Sex between men in the context of HIV

The AIDS 2008 Jonathan Mann Memorial Lecture in health and human rights, via Journal of the International AIDS Society, by Jorge Saavedra, Jose Antonio Izazola-Licea, and Chris Beyrer

Gay, bisexual, and other men who have sex with men (MSM) have been among the most affected populations by HIV since the AIDS pandemic was first identified in the 1980s. Evidence from a wide range of studies show that these men remain at the highest risk for HIV acquisition in both developed and developing countries, and that despite three decades of evidence of their vulnerability to HIV, they remain under-served and under-studied. Prevention strategies targeted to MSM are markedly under-funded in most countries, leading to limited access to health services including prevention, treatment, and care.

... The exclusion of MSM from surveillance, targeted prevention, and treatment and care still limits the global response to HIV/AIDS. To improve the human rights and health of MSM comprehensive advocacy efforts are needed. In the third decade of AIDS it is time to realize the equal rights of MSM to access health and other services in environments that are friendly to their sexual orientation, and to recognize that meeting these needs is both a global public health priority, and a compelling human rights issue. To achieve the latter, there is a clear need to significantly increase the proportion of HIV resources targeted towards MSM.

Read the whole article.

Is 'bareback' a useful construct in primary HIV-prevention? Definitions, identity and research

Carballo-Diéguez A, Ventuneac A, Bauermeister J, Dowsett GW, Dolezal C, Remien RH, Balan I, Rowe M.

HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, USA. ac72@columbia.edu

The terms bareback and bareback identity are increasingly being used in academic discourse on HIV/AIDS without clear operationalization. Using in-depth, face-to-face interviews with an ethnically diverse sample of 120 HIV-infected and -uninfected men, mainly gay-identifying and recruited online in New York City, this study explored respondents' definitions of bareback sex, the role that intentionality and risk played in those definitions, and whether respondents identified as 'barebackers'. Results showed overall agreement with a basic definition of bareback sex as condomless anal intercourse, but considerable variation on other elements. Any identification as barebacker appeared too loose to be of use from a public health prevention perspective. To help focus HIV-prevention efforts, we propose a re-conceptualization that contextualises risky condomless anal intercourse and distinguishes between behaviours that are intentional and may result in HIV-primary transmission from those that are not.

Examining the Long-term Impact of PrEP

A new study in the journal Clinical Infectious Diseases looks at the impact of preexposure HIV prophylaxis (PrEP) on lifetime infection risks. “The combination of tenofovir and emtricitabine shows promise as HIV PrEP, taking into account uncertainties regarding efficacy, the risks of developing drug resistance and toxicity, behavioral disinhibition, and drug costs,” note the study authors.

“PrEP could substantially reduce the incidence of HIV transmission in populations at high risk of HIV infection in the United States,” the authors concluded. “Although it is unlikely to confer sufficient benefits to justify the current costs of tenofovir-emtricitabine, price reductions or increases in efficacy could make PrEP a cost-effective option in younger populations or populations at a higher risk of infection. Given recent disappointments in HIV infection prevention and vaccine development, additional study of PrEP-based HIV prevention is warranted.”

Read the rest on HIVPlusMag

Hidden worlds | Male sex workers in India

Summary:

They have the same customers. Their life histories and experiences are similar. They have the same problems. The stories they have to tell are similar: stories of missed opportunities, of poverty, hopelessness and exploitation. But one thing is different: female sex workers in India are visible, male not. Most are Kothis – men who feel themselves to be women and to be attracted to men - or gays and bisexuals, who pursue sex work. Mostly they are driven by lack of money. Many have no job at all, or an underpaid one.

Men who pursue sex work in India are doubly criminalised. On the one hand, same sex practices are prohibited by article 377 of the Indian penal code. On the other hand, sex work is illegal. Male sex workers operate thus outside the law, which leaves them unprotected and defenceless. They are often victims of violence - and rape.

Check it out on SocialDocumentary.net

Gays in Latin America: Is the Closet Half Empty?

via Foreign Policy, by Javier Corrales
Special thanks to our Bogota connection, Sr. Merrell, for forwarding this to IRMA.

Most analysts haven't noticed, but a major social revolution is taking place in Latin America. The region is becoming gayer. It's not that there are more gays and lesbians living in Latin America (we would never know). Rather, the region is becoming more gay-friendly. A generation ago, Latin America was the land of the closet and the home of the macho. Today, movements fighting for lesbian, gay, bisexual, and transgender (LGBT) rights are taking advantage of the region's more globalized, open regimes. They are promoting their cause through smart, mainstream political and economic alliances. So, though closets and machos are still ubiquitous, Latin America is now the site of some of the most pro-gay legislation in the developing world.

Gay rights expanded in democratic Western Europe starting in the late 1960s, and in the United States more gradually since the 1970s. Despite being democratic and kind-of-Western, Latin America lagged behind. Then, in the late 1990s, legislation started to change. In 1998, Ecuador's new constitution introduced protections against discrimination based on sexual orientation. In 1999, Chile decriminalized same-sex intercourse. Rio de Janeiro's state legislature banned sexual-orientation discrimination in public and private establishments in 2000. In 2002, Buenos Aires guaranteed all couples, regardless of gender, the right to register civil unions.

The policy changes just kept coming. In 2003, Mexico passed a federal antidiscrimination law that included sexual orientation. A year later, the government of Brazil initiated "Brasil sem homofobia" (Brazil without homophobia), a program with nongovernmental organizations to change social attitudes toward sexuality. In 2006, Mexico City approved the Societal Cohabitation Law, granting same-sex couples marital rights identical to those for common-law relationships between a man and a woman. Uruguay passed a 2007 law granting access to health benefits, inheritance, parenting, and pension rights to all couples who have cohabited for at least five years. In 2008, Nicaragua reformed its penal code to decriminalize same-sex relations. Even Cuba's authoritarian new president, Raúl Castro, has allowed free sex-change operations for qualifying citizens.

