NEW Rectal Microbicide Trial is Recruiting

Official Title: “A Two-site, Phase 1, Partially-blinded, Placebo-controlled Safety, Acceptability and Pharmacokinetic Trial of Topical, Vaginally-formulated Tenofovir 1% Gel Applied Rectally Compared With Oral 300 mg Tenofovir Disoproxil Fumarate in HIV-1 Seronegative Adults”

Clinical Trial Phase: Phase 1 | Start Date: September 2009

Overall Status: Recruiting

Estimated Enrollment: 18

To date, the majority of microbicide research has focused on the assessment of the safety and effectiveness of vaginal microbicides used for the prevention of HIV transmission via the vaginal compartment. Receptive anal intercourse (RAI) is common among men who have sex with men (MSM), and there is increasing evidence that heterosexual women in the developed and developing world also practice anal sex. It can, therefore, be anticipated that once vaginal microbicides are licensed, they will be used in both the vaginal and rectal compartments. As a consequence, there is a need to evaluate both the rectal and vaginal safety profile of candidate microbicides. Therefore, the primary objective of this study is to evaluate the systemic safety of 1% vaginally formulated tenofovir gel applied rectally.

In addition, this study will evaluate the immunotoxicity of the gel and evaluate its acceptability; it will also use the oral tenofovir disoproxil fumarate tablets (TDF), rectally-applied tenofovir gel,and a placebo gel to compare their systemic and compartmental pharmacokinetic (pK) profiles.

Read the rest of the info on this study here.

US activist group urges caution on vaccine trial results

by Keith Alcorn, via Aidsmap

The results of the RV 144 HIV vaccine trial should be treated with caution until further data are presented, US advocacy organisation Treatment Action Group said on Friday, following the announcement that the combination of vaccines used in the study resulted in a 31.2% reduction in the risk of HIV infection.

“Based on the limited amount of information that has been released, it appears that the statistical significance [of the result] hangs on very few cases of HIV infection. TAG urges caution in interpreting the findings until more detailed information is available,“ the group stated in a press release.

Seventy-four out of 8198 volunteers in the placebo group became infected, compared with 51 out of 8197 volunteers who received a combination of two vaccines, ALVAC vCP1521 and AIDSVAX B/E. Participants in both the vaccine group and the placebo group received counselling on how to reduce their risk of HIV infection.

Although the difference in the risk of infection was statistically significant, the confidence intervals for the estimate were extremely wide.

Read the rest.

Microbicides - A Visual Representation

[click to enlarge]

via peripheries (blog by Roger Tatoud - an IRMA Steering Committee member)

Vaccine trial “is the beginning” of a new path of research + more info/resources for you

Vaccine trial “is the beginning” of a new path of research, says US health chief

via Aidsmap, by Gus Cairns

General Eric Schumaker, Surgeon-General of the US Army, said today that the result of the RV144 HIV vaccine trial - see this report - “opened new doors and switched on lights” in the field of HIV vaccine research but emphasised that the “modest” efficacy seen in the trial posed more new questions than it provided answers.

Dr Anthony Fauci, the Director of the US National Institute of Allergies and Infectious Diseases (NIAID), said: “This is the beginning of a new HIV vaccine research effort, not the end.”

But he added: “This is a welcome and exciting result in a field characterised by disappointment in the last two decades.”

The trial today produced an unexpectedly positive result when 31% fewer infections were seen in recipients of the combined ALVAC/AIDSVAX prime-boost vaccine than in placebo recipients, despite previous trials of both individual vaccine concepts producing negative results.

“This trial poses fundamental ‘black box’ questions,” Fauci continued. “What are the correlates of HIV immunity? Has this trial overturned our understanding of what might constitute a protective response to HIV? Can we improve on this efficacy? And does this result mean we should refocus more on clinical research than basic science?”

He answered his own last question by saying “Not at all. NIAID’s commitment to keeping an appropriate balance between basic science and vaccinology versus empirical clinical trials has not changed.”

Read the rest of this article (and check out other resources) here.

Also of interest: AVAC held a civil society call to discuss the trial and the initial results on Thursday, September 24. This call provided an opportunity for advocates to discuss the results with the researchers and to ask questions about the results and related issues the data may raise. Click here to listen to a recording of the call.

More info on the trial, via AVAC.

