DIAGRAM - Barriers to Condom Use

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via peripheries

The Latest Fight Over the Foreskin

via New York Times, by Roni Caryn Rabin

In the late 19th century, Victorian-era doctors described the male foreskin as a “source of serious mischief.”

Convinced that masturbation led to insanity, and that it was the sensitive, responsive foreskin that stimulated masturbation, surgeons started promoting therapeutic circumcision to cure young men of the “sin” of excessive indulgence and prevent its corollary, “masturbatory insanity,” a catchall phrase for various psychiatric and physical disorders that perplexed physicians.

Now, in the 21st century, the foreskin has been exonerated as far as masturbation and mental illness go. But public health experts are making a pretty strong scientific case that cells in the foreskin act as a magnet for H.I.V. and, as such, may increase a man’s risk of acquiring the virus from an infected woman if he is uncircumcised.

Read the rest.

Learn how to blog about AIDS

The "Blogging Positively" Guide is the brainchild of bloggers seeking to address the HIV/AIDS pandemic in a meaningful way. Citizen media tools -- including blogs, podcasts, and online photo and video sites -- present powerful new opportunities for activists aiming to spread awareness and promote discussion about HIV/AIDS and its societal stigma.

Open and read the PDF - and learn why it's important to blog about HIV/AIDS, find tips on how to get started.

VIDEO: Preparing for PrEP - A Stakeholder's Dialogue

PrEP- livestreaming video powered by Livestream

The Goal of this one-day conference (held in Atlanta August 23, 200) was to gather researchers, policy-makers, providers, consumers and community representatives to hear the latest news on Pre-Exposure Prophylaxis (PrEP) and discuss what the future of HIV prevention will look like when this revolutionary biomedical intervention is added to the existing menu of HIV prevention options.

Factors associated with unprotected anal intercourse among men who have sex with men in Douala, Cameroun

Sex Transm Infect. 2009 Aug 24. [Epub ahead of print]


Henry E, Marcellin F, Yomb Y, Fugon L, Nemande S, Gueboguo C, Larmarange J, Trenado E, Eboko F, Spire B.

Coalition Plus, Pantin, France.

OBJECTIVES: Research on men who have sex with men (MSM) in Sub-Saharan Africa was neglected for a long time. The objective of our study was to understand factors associated with unprotected anal intercourse (UAI) with male partners among a group of MSM living in the city of Douala, Cameroon.

METHODS: In 2008, a survey on the sexual activity and practices of MSM was set up in Douala in collaboration with a local community-based organization. Data were collected among a convenience sample of 168 MSM during face-to-face interviews with trained interviewers.

RESULTS: A total of 142 individuals reported sexual activity during the previous six months, among whom 80 (57%) reported UAI with male partners. In a multivariate logistic regression model adjusted for the frequency of sexual intercourse, not having had access to prevention interventions and not knowing any HIV-infected person were both independently associated with a higher risk of UAI. Other factors associated with this higher risk included having had a stable male partnership at some point in one's life and not having been out of Douala for more than four weeks during the previous year.

CONCLUSIONS: This community-based research is the first study of MSM in Cameroon and the HIV transmission risks they face. Results show the importance of HIV prevention interventions from peers and underline the need to maintain efforts to develop specific interventions targeting MSM more efficiently in the African context.

IRMA on Video - IAS Webcast of Rectal Satellite Session in Cape Town

Rectal Microbicide Development - An African Perspective, a satellite session held July 19, 2009, at the IAS 2009 meeting in Cape Town, South Africa, described the role of anal intercourse (AI) in HIV transmission and discussed recent research towards the development of rectal microbicides for the prevention of AI-associated HIV infection. Data from the African continent was highlighted.

Click here for Ian McGowan (IRMA Scientific Vice Chair) and Jim Pickett (IRMA chair) on video.

Following are all of the presenters and their linked presentations.

Click here for photos from the session, on Flickr.

