Anal 101 with Tristan Taormino

Tristan Taormino recently sat down with Keith Orr from AIDS Action's MALE Center before she held a workshop dealing with issues around anal sex.




Check out her Pucker Up posts on anal sex.

Homophobia Is the Problem, Not Gays - Havana Times.org

originally posted May 19 by Havana Times.org

Havana’s 23rd Street was a grand fiesta on Saturday as people of all ages and sexual orientations formed a winding conga line that extended to Pavilion Cuba, the place where Sexual Diversity Day was formally initiated. Havana Times was on the scene to listen to speakers, capture photos, and talk with several participants.

In her opening words, Sexual Education Center (CENESEX) director Mariela Castro Espin noted, “This it is not a gay pride march, that’s not our intention at this time. In reality, we’re identifying with a proposal made by a French activist to designate a World Day against Homophobia. Gays are not a problem, the problem is homophobia!”

CENESEX-supported by other institutions across the country-encouraged discussion and reflection within families about sexual diversity on Saturday the day before the World Day on May 17, said Mariela.

The aim was not to question the family structure that predominates in Cuban society, but to consider other forms, which people are less accustomed to, but are part of the country’s reality. Lesbians, gays, transsexuals and their families all had their chance to speak and exchange experiences-some bitter, others buoyant.

Thanks to educational campaigns such as this, the issue of homophobia is being addressed at some levels, though generally Cuban society continues to be homophobic.

Read the rest.

IDAHO - Report from Nairobi

by Larry Misedah
IRMA Steering Committee Member

Even though same sex practices are criminalized in Kenya, there have been milestones that are of great significance. It is however of great importance that people and institutions maintain their commitment and strengthen the links between scholars, advocates and service providers in ways that build and sustain the development of skills, knowledge production, and the accessibility of local literature.

As the world marked the International Day Against Homophobia (IDAHO - May 17), this year saw a remarkable commemoration of the day in Kenya graced by great panelists from the mainstream human rights organizations. The issue of strategies came out strongly from both the Commissioner for the Kenya National Commission on Human Rights, Lawrence Mute and the Executive Director of the Kenya Human Rights Commission, Muthoni Wanyeki .

In his speech about the use of Yogyakarta Principles to advance human rights for LGBTI people in Kenya, Mr. Mute pointed out the challenges still faced in Kenya especially in terms of intervention programs. He pointed out the inclusion of MSM (men who have sex with men) in the Kenya National Strategic Plan yet there are no intervention programs on the ground apart from the initiative of a few organizations. Perhaps key to the health awareness for MSM/WSW (women who have sex with women), was Nguru Karugu, a public health consultant who gave a speech about how homophobia hinders HIV/AIDS intervention programs for MSM/WSW. Mr. Karugu stressed on the issue of internalized homophobia drawing from varied research that have been carried out. As a way forward, he put the different groups at task to try and find out the possible ways of investigating whether internalized homophobia also has implications for the activities carried by the different organizations in trying to prevent sexual risk behavior.

In the presentation about th importance of inclusion of MSM in research projects – Joseph from the Kenya AIDS Vaccine Initiative( KAVI) made a strong emphasis on the importance of inclusion of MSM as a sub group in the HIV/AIDS Vaccine research in ensuring an effective vaccine for all taking into consideration the different strains of HIV. Notably, KAVI still remains one of the few organizations that provide intervention programs for MSM.

Despite the research done by Coalition of African Lesbians in South Africa, WSWs are still not believed to not be at a higher risk of HIV infection. This has led to being left out at the National Plans for HIV/AIDS intervention Programs citing lack of evidence. This brought out clearly the importance of data in providing evidence since interventions can only be carried out where the facts have been verified.

As the day came to a close with a silent candle light vigil held in memory of those who have suffered and even lost their lives to homophobia. With the prevalence rate of 22% following the VCT services carried out at the Gay and Lesbian Coalition of Kenya (GALCK) in December 2008, hearts poured out to those who have lost their lives to HIV and suffered severe consequences of other STIs in silence. With the Access Project, an Initiative of Ishtar MSM with funding from the amfAR with technical support from Liverpool VCT care and treatment, it is of utmost hope that the project and other initiatives will provide access to relevant sexual health information to MSM in Nairobi in order to reduce the rate of spread of HIV/Aids and STIs among the group.

"Bareback Sex" motivations in HIV risk contexts

Assessing motivations to engage in intentional condomless anal intercourse in HIV risk contexts ("Bareback Sex") among men who have sex with men.
JA Bauermeister, A Carballo-Dieguez, A Ventuneac, and C Dolezal
AIDS Educ Prev, April 1, 2009; 21(2): 156-68.

Although condom use is an effective barrier against HIV transmission, some men who have sex with men (MSM) engage in bareback sex (unprotected anal sex in risky contexts) and increase their risk for HIV (re)infection. Understanding MSM's decision to bareback (vis-à-vis condom use) is essential to develop effective HIV/AIDS prevention programs for this population.

An ethnically diverse sample of men who bareback (n = 120) was recruited exclusively on the Internet and stratified to include two thirds who reported both unprotected receptive anal intercourse (URAI) and being HIV uninfected.

We used exploratory factor analysis to explore the domains within the Decisional Balance to Bareback (DBB) scale, and test the association between DBB and risky sexual behaviors. HIV-positive MSM (n = 31) reported higher costs/losses associated with condom use than HIV-negative men (n = 89).

We found two underlying factors in the DBB scale: a Coping with Social Vulnerabilities subscale (eight items; alpha = .89) and a Pleasure and Emotional Connection subscale (five items; alpha = .92). We found a positive association between DBB (i.e. greater gains associated with bareback sex) and URAI occasions, number of partners, and having one or more sero-discordant partners in the past 3 months.

We conclude that because MSM may avoid using condoms in order to cope with psychosocial vulnerabilities and create intimacy with other MSM, this population could benefit from alternatives to condoms such as pre/post exposure prophylaxis and rectal microbicides.

Hans Rosling on HIV: New facts and stunning data visuals on Ted.com

Hans Rosling unveils new data visuals that untangle the complex risk factors of one of the world's deadliest (and most misunderstood) diseases: HIV. He argues that preventing transmissions -- not drug treatments -- is the key to ending the epidemic.

[Thanks to IRMA Steering Committee Member Roy Wadia for bringing this to our attention]

Excerpt:

But focus now is back on prevention. It is only by stopping the transmission that the world will be able to deal with it. Drugs is too costly -- had we had the vaccine, or when we will get the vaccine, that's something more effective -- but the drugs are very costly for the poor. Not the drug in itself, but the treatment and the care which is needed around it. So, when we look at the pattern, one thing comes out very clearly: you see the blue bubbles and people say HIV is very high in Africa. I would say, HIV is very different in Africa. You'll find the highest HIV rate in the world in African countries, and yet you'll find Senegal, down here, the same rate as United States. And you'll find Madagascar, and you'll find a lot of African countries about as low as the rest of the world. It's this terrible simplification that there's one Africa and things go on in one way in Africa. We have to stop that. It's not respectful, and it's not very clever to think that way.