Jamaica’s battle against AIDS fought in the shadows

via Worldfocus

• Violence and anti-gay attitudes tarnish Jamaican beauty
• There are no gay pride parades in Jamaica
• Ida’s story: Reversing the stigma of HIV in Jamaica
• Gay men in Jamaica must lead two separate lives
• Jamaica’s AIDS epidemic, by the numbers
• Pascal and Vestine are alive in Congo, but still not home
• Fighting the stigma and treating HIV across South Africa
• AIDS ravages 1,000 people per day in South Africa
• Gays seek asylum outside Jamaica
• Cambodia fears growing resistance to malaria drugs

Jamaica may be on the verge of losing its battle against the AIDS epidemic because of deeply entrenched anti-gay attitudes and laws.

Correspondent Lisa Biagiotti, producer Micah Fink and director of photography Gabrielle Weiss report from the front lines of Jamaica’s battle against HIV and AIDS, a war waged in the shadows.

Click to watch the video.

Moving Forward! HIV Vaccine Shows Promise for First Time, Study Shows

via Bloomberg, by Simeon Bennett

An experimental vaccine prevented HIV infections for the first time, a breakthrough that has eluded scientists for a quarter century.

A U.S.-funded study involving more than 16,000 volunteers in Thailand found that a combination of ALVAC, made by Paris- based Sanofi-Aventis SA, and AIDSVAX, from VaxGen Inc., of South San Francisco, cut infections by 31.2 percent in the people who received it compared with those on a placebo, scientists said today in Bangkok. Neither vaccine had stopped the virus that causes AIDS when tested separately in previous studies.

The finding represents a revival in a campaign that appeared to stall just two years ago when use of Merck & Co.’s experimental Ad5 vaccine boosted some people’s chances of infection in a study. The latest result will transform future research, said Mitchell Warren, director of the New York-based AIDS Vaccine Advocacy Coalition.

“Wow,” said Warren, who was not involved in the study, in a telephone interview today. “We are in a new place in the search for an AIDS vaccine. It’s safe to say that the scientific community is caught off-guard.”

The findings don’t mean the vaccine can be delivered worldwide, because of the complexity of the process and the fact that it’s based on old technology, Warren said. Instead they will serve to spur scientists to look for better combinations in more user-friendly regimens with higher success rates, he said.

Read the rest.

RELATED: Check out commentary by Keith Alcorn on Aidsmap
An unpopular vaccine study produces surprising result

Love to the Elton John AIDS Foundation from IRMA

Once again, the Elton John AIDS Foundation (EJAF) has recognized the important work IRMA is doing, providing us with $25,000 in their latest round of 2009 grants (see blurb below.)

Many, many thanks to EJAF for their ongoing support - it is deeply appreciated. We really couldn't continue without them. And IRMA can't do this work without YOU - so thanks to each of you for making your voices heard on the importance of developing safe, effective, acceptable and accessible rectal microbicides for women and men worldwide.

AIDS Foundation of Chicago (AFC), Chicago, IL, $25,000
This grant will support the International Rectal Microbicide Advocates’ (IRMA) global advocacy across six continents. Since AFC launched IRMA with three other North American partners in 2005, this coalition has grown to include more than 800 scientists, advocates, and policy makers promoting the research and development of safe, effective, and acceptable rectal microbicides for the women and men who need them. Through concerted global advocacy, IRMA has brought visibility, legitimacy, and respect to the emerging rectal microbicide development field and set the stage for researchers to develop these new, lifesaving tools more quickly and effectively. Thanks to support from EJAF in FY09, IRMA further expanded its reach and capacity, forming a close strategic collaboration with the AIDS Vaccine Advocacy Coalition (AVAC); supporting the launch of a sister organization in Latin America, IRMA – ALC (América Latina y El Caribe, based in Lima, Peru) and in Africa through the launch of IRMA-Nigeria; and increasing its global membership by 60% since 2006. During this time, UCLA completed and reported on the first Phase I human rectal safety trial, and up to three additional Phase I rectal safety studies are about to begin. In FY10, AFC sees great potential for the rectal microbicides field, as there has never been more global recognition or support for the development of these new prevention tools.

MSM at ICAAP 2009 - special report and content review

Click here for A Special Report on MSM at ICAAP 9 from AIDS Projects Management Group. This content review provides detailed transcripts of speeches at main symposiums and oral presentations a well as reports on posters presented . The 9th International Congress on AIDS in Asia and the Pacific (ICAAP), was held in Bali, Indonesia from 9-13 August 2009. The theme for this ICAAP was 'Empowering People, Strengthening Networks".