Chris Beyrer, US - Epidemiology of HIV among MSM in Africa: Implications for rectal microbicides

James McIntyre, South Africa and Sibongile Dladla, South Africa - Accessing MSM in Africa for health care and HIV prevention studies

Ian McGowan, US - Development of rectal microbicides

Jim Pickett, US - Go tell it on Table Mountain - rectal microbicide advocacy from here to there

Related:

IRMA's Jim Pickett guests on the Windy City Queercast to talk about the IAS Conference in Cape Town, inspiring grannies, and of course, rectal microbicides.

Click here for the podcast.

Reference: WCQ325 Jim Pickett and the International AIDS Conference 2009-09-01

Click here for pics of those inspiring grannies, and more.

Study: Circumcision doesn't protect gays from AIDS virus

Previous research has suggested circumcision doesn't make a difference when anal sex is involved. The latest study, by CDC researchers, looked at nearly 4,900 men who had anal sex with an HIV-infected partner and found the infection rate, about 3.5 percent, was approximately the same whether the men were circumcised or not.

via AP, by Mike Stobbe

Circumcision, which has helped prevent AIDS among heterosexual men in Africa, doesn't help protect gay men from the virus, according to the largest U.S. study to look at the question.

The research, presented at a conference Tuesday, is expected to influence the government's first guidance on circumcision.

Circumcision "is not considered beneficial" in stopping the spread of HIV through gay sex, said Dr. Peter Kilmarx, of the U.S. Centers for Disease Control and Prevention.

Read the rest.

Hijras take to Dhaka catwalk as part of unique awareness campaign

via bdnnews24.com, by Fahmida Wadud Chaity

Dhaka, Aug 18 (bdnews24.com)—The audience at a show titled "Agony and Ecstasy," at the National Museum on Tuesday, were treated to a unique event as Hijras took to the catwalk in a fashion show as part of the programme's aim to to sensitise the larger community on transgender issues.

The programme, also aiming to create awareness about the risks of HIV/AIDS and drug-use, was organised by the Bandhu Social Welfare Society, which works for the wellbeing of the socially excluded "males and their partners" through the provision of sexual health services, support of their human rights and alternate livelihoods.

Shale Ahmed, executive director of BSWS told bdnews24.com, "They are regularly stigmatised in many ways, which harm their self esteem. They tend to think they are useless. They feel isolated and excluded."

"This particular programme is a part of our protest against the stigma. It is an effort to make the community feel empowered."

Read the rest.

Serosorting and 'strategic positioning' used by HIV-positive US gay men to reduce HIV transmission risks, shows meta-analysis

via Aidsmap, by Michael Carter

Over 40% of gay and other men who have sex with men diagnosed with HIV in the US have unprotected anal intercourse, according to the results of a meta-analysis published in the August 24^th edition of AIDS. However, there was evidence that those engaging in unprotected sex were attempting to limit the risk of HIV transmission to partners by employing strategies such as "serosorting" (sex with other HIV-positive men) or “strategic positioning” (adopting the receptive role during unprotected sex). There was no evidence that clinical factors such as adherence to HIV treatment, or an undetectable viral load affected unprotected sexual activities.

Read the rest.

Most gay men in Asia have no access to HIV prevention, care

More than 90 per cent of men having sex with men (MSM) in Asia and the Pacific do not have access to HIV prevention and care services. And if the situation is not urgently.

Laws across the region need a dramatic and urgent overhaul to allow public health workers to reach out to gay men, or the consequences could be dire and stretch well beyond MSM to affect the general population.

This warning came at a symposium - "Overcoming Legal Barriers to Comprehensive Prevention Among Men who have Sex with Men and Transgender People in Asia and the Pacific" - held at the 9th International Congress on Aids in Asia and the Pacific (ICAAP). The event was hosted by the UN Development Programme (UNDP) and the Asia Pacific Coalition on Male Sexual Health (Apcom).

Read the rest.

Rao - "main challenge is overcoming the whole issue of stigma and discrimination"

via AlertNet, by Tan Ee Lyn

Leading health experts on Monday called for repeal of outdated laws criminalising prostitution and homosexuality so that people suffering from HIV/AIDS or at risk from the disease could get medical treatment.