Watch, listen, read the transcript.

Testing Formula to Better Predict Treatment Failure/Drug Resistance

via Deborah Baron
IRMA Steering Committee Member

The Journal of the International AIDS Society published an article on a recent study testing a formula to better predict ARV treatment failure and possible drug resistance in the absence of viral load testing. According to a New York Times article on the study, "Scientists from Makerere University’s hospital in Kampala, Uganda, along with American and Belgian scientists, have developed a formula, based on close questioning of patients, for predicting which ones are most likely to have treatment failure."

The researches then compared their formula with the existing WHO guidelines, which relies on clinical and immunological criteria to identify treatment failure. They concluded that although "the WHO guidelines are used as a standard across many RLS [resource-limited setting, i]t is our view that this standard of care needs to be improved to reduce the late detection of viral failure and to minimize unnecessary switching of patients to second-line ART."

This formula could help provide useful insight to the ARV-based prevention research field, as it prepares for possible scenarios and challenges (if and when a product proves effective) around scaling up ARV-based prevention.

Check it out "Development and evaluation of a clinical algorithm to monitor patients on antiretrovirals in resource-limited settings using adherence, clinical and CD4 cell count criteria."

You can also link to the New York Times article on this study, "AIDS: Questions Help Find AIDS Patients Who Are Vulnerable to Drug Resistance"

Greater involvement of people living with HIV in health care

via Journal of the International AIDS Society, by Odetoyinbo Morolake1, David Stephens2 and Alice Welbourn3

1Positive Action for Treatment Access, Lagos, Nigeria
2Nossal Institute for Global Health, University of Melbourne, Victoria, Australia
3International Community of Women Living with HIV/AIDS, London, UK

Journal of the International AIDS Society 2009, 12:4doi:10.1186/1758-2652-12-4

Greater Involvement of People Living with HIV/AIDS represents a mobilising and an organising principle for the involvement of people living with HIV in program and policy responses. People with HIV have been at the forefront of designing and implementing effective HIV treatment, care and prevention activities. However, governments and health systems have yet to act to fully harness the potential and resources of people living with HIV in addressing the epidemic.

The lives and experiences of people living with HIV highlight the need for a shift in the existing paradigm of disease management. The high prevalence of HIV amongst health care providers in many countries, exacerbated by stigma towards those with HIV in the health care professions, is seriously undermining the capacity of health systems and signals the need to change the current nature of health care delivery. Moreover, the negative experiences of many people with HIV in relation to their health care as well as in their daily social interactions, coupled with the ever-limited current investment in treatment, care and support, demonstrate that the current system is drastically failing the majority of people with HIV. Current health management systems urgently need to be more effectively maximised, to increase the quality of standards of health care systems and services in resource poor countries. An integrated approach to health care based on a human rights framework, grounded in community realities and delivered in partnership and solidarity with people living with HIV, offers the most viable approach to overcoming the crisis of HIV in the health care system.

Read the rest.

AVAC releases "Piecing Together the HIV Prevention Puzzle"

It’s an exciting time in HIV prevention research. We will see results from a number of critically important HIV prevention research trials this year, as well as see the start of new trials around the world that will yield important answers in the years to come, said Mitchell Warren, AVAC executive director, at the release of AVAC’s 13th annual report of the field.

But scientific, community and political leaders must act now to plan for continued research and implementation of effective strategies, or this excitement will be wasted, Warren added.

May 18, 2009

Dear Advocates,

Today, on HIV Vaccine Awareness Day, AVAC is pleased to announce the publication of our 2009 AVAC Report on the state of AIDS vaccine and biomedical HIV prevention research, Piecing Together the HIV Prevention Puzzle. As usual, the AVAC Report is an opinionated, wide-ranging discussion of the strengths and challenges of the biomedical HIV prevention research field in the past year and for the years to come.

Please click here to download the Report in full or by article, view and download figures, tables and graphics from the Report, and to order print copies.

Click here to download the press release that we released today about the Report.

To structure this year's Report, we took inspiration from a quotation in the recent review of the Collaboration for AIDS Vaccine Discovery, which states that the ultimate goal "is to develop a vaccine that prevents HIV infection or disease--anything less than that can be characterized as progress, but not success."

In the first section of the Report, "Puzzling Out Progress," we report on the AIDS vaccine field, where there's an energized focus on discovery, innovation, and basic science. In the second section, "Puzzling Out Success," we turn to the implications of PrEP and other strategies in efficacy trials today. Throughout, we argue that success will depend on combination approaches: on research plus implementation; on vaccines plus PrEP, should either show benefit; and on communities plus researchers working towards common goals.

We hope you'll take time to look at the Report, which addresses various questions, including:

• What does the AIDS vaccine field's renewed focus on basic science mean, and has there been any progress?
  

• What could or should WHO and UNAIDS be doing to prepare for potentially encouraging results from pre-exposure prophylaxis (PrEP) trials?
  

• What can biomedical prevention research contribute to the global epidemic in gay men and other men who have sex with men?
  

• What has the Global HIV Vaccine Enterprise accomplished to date--and what more must it do?
  

• What are the scientific lessons that the Step AIDS vaccine trial has taught us--and that the field wouldn't have learned otherwise?
  

• How might the field plan ahead for innovative multi-intervention HIV prevention trials?
  

• Where are we on the road to the launch of HVTN 505, the next large test-of-concept AIDS vaccine trial?
  

• What happens if PrEP is proven safe and effective?
  
  

We'd love to hear your opinions too! Please let us know what you think and what topics you'd like to see us cover in the future. You can email us at avac@avac.org.

Best,
AVAC

The Uncelebrated Beauty of Men's Sexuality - The Indypendent

Pornography, it seems to me, presents a highly distorted image of men. While my research with thousands of men shows a different picture of “who men are sexually,” pornography imposes a rigid ideological view on male sexual feelings, expression and behavior. They are not the monolithic beings depicted in most porno images, nor do they find their authentic selves in pornography.

via The Indypendent, by Dr. S. Hite

Ironically, pornography seems friendly to men — more than to women — but its underlying message makes fun of men. Subliminally, it tells men that their sexual expression is ridiculous, base, insensitive, even grotesque. Visually it frequently makes men look ugly and coarse, foolish and unappealing.

Who hasn’t seen porno images? They’re all around us, in magazines, on the internet and even in fine art. The makers and distributors of the images must believe men like them, that they are generally making “what men like,” because they market it to men, and the industry is growing. Although few women buy porno, most industry spokespersons claim that “the number of women is increasing”; any gain they refer to is nominal.

Do most men really like pornography? Do they find it laughable or do they think to themselves: I wish I could be like him, lucky guy?

Read the rest.

Is HIV Treatment HIV Prevention?

HIVision is an ongoing forum series bringing research and evidence to bear on timely policy and programmatic issues. As thinking on HIV/AIDS continues to evolve, HIVision provides a safe venue to engage the community on potentially controversial topics.

