Poor countries fail gay men

via Science Alert

On the eve of World AIDS Day (Tuesday, 1 December), a landmark paper documents the failure of low and middle income countries to protect men who have sex with men from contracting HIV/AIDS.

The research, led by academics from the University of New South Wales (UNSW), was commissioned by UNAIDS and presents the largest set of data available on HIV prevention in men who have sex with men (MSM) in low and middle income countries (LMIC).

The research, which has just been published in a special issue of the Journal of AIDS, shows that on average fewer than a third of MSM in these countries have ever been tested for HIV (31 per cent), around a third have been reached by HIV prevention programs (33 per cent), fewer than half had correct HIV knowledge (44 per cent) and just over a half had used condoms the last time they had sex with a man (54 per cent).

Read the rest.

Eric Goosby: No Hold on PEPFAR Funds for Uganda

I think I would do more harm than good by connecting our resources to respond to the epidemic to making them dependent on a behavior that they're not willing to engage in on their own.

via Newsweek blog, by Katie Paul

Stigma is anathema to effective public-health work, but that's never stopped homophobic crusaders from mucking up the fight against HIV/AIDS before. Now, just as the South African government is finally changing its tune on the matter, Uganda is emerging as the world's new problem country. The recipient of $287 million in PEPFAR funds last year, Uganda is also the site of a vicious campaign against homosexuality, which took a turn for the worse last month when the "Anti-Homosexuality Bill" was introduced to Parliament. The bill threatens harsher punishments for actual or even perceived homosexual activity, which is already illegal under Ugandan law; convicted offenders could face the death penalty. "Promoting homosexuality" would also be illegal, as would a failure to report any of the above to police within 24 hours.

Even by regional standards, such penalties would be exceptionally harsh, especially since they would effectively criminalize the work of HIV/AIDS prevention efforts under the "promotion of homosexuality clause." The thinking behind them is just as disturbing, since this latest round of antigay fervor was kicked off at a conference held by by American missionary groups that went to proselytize about the twin evils of Nazism and homosexual behavior in Kampala earlier this year. Just to hammer home how far-out that is, this means the Ugandan government got its advice from the author of a book called The Pink Swastika: Homosexuality in the Nazi Party, which claims the Nazi movement was "entirely controlled by militaristic male homosexuals throughout its short history." The result has been a vigilante campaign against the country's LGBT community, whereby gay detainees are tortured and tabloids publish the names, places of employment, addresses, and physical descriptions of gay-rights advocates under headlines that scream "TOP HOMOS IN UGANDA NAMED." It would seem the stuff of Orwellian parody, but it's real.

Read the rest.

Pre-exposure prophylaxis: cost-effectiveness dilemmas analysed by Australian study

via Aidsmap, by Gus Cairns

Pre-exposure prophylaxis would maintain HIV prevalence among high-risk gay men at the current level and prevent a prevalence increase of up to 5%, a mathematical model has shown, even if it were taken only half the time and only prevented one in two infections.

However for PrEP to significantly reduce HIV prevalence in this population it would need to be 90% effective and be taken continuously.

If prescribed in either of these two ways it would be barely cost effective. Intermittent PrEP could be more cost effective, but to be so it would need to have higher efficacy than yet demonstrated – around 90%.

The model was presented to the European AIDS Conference by Jonathan Anderson of the Australian National Centre in HIV Epidemiology and Clinical Research. He noted that past analyses of whether PrEP could be cost-effective, based on the US epidemic, had produced contradictory results.

Read the rest.

Homophobic Ugandan Bill Demonizes People with HIV

Remarks by Stephen Lewis, Co-Director of AIDS-Free World delivered at the Commonwealth People's Forum on the eve of the Commonwealth Heads of Government Meeting (CHOGM) Tuesday, November 24, 2009, 10:00 a.m., Port of Spain, Trinidad and Tobago:

It’s one thing to talk about the promotion of the ‘traditional family’ as the author of the Bill does ad nauseam; it’s quite another thing to incite the promotion of disease and murder. Gays and lesbians don’t challenge traditional families; their private sexual practices don’t invade the sanctity of family life. The accusation is a vile canard. People who plead the supremacy of family values over other human values have one of two motives: either they’re biblical fundamentalists whose religiosity has gone haywire, or they’re so steeped in irrational fear of different sexual orientation that human rights have no meaning. 

This is a moment of truth for the Commonwealth. The anti-homosexuality Private Member’s Bill introduced into the parliament of Uganda, and now proceeding through the normal legislative process, puts the Commonwealth’s legitimacy and integrity to the test.