"The main challenge is overcoming the whole issue of stigma and discrimination, repealing of outdated laws and legislation that countries have got," Prasada Rao, director of UNAIDS Asia Pacific regional support team, said on the margins of an HIV/AIDS conference.

Rao and other experts, kicking off a four-day meeting, said that while progress has been made in research and getting people treated for AIDS, huge challenges lie ahead and much more needs to be done.

Read the rest.

Sex Workers’ Rights in Kenya: "It's Better to Be a Thief Than Gay in Kenya"

via Toward Freedom, by Siena Anstis

People think you have been cursed. It's painful, we wish we had freedom.

John Mathenke was once arrested for being gay but, after failing to pay the customary bribe, was forced to have sex with the policeman. He had an orgy with a priest who publicly excoriates homosexuality, along with five other Masaai boys. And his Arab trader clients curse him during the day, but come back looking for sex at night. Such is the life of a homosexual prostitute in Nairobi, Kenya.

"It's better to be a thief than gay in Kenya," Mathenke says. Both are often punished by death, but being the latter means never revealing yourself to the public and remaining perpetually closeted. It means dealing with homophobes at day and pleasuring them at night.

In Kenya, statutes dating from the colonial period dictate prison sentences of up to 14 years for male homosexuality (there are no laws targeting lesbians). These laws are further influenced by powerful Christian and Muslim religious leaders who publicly condemn homosexuality. In turn, homophobia towards the LGBT community in Kenya is widespread, and as calls to decriminalize homosexuality grow, the backlash is strong. In late April, one woman was hit outside a bar with a bottle for being a lesbian.

Read the rest.

Gay, straight or MSM? In Bangladesh, how you define your sexuality can depend on class, education and family circumstances

via guardian.co.uk, by Delwar Hussain

There are many in Bangladesh who inhabit a grey area that is neither public nor private, where things that are illegal or socially and religiously taboo are permissible so long as they are not discussed openly. Drinking alcohol, falling in love and disbelieving in God are areas where people rarely disclose their thoughts or activities except in like-minded circles.

Living in such a way protects them from conservative elements of society and allows them to maintain cordial relationships with family and friends. Suleman, an imam at one of the largest mosques in Dhaka, lives with this kind of contradiction every day. None of his family or colleagues suspect anything about his relationship with his male partner, who is publicly acknowledged as "just a friend". This is not so difficult to comprehend. A few years ago Suleman married a woman. Having fulfilled his social and religious obligations in both public and private matters (they have two children together), he is free to continue his relationship with his "friend".

Suleman is well aware of the consequences if knowledge of his "friend" became public. He could be thrown out of the mosque or physically punished; there are many who think a man loving another man is among the worst sins a person can commit. Suleman himself believes it is very important that gay Muslims be allowed to marry, as a way to avoid promiscuity. Called upon by gay friends to bless their relationships, he performs readings from the Qur'an and prayers at such ceremonies.

In this regard Bangladesh is hardly any different from other conservative societies around the world, but new ideas are cautiously surfacing. The Bandhu ("friend") organisation provides healthcare and support for men who have sex with men. It says that 7%-15% of Bangladeshi men over the age of 15 (that is between 2.5 million and 5.25 million people) have sex with another man at least once a month (most will do so while they are single and stop once they get married).

Saleh Ahmed (pictured), who runs Bandhu, stresses that the people it works with are not "gay" but fall within the looser category of "men who have sex with men" (MSMs). According to Ahmed, there are two main differences between the categories: MSMs have sex just for "fun" or "physical release", without the emotional and identity implications of a gay relationship. The second difference between being gay and MSMs is that of class. MSMs generally have low-paid, menial jobs. Gay men come from a middle and upper class background; they tap into a wider, global gay identity and its trappings.

Read the rest.

Stephen Lewis on homophobia

[Excerpt from Stephen Lewis' speech at the IAS Conference, Cape Town, South Africa, July 19, 2009. Read the full speech.]