Read the rest.

Clearinghouse on Male Circumcision for HIV Prevention - Website Launched

The Clearinghouse on Male Circumcision for HIV Prevention -- www.malecircumcison.org -- was launched yesterday. The Web site is designed to generate and share authoritative information about the role of male circumcision in HIV prevention.

The Clearinghouse was initiated by the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the AIDS Vaccine Advocacy Coalition (AVAC), and Family Health International (FHI).

"The Clearinghouse will serve as a virtual resource that provides a 'one-stop-shop' for the most recent news, research, and resources on the use of male circumcision to prevent HIV," says Dr. Kim Eva Dickson, Medical Officer, HIV Prevention in the Health Sector at WHO in Geneva. "This site will fulfill the needs of the international public health community involved in male circumcision for HIV prevention -- including scientists, civil society groups, policy-makers, health providers, and programme managers."

The Clearinghouse will provide evidence-based guidance to support the delivery of safe male circumcision services as one component in a comprehensive approach to HIV-prevention services. "It will be continually updated with emerging information on country progress in expanding access to safe male circumcision services, including lessons learned in implementation," says Dr. Catherine Hankins, Chief Scientific Adviser to UNAIDS. "Providing access to tools and guidance, the Clearinghouse is an essential Web site aid for all those working on male circumcision for HIV prevention."

Visitors to the Clearinghouse will find:

-- A browsable database of hundreds of scientific abstracts and full-text

articles

-- An inventory of research activities on male circumcision

-- Tools and guidelines for provider training and programme scale-up

-- Evidence-based protocols and guidelines

-- A compendium of better and best practices

-- User-friendly summaries of advocacy issues and civil society engagement

-- An opportunity to sign up for an RSS feed on news related to male

circumcision

-- A global mechanism for exchanging and integrating information on male

circumcision programmes and associated services

Mardi Gras and Sexual Behavior

excerpt from Kinsey Confidential

...Several years ago, some of our colleagues in the School of Health, Physical Education and Recreation here at Indiana University actually studied sexual behavior in the context of Mardi Gras. Using a theory that takes notice of the influence of a person's environment (the people around them as well as their surroundings) and perceptions about what's appropriate in a given context (say, on Bourbon Street), they examined people's behavior at Mardi Gras.

They found that about half of men in their study expected to have a new vaginal or oral sex partner while at Mardi Gras and about 20% expected to have anal sex with a new partner. Fewer women had such expectations. What happened is that more women had new partners than planned to - and, as you might guess, some of the men overestimated their chances of hooking up at Mardi Gras. A person's situational conditions (in this case, feeling as though they were in a sexualized environment, drinking and being a part of the Mardi Gras culture of beads and costumes) was also linked to their sexual behavior at Mardi Gras. (Read the full study here.) In other words, context matters...

Read the whole item.

Where are the black gay men?

via Housing Works

Two weeks ago individuals and organizations across the nation marked National Black HIV/AIDS Awareness Day. Judging by many of the articles, press releases and events commemorating the day, however, you might never guess that the highest percentage of new HIV infections in 2006 was among black gay men.

Why, even on a day dedicated to black AIDS awareness, do black gay men remain a footnote?

“It’s symptomatic of the problem we face of ridding our community of HIV in order to break the back of the epidemic,” said Ernest Hopkins, policy director of the Black Gay Advocacy Coalition. “The most heavily impacted population by percentages is black gay men. If you want to talk about this epidemic you have to start there, and then move very quickly to black women, or you’re not doing your job.”

Two events that got advocates talking were the National Black Leadership Commission on AIDS (NBLCA)’s forums in New York and in Washington, D.C. (the latter included black ministers from the D.C. area).

The New York forum extensively covered women, incarceration and drug use, while gay men and homosexuality were mentioned in passing and only as they related to women being infected by men who have sex with men. The theme of the BLCA event was “HIV/AIDS and Black Women,” but the question remains why, on National Black HIV/AIDS Awareness Day, one of the highest profile African-American groups failed to address the most-affected black demographic.

“A lot of us left the session angry and we weren’t sure why,” said Kristin Goodwin, Housing Works Director of New York Policy and Organzing. “There was nothing wrong on the surface, but it was distressing the way the event made women seem like victims and didn’t even account for gay men who don’t have sex with women.”

NBLCA President C. Virginia Fields told the Update that her speech at the event was intended to be broad-based. “I was focused on the community. I think when you talk about the disease, you talk about all people,” she said, adding that there was particular focus on women and children because “that’s the population I find often does not get mentioned.” Fields also said that “it’s crucial that black gay men be part of the conversation not just around AIDS, but making homophobia unacceptable.”

Celebrity scandalette

Another Black AIDS Day dust-up involved Sexuality Information and Education Council of the United States (SIECUS), which solicited its board member, ER star Gloria Reuben, to write an op-ed for Huffington post about AIDS in the black community and the need for comprehensive sex education.

People were upset because Reuben didn’t mention gay men, or men period, in her piece.

“HIV/AIDS in this country is a man’s disease – about ¾ of the epidemic – most of which is among gay men of all races, and particularly among gay black men and gay Latino men. Not mentioning this fact in one sentence, or even a phrase, is absolutely unacceptable,” Jim Pickett of the AIDS Foundation of Chicago wrote in a message to the Federal AIDS Policy Partnership (FAPP) listserv.

Read the rest.

Burundi defeats homophobic bill

What happened in Burundi- according to IGLHRC

In an overwhelmingly positive vote for lesbian, gay, bisexual and transgender (LGBT) people in the Central African nation of Burundi, the country's Senate has rejected a provision that would have criminalized consensual same-sex activity. Legislation to revise the Penal Code was introduced in the Burundian Senate in November 2009 after having first been passed the National Assembly. The revision had a number of key advances for human rights, including the abolition of the death penalty, and the rendering of torture and genocide as crimes against humanity punishable under Burundian law. However, the revision also included a penalty of up to 2 years in jail for “anyone who has sexual intercourse with a person of his/her own sex.”

