercourse when a woman is menstruating, avoiding embarrassment, discomfort and the ‘messiness’ of blood on the bed sheets and bodies of both sexual partners.

…when she (my friend) had her period, they (her and her boyfriend) used to always just have anal sex instead, because then she could wear a tampon, and so that there didn't have to be any blood. [Female respondent, Duby, 2008]

Interviewer: You mentioned before that anal sex was something you did in your first relationship when you were menstruating – why?
Female respondent: Um – just because… firstly you didn’t want to get blood everywhere, all over the sheets and stuff, and secondly I didn’t feel very comfortable with getting blood on him… I felt like… I dunno – I just didn’t like the thought of that. And I never really asked him about what he thought about that – and then sometimes it can be a bit painful to have (vaginal) sex when you’re menstruating. [Duby, 2008]

Additionally, in some societies menstrual blood is seen as a dirty polluting substance, potentially dangerous for men to come into contact with.

vi. For money
In the world of commercial sex work, evidence suggests that men will pay more for anal sex, with added value if it is without a condom. Motivation for commercial sex workers to engage in anal intercourse with their clients lies in the offer of higher financial benefits for anal sex than for vaginal sex. Evidence also suggests that more economically or socially vulnerable sex workers, as well as drug-abusing women, are more likely to offer unprotected anal intercourse for clients, being more driven by financial incentives than their less vulnerable and more financially secure co-workers.

vii. For him
Some feminist writers have argued that women have only come to understand their sexual pleasure and desire in terms of a patriarchally defined female sexuality which serves the male. In the process women are denied their own sexual subjectivity and pleasure. However it may be informative to examine the personally perceived moral obligations that a woman has to fulfill and satisfy her sexual partner’s desires, needs and fantasies. Popular contemporary media often compounds the perception that good sex in a relationship is the woman’s responsibility (however it would not be fair to say that men do not also come under pressure to provide sexual pleasure to women).

…my partner is always eager to do that (have anal sex)… and then I’m always kind of like “I don’t know” – so I think that mutual enjoyment out of it would be nice… which is probably why I really want to explore it a little more… I think it’s… it’s selfish in a way – you know you don’t want to be too giving in a sexual relationship – you want to get just as much enjoyment out of it as him at the same time… so I suppose it’s about getting to that point where we’re both enjoying it as much as the other. [Female respondent, Duby, 2008]

Many heterosexual women feel compelled to provide anal sex to their male partner, believing it to be more pleasurable for him. Women accommodate the perceived needs and desires of men, incorporating male needs into their own perceptions of what they want themselves. Many heterosexual women express the concern that if they fail to provide the sex that their male partner desires, they will be rejected; the provision and accomodation of a male partner’s needs enhances security within a relationship. This is especially the case in cultures where women’s sexual pleasure is not recognised or valued.

…he didn't make me do it (have anal sex) if I really didn’t want to, but I did it because it was interesting for him to… explore this activity... this feeling… [Female respondent, Duby, 2008]

Interviewer: So why do you think men enjoy anal sex?
Female respondent: I think… in an animalistic sense, it’s more the power… the control, without it really even being rape – you know it’s not violent, it’s not… the person is allowing you to do it… and it probably makes them feel powerful – and you know it’s supposed to be tighter as well…

Interviewer: And do you feel, when you’re in that situation, do you feel it makes you more submissive?
Female respondent: Definitely. Because I’m not submissive by nature – and I suppose that’s why it feels a bit weird emotionally because you know I am literally not in control... I mean even from my experience of a partner’s reaction during anal sex, he kind of gets very… like an animal in a way… and he kind of loses a bit of himself and it becomes kind of… It’s difficult to explain... it has happened where it got to the point where I was like “ok, enough”… and they haven’t heard me… by choice – to put it bluntly… and that’s not… that’s not nice… that’s not cool, and that’s very sort of demoralising – and afterwards you really do feel violated… [Duby, 2008]


viii. Domination/submission
…some women enjoy it (anal sex) mostly because it pleases their partner and some women enjoy it because they do like the sensation – or they like being maybe more submissive or something like that… [Female respondent, Duby, 2008]

Penile-anal sex is sometimes viewed as more aggressive and transgressive than penile-vaginal sex, involving the domination of one partner over the subordinate other.