When the Government of Senegal jails eight gay AIDS activists for no reason except homophobia, setting back the fight against AIDS, where are the scientific voices of condemnation?

Right now, in the Caribbean, every country save the Bahamas, has laws that criminalize homosexuality. We tiptoe round this twisted form of racism. We submit to ridiculous claims of cultural relativism.


The Prime Minister of Jamaica, in the safety of Parliament, makes the most contemptible statements about gay men, leaving every elemental component of human rights in tatters, and he’s never called to account ... not by the UN Human Rights Council, not by the G8, not by the G20, not by the Commonwealth … only by the gay activists themselves.

What is wrong with the international community? If this is how it behaves, it doesn’t deserve the name “community” at all.

And if the political leadership lacks the courage to confront such outrageous slander, you shouldn’t lack the courage. You’re scientists. You know that it’s a scientific reality that a certain percentage of the world’s people is gay. So tell the political philistines to get over it and stop wrecking such damage. More, you know that an ugly homophobic culture is a threat to public health that inevitably serves to spread the virus … I beg you to say so. The majesty of science is its influence.

Nature Medicine Covers IAS Rectal Microbicide Satellite

Nature Medicine 15, 829 (2009)
doi:10.1038/nm0809-829b

by Cassandra Willyard

Despite some disappointing results from recent trials, microbicides have been touted as a potential tool to stop HIV infection through vaginal sex. Last month, however, the International AIDS Society conference in Cape Town, South Africa dedicated an entire session to rectal microbicides for the first time. "The field is picking up momentum now," says Ian McGowan, an infectious disease expert at the University of Pittsburgh School of Medicine who organized the session. "We're beginning a new phase of clinical trials."

The current focus is on testing vaginal microbicides in the rectum. Researchers have already completed a phase 1 clinical trial to test the rectal safety of UC-781, an antiretroviral being developed for vaginal use. The results have yet to be published, but McGowan, who was a co-investigator on the study, says UC-781 seemed to be safe and acceptable. Other forthcoming trials will test the rectal safety of a vaginal microbicide that contains the anti-HIV drug tenofovir.

The rectum and the vagina are "two very different environments," McGowan says, so there is no guarantee that one product will be safe and effective both places. The vaginal lining is composed of "layer upon layer of cells," he says. The lining of the rectum, in contrast, is just one cell thick, and thus more fragile. Moreover, because the rectum feeds into the colon, a larger surface area needs to be protected. Researchers are already thinking about how to design microbicides specifically for rectal use.

Money will probably be a limiting factor, however. "It's still not clear whether there's enough will from funders to do a full-scale efficacy trial for any rectal microbicide," says Robin Shattock, an immunologist at St. George's, University of London. "That's the biggest hurdle."

[A number of our presenters' slide sets are available. Click the Community Presentations link on the IRMA website to access presentations such as "Epidemiology of HIV among MSM in Africa: Implications for rectal microbicides" and "Go tell it on Table Mountain - rectal microbicide advocacy from here to there."]

Rectal Microbicide Development - An African Perspective - MATERIALS AVAILABLE

This satellite session, held July 19, 2009, at the IAS 2009 meeting in Cape Town, South Africa, described the role of anal intercourse (AI) in HIV transmission and discussed recent research towards the development of rectal microbicides for the prevention of AI-associated HIV infection. Data from the African continent was highlighted.

The event was sponsored by the AIDS Vaccine Advocacy Coalition, the International Rectal Microbicide Advocates, the Microbicide Trials Network, and Health4men.

A number of our presenters' slide sets are available. Click the Community Presentations link on the IRMA website to access presentations such as "Epidemiology of HIV among MSM in Africa: Implications for rectal microbicides" and "Go tell it on Table Mountain - rectal microbicide advocacy from here to there."

Click here for all the presentations, including video webcast of a portion of the session, on the IAS website.

Click here for exciting action pics - thanks Lisa Rossi!