MSM in most countries in this region are highly vulnerable. 20 of the countries here criminalize sex between men and that is a situation I grew up in, in Australia. I grew up in that situation and it makes you feel like you have second class status and it means marginalized groups can exist outside the messages of society and those messages that aim to protect them. So many will not put it [being MSM] out on the table and they will keep it to themselves. And yet by not bringing it out and by not being open about sexuality the reality is that MSM conspire in the attitudes of society toward them. If only every person who was gay identifying or MSM stood up in society – if they all stood up the whole shabby and dishonorable strategy to denigrate and put them outside the family would be over.

Read the entire post, and access related presentations.

India needs new prevention technologies for HIV, other STIs and unwanted pregnancies

via Elites TV, by Citizen News Service

“India needs the [new prevention] technologies for meeting all the three important [sexual and reproductive health] needs of an individual as well as for the country – i.e. prevention of unwanted pregnancies, prevention of non-HIV sexually transmitted infections (STIs) as well as HIV” said the Dr Badri N Saxena, President-elect of Microbicides Society of India (MSI).

The Microbicides refers to a new type of product being developed that people could use vaginally or rectally to protect themselves from HIV and possibly other sexually transmitted infections. A microbicide could be produced in many forms, including gels, creams, suppositories, films, or as a sponge or ring that releases the active ingredient over time. They are still being researched upon around the world and not available over the counter (for more information on microbicides, go to: www.global-campaign.org).

“According to the National AIDS Control Organization (NACO) in India, unsafe sex is the highest risk factor for HIV transmission in the country. About 86 percent HIV incidence in the country is from unprotected sex. Globally too, unsafe sex is recognized as one of the highest risk factors for disability and deaths worldwide. More people acquire curable sexually transmitted infections (STIs) other than HIV, than HIV globally. The data is shocking: every year, about 34 crore people (340 million) get infected with at least one of the four primary curable STIs: Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), and syphilis, and just under 30 lakhs (3 million) become infected with the human immunodeficiency virus (HIV). It is evident from clinical experiences in India, that a large number of people acquire chronic infections with pathogens such as the herpes simplex virus (HSV), a cause of genital ulcers, and the human papilloma virus (HPV), responsible for cervical cancer. According to the United Nations Population Fund (UNFPA) recent research estimates of 2005, over 200 million women in developing countries have an unmet need for effective contraception. Every life is invaluable so we need to advocate for prevention of HIV, non-HIV STIs, and effective contraception as well” further explains Dr Badri N Saxena.

Read the rest.

Homophobia intensifies Jamaican HIV epidemic

How AIDS became a Caribbean Crisis
via Atlantic Online, by Micah Fink

“If it were AIDS that were killing us,” he said, “I would use a condom. But it’s people, not AIDS, that is killing us. AIDS has nothing to do with it.”

We may be accustomed to thinking of AIDS as most rampant in distant parts of the world like Africa, India, and South Asia. But these days the epidemic is flaring up a bit closer to home, in the Caribbean. Indeed, AIDS is now the leading cause of death among adults there, and the Caribbean’s rate of new infections is the second highest in the world, following just behind Sub-Saharan Africa.

A major factor in the region’s susceptibility to the epidemic is its pervasive atmosphere of homophobia, which makes education and outreach efforts nearly impossible. Jamaica, which lies near the middle of the Caribbean and, as of last year, was found to have an astounding 32 percent HIV infection rate among gay men, offers a case study in how anti-gay attitudes have helped spread and intensify the epidemic’s impact.

In Jamaica, homophobic attitudes are reflected in everything from laws that criminalize anal sex, to the lyrics of popular dancehall music that celebrates the murder of gay men, to widespread acts of anti-gay violence, and a gay culture of sexual secrecy and high-risk behavior. Each of these factors is intensified by a religious context that defines homosexuality as a mortal sin and points to the Bible for moral justification in violently rejecting the concerns of the gay community.

Read the rest.

UNAIDS Forum on HIV, Human Rights and Men Who Have Sex with Men

As part of his official visit to Washington, D.C., UNAIDS Executive Director Michel Sidibé participated in the Forum on HIV, Human Rights and Men Who Have Sex with Men on 16 September 2009. The event was organized by UNAIDS in collaboration with the HIV Policy Working Group on Men Who Have Sex with Men and Other Sexual Minorities, and in cooperation with the Honorable Howard Berman (D-CA) and the Honorable Barbara Lee (D-CA).