I think it’s definitely… the most vulnerable position a woman can be in… it obviously depends on the partner as well … what space he’s in when he initiated it... If it’s more because he’s not thinking about you in the process... there have been times when it’s been great, but sometimes it just makes you feel violated… even though you love the person that you’re with – and you care for them, you still feel a little bit violated after that… It also depends on how it’s received – how it’s valued… by the partner – because if it’s kind of like as they say “wham bam thank you maam”, then it’s sort of not appealing after that – but if it’s – if something does happen emotionally - and you do feel closer to that person and you can see that it’s reciprocated, then it becomes more intriguing, and then you think “maybe it won’t be so bad”… [Female respondent, Duby, 2008]

I think it’s quite a submissive thing to do… to be on the receiving end of it – I think there’s much more of a power dynamic than I think there is with ‘normal sex’…. That was all part of it – that was just part of the fantasy and the – you know what makes it fun…. and for him – I think that’s why he liked it as well - I think partly because you know you’re not facing each other – so it’s more about just the sex than about the love or anything…. [Female respondent, Duby, 2008]

ix. Love and intimacy
Some people feel that anal sex requires greater intimacy between sexual partners; couples may practice it out of the desire to expand their physical and intimacy boundaries, to “get closer” to each other and perhaps explore previously uncharted territory together.

…there’s a comfort level that goes above and beyond the comfort level of just having regular sex with somebody. Just to be able to do that and not feel gross and self-conscious about it… [Female respondent, Duby, 2008]

Due to both the physically and morally sensitive nature of anal sex, sometimes it is more symbolically imbibed than vaginal sex, involving a further degree of intimacy and trust between individuals (in the case of consensual anal sex).

x. Sexual adventure and sensation seeking
The historical association of anal sex with deviancy and pathology gives the impression that anal sex is something only practiced by perverse individuals. This of course is not the case; consensual anal sex constitutes a pleasurable part of many healthy sexual relationships. Heterosexual couples may practice anal sex out of a desire to try new things, experience novel sensations, explore physical boundaries and anatomical regions. Curiosity may induce temptation to try new sexual acts and positions.

…it’s like bungee jumping – you know you’re going to get scared – and you know it’s not going to be pleasant for the first few minutes but you know afterwards you’ll think: that wasn’t so bad… [Female respondent, Duby, 2008]

…it was mostly just because it was… just a different sensation or whatever… [Female respondent, Duby, 2008]

The first time I did it, I had to get used to the feeling – you know because it’s something that’s completely different from anything you’ve felt before… [Female respondent, Duby, 2008]

The ‘accomplishment motive’ may be particularly relevant to adolescents practicing anal sex, feeling they are under pressure to do everything that their peers have done. Alfred Kinsey referred to this desire that some people have to ‘keep score’ and have sex in every position available and known about, to attain a sense of achievement.

Interviewer: So what would you say are your key motivations for having anal sex?
Female respondent: I think just curiosity… to finally prove whether I’m going to like it or not… I don’t think I’ve explored it enough… to be honest… Just curiosity – I need to get it out of the way… otherwise I’ll just be wondering… [Duby, 2008]

xi. Sexual choice and variety
Sex is a consumer product in the context of the consumerist society we live in. There is a plethora of sexual choices and lifestyles that the (‘free’ and ‘modern’) individual sifts through and samples as a means through which to express the self. With sex shops, pornographic material, sex toys and sex shows becoming increasingly accessible and popular, we are inundated with imagery of the weird and wonderful world of adventurous and exciting sex. Within this jungle of sexual opportunities we are encouraged to find our sexual selves. In a context free from coercion, exploitation and economic pressure, the modern Western individual reaches sexual self-realisation through conscious choice.

Until now safe sex messages and HIV prevention programmes have retained a limited and narrow view of sex. Only recently have condom and lubricant manufacturers cottoned onto this thirst for sexual adventure and fun in the affluent West, and have increasingly geared certain products towards this and away from boring, outdated and conventional sex.

Interviewer: What would you say your motivations for trying anal sex the first time were?
Male respondent: I suppose curiosity… it feels like a part of my sexuality – maybe aspects of… aspects of it that intrigued me or aroused me – um… yeah all those reasons – and maybe I could even ask myself whether boredom, sexual boredom was initially a reason… [Duby, 2008]


xii. Subversion and deviance
The Christian influenced Western world has been largely conditioned by the pervasive philosophy of sex as a sin. In the dualistic notion of the temptation of the ‘forbidden fruit’, desire is increased by the forbidden nature of a sexual act, and sexual activity itself is enhanced by the very fact of transgression. The risk of ‘defying rules’ creates an aura of excitement and ‘additional thrill’. Arousal may be substantially increased if the sexual act is perceived to be an ‘illegitimate activity’.