Recent studies offer evidence and raise questions about the role of antiretroviral medications in curbing the spread of HIV. Are HIV-positive people who take antiretroviral drugs less likely to transmit the virus? Can these same drugs taken by HIV-negative people help keep them negative? And if so, what are the ethical, financial, and health issues surrounding these HIV prevention strategies? We'll be posting an audio recording soon of this forum on the science and controversies surrounding the use of anti-HIV drugs to prevent HIV transmission and acquisition.

Check out a number of podcasts and materials on this topic here.

You will find this Download a recording of the HIVision forum, Is HIV Treatment HIV Prevention? (.mp3, 100MB, 120 min.) and MUCH MORE.

ILGA Releases 2009 report on State-sponsored homophobia

Report available in English, Spanish, Portuguese, and French

80 countries around the world consider homosexuality illegal, five of them punish homosexual acts with death

ILGA, the International Lesbian, Gay, Bisexual, Trans and Intersex Association publishes the third edition of its report and map on State Sponsored Homophobia based on research by Daniel Ottosson. The report is a collection of legislation criminalising consensual sexual acts between persons of the same sex in private over the age of consent*.

With Panama decriminalising homosexuality in 2008 and Burundi for the first time in its history criminalizing homosexuality in 2009, the world now counts 80 countries with State-sponsored homophobic laws: 72 countries and 3 entities (Turkish Cyprus, Gaza and Cook Islands) punish consenting adults with imprisonment, while 5 countries (Iran, Mauritania, Saudi Arabia, Sudan, Yemen and parts of Nigeria and Somalia) punish them with the death penalty.

Gloria Careaga, co-secretary general of ILGA:

“Homophobia is the fear of, aversion to, or discrimination against homosexuality or homosexuals. It is the hatred, hostility, or disapproval of homosexual people. While appalling and dangerous – and at times murderous – it makes life for lesbian, gay, bisexual, trans or intersex (LGBTI) persons a misery, often leading them to a devastating feeling of insecurity even within their families of origin. Homophobia is even more appalling and dangerous – and again murderous – when found in the very letter of the law. When discrimination and hatred are enshrined in the texts meant to sanction the social pact embodied by a State, a homosexual knows that there is nowhere to turn to for help. The idea of a State condoning, sanctioning and encouraging these practices, particularly when the same State proclaims to abide by the principles of the Human Rights Declaration is unacceptable.”

Renato Sabbadini, Co-secretary general of ILGA:

“The truth is that while the differences in sexual orientation and gender identity or expression are probably inborn – who would be so crazy to choose to be a lesbian in an extremely homophobic country? – the same cannot be said for homophobia, which is often the result of a certain time and context in history, a time and a context always marked by a strong inequality between men and women. Indeed, at the heart of homophobia, lesbophobia and transphobia lies the belief that men and women should not be equal, should play roles incompatible with each other and should be confined in a hierarchy where the former dominate the latter.”

In a speech given in New York December 18, 2008 on occasion of the United Nations Statement signed by 66 countries from all continents against the criminalization of homosexuality, the UN High Commissioner for Human Rights, Ms. Navanetham Pillay, said “there are those who argue that because sexual orientation or gender identity are not explicitly mentioned in any of the conventions and covenants, there would be no protection. My response is that such a position is untenable in legal terms, which is confirmed by the evolving jurisprudence. The principle of universality admits no exception. Human rights truly are the birthright of all human beings.”

With this report, ILGA, a world-wide network of national and local groups, with more than 700 member organizations from every continent and representing 110 countries, dedicated to achieving equal rights for lesbian, gay, bisexual, trans and intersex (LGBTI) people, wants to name and shame the States which at the end of the first decade of the 21st century still treat their LGBTI citizens like lesser persons, unworthy of consideration. The unworthiness rests entirely on these States, for theirs is the shame of depriving a significant number of their citizens of dignity, respect and the enjoyment of equal rights.

*Laws relating to such acts in public, with under aged persons, by force or by any other reason are not included. Nor does it include countries where such acts are legal.

ILGA is the International Lesbian, Gay, Bisexual, Trans and Intersex Association. It is a world-wide network of national and local groups dedicated to achieving equal rights for lesbian, gay, bisexual, trans and intersex (LGBTI) people everywhere. Founded in 1978, it now has more than 700 member organizations. Every continent and approximately 110 countries are represented. ILGA is to this day the only international non-governmental community-based association focused on fighting discrimination on grounds of sexual orientation and gender identity as a global issue.

Source.

Next IRMA Global Teleconference - Microbicides: The herstory of a movement

Join IRMA, and the Global Campaign for Microbicides
for an International Teleconference

Thursday, June 11, 2009

Microbicides: The herstory of a movement

If you ever wanted to know how the microbicides movement got started from two of the women who were there from the beginning, this is the teleconference for you.

•How did microbicides get their name?

•What early role did the women's movement play in advocating for female-initiated HIV prevention methods?

•How did rectal microbicides advocacy get started in the mid-1990s?

•How did advocates successfully get funding for microbicide research in Europe and North America?

•What lessons can we learn from early microbicide advocacy campaigns?

Join us for an important discussion on the story before the headlines and learn the context of this incredible movement that we're all a part of today. Because if you don't know the past, it's hard to understand the present, let alone advocate for the future!

Lori Heise, founding Director of the Global Campaign for Microbicides, will speak about her experience over the past 15 years advocating for microbicides, early watershed moments and the field that's emerged worldwide.

Anna Forbes, Deputy Directory of the Global Campaign for Microbicides, will present on the role of civil society in Europe and North America over the past decade to build awareness and help raise millions to dramatically increase funding for microbicide research. She will also discuss early efforts to get gay men and MSM involved in rectal microbicide advocacy that helped plant the seeds for what is IRMA today.

Times: Thursday, June 11, 2009

Sydney – 12:00am Friday, June 12 (sorry Sydney!)
Kuala Lampur - 10:00pm
Delhi - 7:30pm
Cape Town - 4:00pm
Lagos / London - 3:00pm
Washington DC / NYC - 10:00am
Chicago / Lima - 9:00am
Seattle - 7:00am

Please RSVP here. Everyone who RSVPs will receive toll-free dial-in information.

US gay men mostly getting HIV from main partners; minority of transmission from men with diagnosed HIV

via Aidsmap, by Michael Carter

Over 50% of HIV transmissions in US gay men are from main sexual partners, investigators report in a study published in the online edition of AIDS. The researchers also found that 46% of infections were from partners who were believed to be HIV-negative and that approximately a quarter of transmissions were the result of insertive anal sex. [Read the paper here.]

Gay men remain the group most affected by HIV in the US. There is some evidence that the number of new HIV infections in this group has increased since 2000. This has prompted calls for a renewed focus on the continuing HIV epidemic amongst gay men and the development of new prevention interventions.