Prepping for a prevention trial, and unexpected homophobia

Prepping for a PrEP trial
Critical observations before the study even begins
via Positively Aware, by Keith R. Green

I asked him how he addressed homosexuality during his church prevention work. His response made my head spin.

I recently accepted a position as Project Director for a research study designed to assess the initial acceptability and feasibility of a pre-exposure prophylaxis (PrEP) trial among young men who have sex with men (YMSM) in Chicago.

The concept of PrEP, in a nutshell, involves administering medications used in the treatment of HIV (particularly Viread or Truvada at this point) to “high risk” HIV-negative individuals, in hopes of preventing transmission of the virus. Several PrEP trials are currently underway across the globe, many of which will likely demonstrate the efficacy of both Viread and Truvada as biomedical interventions for the prevention of HIV.

Though young men who have sex with men, particularly those of color, continue to contract HIV at alarming rates, these current trials ironically have very few young men enrolled in them. Therefore, if in fact these studies are able to prove the effectiveness of PrEP, we will know very little about its implementation within the population that could benefit most from this technology. The PrEP study that I am involved with seeks to provide some insight into this.

For this study, we will attempt to recruit 99 YMSM between the ages of 18 and 22, and to follow them for six months.

There are three separate arms in the study. All participants will go through an intensive evidence-based behavioral intervention and then be randomized to one of three groups. One group will receive once-daily Truvada, another group will receive a placebo (or sugar pill), and yet another group will receive nothing. Participants will be regularly monitored for HIV seroconversion, behavioral disinhibition (getting buck wild sexually because they feel that they are protected by PrEP), and any adverse effects (among a host of other things).

Aware of my search to hire research assistants who will largely be responsible for recruiting and retaining participants, a close friend recommended a friend of his for one of the positions. Trusting the judgment of my friend, I followed up on his recommendation and called his friend to arrange an interview.

Read the rest.

The IRMA 500: A Virtual Tour of the Rectal Microbicides World!

On March 9, 2008, IRMA expanded its web presence with the first post on the new IRMA blog! We've come a long way, baby...

“It’s about time!” Moments
Since then, over the course of 500 blog postings, IRMA has helped to bring about and bear witness to important shifts in the HIV prevention landscape.

Moment #1: Increasing recognition that gay men and other men who have sex with men (MSM) not only exist in Africa and throughout the developing world, but that they have disproportionately high rates of HIV nearly everywhere in the world. Studies and reports confirmed this from Africa (including South Africa) to Asia (including India and Laos). We saw an increasing number of events highlight this reality, from AIDS 2008 in Mexico and CROI 2009 in Montreal to IAS 2009 in Cape Town. IRMA helped to organize and present at some of these events (AIDS 2008; IAS 2009).

Moment #2: Increasing acknowledgement that women and men engage in anal intercourse in all parts of the world. As IRMA has shared, studies are giving us a clearer picture of the extent to which women engage in anal sex. The frequency and context within which young women and men in particular engage in anal sex together also becomes clearer with additional studies. We also learn why rectal microbicides could play an important role in prevention.


Moment #3: Including “rectal” in the definition of microbicides. After a range of tactics – from shaming to making a case to recognising to acknowledging to celebrating – it seems the HIV prevention field has embraced the idea that microbicides are products that could be applied vaginally OR rectally to reduce the risk of HIV infection. And that MEN and WOMEN have rectums that need protection.

IRMA blog as a source for new research findings
If you want to learn about the latest developments in the field of rectal microbicides and related areas of study, IRMA’s blog is the place for you! We provide you with links to everything from new assays for predicting the safety of microbicides, summaries of studies in macaques and the latest findings from conferences… not to mention news of sexually transmitted hepatitis C, the effects of treatment on sexual transmission of HIV, and tons of other interesting research.

We also occasionally do informative interviews, such as with Dr. Jim Turpin from the Microbicides Research Branch at the US National Institutes of Health - a key champion of rectal microbicide research.

IRMA's global family
We like everyone in the IRMA family to keep in touch and share news about themselves. The IRMA blog is an excellent way to keep up to date on what our friends are doing in Latin America, Nigeria, the UK and Spain for example. We share photo albums, announce our new Steering Committee, and highlight the work of IRMA members from around the world.