…with my last sexual partner, I would often say to her, I feel like something nasty tonight… some days we’d be on the same page and other days we wouldn’t… I don’t know if subversion is the right word but something… you know sometimes you feel a little destructive – and letting your hair down and being a little nasty... is attractive… [Male respondent, Duby, 2008]

Some individuals choose to practice anal sex because of its moral positioning as “deviant”. In an attempt to challenge society and break from mainstream culture, people seek to indulge in behaviour, sexual and otherwise, that they perceive to be in opposition to societal norms and expectations. By making the conscious decision to practice anal sex they may be engaging in a discourse of subversion. The individual choosing to assert their agency in experimenting with sex and breaking away from socially ascribed sex norms and positions may get some satisfaction from the sense of subversion and escape from societal control.

…just because it is so taboo – I think that’s what makes it more appealing. [Female respondent, Duby, 2008]


Conclusion
Evidence for the high incidence of heterosexual anal sex increases, alongside scientific knowledge about the high risks of HIV and STI transmission through penile-anal intercourse. It can no longer be ignored. As long as the cloak of denial and taboo remains over the subject of heterosexual anal sex, not only are people continually being denied access to comprehensive information and health service provision catering to all their sexual health needs, but they are not being given the opportunity to make informed choices about practicing safe sex and thus protecting themselves and their partners from HIV infection.

The censure and stigmatisation of a commonly practiced sexual behaviour not only puts people at greater risk but also creates an atmosphere of shame and disgust around what for many people may be a desirable, pleasurable and consensual part of sexual relationships and intimate interaction.

Pervading moral judgements are hard to change but in creating and allowing space for discussion and expression of sexuality, sexual attitudes and sexual desires, dialogue will inevitably lead to a greater acceptance and acknowledgement of what has for so long been hidden and ignored. Research must begin to address heterosexual anal sexual practices more attentively to enable greater understanding of sexual motives and sexual behaviour, which in turn will inform HIV prevention programmes.


Interview data referenced from:
Duby, Zoe 2008. Heterosexual anal sex in the age of HIV: An exploratory study of a silenced subject Unpublished Master’s dissertation, Department of Sociology, Graduate School of Humanities, University of Cape Town

HIV Prevention Hypocrisy Watch: Fight the Virus, Punish the Victim?

via RH Reality Check

Two weeks ago, nine HIV activists were sentenced to eight years in prison in Dakar, Senegal for "indecent and unnatural acts" and "forming associations of criminals." They were arrested in December, just after the 15th International Conference on AIDS and STIs in Africa (ICASA), on suspicion of having engaged in homosexual acts. Such arrests are all too common around the world. And under the Bush Administration, U.S. foreign policy leaders were far too reluctant to name such abuses for what they are - serious human rights violations.

Finding similar laws in the United States unconstitutional, the U.S. Supreme Court has said that they demean the existence of homosexuals. In so doing, such laws limit the effectiveness of our global commitment to fighting the HIV/AIDS epidemic. It is time for the new Obama Administration to take a principled stand for human rights.

In Senegal, the ICASA discussions highlighted the hypocrisy of countries, like Senegal, that support crucial HIV-prevention efforts for men who have sex with men, while simultaneously enforcing laws that criminalize consensual homosexual conduct and drive homosexuals into the shadows - often to a precarious and fearful legal existence that is well beyond the reach of any effective health intervention. There are far too many countries like Senegal, where the rights of LGBT communities are denied with impunity, and where the efforts of public health officials are continually thwarted.

Our existing legal commitments to human rights, together with our massive global investments in combating HIV/AIDS, should compel those who represent our country - in Congress, in the White House, in U.S. embassies and in U.S. corporations - to use the diplomatic, political and economic leverage available to them to oppose human rights abuses that are too often directed at individuals because of their sexual orientation, gender identity or gender expression. Public opposition to international human rights abuses impacting LGBT individuals was unusual under the Bush Administration. It will be sorely needed under the Obama Administration.

For example, at the United Nations General Assembly this past December, more than 60 countries submitted a ground-breaking statement on human rights, sexual orientation and gender identity that called on all governments around the world to ensure that sexual orientation and gender identity are not subjected to criminal penalty, and that individuals are not executed, arrested or otherwise detained because of their sexual orientation or gender identity. Despite thousands of individual calls to the State Department from US citizens, letters from Members of Congress, and requests from close U.S. allies, the United States refused to join the Statement. The United States was one of the only countries in the "Western Group" at the United Nations that did not sign the Statement.