Research from the Netherlands suggests that most HIV infections from young men are contracted from main sexual partners. To gain a better understanding of the dynamics of HIV transmission amongst gay men in the US, investigators designed a model using information obtained from the National HIV Behavioral Surveillance System (NHBS), involving gay men in five large US cities between 2003 and 2005, and the HIVNET Vaccine Preparedness Study (VPS), which recruited gay men in six US cities between 1995 and 1997.

Data from the NHBS study were used to estimate the number of gay men with main and casual partners in a year, the number of casual partners, the HIV status of partners, and sexual behaviour with partners. Information from the VPS was used to estimate the number of sexual episodes per year for men with main and casual partners.

A total of 3652 men from the NHBS study were included in the investigators’ analysis. These men reported 2395 main partners and 2850 casual partners. Based upon information from the VPS, the investigators estimated that the combined total of sex acts with main partners was 195,000 per year and 175,000 per year for casual partners.

Read the rest.

HIV prophylaxis programs "not working" - Australian study

via 6minutes.com.au, by Michael Woodhead

Programs that offer gay men access to anti-HIV drugs for postexposure prophylaxis after high risk sexual behaviour are not working, an Australian study has found.

While homosexual men tended to use prophylaxis appropriately, they do not modify their high risk behaviour in the longer term and do not use prophylaxis for all episodes of unprotected intercourse, a prospective five year study in Sydney has shown.

Published in the journal AIDS (online 4 May), the findings from the National Centre in HIV Epidemiology and Clinical Research show that almost all the 1427 participants had heard of non-occupational post-exposure prophylaxis (NPEP). Usage of prophylaxis increased over the duration of the study, and was mostly used after unprotected intercourse. In 80% of participants it was used only once.

However, the use of prophylaxis did not result in any change in risk behaviour, a finding the researchers said was ‘disappointing’ given that behavioural counseling was always provided when prophylaxis was dispensed.

The study also found that over the five year study period prophylaxis was only used by men on 7% of high risk periods such as unprotected intercourse, and that users had three-fold higher rate of seroconversion to HIV.

“This study paints a picture of increasing and mainly appropriate use of [prophylaxis] among homosexual men in Sydney,” the authors write.

But given the lack of impact of prophylaxis on either HIV risk behaviour or HIV incidence, there is a need to redesign the programs and improve the interventions to reduce personal HIV risk, they say.

Holtgrave - To End America's AIDS Crisis, Reinvest in Prevention

To turn the tide of this epidemic, CDC's domestic HIV prevention budget should be expanded from its current level of roughly $750 million to $1.3 billion per year for the next five years.

via Huffington Post, by Dr, David Holtgrave

For the past decade, America's response to its domestic AIDS epidemic has stalled, due to declining resources and attention at all levels. Last month, HIV advocates thought the tide was finally turning when, in its first domestic action on AIDS, the Obama administration and the CDC announced a $45 million, five-year communication campaign to put HIV/AIDS back on America's radar. A key theme: Every 9½ minutes, another person in the U.S. becomes infected with HIV.

But last Thursday President Obama released a deeply disappointing 2010 budget proposal with only a small increase in domestic HIV prevention funding. The $53 million in new funds requested of Congress is less than one-tenth of what is needed to drive down HIV infection rates in the United States, and is even less than President Bush's most recent annual requests to Congress.

We learned last year that the number of Americans becoming infected with HIV is far higher than previously known -- about 56,000 per year. HIV continues to take a disproportionate toll on African American communities, and HIV infections have been increasing at an alarming pace among gay and bisexual men of all races.

If we are to reduce HIV infection rates in the U.S., we must invest significantly more resources into prevention programs. My research demonstrates that federal funding for prevention is highly effective. There is a direct correlation between federal dollars spent and national HIV infection rates. Yet, the CDC's budget for HIV prevention has declined by almost 20% in real dollars since 2002.

To turn the tide of this epidemic, CDC's domestic HIV prevention budget should be expanded from its current level of roughly $750 million to $1.3 billion per year for the next five years. This would undo the harmful effects of inflation, address the unmet needs that have continued to grow over time, and rectify our failure as a nation to invest in programs at the scale needed to dramatically alter the course of the epidemic. This is one of the smartest public health investments the U.S. can make -- over five years, it could prevent approximately 89,000 new HIV infections, save $18.5 billion in averted treatment costs, and, most importantly, save some 1,350 lives.

Read the rest.

Adding the Female Condom to the Public Health Agenda on Prevention of HIV and Other STIs Among Men and Women During Anal Intercourse

June 2009, Vol 99, No. 6 | American Journal of Public Health 985-987
© 2009 American Public Health Association
DOI: 10.2105/AJPH.2008.141200

Adding the Female Condom to the Public Health Agenda on Prevention of HIV and Other Sexually Transmitted Infections Among Men and Women During Anal Intercourse

Elizabeth A. Kelvin, PhD, MPH, Raymond A. Smith, PhD, Joanne E. Mantell, PhD, MSPH and Zena A. Stein, MA, MBBCh

The authors are with the HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York. Zena A. Stein is also with the G. H. Sergievsky Center, Columbia University, New York.

Correspondence: Requests for reprints should be sent to Elizabeth A. Kelvin, PhD, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, Unit 15, New York, NY 10032 (e-mail: eak34@columbia.edu).



Legal barriers to conducting public health research on methods of protection for anal intercourse were lifted in the United States in 2003 when the US Supreme Court invalidated all state antisodomy laws. Although research funding has been available for the development of rectal microbicides, the female condom, which has already been approved for vaginal use, has not been evaluated for anal use.

Although there is no evidence that the female condom is safe for anal intercourse, it has already been taken up for off-label use by some men who have sex with men. This demonstrates the urgent need for more protection options for anal intercourse and, more immediately, the need to evaluate the safety and efficacy of the female condom for anal intercourse.

In the United States, anal intercourse is a common practice. Among men aged 25 to 44 years in the United States, 3.9% report having had anal intercourse with another man, and 40% report having had anal intercourse with a woman. Among women aged 25 to 44 years in the United States, 35% report having had heterosexual anal intercourse.1 Hence, discussions about anal intercourse should not assume that the practitioners are all men who have sex with men (MSM). In fact, there are an estimated 4 times more women than there are MSM practicing receptive anal intercourse in the United States.2 Unprotected anal intercourse is the sexual activity associated with the highest risk of HIV infection.3

Despite the fact that it is a common practice among heterosexual as well as homosexual couples,1 anal intercourse has long been subject to religious prohibition, criminal sanction, and social stigma worldwide.4 Scriptures in Leviticus (18:22 and 20:13) have traditionally been interpreted to prohibit anal intercourse, at least between men, under punishment of death for both partners, and the story of Sodom in Genesis chapter 19 provided a name for the act: sodomy. Medieval Christianity condemned anal intercourse along with other nonprocreative activities such as fellatio, homosexual contact, and sexual activity with animals.5 With the emergence of secular governments, "sins against nature" became codified in the law as "crimes against nature" through the enactment of antisodomy statutes. Although, in theory, any sexual activities not leading to procreation, such as male–female oral and anal sexual intercourse, were illegal, in practice, these statutes were applied primarily in cases of male–male sexual activity.5