The provision criminalizing consensual same-sex activity survived various revisions to the overall Code and was included in the final version of the bill that was submitted to the Burundian Senate on February 6, 2009. On February 17, 2009, however, 36 out of 43 Senators voted to strike it from the bill.

Read the rest on GayUganda.

Young Spaniards Use Condoms To Prevent Pregnancy Not Diseases

Researchers from the University of Vigo have studied the sexual practices of young Spaniards aged between 14 and 24. The results of the study show that girls use condoms more than boys during vaginal sex, but less during anal and oral sexual practices.

Sexual behaviour among young people is undergoing great changes. Researchers from the University of Vigo periodically carry out an evaluation of sexual practices among young adults and adolescents in Spain in order to study their use of condoms in relation to high-risk behaviours and sexually-transmitted diseases.

The research study, which has been published in the Spanish journal Gaceta Sanitaria, analysed a sample of 2,171 young men and women aged between 14 and 24 in three autonomous regions (Galicia, Andalusia and Madrid). The researchers divided them into two study groups - adolescents (14 to 18-year-olds) and young adults (19 to 24-year-olds).

"The results show that condom use among young Spanish males and females has more to do with preventing unwanted pregnancies than with preventing infection with sexually-transmitted diseases, because they are used more during vaginal sex than oral or anal sex," José María Faílde, lead author of the study and a researcher at the Galician university, tells SINC.

Read the rest on Medical News Today.

Bottom Monologues - looking for gay men to share their stories

[from the Bottom Monologues website]

I. First, we’re collecting *your* stories about *your* lives as a bottoms, tops, versatiles, or none-of-the-above. We’ve developed this lovely online questionnaire for your fill out that asks some pretty broad questions about bottoms: what is a bottom, what’s great sex as a bottom, what’s different between tops and bottoms —that sort of thing! I think it’s a pretty fun exercise, since most of us really don’t get to talk about bottomming out in the open. Which is exactly what this project is all about!

II. We’ll collect all those amazing and fabulous stories and look for consistencies across them. What’s similar in the stories we get? Is there a particular narrative that pops up in many of your stories? And of course, we’ll also be looking for stories that stand out from those similarities and challenge the those common themes.

III. Once we’ve had a chance to pour over the data, we’ll do our best to distill the stories into “composite characters” — our best effort to boil down dozens of stories into one. These will be the products that will be shown on stage in the “Bottom Monologues,” an expression of the diversity and richness of bottoms’ lived experiences. You may not see the word-for-word account of your fabulous experiences in the final product, but you can be assured that it has had an impact on the stories we’ll tell on stage.

I hope you join in on this amazing project. Help us bring the “Bottom Monologues” to life. It will be fabulous. You can have a hand in making our vision happen. Join us! Tell us your story today!

The Female Condom - where the girls AND boys are

IRMA's first Global Teleconference of the year

Thursday, February 26, 2009

Get the skinny on the NEW female condom and discuss its implications for anal sex. Featuring presentations by Serra Sippel, CHANGE Executive Director and Mitchell Warren, AVAC Executive Director. Slides and other materials will be made available in advance of the call on the IRMA website.

Special thanks to AVAC for hosting the call!

Thursday, February 26, 2009

Kuala Lumpur - mindnite
Mumbai - 9:30pm
Nairobi - 7pm
Cape Town - 6pm
London - 4pm
New York - 11am
Lima - 11am
Chicago - 10am
Los Angeles - 8am

Contact us if you'd like to join the call.

Call for Proposals - 2009 LGBTI Health Summit

2009 National LGBTI Health Summit, Chicago
Call for Workshop Proposals


The 2009 National LGBTI Health Summit is currently accepting workshopproposals for the upcoming gathering, to be held in Chicago, IL August14-18, 2009. Proposals will be accepted through March 31, 2009.

www.2009lgbtihealth.org

The 2009 National Lesbian, Gay, Bisexual, Transgender, Intersex Health Summit and Bi Health Summit will focus on “Health Through the Life Course.”

Individuals and groups are invited to submit workshop proposals that address wellness issues (emotional, physical, spiritual, psychological, environmental, social, and/or sexual health) of LGBTI people. Applicants are encouraged to address the Summit's theme of"Health Through the Life Course" by focusing on specific age groupswithin the LGBTI community, specific topics that may impact several agegroups, or issues that impact LGBTIs over time. Proposals that seek to bridge generations for the sharing of new and worldly wisdom are welcome.

Creative and traditional formats are accepted. Sessions will last oneand a half hours – interested parties should consider collaboratingwith friends and colleagues.

The proposal format and instructions, as well as complete informationabout the Health Summit is available at www.2009lgbtihealth.org.

Interested parties are invited to engage in planning activities alreadyunderway on the site.

Lack of services for Asia gays is fuelling epidemic

via The Earth Times

Manila - The World Health Organization (WHO) warnedTuesday that unprotected male-to-male sex was fuelling the spread of HIV and AIDS in Asia, where the epidemic could worsen amid a lack of services to gays. "Men who have sex with men have been identified as one of the most at-risk populations for HIV/AIDS," the Manila-based WHO Regional Office for the Western Pacific said in a statement ahead of a meeting in Hong Kong.

"Asia is believed to have the world's largest number of men having sex with men, estimated at 10 million," the office added.

WHO noted that a review in December 2007 of the HIV/AIDS situation in Asia showed that in Cambodia and Vietnam, men who have sex with men were more likely to contract the deadly virus compared with the general population.

The risk of infection was also 45 times higher for men who have sex with men in China.

Read the rest.

Increased visibility: more light shed on MSM in Africa and India

via Aidsmap

The majority of men who have sex with men (MSM) in three different African countries and in Tamil Nadu State in India also have sex with women, according to two presentations and a poster at the CROI Conference in Montreal.