The Forum was held to raise attention to the human rights issues that affect men who have sex with men (MSM) and other sexual minorities, as well as the policy and structural barriers that prevent MSM and other sexual minorities from accessing HIV services, including prevention, treatment, care and support.

“We are here because it remains an undeniable fact in all regions of the world—including here in the US—that men who have sex with men lack universal access to HIV services,” said Michel Sidibé.

Read the rest.

Top Scientists Get to the Bottom of Gay Male Sex Role Preferences

via Scientific American, by Jesse Bering

It’s my impression that many straight people believe that there are two types of gay men in this world: those who like to give, and those who like to receive. No, I’m not referring to the relative generosity or gift-giving habits of homosexuals. Not exactly, anyway. Rather, the distinction concerns gay men’s sexual role preferences when it comes to the act of anal intercourse. But like most aspects of human sexuality , it’s not quite that simple.

I’m very much aware that some readers may think that this type of article does not belong on this website. But the great thing about good science is that it’s amoral, objective and doesn’t cater to the court of public opinion. Data don’t cringe; people do. Whether we’re talking about a penis in a vagina or one in an anus, it’s human behavior all the same. The ubiquity of homosexual behavior alone makes it fascinating. What’s more, the study of self-labels in gay men has considerable applied value, such as its possible predictive capacity in tracking risky sexual behaviors and safe sex practices.

People who derive more pleasure (or perhaps suffer less anxiety or discomfort) from acting as the insertive partner are referred to colloquially as “tops,” whereas those who have a clear preference for serving as the receptive partner are commonly known as “bottoms.” There are plenty of other descriptive slang terms for this gay male dichotomy as well, some repeatable (“pitchers vs. catchers,” “active vs. passive,” “dominant vs. submissive”) and others not—well, not for Scientific American , anyway.

In fact, survey studies have found that many gay men actually self-identify as “versatile,” which means that they have no strong preference for either the insertive or the receptive role. For a small minority, the distinction doesn’t even apply, since some gay men lack any interest in anal sex and instead prefer different sexual activities. Still other men refuse to self-label as tops, bottoms, versatiles or even “gay” at all, despite their having frequent anal sex with gay men. These are the so-called “Men Who Have Sex With Men” (or MSM) who are often in heterosexual relations as well.

Several years ago, a team of scientists led by Trevor Hart at the Centers for Disease Control and Prevention in Atlanta studied a group of of 205 gay male participants. Among the group’s major findings—reported in a 2003 issue of The Journal of Sex Research —were these:

Read the rest.

Making sense of PrEP - a visual aid

click to enlarge

Source: peripheries

Pre-exposure prophylaxis (PrEP) is an experimental HIV-prevention strategy that proposes using antiretrovirals (ARVs) to reduce the risk of HIV infection in healthy uninfected people at risk of acquiring the virus. PrEP is not proven to work and is currently being tested in HIV-negative people in several clinical trials across the world. It is a controversial strategy that raises many hopes but also many questions.

For further information check the PrEPWatch Website.

Playboy Sex Poll: 47% of college students have had anal sex

click image to enlarge

Spectacular 7 - Meet IRMA Steering Committee members who are leading the way

“Research ends up on dusty tables without advocacy,” says Lanre Onigbogi. "A safe and effective lube seems like a no-brainer to protect people who enjoy anal sex," says Ken Mayer.

Read more about Lanre and Ken, and five IRMA Steering Committee members on the IRMA website, here.

FRESH Rectal Microbicide Advocate profiles (posted September 12) include Bridget Haire of Sydney, Australia; Rick Jones of Amsterdam, Netherlands; Ken Mayer of Boston, USA; Lourence “Larry” Misedah of Nairobi, Kenya; Kate Morrow of Providence, RI, USA; Lanre Onigbogi of Ibadan, Nigeria and Roy Wadia of Vancouver, BC, Canada.

Who is completing their PhD in bioethics? Who used to work for CNN? Who was the Principal Investigator of the first human trial of Tenofovir gel? You'll have to read to find out! IRMA couldn't be more proud to have these wonderful folks as our leaders. Click here to check out the rest of the SC members - 23 in all and representing 10 countries.