Read the rest on RH Reality Check.

Risk reduction strategies are safer for Sydney gay men than other unprotected sex practices - but less safe than consistent condom use

via Aidsmap.

Gay men in Sydney who only have unprotected anal intercourse as part of a risk reduction strategy such as serosorting or negotiated safety have a considerably lower risk of acquiring HIV than men who have unprotected sex in other ways, report Australian researchers in the January 14^th issue of AIDS.

Men who have unprotected anal intercourse only as the insertive partner, and those who ensure that their partner withdraws before ejaculation, also had a lower risk of acquiring HIV than men who don't employ any form of risk reduction strategy when they have unprotected anal intercourse.

Taken together, men using any of these practices were three times more likely to acquire HIV than men who had no unprotected anal intercourse (UAI). However men who practiced UAI without any of these safeguards were almost eleven times more likely than men having no UAI to acquire HIV.

Moreover, withdrawal before ejaculation was the riskiest practice studied. It was associated with a five fold increase in the risk of infection (compared to no UAI).

These strategies have been used by gay men for many years and some scientists consider them to be biologically plausible, but until now there has been limited evidence on their effectiveness in the real world. One important study came in 2007 when Fengyi Jin reported that a third of Australian gay seroconverters had tried to employ a risk reduction strategy.

Read the rest.

Editorial

In an editorial accompanying the Australian report, Frits van Griensven of the Thailand Ministry of Public Health and U.S. Centers for Disease Control asked if non-condom risk-reduction behaviors can help contain the spread of HIV infection among MSM.

"In a world where condom use during anal intercourse has been the cornerstone of HIV prevention among MSM, it is remarkable that all these risk-reduction behaviors include anal intercourse without condom use, he wrote. "This inevitably raises the question why the sexual behavior identified as the primary driver of the HIV epidemic in MSM has become the central component of HIV risk-reduction behaviors employed by MSM."

"The answer lies in how institutional and individual HIV-prevention strategies have evolved over the past 25 years," he continued. In the early years of the epidemic, HIV prevention for MSM was based on the principle of "risk-elimination," such as avoidance of any unprotected anal intercourse. "Because anal intercourse appeared to be too difficult to change," he wrote, condom use soon became the norm in HIV prevention among MSM, and widespread changes in sexual behavior led to a dramatic decrease in HIV transmission among gay/bisexual men in the Western world.

HIV prevention based on risk elimination "probably worked well until the mid-1990s," van Griensven continued, at which point men started to develop "safe-sex fatigue" and began looking for alternative prevention strategies. Around the same time, younger generations of gay/bisexual men came of age who "had not personally experienced the devastating effects of AIDS in the MSM community," and the advent of HAART led many men "to no longer view HIV infection as a death sentence but as a manageable chronic disease."

With these developments, "Risk for HIV infection was no longer seen as constant across partners, but varied according to certain conditions, such as partner characteristics (e.g. serostatus) or sexual position in anal sex (e.g. insertive versus receptive intercourse)," he wrote. But, he noted, until now there have been no solid data on such risk-reduction strategies from prospective studies.

In summary, he wrote, based on the Australian data, "we can say that with the exception of withdrawal and possibly serosorting, risk-reduction behaviors in this population of MSM were equally to somewhat less effective in preventing HIV infection than was no unprotected anal intercourse."

"Serosorting and negotiated safety require honest communication between partners who are accurately informed about their HIV status, whereas the effect of strategic positioning is supported by epidemiologic data indicating the decreased risk of insertive anal intercourse compared to receptive anal intercourse," he continued. "The risk of withdrawal during unprotected receptive anal intercourse has not been well documented, but this practice seems unreliable because of possible exposure to body fluids and cells, including those from untimely withdrawal and pre-ejaculate."

Looking at the conditions under which non-condom risk-reduction behaviors can be effective, van Griensven wrote, "First of all it is crucial that MSM have updated and accurate information about their HIV serostatus…Second, HIV seropositive MSM need to be willing to disclose their HIV serostatus…Third, strategic positioning needs to be common, with HIV seronegative men taking the insertive and HIV seropositive men taking the receptive role in anal and oral sex."