In Tamil Nadu, HIV prevalence is substantially higher in MSM than the general population and they could serve as a ‘bridge’ for HIV transmission between minority communities and women, researchers found.

In Africa, in the first-ever surveys of their kind, researchers uncovered communities of men with high levels of HIV risk behaviour, including injecting drug use. They found that the already-noted tendency in Africa to have long-term concurrent relationships with more than one partner – one explanation advanced for the high HIV prevalence there – was the same for MSM, with a high proportion of men engaging in ‘bisexually concurrent’ relationships.

Three African countries Chris Beyrer of the Center for Public Health and Human Rights at the Johns Hopkins School of Medicine in Baltimore presented updated findings from a programme of surveys of MSM and HIV in a number of African countries. Preliminary findings from the first of these surveys in Malawi were presented at the pre-World AIDS Conference satellite meeting in Mexico City last year – see this report. Beyrer added data from Namibia and Botswana – other surveys are ongoing in Nigeria and South Africa.

In most of these countries there has hitherto been literally no data on MSM, Beyrer said. Male/male sex is illegal and stigmatised, and until recently surveys of MSM would have been impossible. Recently, however, health ministries in some African countries have become more supportive of research and prevention work among this community and local non-governmental and community organisations have been willing to act as local hosts for the research programme.

Read the rest.

Jo'Burg - The marginalization of lubricant

via PlusNews - Johannesburg, South Africa

On Valentines Day, happy couples all over the world will be cozying up, dimming the lights and turning on Marvin Gaye - much to the chagrin of their single counterparts everywhere. But what if - when the moment is just right - the unthinkable happens?

Your partner slides on a condom, only to spit on it! That "moment" will pack its toothbrush and disappear out the door.

According to a study published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS) this month, almost 90 percent of men who have sex with men (MSM) have resorted to using their own saliva as a lubricant in the absence of conventional water-based varieties – nearly one-quarter of them while practicing what would otherwise be safe sex. It's not a pretty thought.

When used with latex condoms, water-based lubricants like Astroglide and KY Jelly can help prevent condom breakage and thus aid the prevention of HIV transmission.

Saliva, when used as a lubricant, may not be sufficient to protect the condom from friction and tears, and may even present a vector for the transmission of diseases like Hepatitis B.

So, if a quarter of these men were striving to protect themselves by using a condom, why would they not also get lube? And now that I think of it, when last were you handed a free condom and lube?

If whole groups of people can be marginalised, then maybe safer sex strategies can be too – the female condom, lubricant. Some go out of fashion, but others - like lubricant – never even made it onto the mainstream catwalks of our sex lives. Why? Because conventional wisdom says lubricant means anal sex, and anal sex is the kind of sex that is, well, still a long way from that catwalk.

In short, anal sex is still "a gay thing". Or is it? A survey by the US Centres for Disease Control in 2002 said that about 40 percent of straight men and 35 percent of straight woman reported having had anal sex by their mid-40s.

So then, lubricant = anal sex = ? This Valentine's Day, maybe it's time we rethink the equation, and some of our misconceptions.

Rectal Microbicide Research at CROI 2009

The prevalence of receptive anal intercourse among men and women the world over requires the research and development of safe, effective and acceptable microbicides designed specifically for the rectum as well.

Today at CROI 2009, two interesting Poster Discussions were held of special interest to IRMA members.

You can access the abstracts and actual posters for each of these.

IRMA asked Drs. Peter Anton and Ian McGowan for their thoughts regarding these important findings. You can read their remarks below.






A Phase 1 Safety and Acceptability Study of the UC781 Microbicide Gel Applied Rectally in HIV Seronegative Adults: A First in Field

Peter Anton, A Adler, E Khanuknova, J Elliott, W Cumberland, Y Zhou, A Ventuneac, A Carballo-Dieguez, C Mauck, and I McGowan

Representing David Geffen Sch of Med, Univ of California, Los Angeles, US; Translational Sci Corp, Mill Valley, CA, US; Univ of California, Los Angeles Sch of Publ Hlth, US; HIV Ctr for Clinical and Behavioral Studies, New York, NY, US; CONRAD, Arlington, VA, US; and Magee-Womens Res Inst, Pittsburgh, PA, US

Click here for the abstract.

Click here for the PDF of the poster.



Strong Ex-Vivo Suppression of HIV-1 Infection of Colorectal Explants from In-Vivo Rectal Application of UC781 Gel: A Novel Endpoint In A Phase 1 Trial

Peter Anton, J Elliott, I McGowan, A Adler, K Tanner, EJ Johnson, T Saunders, C Siboliban, E Khanukova, Y.Zhou.

Representing David Geffen School of Medicine, Los Angeles, CA,
Magee-Women’s Research Institute, University of Pittsburgh Medical School, Pittsburgh, PA

Click here for the abstract.

Click here for the PDF of the poster.


Dr. Peter Anton – "The Phase I rectal safety trial of the vaginal gel formulation of UC781 was historic in that it was the first of its kind in the field. While we determined that the gel appeared safe, well tolerated and acceptable among trial participants, it is noteworthy that we also observed signs of efficacy. Namely, this type of test could be an important new protocol the entire microbicide field might adopt as a way to help evaluate which products move forward in the pipeline.

"This Phase 1 rectal safety study for microbicides, using CONRAD’s UC781 lays the foundation for the many necessary trials to follow. This study required close, active collaboration with CONRAD, NIH and the FDA, as well as the academic research institutions (UCLA, U Pittsburgh/McGee Women’s Hospital and Columbia University).

"So, the first point is that this study has forged new territory in beginning to define relevant procedures, definitions of risk and mucosal injury.

"Second, the study itself showed great results for Phase 1: the drug and formulation appears safe by all indices measured. This bodes well for its advancing and also assisting an FDA application for vaginal use (should that prove possible) by already having a rectal safety study completed.