As late as 1961, antisodomy laws in the United States were included in the criminal statutes of all 50 states of the union. By 1985, half of the states had repealed or struck down these laws, but in that year the US Supreme Court upheld the constitutionality of the remaining laws in the case of Bowers v Hardwick. The court ruled that the equal protection provisions of the 14th Amendment did not extend to anal intercourse and that majority disapproval of such a sexual activity was sufficient to pass a "rational-basis" standard under US constitutional law.6

Bowers v Hardwick occurred during the early years of the AIDS epidemic, which was understood at that time to affect mainly MSM. The ruling effectively reinforced the US government in its reluctance to sponsor research on the particular sexual activity associated with the highest risk of HIV infection.2 The US Food and Drug Administration has never approved a male or female condom specifically for use in anal intercourse, at least in part because antisodomy laws made anal intercourse an illegal activity in some states.7,8

In 2003, the US Supreme Court, in the case of Lawrence v Texas,9 invalidated the remaining state antisodomy laws as they apply to behavior between consenting adult civilians in private. In overturning their own precedent in Bowers v Hardwick just 17 years earlier, the Supreme Court may have been responsive to rapidly evolving social attitudes and scientific knowledge about homosexuality, as well as about HIV transmission and human sexuality in general.

The 6-to-3 ruling in Lawrence v Texas was notably broad, stating that "liberty gives substantial protection to adult persons in deciding how to conduct their private lives in matters pertaining to sex" and that the antisodomy law in question "furthers no legitimate state interest which can justify its intrusion into the individual's personal and private life."9 Thus, the period following Lawrence v Texas marks the first time in US history that anal intercourse has not been subject to criminal prosecution. It also offers an ideal opportunity for the development of a new public health research agenda on anal intercourse—one unfettered by legal constraints.

In 2004, the National Institute of Allergy and Infectious Diseases awarded a grant to the University of California, Los Angeles, and collaborative institutions to develop a pipeline for testing the anal use of microbicides. In 2007, the first rectal microbicide safety trial was conducted to evaluate the candidate product, UC-781.4 However, we do not yet have an effective microbicide for vaginal use, and the development of candidate rectal microbicides lags farther behind that of vaginal products.10 Consideration of whether technology already available for vaginal intercourse should be evaluated for anal intercourse is surely overdue. One candidate that might be considered for this crossover from vaginal to anal use is the female condom.

Although there is some research supporting equal efficacy of the female condom compared with the male condom in preventing sexually transmitted infections (STIs) when used vaginally,11–15 there is at present no data on female condom efficacy during anal use. However, because both male and female condoms act similarly as physical barriers, it may be reasonable to assume that using a female condom for anal intercourse would be safer than using no protection at all. Observational studies in the United States indicate that some MSM already use the female condom for anal intercourse.16–18 According to interviews we conducted in 2002 with 78 health care providers in 5 different health care settings in New York, some health care providers in the United States are presenting the female condom as an option for their MSM clients,19 and Population Services International, a non-profit, social marketing organization, has implemented social marketing of the female condom to MSM in Thailand20 and Myanmar.21

Furthermore, our search on the Internet for the phrase "female condom for anal sex" or variants thereof found that numerous Web sites address use of the female condom for anal intercourse, in some cases providing detailed instructions. We also looked at the Web sites of all 50 state departments of health in the United States to see if use of the female condom for anal intercourse was mentioned. Although we found anal use of the female condom mentioned on 7 state department of health Web sites, the content of the messages was inconsistent. For example, although the Web sites of 5 health departments in the United States and Canada support the use of the female condom for anal intercourse and even provide instructions on how to insert the device,22–26 the Web site of the New York State Department of Health warns that "female condoms should not be used for anal sex, as they do not provide adequate protection."27

In addition, among those health departments that do support anal use of the female condom, the specific instructions provided on their Web sites differ with regard to use of the inner ring. The Massachusetts22and Hawaii23 state department of health Web sites indicate that the inner ring should be removed prior to use for anal intercourse, whereas the Web sites of the District of Columbia Department of Health,24the Seattle and King County Department of Health,25 and the STD Resource.com site of the Vancouver Department of Health26 instruct users to leave the ring in or take it out, depending upon individual preference. Finally, the "STDs and Condoms Fact Sheet" of the Texas State Department of Health provides no instructions to potential users and simply states, "Most condoms go over a man's penis. A newtype of condom was designed to fit into a woman's vagina. This ‘female’ condom can also be used to protect the anus."28 Thus, the absence of consistent messages and rigorous research has relegated use of the female condom for anal intercourse to a subject of conjecture, contradiction, and potential misinformation rather than one based on sound scientific evidence.

Because of the current lack of alternatives for protection during anal intercourse, people have experimented with the off-label use of new products to meet their needs. The determination of some couples to find new forms of protection for anal intercourse underscores the need for alternatives to the male condom. However, before promoting the female condom for anal intercourse, research is urgently needed. With the male condom, the sexual anatomy of the penetrative partner, the penis, is the same in both anal and vaginal intercourse, and therefore, the lack of US Food and Drug Administration approval of male condoms for anal intercourse has not been problematic. However, the female condom has features specifically designed for insertion into the vagina, most notably a flexible inner ring that is secured by the cervix. When used in the anus, the female condom may not be easy to insert, comfortable, or even safe. In addition, the female condom can be inserted into the vagina up to 8 hours prior to intercourse,29 but this may not be true when using the product in the anus.

Therefore, studies are needed to determine the optimal methods for using the female condom during anal intercourse, especially with regard to the inner ring. The few safety studies that have been conducted to date have provided different instructions regarding the inner ring and have had numerous other flaws, including small sample size, high loss to follow-up, and poor adherence to protocol, making them inconclusive (Jobst RG, Johns JS, unpublished manuscript, 1994).16,30 Additional research on the safety of the female condom for anal intercourse is needed to address the limitations of the previous studies, and clinical trials comparing the efficacy of the female condom to that of the male condom are also needed to help those who practice anal intercourse decide how best toprotect themselves from rectalacquisition of HIV and other STIs.

Once the necessary studies have been conducted and safety and efficacy have been demonstrated, the marketing of the female condom for anal intercourse should be widespread and must consider the diversity of the potential users in terms of gender, sexual orientation, and sexual practices. Perhaps one reason why the female condom has not become more popular is because it is being marketed only to women and only for vaginal sexual intercourse. The more popular male condom, on the other hand, is recommended for both vaginal and anal intercourse and, although it is worn by a male partner, it is generally marketed to and purchased by both men and women. One study among women who practice anal intercourse found that they frequently do so in conjunction with vaginal intercourse and, thus, need a condom that can be used for both activities.30 By making the female condom less gender specific and diversifying its use to include anal intercourse, the female condom may become even more acceptable than it is now. A first step toward this end would, obviously, be a different name for the female condom.