This is also an excellent place to meet all your colleagues: Sholotan (Nigeria), Shaleena (Canada), Craig (US), Henrik (Denmark), Patricia (Peru), Gabriel (Spain), Jeremy (Malaysia), Kadiri (Nigeria), Bill (US), Lanre (Nigeria), Nesha (US), Ayoo (Uganda), Obrian (Zimbabwe), Ross (US), Pamina (US), Rajeev (India), Sean (US), Morenike (Nigeria), Paolo (US), Gail (US), Gus (UK), Anna (US), Ian (US), Arwa (Netherlands)…

Homophobia -- and the efforts to fight it -- from around the world
The state of homophobia around the world makes HIV prevention among gay men all the more challenging. Indeed homophobia is seen everywhere: Malawi, Namibia, Botswana, Uganda, Cuba, Iraq… IRMA has shared news about numerous global and local efforts to fight homophobia, including in India, Kenya, Burundi and in fact all of Africa.

Focus on women
IRMA has made it clear from the beginning that we are interested in both vaginal and rectal microbicide development for women and men. As such, HIV prevention issues for women are of interest to us. We are happy to share important information related to vaginal microbicides, women’s anal health and anal sex practices, HIV disease progression and contraception, lesbians, female condoms and circumcision’s impact on women (see section on related prevention issues).


Our most controversial topic: circumcision?
Given the number and nature of comments that have been posted, IRMA thinks circumcision may be the most controversial topic on the blog. Even two years after the trials have been completed, discussions and debates continue about the role of circumcision in HIV prevention and the prevention of other STIs, about whether gay men should be circumcised, about impact of circumcision on women’s risk. Even announcements about circumcision-related information are cause for controversy!

Related prevention issues
IRMA has always been interested in a range of HIV prevention-related issues, including female condom access, female condoms for anal sex, female-controlled STI prevention, serosorting, barebacking, debates surrounding treatment as prevention, HPV-related risk and debates on the HPV vaccine for men.

And last, not least - a few of IRMA’s favourite posts

Just plain interesting! A condom specifically for anal intercourse?

Just plain unacceptable! Funding for rectal microbicides has DECREASED in two years

A good reminder: Caveat Rectum!

Perhaps the most inspiring and informative post: Putting My Ass On The Line…..Literally!

UK's Buzz Cafes get distinction at IAS conference

[Click image to enlarge]

The UK African Microbicides Working Group submitted an abstract on 'Experiences of the Buzz Cafe in Microbicides Advocacy in the United Kingdom' at the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention held in Cape Town, South Africa between the 19-22 July 2009.

The abstract was accepted for a poster presentation and was presented by Eunice Sinyemu and Titise Kode. It was selected by the Scientific Programme Committee for distinction based on merit.

The Buzz Cafes have been a great success. As reported previously by IRMA, one of them focussed on rectal microbicides.

Congratulations to the UK African Microbicides Working Group!

New HIV strain discovered

A new strain of the virus that causes AIDS has been discovered in a woman from the African country of Cameroon.

It differs from the three known strains of human immunodeficiency virus and appears to be closely related to a form of simian virus recently discovered in wild gorillas, researchers report in Monday's edition of the journal Nature Medicine.

The finding "highlights the continuing need to watch closely for the emergence for new HIV variants, particularly in western central Africa," said the researchers, led by Jean-Christophe Plantier of the University of Rouen, France.

The three previously known HIV strains are related to the simian virus that occurs in chimpanzees.

The most likely explanation for the new find is gorilla-to-human transmission, Plantier's team said. But they added they cannot rule out the possibility that the new strain started in chimpanzees and moved into gorillas and then humans, or moved directly from chimpanzees to both gorillas and humans.

Read the rest from cbc.ca

Read the article in Nature Medicine

Plantier J-C et al. "A new human immunodeficiency virus derived from gorillas", Nature Medicine, Published online: 2 August 2009.