"Thirdly, and of great interest for future trials, were the remarkable results from the novel “explant study”, which saw a strong suppression of HIV replication (HIV was applied to tissue biopsies in the laboratory) from study subjects who had received the study drug (in vivo) 30 minutes before biopsy.

"This is the closest we can come to testing real, human, sexually-exposed tissue, already treated with a microbicide to determine if it helps to resists HIV infection. In this study, it did….a remarkable result that even we did not anticipate to this degree.

"With limited resources and the clear necessity for both vaginal and rectal microbicides, we need sophisticated tools to make the best decisions earlier about the viability of any candidate microbicide and which ones to advance to more expensive, longer studies. This is not yet an actual early marker of eventual efficacy, but it is an exciting start."

Dr. Ian McGowan – “The results of the UC781 trial, in which we observed both safety and efficacy signals after testing the vaginal gel formulation of an NNRTI, are encouraging for the field of rectal microbicides.

"Later this year, the Microbicide Trials Network will launch a new Phase I safety trial to determine the safety and acceptability of Tenofovir vaginal gel applied rectally and will co-sponsor a parallel Phase 1 trial using tenofovir gel and oral formulations with NIH’s Integrated Preclinical-Clinical Program (IPCP) for microbicides.

"There is an associated 10-20 fold increased risk of HIV transmission during unprotected anal intercourse compared to unprotected vaginal intercourse. Anal intercourse among gay men, men who have sex with men, and between heterosexual men and women is common globally. We know that much of this behavior is unprotected.

"Therefore, we need two things. first, we must have rectal safety data on all vaginal microbicides in the pipeline, because we know they will be used vaginally and rectally.

"And secondly, the prevalence of receptive anal intercourse among men and women the world over requires the research and development of safe, effective and acceptable microbicides designed specifically for the rectum as well."

IRMA Announces New Steering Committee Members

Thirteen new members join IRMA's leadership
Push for greater investment, portfolio diversity, global plan

Click here to see individual names and pics of new and returning SC members.



International Rectal Microbicide Advocates (IRMA) is delighted to announce the final selection of 13 new members to our international advocacy network’s Steering Committee (SC). An exhaustive process over several months brought in a total of 24 superlative applicants, and after a thorough evaluation, the Nominations Committee highly recommended 13 individuals to join.

“We were both thrilled and humbled by the very high quality of the applications we received for the Steering Committee,” said Marc-André LeBlanc, IRMA Secretary. “With limited space, this made the work of the Nominations Committee quite challenging. As it is, the group recommended more individuals than we had planned for – so we expanded the SC to accommodate.”

With the new members, the IRMA SC is now comprised of 23 individuals from 11 countries on six continents. The group is charged with providing strategic advice, expert guidance and scientific leadership for IRMA’s advocacy objectives, including the call for greater investment in rectal microbicide research, development and advocacy activities, a diversification of funders in the rectal microbicide portfolio, and the articulation of a Global Rectal Microbicide Development Plan.

“The honeymoon for the new SC is going to be sweet, but very short. IRMA has a lot of work to do to fight the stigma and denial surrounding anal sex practices the world over as well as advocate for expanded new prevention technology resources that will provide adequate funding to the underfunded rectal microbicide field,” said IRMA Chair Jim Pickett.

“Being that anal intercourse is a common behavior among heterosexual men and women, gay men, and other men who have sex with men globally, and since unprotected anal intercourse is 5 to 80 times more likely to result in HIV transmission compared to unprotected vaginal intercourse, it is imperative we develop safe, effective and acceptable rectal microbicides for women and men,” Pickett continued.


New SC members include:

1.Kadiri Audu, National Youth Network on HIV/AIDS and Population Control, Lagos, Nigeria
2.Deborah Baron, Microbicides Media and Communications Initiative, Johannesburg, South Africa
3.Latifa Boyce, Alliance for Microbicide Development, Washington, DC, USA
4.Dr. Alex Carballo-Dieguez, Columbia University, New York, NY, USA
5.Dr. Ross Cranston, University of Pittsburgh, Pittsburgh, PA, USA
6.Cindra Feuer, AIDS Vaccine Advocacy Coalition, New York, NY, USA
7.Edward Fuchs, Johns Hopkins University, Baltimore, MD, USA
8.Lourence Misedah, Ishtar MSM, Nairobi, Kenya
9.Dr. Kathleen Morrow, Alpert Medical School of Brown University, Providence, RI, USA
10.Dr. Olanrewaju Onigbogi, University College Hospital, Ibadan, Nigeria
11.Jo Robinson, Terrence Higgins Trust, London, UK
12.Dr. Jorge Sanchez, Peruvian HIV Clinical Trials Unit, Lima, Peru
13.Dr. Roger J. Tatoud, Imperial College London, London, UK


New SC members will join returning members who have, to date, been working with IRMA for almost three years. Returning members include:


1.Julie Davids, Community HIV/AIDS Mobilization Project, Providence, RI, USA
2.Jerome Galea, University of California Los Angeles Program in Global Health, Lima, Peru
3.Bridget Haire, IRMA Vice Chair, Australian Federation of AIDS Organizations, Sydney, Australia
4.Marc-André LeBlanc, IRMA Secretary, Global Campaign for Microbicides, Ottawa, Canada
5.Rick Jones, GNP+, Amsterdam, Netherlands
6.Jeremy Kwan, PT Foundation, Kuala Lumpur, Malaysia
7.Dr. Ken Mayer, Brown University, Fenway Community Health, Boston, MA, USA
8.Dr. Ian McGowan, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
9.Jim Pickett, IRMA Chair, AIDS Foundation of Chicago, Chicago, IL, USA
10.Roy Wadia, British Columbia Centre for Disease Control, Vancouver, Canada, currently in Mumbai, India


For more on IRMA’s advocacy goals and objectives, see “Less Silence, More Science – Advocacy to Make Rectal Microbicides a Reality,” published in 2008 and released at the Microbicides 2008 conference in New Delhi, India. Click here for the report in Spanish.