The public health community needs to advocate for studies to examine the safety and efficacy of current vaginal products, as well as new products, for anal use. Because we lack an effective microbicide at this time, the potential of the female condom as an HIV- and STI-prevention barrier for anal intercourse urgently needs to be explored. In addition, this research may help guide future studies on microbicides for anal use when they become available. The goal of the public health agenda must be to provide more safer-sex options to all, regardless of gender, sexual orientation, and sexual practices, as soon as possible.



1. Mosher WD, Chandra A, Jones J. Sexual behavior and selected health measures: men and women 15-44 years of age, United States, 2002. Adv Data. 2005;362:1–55.[Medline]
2. Halperin DT. Heterosexual anal intercourse: prevalence, cultural factors, and HIV infection and other health risks, Part I. AIDS Patient Care STDs. 1999;13:717–730.[ISI][Medline]
3. Leynaert B, Downs AM, de Vincenzi I. Heterosexual transmission of human immunodeficiency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV. Am J Epidemiol. 1998;148:88–96.[Abstract/Free Full Text]
4. International Rectal Microbicide Advocates. Less silence; more science. Advocacy to make rectal microbicides a reality. Presented at: Microbicides 2008; February 24–27, 2008; New Delhi, India. Available at: http://www.rectalmicrobicides.org/docs/IRMAColorFinalWeb.pdf. Accessed September 1, 2008.
5. Johansson W. Sodomy. In: Dynes W, Johansson W, Percy W, Donaldson S, eds. Encyclopedia of Homosexuality . New York, NY: Garland Publishers; 1990:1231–1232.
6. Bowers v Hardwick, 478 US 186 (1986). Available at: http://straylight.law.cornell.edu/supct/search/display.html?terms=bowers%20v.%20hardwick&url=/supct/html/historics/USSC_CR_0478_0186_ZO.html. Accessed April 4, 2008.
7. Salinas M. "Female condoms" for male-male sex: FDA denies reality to gays. Bay Area Reporter. February 29, 1996. Available at: http://www.aegis.org/news/misc/1996/BAR60201.html. Accessed September 25, 2007.
8. Scarce M. Gay men and the female condom: is rectal reality getting a bum wrap? In: Smearing the Queer Medical Bias in the Health Care of Gay Men . New York, NY: Harrington Park Press; 1999:51–82.
9. Lawrence v Texas, 539 US 558 (2003). Available at: http://www.law.cornell.edu/supct/html/02-102.ZS.html. Accessed October 22, 2007.
10. Global Campaign for Microbicides. Rectal microbicides. 2007. Available at: http://www.global-campaign.org/rectal.htm. Accessed September 26, 2007.
11. French PP, Latka M, Gollub EL, Rogers C, Hoover DR, Stein ZA. Use-effectiveness of the female versus male condom in preventing sexually transmitted disease in women. Sex Transm Dis. 2003;30:433–439.[ISI][Medline]
12. Feldblum PJ, Kuyoh MA, Bwayo JJ, et al.. Female condom introduction and sexually transmitted infection prevalence: results of a community intervention trial in Kenya. AIDS. 2001;15:1037–1044.[CrossRef][ISI][Medline]
13. Fontanet AL, Saba J, Chandelying V, et al.. Protection against sexually transmitted diseases by granting sex workers in Thailand the choice of using the male or female condom: results from a randomized controlled trial. AIDS. 1998;12:1851–1859.[ISI][Medline]
14. Soper DE, Shoupe D, Shangold GA, Shangold MM, Gutmann J, Mercer L. Prevention of vaginal trichomoniasis by compliant use of the female condom. Sex Transm Dis. 1993;20:137–139.[ISI][Medline]
15. Drew WL, Blair M, Miner RC, Conant M. Evaluation of the virus permeability of a new condom for women. Sex Transm Dis. 1990;17:110–112.[ISI][Medline]
16. Renzi C, Tabet SR, Stucky JA, et al.. Safety and acceptability of the Reality condom for anal sex among men who have sex with men. AIDS. 2003;17:727–731.[CrossRef][ISI][Medline]
17. Gross M, Buchbinder SP, Holte S, Celum CL, Koblin BA, Douglas JM Jr. Use of Reality "female condoms" for anal sex by US men who have sex with men. HIVNET Vaccine Preparedness Study Protocol Team. Am J Public Health. 1999;89:1739–1741.[Abstract/Free Full Text]
18. Wolitski RJ, Halkitis PN, Parsons JT, Gomez CA. Awareness and use of untested barrier methods by HIV-seropositive gay and bisexual men. AIDS Educ Prev. 2001;13:291–301.[CrossRef][ISI][Medline]
19. Mantell JE, Kelvin EA, Exner TM, Hoffman S, Needham S, Stein ZA. Anal Use of the Female Condom: Does Uncertainty Justify Provider Inaction? AIDSCare. In press.
20. Population Services International. Products and services female condoms. 2007. Available at: http://www.psi.org/our_programs/products/female_condom.html. Accessed June 19, 2008.
21. Population Services International. AIDS Mark. A Decade of Innovative Marketing for Health: Lessons Learned. Washington, DC: Population Services International; 2007. Available at:http://www.psi.org/aidsmark/EOP_Reports_PDF/End-of-Project-Report.pdf. Accessed September 1, 2008.
22. Massachusetts Department of Public Health. Be safer, use condoms. 2007. Available at: http://www.mass.gov/dph/cdc/factsheets/condoms.pdf. Accessed September 5, 2007.
23. Hawaii State Department of Health. HIV basic information. 2007. Available at: http://www.hawaii.gov/health/healthy-lifestyles/std-aids/hiv-aids/basic-information.html. Accessed September 25, 2007.
24. District of Columbia Department of Health. Instructions for using a female condom for anal sex. 2007. Available at: http://doh.dc.gov/doh/cwp/view,a,1371,q,602668.asp. Accessed September 4, 2007.
25. Public Health Seattle and King County. How to use a condom and other types of barriers. 2007. Available at: http://www.metrokc.gov/health/apu/std/condomuse.htm. Accessed September 25, 2007.
26. British Columbia Center for Disease Control. Female Condoms 2007. Available at: http://www.stdresource.com/concern/c1_d_3_e_2.php. Accessed September 4, 2007.
27. New York State Department of Health. Frequently asked questions (FAQs) about condoms. 2007. Available at: http://www.health.state.ny.us/diseases/aids/facts/condoms/faqs.htm. Accessed September 5, 2007.
28. Texas Department of State Health Services. STD and condoms fact sheet. 2007. Available at: http://www.dshs.state.tx.us/hivstd/info/edmat/condoms.pdf. Accessed September 25, 2007.
29. The Female Health Company. Female condom package insert. 2008. Available at: http://www.femalehealth.com/pdf/US_Package_Insert.doc. Accessed June 19, 2008.
30. Gibson S, McFarland W, Wohlfeiler D, Scheer K, Katz MH. Experiences of 100 men who have sex with men using the Reality condom for anal sex. AIDS Educ Prev. 1999;11:65–71.[ISI][Medline]
31. Exner TM, Correale J, Carballo-Dieguez A, et al.. Women's anal sex practices: implications for formulation and promotion of a rectal microbicide. AIDS Educ Prev. 2008;20:148–159.[CrossRef][ISI][Medline]

Cape Town, South Africa - Unsafe sex among HIV+ teens

via Health24.com

As adolescents whose mothers had HIV and who were born with HIV become sexually active, researchers are calling for public health initiatives aimed at preventing them from passing on the virus to their partners.