Anal warts and anal gonorrhoea associated with HIV infection in gay men

by Roger Pebody, via Aidsmap

The two sexually transmitted infections most strongly associated with HIV acquisition in gay and bisexual men are anal warts and anal gonorrhoea, Australian researchers report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

Herpes infections did not emerge as significant in this study, but men with warts were three times more likely to acquire HIV, and men with gonorrhoea were seven times as likely. The authors suggest that more frequent screening for anal sexually transmitted infections in gay men should be investigated as a means of HIV prevention.

Numerous observational studies have suggested that sexually transmitted infections (STIs) facilitate the acquisition and transmission of HIV. However most studies have been conducted among heterosexuals, and previous prospective studies have not examined the full range of sexually transmitted infections that are common in gay and bisexual men.

In particular, genital or anal warts have often been overlooked, and many studies have not distinguished between genital and anal infections.

Warts are caused by infection with certain strains of the human papilloma virus (HPV). Infection with other strains of HPV may lead to cervical or anal cancer, but people with warts are not more likely to develop cancer. A recent study found that men infected with cancer-causing HPV are more likely to acquire HIV.

Read the rest.

Bud Light's New Ads - Obsessed with Anal Sex

Hearing on HPV Vaccine for Boys: Public Comments Welcome

via POZ

Should the federal government pay for the Gardasil HPV vaccine for boys and young men covered by government-funded health programs? The Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC) is holding a public hearing October 21 and 22 in Atlanta to discuss this important question and would like to hear from concerned community members, both in person and in writing.

Gardasil was approved in 2006 to help protect young women from the strains of human papilloma virus (HPV) that are most likely to cause cervical cancer and genital warts. Current guidelines recommend treating girls before they become sexually active, because a majority of women become infected with HPV within a short time after sexually activity has commenced.

The Food and Drug Administration (FDA) is now poised to approve the same vaccine to protect men from the same HPV strains that cause anal and penile warts and cancer. The FDA is expected to approve the vaccine’s use in preteen and teenage boys who have not yet become sexually active.

FDA approval is more scientific than political. The same is not true, however, when it comes to government decisions to pay for certain components of medical care. When ACIP recommended that government funds be used to vaccinate girls and young women, conservative activists objected strongly, claiming that the vaccine promoted promiscuity.

HIV and gay men’s health activists anticipate similar controversy at the ACIP hearing to determine whether the government should pay for the vaccine to protect men.

The mobilization of HIV and gay health activists is due, in part, to the fact that men who have sex with men have the highest rates of HPV infection and are likely to need the vaccine the most. Conservative groups are also expected to advocate against the government recommending payment for the vaccine, suggesting that it will promote both promiscuity and homosexuality.

Information about the ACIP hearing, which is open to the public, can be found on the CDC website. Written comments can also be submitted to the ACIP by e-mail at acip@cdc.gov.

GayUganda - Ignorance is a curse (and so is petroleum jelly)

Short story.

Ok, I had a very, very long night. Out partying. Continued sleeping into the early afternoon. And what with sex and sleeping again. Am exhausted!!!!!! Oh well, one is only young once. Let us party….!

Someone, a visitor to Uganda, came across this blog. Was kind of tickled. He decided to write a long letter to me. Instructive.

There were a couple of paragraphs that I would like to share with you. This is his experience. In his words.

“Reading your blog today about the water based lube, reminded me of a discussion I had with one of the guys when I was there. They had had a meeting of lgbt people shortly before I visited. They had discussed the use of condoms and someone mentioned that condoms were being used and people were still getting AIDS. The problem was attributed to the fact that being made in India and old, they tended to break. Then in my conversation with my friend , he mentioned they were using petroleum jelly. Needless to say, I was flabbergasted. I said "A--, if you use PJ, there is no point in using a condom!" He informed me that non of them could afford to buy KY jelly . I had a large tube of KY with me (hope runs eternal), I gave him the KY and later learned several people used it and as we say here, it was the best thing since sliced bread.”

Read the rest.

Hitler = HIV in New German Ad

So, how many infections do you think this campaign will help prevent?





Read the pinknews article on this.

Read the piece on ABC News.

Read commentary by Shawn Syms on xtra.ca

The Promise and Perils of ARV-Based Prevention: A Dialogue of Optimism & Informed Scepticism

Satellite session at IAS 2009 - held July 19, 2009

Click here for webcast.

Click here for exciting action pics.

Read an article about this session on Aidsmap.