Click here to see individual names and pics of both new and returning SC members.

In the coming weeks and months, IRMA will be sharing a few profiles of our new SC members in the Meet a Friendly Rectal Microbicide section of the IRMA website.

PrEP could work even if taken several days in advance

via Aidsmap

A study using tenofovir and FTC (Truvada) to prevent rectal HIV infection in monkeys – so-called pre-exposure prophylaxis (PrEP) - has shown that it is as effective to take the medication up to three days before exposure as it is to take it a day before. Even taking Truvada a full week before exposure resulted in a considerable reduction in the risk of infection.

In contrast, taking the medication only two hours before exposure resulted in a smaller protective effect, possibly because intracellular concentrations of the drugs had not reached high enough levels.

Read the rest.

CROI - Sex Gels Show Protection in Women, Monkeys; plus PrEP news

via Bloomberg

A vaginal gel made by Indevus Pharmaceuticals Inc. showed first signs that such a product might protect women from the AIDS virus.

Women who used the gel were 30 percent less likely to become infected with the virus than those using no gel or an unmedicated product, said Salim Abdool Karim, a Columbia University researcher who presented the study today at an AIDS meeting in Montreal (CROI - Conference on Retroviruses and Opportunistic Infections.) While the finding didn’t pass a test for statistical significance, it should spur further examination of Lexington, Massachusetts-based Indevus’s product, he said...

---- snip

...U.S. government research presented at the conference also suggested that Gilead’s Viread and Truvada, used in gels or in oral pills, might prevent the spread of HIV, said scientists studying a monkey equivalent of the disease.

In one test, animals treated with a gel containing Viread were completely protected from SHIV, an animal version of the AIDS virus, U.S. Centers for Disease Control and Prevention scientists said today at the conference in Montreal. The single- drug gel was just as protective as a gel containing two-drug Truvada, said Walid Heneine, laboratory chief of CDC’s division of HIV/AIDS prevention, who led the study.

“This is very promising, although we’re waiting for the results of human trials to see if they correlate with animal studies,” Heneine said in an interview.

The second trial measured how oral doses of Truvada, a combination of two Gilead drugs, would affect monkeys exposed to HIV through the rectum.

Almost all untreated monkeys were quickly infected after being exposed to the virus twice. Two doses of Truvada, one before and another after rectal exposure, protected most monkeys from infection, said Gerardo Garcia-Lerma, a CDC senior scientist in the HIV/AIDS prevention division...

---- snip

Read the complete article on Bloomberg here.

Chicago Organizers Launch 2009 National LGBTI Health Summit Website

The Chicago organizers of the 2009 National LGBT Health Summit are excited to announce the launch of their new website – a one-stop-shop for all related organizing and planning activities. The Summit is scheduled for August 14-18, 2009 at the Chicago Hilton and Towers. Visit the Summit’s website here – www.2009lgbtihealth.org.

“We are delighted to welcome LGBTI health communities from across the country and around the world to Chicago this August,” said Summit co-chair Cat Jefcoat, Director of the Lesbian Community Care Project at Howard Brown Health Center (HBHC). “This year marks the 40th anniversary of the Stonewall Riots in New York City, a significant milestone in the LGBTI rights movement in the Unites States and a great time to focus on improving the health and well being of our diverse communities.”

The 2009 National LGBTI (Lesbian Gay Bisexual Transgender Intersex) Health Summit is an event dedicated to preserving and improving the emotional, physical, spiritual, intellectual, psychological, environmental, and social health and wellness of LGBTI people, a population that continues to experience significant health disparities because of its members’ sexual orientations and/or gender identities. The Summit’s theme is “Health Through the Life Course” and individuals of all ages, races, ethnicities, gender identities and professional backgrounds are encouraged to participate. Students are also welcomed!

The Bi Health Summit will be held in conjunction with the LGBTI Health Summit on August 14th, although bisexual health issues will be addressed throughout the five days in workshops and panels.

The Summit’s newly launched website allows for a range of interactive planning activities, including registration, housing, fundraising, and workshop proposal submission. It also includes information on the Bi Health Summit.

“The site offers the opportunity for our communities throughout the country and across two oceans to regularly interact with each other, offer input, and become engaged early and often in every aspect of the planning process,” said Summit co-chair Jim Pickett, Director of Advocacy at the AIDS Foundation of Chicago (AFC). “Users can participate in discussion forums, volunteer, apply for scholarships, develop ideas for programming– including social activities–and ensure the process is open and dynamic.”

Philadelphia hosted the last National LGBTI Health Summit in 2007. This year’s Summit in Chicago will be the fourth gathering of its kind. Local organizational partners currently include Center on Halsted, Test Positive Aware Network, Haymarket Center, the Chicago Department of Public Health’s Office of LGBT Health, AFC and HBHC, among others. Organizers may be contacted through the Summit website www.2009lgbtihealth.org.

GCM updates rectal microbicide info on website

Big thanks and bigger love to the Global Campaign for Microbicides - namely Arwa Meijer (pictured above in Cape Town during Microbicides 2006) - for recently updating the rectal microbicides page on their website. Arwa has been a longtime friend and supporter of IRMA's work and we appreciate her passion, energy, and expertise... and for having IRMA's um, back!

Mumbai: Male professionals double as sex workers for extra income

Gym instructors, call centre workers and direct sales agents are among thousands of professional men moonlighting as sex workers in the city to supplement incomes they feel are too meagre to give them a decent life in Mumbai.

Unlike female sex workers, these men do not walk the streets but operate entirely through social networking websites, according a study funded by the Melinda and Bill Gates Foundation, dedicated to AIDS research, and executed by the Humsafar Trust, a non-profit focusing on gay and transgender sexual health.