The recommendation follows an investigation by the Paediatric HIV/Aids Cohort Study showing that most such HIV-positive youngsters say they have not yet initiated sexual activity, but those who have say they started early and do not consistently use condoms.

"While our data are preliminary and we are still enrolling patients, it is clear that these HIV-positive children and adolescents are starting to become sexually active, and that interventions are needed to help them delay sexual initiation, consistently use condoms once they do become sexually active, and discuss their HIV status with their sexual partners," Katherine Tassiopoulos said at the meeting of the Paediatric Academic Societies.

Living longer on ARVs
With the introduction of potent antiretroviral drugs, children in developed countries who were infected with HIV before birth are surviving into adolescence and adulthood, the investigators wrote in their conference poster.

They also noted that adolescence is often a time of sexual initiation as well as decreased adherence to HIV treatment.

For their study, Tassiopoulos, a research scientist in the Department of Epidemiology at the Harvard School of Public Health in Boston, and her colleagues analysed responses to sexual behaviour questionnaires completed by 153 children and adolescents 10 years of age or older with perinatally acquired HIV infection.

Overall, 124 of them reported no sexual activity. Thirteen reported genital touching only, and 16 reported vaginal, anal or oral sex.

The 10 sexually active boys in this series were on average 12 years old at sexual initiation, and the 6 sexually active girls were 16 years old.

Inconsistent condom use
One third of the sexually active subjects reported at least one instance of unprotected vaginal or anal sex. Furthermore, half of them had detectable levels of HIV in their blood, including all of the four males who reported inconsistent condom use.

The investigators were also surprised to find that all of the sexually active individuals who reported giving or receiving oral sex also reported vaginal or anal sex. "This is contrary to other published and anecdotal evidence that suggests more teens have oral sex rather than penetrative sex, perhaps due to perceptions that it is less risky or more acceptable," Tassiopoulos said. - (Jill Stein/Reuters Health, May 2009)

When the Cellphone Teaches Sex Education

via the New York Times, by Jan Hoffman

Excerpt:

The North Carolina center permitted a New York Times reporter to read through some phone logs, after cellphone numbers and towns were redacted. The questions span the spectrum of adolescence itself, from the goofy to the ghastly. Many ask how to talk with parents about sexuality. Combining a teenager’s capacity to cut to the chase with the terseness of texting, they are often brutally direct:

“Do I love her or do I love the sex?”

“What happens if you swallow a piece of condom?”

Some questions could have been written to teen magazines 50 years ago:

“Why don’t girls like short guys?”

“how do u move yr tongue when u tongue kiss?” (“Kissing is not a science,” the reply notes. “Go at your own pace and you will figure it out.”)

But many questions vault past the basic training manual: “I like boys but I also like girls. What should I do?” (“Some people just like who they like. ... Only you can know for sure and only you know what is right for you.”)

Some reveal dangerous chasms of ignorance. Girls and boys alike ask about anal intercourse: Will it prevent pregnancy? Let a girl remain a virgin?

“If ur partner has aids,” one teenager asks, “and u have sex without a condom do u get aids the first time or not?”

Read the rest.

Right-Wingers Give Limbaugh's Anal Sex References A Pass

via Huffington Post, by Terry Krepel

Media Research Center chief Brent Bozell is, to put it succinctly, not a fan of anal sex:

-- In 2006, he complained that at a Comedy Central roast for William Shatner, "the audience was buried in man-on-man anal-sex and oral-sex jokes."

-- In 2008, he was offended that the ABC show "Ugly Betty" includes "catty references" to, among other things, "anal sex."

-- On March 13, he bashed "Family Guy": "This Jesus-bashing is offensive, but it isn't so surprising - it's a 'Family Guy' staple. Now add the allusions to anal penetration and we're on another trip down Grossout Lane."

WorldNetDaily feels much the same way on the issue. It has criticized Wikipedia for including a "photo of two nude men having anal sex on a bed," bashed Spencer Gifts for carrying "pornaments" that "graphically depict anal intercourse between a snowman and a bare-breasted 'snowwoman,'" disapproved of the Wal-Mart website selling a book that "gives explicit instructions for engaging in oral or anal sexual acts," and denounced the movie "Brokeback Mountain" for depicting characters who "awkwardly and violently engage in anal sex." WND founder and editor Joseph Farah even asks: "Isn't it time to make anal sex taboo, again?"

Bozell and WND have thus clearly established their opposition to references to anal sex in the media and popular culture. So why do they give Rush Limbaugh a pass for making those very same "allusions to anal penetration"?

Read the rest.

International Day Against Homophobia - May 17, 2009

Philosophy of the Event

Few minority groups have been as discriminated against as the gays and lesbians. But major breakthroughs have occurred, and homosexual people are stepping out of the shadows. From the outside, it could be construed that all problems have been solved. The media are sympathetic, public personalities come out, television shows feature lesbian and gay characters in scenes of everyday life. Nevertheless, the reality is quite different. Many individuals are unable to live their sexual orientation, encounter difficulties if they do, or end up role-playing to protect themselves.

Despite these dire situations, the implementation of the International Day Against Homophobia should not rest on a “victimization“ philosophy. In fact, the Day may be seen as a great opportunity to highlight positive aspects of homosexuality and celebrate the contribution of lesbians and gays to society.

Target Audience

Homophobia is an insidious process that channels its effects through subtle, usually transparent ways. No one is safe from hostile manifestations to homosexuality. Quite surprisingly, many homosexual individuals themselves adopt homophobic behaviour, hoping it would protect them against prejudice from their entourage. The International Day Against Homophobia aims to reach all groups of society, regardless of their sexual orientation.

Becoming Involved

An International Day Against Homophobia belongs to no one individual. It’s about all people hoping for a prejudice-free world that can provide a place at the table for everyone regardless of their sexual orientation. Inspired by all world theme-days, the day set aside to fight homophobia needs to be appropriated by all of those actively involved in civil society: gay and lesbian community organisations, those organisations focusing on other types of sexual diversity, unions, employers, private businesses, governments, public administration, professional associations, and all individuals seeking equality.