In a fashion unmistakable in both clarity and intent, the putative legislation declares war on homosexuality. There are deeply offensive sodomy laws and homophobic statutes on the books of many other Commonwealth countries, particularly here in the Caribbean. But nothing is as stark, punitive and redolent of hate as the Bill in Uganda; nothing comes close to such an omnibus violation of the human rights of sexual minorities. For some time now, Uganda has had offensive anti-homosexual legislation on the books, but this variant, this inflammatory redesign makes of the law a veritable charter of malice.

What is truly staggering about all of this is that not a peep of skepticism or incredulity has come from President Museveni (pictured). And President Museveni is chairing the Commonwealth Heads of Government summit. In so doing, he makes a mockery of Commonwealth principles.

One must remember that the last meeting of CHOGM was held in Uganda in 2007, and issued what is called the “Munyonyo Statement of Respect and Understanding”. It asserted that the Commonwealth “is a body well-placed to affirm the fundamental truth that diversity is one of humanity’s greatest strengths”. It went on to say that “accepting diversity, respecting the dignity of all human beings, and understanding the richness of our multiple identities have always been fundamental to the Commonwealth’s principles and approach …”. President Museveni signed the document. How in the world does he reconcile the affirmation then with the defamation now?

It is noteworthy that much of the strongest opposition to the Bill is coming from the courageous Lesbian, Gay, Bisexual, and Transgender activists on the ground. LGBT activism always commands admiration, but in this instance especially so, because their very lives hang in the balance.\

Read the rest on AIDS-Free World.

Circumcision may protect HIV-negative gay men from syphilis

via Aidsmap, by Michael Carter

Circumcision protects HIV-negative gay men from infection with syphilis, Australian investigators report in the December 15th edition of the Journal of Infectious Diseases. However, circumcision did not affect the risk of acquiring any other sexually transmitted infection.

The study was conducted by investigators from the Health in Men (HIM) study. This is the same group of investigators who recently reported that circumcision may protect gay men with a “preference” for insertive anal sex from HIV.

Gay men are disproportionately affected by sexually transmitted infections and new methods of preventing them are required.

Observational studies conducted in heterosexuals have suggested that circumcision is protective against ulcerative sexually transmitted infections, including genital herpes and syphilis. In addition, the Rakai randomised controlled trial showed that circumcision protected against genital herpes, but not syphilis.

Read the rest.

Enter through the back door, please

via The Pleasure Project

Will it be called ‘Recto-prevent’ … or Backdoor Butter? Will it be stigmatized, or celebrated as a way to have great sex while lowering the risk of infection?

Reporting live from the hallowed halls of the University of Oxford was never more exciting than last week, when Jerry Gallea of the UCLA Programme in Global Health and the International Rectal Microbicide Advocates (IRMA) talked about the frontiers (or should that be ‘rear-iers’) of HIV prevention: the search for an effective rectal microbicide.

His visit was hosted by Oxford’s Centre for Evidence-Based Intervention (CEBI) in the Department of Social Policy and Social Work, and featured the facts about who’s having anal sex around the world (news flash: not just gay men), and the slippery subject of how to have your anal play and stay safe, too.

Read the whole item.

Read Jerry's account of his Oxford presentation (and check out his slides too).

Next IRMA Global Teleconference - Efficacy and Effectiveness - What is Good Enough? Who decides?

JOIN US
Efficacy and Effectiveness - What is Good Enough? Who decides?
Friday, December 4, 2009

7a – Los Angeles
9a – Chicago, Lima
10a – NYC
3p - London
4p - Lagos
5p - Johannesburg
8:30p - Delhi
2A - Sydney

Join IRMA, the Global Campaign for Microbicides and the AIDS Vaccine Advocacy Coalition and our panel of distinguished speakers (below) for what is sure to be a provocative and dynamic discussion about efficacy and effectiveness of new prevention technologies – PrEP, male circumcision, vaccines, and microbicides.

What is acceptable to communities in both the developing and developed world? What about behaviour change? How do we balance public health impact vs. the needs of the individual? We won’t be able to answer all of these questions – but we can start the discussion!

Please RSVP today.You must RSVP to receive dial-in information.

Featured speakers include Gus Cairns, Editor, HIV Treatment Update NAM Publications (Aidsmap); Dr Sheila Harvey MDP301 Trial Coordinator, Mwanza, Tanzania; and Dr. Roger Tatoud, Senior Programme Manager, International HIV Clinical Trial Research Management Office, Imperial College London. Representatives from AVAC and GCM will also make comments.