“I cannot afford to live in the city if I don’t double up as a sex worker,” said Sujit, 28, who works as a gym instructor in Vakola and was part of the study, but did not want Hindustan Times to use his last name.

The six-year study, which will be completed in March, estimates that Mumbai has 6,000 male sex workers. This is a fairly significant number as it is almost a third of the 20,000 female sex workers that civic body’s Mumbai District AIDS Control Society estimate operate in the city.

Read the rest in the Hindustan Times.

Microbicide uses RNA interference technology to halt viral infection

via Aidsmap

Scientists at Harvard Medical School have succeeded in protecting mice against herpes infection for one week using a single application of a microbicide based on a new technology called RNA interference.

The technology, still in its infancy as a therapeutic tool, could have a powerful impact as an HIV prevention tool, according to Professor Judy Lieberman, lead investigator.

Read the rest.

WHO and UNAIDS resource kit for writing Global Fund HIV proposals for round 9

As applicants prepare their proposals for the next round of HIV funding, Round 9, UNAIDS and WHO have jointly developed an online resource kit to provide guidance in planning and writing strong Global Fund proposals.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is a financial mechanism that provides grants in support of evidence-informed, technically sound and cost-effective programmes for the prevention and treatment, care and support of persons infected and directly affected by HIV, tuberculosis and malaria. By 1 December 2008, it had signed grant agreements worth US$ 10.2 billion for 579 grants in 137 countries around the world.

The aim of the fund is to direct money to areas of greatest need so that a real difference can be made in peoples' lives. As a part of this process hundreds of pages of technical documentation on how to design programmes or write a grant proposal have been developed by a range of technical experts. The challenge for the country partners writing their proposals is sifting through these myriad long and complex guidelines.

To simplify this, the resource kit has been designed to focus on the essential points which are presented in a user friendly way. The information is structured in a way that echoes the development of a proposal. It is aimed to be a practical tool that country partners can use with ease.
People are already finding it useful. "In the jungle of technical guidance for writing proposals that's out there, communicating the unique relevance of this tool is the biggest challenge. However, country teams across this region have already begun to benefit from this important resource." said Geoff Manthey, UNAIDS Global Fund regional focal point, Asia Pacific Regional Support Team.

Compilation of guidance

The content of the resource kit is a compilation of existing guidance developed by different technical agencies including UNAIDS, UNFPA, UNICEF and the World Health Organization. In preparation of the kit, the team reviewed Global Fund feedback on previous proposals and identified recurring weakness areas so that the content of this kit could address these.

"This toolkit is the result of close collaboration between WHO, UNAIDS, and other UN and civil society partners," said Mazuwa Banda, Medical Officer, World Health Organization.

"We hope that it is widely distributed and, most importantly, used; and we will continue to work together to improve it in response to feedback from its users."

It includes a number of technical guidance notes on cross-cutting issues relevant in the design of any HIV programme. These include gender, human rights and law, sexual minorities and social change communication. A number of notes on health systems strengthening are also included as well as guidance on specific intervention areas including HIV prevention, treatment, care and support.

There are also a number of practical tools included on managing the proposal development process including a planning matrix and costing tool.

Know your epidemic

Country data is vital to knowing a country's epidemic in order to design an effective response. Statistics on HIV interventions, links to latest epidemiological fact sheets and other useful country information are also included in the resource kit.

Finding support

In addition to sharing guidance, the online kit includes a "Finding support" section which gives direction to assistance offered through WHO and UNAIDS as well as useful contacts and a list of focal points. While the response to and coordination of technical support to countries should be first addressed at country level within the UN theme group, WHO and UNAIDS can offer support by facilitating the proposal development process and providing general or specific technical guidance, to ensure that the proposal is technically sound and meets the other requirements. UNAIDS has established "Technical Support Facilities" across the world that help match countries technical assistance needs with most well suited technical assistance in the form of individuals and/or companies.

UNAIDS and the Global Fund

Given the complementary strengths and shared commitment to the global AIDS response, Global Fund and UNAIDS collaborate to accelerate progress towards universal access to HIV treatment, prevention, care and support services.

By offering a range of support to country partners to help applicants prepare strong proposals for Global Fund resources UNAIDS, as the United Nations coordinating programme on HIV, also helps to make the resources of the Global Fund work. UNAIDS also supports the Global Fund in monitoring and evaluating the performance of its grantees through strengthening the capacity of principal recipients and sub-recipients to report on grant implementation.

This collaboration is leading to real results on the ground as Nancy Fee who works in Indonesia as UNAIDS Country Coordinator notes: "As Indonesia has seen, a successful application to the Global Fund results in a grant that can make a huge difference to a country's AIDS response."

"Given all the guidance that exists on the application process, a user-friendly web-based tool such as this one, structured to compliment proposal development, can enable a country to navigate the complexities of the process and develop a strong proposal," she added.

Click here to check it out.

Rectal chlamydia - A reservoir of undiagnosed infection in MSM.

abstract via PubMed

Annan NT, Sullivan A, Nori A, Naydenova P, Alexander S, McKenna A, Azadian B, Mandalia S, Rossi M, Ward H, Nwokolo N.

Chelsea & Westminster Hospital NHS Foundation Trust, United Kingdom.

OBJECTIVE: To determine the prevalence of rectal chlamydia infection in a cohort of men who have sex with men (MSM) and the proportion of infection that would be missed without routine screening.

METHODS: MSM presenting to four HIV/GUM outpatient clinics at the Chelsea & Westminster Hospital NHS Foundation Trust between 1/11/05 and 29/9/06 were offered testing for rectal chlamydia infection in addition to their routine screen for sexually transmitted infections (STIs). Chlamydia trachomatis (CT) tests were performed using the Beckton-Dickinson Probe-Tec Strand Displacement Assay (B-D Probetec SDA). Positive samples were re-tested at the Sexually Transmitted Bacteria Reference Laboratory (STBRL), to confirm the result and identify Lymphogranuloma venereum (LGV) associated serovars.