He suggested that these risk-reduction behaviors may well have helped reduce HIV infection in Sydney, where HIV testing rates are high and "a strong MSM community may reduce stigma and discrimination and foster a climate of open communication and responsibility."

"These conditions will certainly be different for many other groups of MSM, such as non-urban MSM, urban MSM of lower socio-economic status, and MSM outside of the Western world," he cautioned. Thus, "we need to be careful in generalizing the results" of the Australian study to HIV prevention programs elsewhere.

1/16/09

References

F Jin, J Crawford, P Garrett, and others. Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men. AIDS 23(2): 243-252. January 14, 2009. (Abstract).

SF Morin, SB Shade, WT Steward, and others (Healthy Living Project Team). A Behavioral Intervention Reduces HIV Transmission Risk by Promoting Sustained Serosorting Practices Among HIV-Infected Men Who Have Sex With Men. Journal of Acquired Immune Deficiency Syndromes 49(5): 544-551. December 2008. (Abstract).

F van Griensven. Non-condom use risk-reduction behaviours: can they help to contain the spread of HIV infection among men who have sex with men? AIDS 23(2): 253-255. January 14, 2009.

missing pieces

HIV Related Needs of Sexual Minorities in India


A National Consultation on the HIV related needs and concerns of Sexual Minorities in India was held on October 24 and 25, 2008 at the India International Centre, New Delhi. The participants at the consultation discussed issues related to Men having Sex with Men (MSM) and Transgender (TG), as well as the status of programmes and advocacy activities within the third phase of the National AIDS Control Programme (NACP III). They subsequently suggested action in strategic areas where the United Nations Development Program (UNDP) can provide support to the National AIDS Control Organisation (NACO).

Read the full report (PDF) here.

Potential New Weapon In Battle Against HIV Infection Identified

via Science Daily

Researchers have discovered a potentially important new resistance factor in the battle against HIV: blood types. An international team of researchers from Canadian Blood Services, The Hospital for Sick Children (SickKids) and Lund University in Sweden have discovered that certain blood types are more predisposed to contracting HIV, while others are more effective at fending it off.

A carbohydrate-containing antigen, termed Pk blood group which is distinct from the well-known ABO and Rh blood grouping systems, is present at variable levels on the surface of white and red blood cells in the general population. A study published today in Blood, which is currently available online, shows that cells from rare individuals (≈ 1 in a million) who produce excess of this blood group antigen have dramatically reduced sensitivity to HIV infection. Conversely, another slightly more common subgroup of people who do not produce any Pk (≈ 5 in a million) was found to be much more susceptible to the virus.

Read the rest.

Traveler's Notes: AIDS Advocacy in the Age of Obama

by David Ernesto Munar
AIDS Foundation of Chicago

via AIDS Connect

Sometimes you do your best thinking on the beach.

So it was a week after the election as I retreated from the 24-hour news cycle to relax with family in Cartagena, Colombia.

Known as the Heroic City, Cartagena readied for its annual independence parades and festivals as I arrived. The laid-back rhythms of this Caribbean colonial port helped soothe my accumulated stress. On a healthy diet of seafood and sun, I gained a renewed perspective about the significance of this transformative period in American history.

"Is he as impressive as he seems?" I was asked frequently. In this predominately multi-racial society where racism nonetheless prevails, President-elect Barack Obama inspires both a sense of pride and enormous awe in the resiliency of the American spirit.

For those of us affected by HIV/AIDS, Obama's ambitious AIDS plan portends a better future. Could our aspirations be dashed, however, under the weight of AIDS complacency and competing priorities?

AIDS advocates have good reason to be cautious. As the U.S. deployed unprecedented assistance to combat the global HIV/AIDS pandemic, the Administration of President George W. Bush blocked lifesaving and science-based HIV prevention, divested from community-based HIV organizations, and allowed the domestic epidemic to grow without a commensurate expansion in services.

The global AIDS response, while commendable, nonetheless neglected proven harm reduction approaches, undermined access to condoms and family planning, and failed to empower women, girls, and gay/bisexual men in the fight against HIV/AIDS.

I harbor resentment that no amount of caravans, protests, facts, or organizing succeeded in dampening the Bush Administration's (and its allies') powerful and ideologically based resistance to sound HIV/AIDS policies.

After these past eight years, I'm practically programmed to be disappointed.

So I gathered with my mix of emotions – and North American newspapers – in the quiet moments of my Colombian vacation to recalibrate my thinking about our movement's next strategies and approaches.

Read the rest on AIDS Connect.