Special thanks to AVAC for hosting the call!

Click here for materials (PowerPoints and recordings) from past IRMA Global Teleconferences.

Got Lube? The slippery slope for African men who don’t

Image from South Africa's Health4Men website - see their very helpful section on lubricant info, including tips on how to make your own - really!

via Positively Aware, by Jim Pickett


Beyond addressing the huge issues faced by African gay/MSM—egregious human rights violations, criminalization, invisibility in official data sets, meaning zero resources and zero programs—we need to do the basics. We need to get these guys lube. Proper water-based lube. Stat.

It seems so simple, doesn’t it? 


Excerpt:

For those of us acquainted with the finer points of anal intercourse, the thought of engaging in this activity without any type of lubrication takes that dropped jaw and turns it into a grimace. And the fact that lube-free anal sex hurts, and tears, and burns creates a perfect storm in the rectum for HIV transmission.

And we all know that oil-based lubes are a big no-no with latex condoms—though using these lubes in the absence of condoms is still much, much better than using nothing.

What’s going on here? There are huge barriers to lubricant use, including cost and very limited availability, as well as the stigma attached to buying lubricant (you shouldn’t need to buy lube for vaginal sex, right? If you’re buying lube, you must be doing bad things.) Many African men who have the ability to travel come back from the West with suitcases packed with lubricant for their friends—the demand is extremely high. But this is not the best distribution system, is it?

It was this last set of facts around lubricant use in general (high) and the amount of men using water-based lubes (low) that hit me like the proverbial ton of bricks. How in the hell can we even talk about getting rectal microbicides to these men when, currently, they don’t even have proper lubricant?

Read the whole thing.

Magee-Womens Research Institute Receives $17.5 million for Rectal Microbicide Research

Dr. Ian McGowan* (pictured), an investigator with the Magee-Womens Research Institute (MWRI), recently received a total of $17.5 million from the National Institutes of Health (NIH) to conduct two studies involving the development of rectal microbicides.

"This is exciting for the field of HIV prevention research, and especially important in terms of moving the research and development of rectal microbicides forward," said McGowan. "We applaud the leadership and vision of our sponsors at the NIH."

Microbicides are topical products that can be applied to the rectal or vaginal mucosa with the intent of preventing, or at least significantly reducing the risk of HIV acquisition in either compartment.

Recognizing the fact that women in the developed and developing world are at risk of HIV infection through anal and vaginal intercourse, the Microbicide Trials Network (MTN), based at MWRI, is currently evaluating the rectal safety of microbicides designed for vaginal use.

Dr. McGowan’s new studies focus the research towards developing microbicide products specifically designed for rectal use.

The first grant is entitled the Combination HIV Antiretroviral Rectal Microbicides or CHARM program. This is an $11 million, five year, multicenter U19 grant that brings together research groups from the University of Pittsburgh, University of North Carolina, Johns Hopkins Medical School, CONRAD, and the University of California at Los Angeles. The U19 grant is part of the NIH funded Integrated Preclinical Clinical Program and is intended to advance candidate microbicides from discovery into early clinical development.

The second grant is a $6.5 million, four year, R01 grant entitled Microbicide Safety and Acceptability in Young Men with Dr. Alex Carballo-Dieguez as the Co-Principal Investigator. The focus of this grant is to evaluate the safety and acceptability of rectal microbicides in young, ethnic minority men who have sex with men (MSM). Funding for this study comes from the National Institute of Child Health and Human Development as well as the National Institute of Mental Health and will generate critical data from a population of young African American and Latino men who are at the highest risk of HIV infection in the United States. Clinical trial sites will be in Pittsburgh, Boston, and Puerto Rico.

"We need to develop safe, effective, acceptable and accessible rectal microbicides for the millions of women and men worldwide who need options beyond condoms," said Jim Pickett, chair of the International Rectal Microbicide Advocates (IRMA) said. "Our global network of advocates, scientists, policy makers and funders is encouraged to see this work moving forward."

Together with ongoing MTN rectal safety studies and another collaborative grant with the University of Oxford, UK, these two new grants establish MWRI as a leading center for rectal microbicide translational research and will hopefully lead to the development of safe and effective products for individuals at risk of HIV infection through unprotected receptive anal sex.
 