ARV-based prevention, such as oral pre-exposure prophylaxis (PrEP) and ARV-based microbicides, is widely viewed as one of the more promising biomedical HIV prevention strategies being studied. Is this enthusiasm warranted?

Challenges remain to proving its effectiveness. Even if trials show benefit, implementation would challenge virtually every aspect of existing AIDS responses. What could and should be done to weigh these challenges against the potential benefits and develop appropriate scientific and operational strategies?

Several sessions during the conference provided updates on ARV-based prevention research. This session provided an opportunity to discuss additional research priorities (additional PrEP candidates and intermittent dosing) and the operational, financial and ethical implications involved in translating positive findings into programmes and public health impact.

Session participants debated the promise and risks of ARV-based prevention, what additional research is needed and how it all might fit into the broader landscape of prevention and treatment services.

Click here for webcast.

No Butts About It - You are Invited to Join Us in Cleveland Sept 16

The CWRU/UH Clinical Trials Unit (Case Western Reserve University/University Hospital) would like to invite you to a special presentation

No Butts About It: Rectal Microbicides and Anal Sex


by Jim Pickett, Director of AIDS Advocacy, AIDS Foundation of Chicago, Chair of the International Rectal Microbicide Advocates

Wednesday, September 16, 2009 at Noon at Trinity Commons, E. 22nd and Prospect Avenue, Cleveland

A light lunch will be provided

RSVPs requested.

To RSVP or if you have questions, please contact Bob Bucklew at 216-844-2247 (rob2@case.edu)

Jim will also be talking at the Free Zone, on Tuesday, September 15, 2009 at 6:00 pm. The Free Zone is a monthly get together for HIV-positive people only. The Free Zone is held at the University Hospitals Foley Building, 3rd Floor conference room (2061 Cornell, Cleveland). For questions about the Free Zone, please contact Dan Gebhardt at 216-844-3225 or at dfg3@case.edu.

Queertastic - IRMA's Jim Pickett guests on the Windy City Queercast

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.

HIV rates in Soweto Township gays

via Scientistlive

New research from UCSF examining HIV among men who have sex with men (MSM) in the township of Soweto in South Africa has found that a third of gay-identified men are infected with HIV.

The study's authors were the first to examine HIV and the community of men who have sex with men in the Soweto Township, an area on the periphery of Johannesburg reserved for black South Africans during apartheid.

The researchers found that Soweto MSM identified themselves as straight, bisexual or gay, with the highest HIV rate among gay identified men, at 33.9 percent. The researchers estimated the rate of HIV infection for bisexual MSM in Soweto to be 6.4 percent and 10 percent for straight identified MSM.

"Our findings clearly indicate that targeted prevention and treatment for men who have sex with men in townships are urgently needed. We also found that, despite South Africa's legal advances in gay rights, stigma and de facto segregation are reflected in the disproportionate rates of HIV infection," said the study's principal investigator, Tim Lane, PhD, MPH, assistant professor at the UCSF Center for AIDS Prevention Studies

The findings are now available in the online edition of the journal AIDS and Behavior and are scheduled for publication in an upcoming print issue.

Of the study's 378 participants, 34.1 percent identified as gay, 30.4 percent as bisexual and 31.7 percent as straight. All but one of the participants were black South Africans and all of South Africa's black African ethnic groups were represented in the sample.

The study showed that MSM's sexual identities predicted their sexual behaviour with other men.

Gay identity was highly correlated with the exclusive practise of receptive anal intercourse and straight and bisexual self-identification was highly correlated with the exclusive practise of insertive anal intercourse with male partners.

"With the correlation of sexual identity and sexual practise, control of condom use in same-sex partnerships tends to be in the hands of bisexual and straight MSM. This finding demonstrates the pressing need to promote condom use among bisexual and straight-MSM for same-sex as well as heterosexual relationships," said Lane.

The authors also looked at other risk factors and found that HIV infection was also associated with being older than 25, lower incomes, purchasing alcohol or drugs for a male partner in exchange for sex, having receptive anal intercourse and having any unprotected anal intercourse with a man.

HIV infection was significantly less likely among men who have sex with men who were circumcised, smoked marijuana, had a regular female partner or reported unprotected vaginal intercourse with women.

"The circumcision findings clearly suggest that for this population of MSM, circumcision could be protective and that MSM should not be excluded from circumcision programs," said Lane.