Website
Facebook group

HSV-2 suppression to reduce HIV transmission among partners

via IRMA member Rober Reinhard:

An interesting paper was published today about HSV-2 suppression to reduce HIV transmission among partners, describing the largest cohort of serodiscordant couples ever organized. It also contains an important explanation of the differences between reducing "transmission" and reducing "acquisition" that affect understanding of the "ACE" prevention study results. An amazing effort which also looked at anal sex practices. The cohort however recruited only heterosexual couples, no doubt because of important design, biology andlogistic reasons but that points to more efforts that could be made to recruit MSM partner cohorts. Some attempts of course have already been made but if you look down the line to what could be learned from this cohort it has ancillary studies potential that could be helpful for microbicides.

"Characteristics of HIV-1 Discordant Couples Enrolled in a Trial of HSV-2 Suppression to Reduce HIV-1 Transmission: The Partners Study"

Click here to read the full paper on PloS Hub for Clinical Trials.

The Partners HSV-2/HIV-1 Transmission Study (Partners Study) is a phase III, placebo-controlled trial of daily acyclovir for genital herpes (HSV-2) suppression among HIV-1/HSV-2 co-infected persons to reduce HIV-1 transmission to their HIV-1 susceptible partners, which requires recruitment of HIV-1 serodiscordant heterosexual couples. We describe the baseline characteristics of this cohort.

UCSF: Cancer-causing virus associated with higher risk of new HIV infection

Public release date: 30-Apr-2009
Source

Infection with anal human papillomavirus, a virus that can cause anal and cervical cancers, is associated with a higher risk of new HIV infection in previously HIV-negative men who have sex with men, according to new UCSF research

Infection with anal human papillomavirus (HPV), a virus that can cause anal and cervical cancers, is associated with a higher risk of new HIV infection in previously HIV-negative men who have sex with men (MSM), according to new UCSF research.

Reported online ahead of print in the journal AIDS, the findings are available now. They are scheduled for publication in an upcoming print issue.

In previous studies, other sexually transmitted infections have been associated with higher risk of HIV infection and HPV is the most common sexually transmitted infection.

"We looked at HIV-negative men who have sex with men who were at high risk for HIV infection and who had multiple risk factors. Our results showed a strong independent association for increased risk of HIV acquisition among those men who were already infected with anal HPV," said the study's lead investigator, Peter V. Chin-Hong, MD, associate professor of clinical medicine and director of the program in transplant and immunocompromised host infectious diseases at UCSF.

The 1400 study participants were part of the EXPLORE trial, a large clinical trial to test the efficacy of a behavioral intervention for HIV-negative MSM with sites in Boston, Denver, New York and San Francisco. Risk factors were calculated from those men who became HIV-infected over the course of the trial and infections were identified by blood tests.

"We think that HPV enhances susceptibility to HIV infection through two mechanisms. Anatomically, the virus causes anal lesions. These lesions bring blood vessels closer to the surface and also the lesions' skin layer is thinner and more easily shredded, which frequently causes bleeding. These disruptions of the mucosal barrier could allow easier entry for HIV," said Chin-Hong.

In addition, HPV activates the immune system. The inflammatory cells recruited to the HPV lesions—dendritic cells, macrophages and CD4 T cells—are the immune cells most susceptible to HIV infection.

HPV vaccine has been found effective in preventing acquisition of the virus by women. Clinical trials testing the effectiveness of the vaccine among MSM are currently under way.

"To date, the focus of attention on HPV has been almost exclusively on its key role in causing squamous cell cancer. This study points to another important means by which HPV infection may be associated with morbidity and mortality, i.e., through potentiation of HIV infection. A direct role for HPV in this process will need to be confirmed in additional studies, and additional studies will be needed to understand the mechanisms by which HPV may do this, said the study's senior investigator and author, Joel Palefsky, MD, professor of medicine and director of the Anal Neoplasia Clinic at UCSF.

"But it is encouraging to note that to the degree that HPV truly plays a role in increasing the risk of acquiring HPV infection, primary prevention of HPV infection through HPV vaccination may potentially reduce that risk," he added.

###

Co-authors of the study include Marla Husnik, Fred Hutchinson Cancer Research Center in Seattle; Ross D. Cranston, University of Pittsburg; Grant Colfax and Susan Buchbinder, San Francisco Department of Public Health; Maria Da Costa and Teresa Darragh, UCSF; Dana Jones, Centers for Disease Control; Franklyn Judson, Denver Department of Public Health; Beryl Koblin, New York Blood Center; and Kenneth H. Mayer, Fenway Community Health Center in Boston.

This research was supported by funding from the University of California Universitywide AIDS Research Program, CYTYC Corporation, National Institute of Allergy and Infections Diseases, National Institute on Alcohol Abuse and Alcoholism, National Institute of Child Health and Human Development, National Institute on Drug Abuse, the National Institute of Mental Health, Office of AIDS Research and National Center for Research Resources.

The AIDS Research Institute (ARI) at UCSF houses hundreds of scientists and dozens of programs throughout UCSF and affiliated labs and institutions, making ARI one of the largest AIDS research entities in the world.

UCSF is a leading university dedicated to defining health worldwide through advanced biomedical research, graduate level education in the life sciences and health professions and excellence in patient care.

[read the paper on the IRMA site]

Pune, India - Whistling in the Dark

It's time to cheer the gay identity
By: Kaumudi Gurjar via Mid-Day




Pune: R Raj Rao has authored a book titled Whistling in the Dark, which is a narrative compilation of the experience of 21 homosexuals from across Pune

Being gay is no longer a taboo, as everything about the community is coming out of the closet. Hence, there no need to hide about one's sexual preferences, says R Raj Rao, a city-based writer.

Rao has authored a book titled Whistling in the Dark, which is a narrative compilation of the experience of homosexuals. The book highlights how most of the homosexuals have been forced to hide their sexual orientation fearing backlash from the larger heterosexual society.

Sting operation

Although Rao is comfortable sharing his identity, the other men whom he had interviewed were quite hesitant to speak about their sexual preferences. "Interviewing them was like a massive sting operation, as many of them were reluctant to share their experiences. May be it's because they didn't want to speak about their private lives or maybe they didn't want to reveal the biggest secret that they had hidden since long," said Rao.

According to Rao, most of the people he had interviewed were associated with Queer Studies Centre a support group that works for the intellectual, cultural, social and political rights of gays in India. He has recorded testimonies of 20 men and one woman from all walks of life, including professors, auto rickshaw drivers, under trials and even foreigners visiting Pune.

Speaking about how he convinced them to speak for the book, he said, "I became friends with them, partied with them sand even took them to overnight jaunts and hill stations. It was then that they opened up to me."
While a majority of interviews in Rao's book appear under assumed names, there are a few people like Christopher Benninger, Ram Naidu, Hoshang Merchant and Bindumadhav Khire who readily agreed to being
quoted.

Beaten

Rao said, "The interviewees told me how the they were bashed up by the heterosexuals. Some even said that their wives had no inkling about their sexual orientation, while some even shared their experiences of being waylaid by the police and hoodlums who threatened to reveal their identity."

Romantic aspect

Rao added that, "Issues related to homosexuality are often hijacked by associating them with HIV. But nobody explores the romantic aspect of being gay. I have attempted to bring that element in my book."