RESULTS: A total of 3076 men were screened. We found an 8.2% prevalence of infection with CT (LGV and non-LGV serovars) in the rectum and 5.4% in the urethra. The HIV and rectal chlamydia co-infection rate was 38.1%. The majority of rectal infections {69.2%, (171/247)} were asymptomatic and would have been missed if routine screening had not been undertaken. Of the samples re-tested, 94.2% (227/242) rectal and 91.8%, (79/86) urethral specimens were confirmed CT positive and 36 cases of LGV were identified.

CONCLUSION: Our data shows a high rate of rectal chlamydia infection, the majority of which were asymptomatic. We recommend routine screening for rectal chlamydia in men at risk, as this may represent an important reservoir for the onward transmission of infection.

'Baby boomers' hit by sex cancers

via BBC

The arrival of the "swinging sixties" may have heralded a rise in sexually-transmitted cancers, say researchers.

Rates of anal, vulval and vaginal cancers rose for "baby boomers" born in the decades after the Second World War.

Excerpt:

Dr David Robinson, who led the study, said: "These results have revealed a snapshot of just how much rates of these cancers have increased in the post war generations.

"For anal cancer, rates are now higher in women than in men - however, programmes of vaccination against HPV, whilst aimed primarily at reducing the burden of cervical cancer, may also help to reduce the incidence of cancers at these other sites."

Dr Lesley Walker, from Cancer Research UK, said that it was important people understood the dangers linked to HPV.

"Using a condom will lower the risk of exposure to the virus. HPV vaccines are an important advance for future generations, but the cervical screening programme remains vitally important in detecting any changes that might lead to cancer."

Read the whole thing on the BBC.

Fauci Validates Need for RECTAL Microbicides

Statement of Anthony S. Fauci, M.D. Director, National Institute of Allergy and Infectious Diseases National Institutes of Health on National Black HIV/AIDS Awareness and Information Day February 7, 2009

Excerpt:

"Treatment is no substitute for prevention, however. NIAID-funded investigators are working to develop and validate new methods to protect against HIV infection, including microbicides that could be applied vaginally or rectally before sex; antiretroviral drug regimens that could be used to prevent infection in people who are at high risk of becoming infected with HIV; and, of course, vaccines to prevent HIV infection."

Read his whole statement here.

PS - IRMA loves you!

Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC)

At the request of Congress, the NIH embarked on a process to provide better consistency and transparency in the reporting of its funded research. This new process, implemented through the Research, Condition, and Disease Categorization (RCDC) system, uses sophisticated text data mining (categorizing and clustering using words and multiword phrases) in conjunction with NIH-wide definitions used to match projects to categories. The definitions are a list of terms and concepts selected by NIH scientific experts to define a research category. Due to significant methodology changes, it is likely that annual totals for categories (year over year) will exhibit a noticeable one-time adjustment. The research category levels represent the NIH’s best estimates based on the category definitions.

The NIH does not expressly budget by category. The annual estimates reflect amounts that change as a result of science, actual research projects funded, and the NIH budget. The research categories are not mutually exclusive. Individual research projects can be included in multiple categories so amounts depicted within each column of this table do not add up to 100 percent of NIH-funded research.

The FY 2005 and FY 2006 data were produced from a reporting process historically used by NIH. The technical elements of the previous reporting process did not have the ability to produce uniform results and led to wide variability in the way research categories were coded. This process caused inconsistencies in reporting data. RCDC’s use of data mining improves the consistency and eliminates the wide variability in defining the research categories reported. To illustrate the effect of the RCDC methodology change, the table shows a side-by-side comparison view of FY 2007 levels produced with the prior method compared with levels that would have resulted if the new methodology had been implemented.

Total Number of Research/Disease Areas: 215

Check it out.

Sex Ed should actually talk about sex - and not just the scary stuff

High school kids are being taught about the birds and the bees with the same fear-mongering tactics many of us remember. But some health educators today are offering teens a more grown-up lesson: Sex isn't necessarily a bad thing.

excerpt from the boston globe

... Halfway through one of Megara Bell's classes, a ponytailed girl in a bright-green shirt asks the most basic of questions.

"Wait," she calls out. "What is sex?"

Bell is a Newton mother of three with short, spiky brown hair and a wry smile that suggests she would be hard to rattle. As director of the nonprofit Partners in Sex Education, she teaches about human sexuality at youth organizations, public and private schools, and juvenile detention centers around Greater Boston, and on this sunny fall afternoon, she's at an all-girls' residential school in Arlington. Six teens have gathered in a small, fluorescent-lit classroom, made name cards in pink and purple ink, and established ground rules like "It is OK to laugh." A game about decision making led to a question about how old a person must be to "have sex," which prompted, "What is sex?"

There's a little snickering, but the ponytailed girl presses ahead, explaining that if they're going to talk about how old you have to be to do certain things, she wants to know exactly which things falls under the rubric of "sex."

"OK, great question." Bell nods at the girl and explains that when "sex" is used to refer to a behavior (as opposed to, say, the male or female sex), it's usually referring to vaginal, anal, or oral intercourse. She defines all three.

"Does foreplay count?" someone shouts. "No!" another girl replies at exactly the same moment a third asks, "What is foreplay?"

The teens start talking over one another: "My friend said . . ." and "I know this dude who . . ." and "What I heard was . . ." Bell steers them back to the main task at hand.

The girl's question epitomizes the murky definitions, and murkier goals, that have plagued US sexuality education since its beginnings in Chicago nearly a century ago. We don't all agree which behaviors constitute "sex," and we agree even less on what sex means. Seen through different eyes, sex can be a pleasurable activity, a sacrament, a means to procreation, an ecstasy, a disappointment, or a source of shame -- the list goes on. These conflicting, deeply personal attitudes toward sex make it difficult to articulate a curricular vision for public schools, where all opinions must be honored...

Read the whole item.