* Dr. McGowan is also a Professor of Medicine in the Division of Gastroenterology, Hepatology, and Nutrition at the University of Pittsburgh Medical Center, with a secondary appointment in the Department of Obstetrics, Gynecology and Reproductive Science.

"What What in the Butt" - IRMA Theme Song?

So, should this be a Rectal Microbicide anthem?

Adding D to ABC: How a Proposed Ban on Homosexuality in Uganda Will Undo AIDS Progress

Adding D to ABC in Uganda will not reduce HIV/AIDS and may make matters worse. For the sake of human rights and a working AIDS policy, ABC is enough.

via Crosswalk.com, by Dr. Warren Throckmorton

Between 2004 and 2008, the United States has provided 1.2 billion dollars to the East African nation of Uganda through the President's Emergency Plan for AIDS Relief (PEPFAR). Instigated by President George W. Bush, PEPFAR's results have been striking. According to a 2009 Annals of Internal Medicine research report, an estimated 1.2 million lives have been saved. The AIDS rate has dropped dramatically. PEPFAR funds three components of AIDS education and prevention: Abstinence education, Be faithful in marriage or to one partner, and Condom usage (ABC).

However, a bill proposed in the Ugandan parliament in early October may add a D to this policy and compromise Bush's good work. The D stands for the death penalty for homosexual offenses, including multiple homosexual acts and engaging in sex while HIV positive.

Introduced by MP David Bahati, the Anti-Homosexuality Bill, 2009 would impose the death penalty on some homosexual behaviors, and maintain life in prison for others. Even touching someone of the same sex could be considered an offense if the intent is sexual. Homosexuality is already illegal in Uganda but this bill cracks down harder on offenders as well as anyone with any relationship to a homosexual. The bill requires persons in authority (pastor, teacher, missionary, physician, parent, etc.) to report any knowledge of any offense covered by the act within 24 hours upon pain of 3 years in jail or a hefty fine. Thus, parents could be expected to turn in same-sex attracted children. Relevant to AIDS relief work, there is no exemption in the bill for professionals. If a patient reveals homosexual behavior in the course of AIDS treatment or education, then those hearing the revelation must report.

Read the rest.

Finding the IRMA Advocate Within - at Oxford!

“Hey, this is something I can do!”

by Jerome Galea, IRMA Steering Committee Member

I’d like to share with the IRMA readership a recent experience I had that I hope inspires others to do the same: give a public presentation on Rectal Microbicides (RM) describing what they are and why we need them.  As Jim Pickett will attest I was pretty nervous about the proposition but with lots of support from IRMA as well as friends who sat through my “dress rehearsal” the day before, I learned that I actually know lots about the topic and can make a decent show of it…which means probably most people reading this could, as well.

A bit of background – I’m studying in London and through some colleagues was asked if I’d be willing to present at a seminar series on evidence based interventions at the Department of Social Policy and Social work at Oxford (!) University.  The invitation happened months ago and I said “sure” without thinking much about it.  But as the day grew nearer and I saw all of the other speakers in the lineup (all PhDs and lots of professors, neither of which I am) I started to panic.

I tried to get out of it but the convener encouraged me to do it saying basically that “a degree doesn’t guarantee you know what you’re speaking on; if you know it, you know it!”

So, the first person I called was Jim Pickett – I knew he’d be able to point me in the right direction and provide support and even materials that I could adapt to my audience.  In this case it was a group of masters and PhD students from varied backgrounds but all interested in learning more about RM.

When I talked to Jim, we discussed what IRMA materials I could use but also how I could personalize the presentation with my particular interests (e.g., RM in Latin America).  In this way I had a solid foundation of time-tested materials to work from to which I could merge in my personal style and interests to come up with something that was unique.

When I started the presentation (which is available on the IRMA website, “No Butts About It – Rectal Microbicides and HIV Prevention” -  blatantly plagiarizing  Jim’s presentations) the first thing I asked of the 50 or so attendees was how many had heard of microbicides and to my surprise about three-quarters had.  Working from that base was great since people already had an idea that such a product was under development, but admittedly most had heard only of vaginal microbicides.

Working from the IRMA materials, I first presented an overview of HIV/AIDS in the world; talked about the “tool box” of prevention interventions and where microbicides fit in; showed how microbicides work and discussed current studies underway; talked about anal sex as a human behavior and then focused in on my interest in Latin America.  I capped-off the talk with a call to advocacy, inviting the audience to take part in IRMA by visiting our website, joining a conference call or taking part in a more formal way. 

To my surprise no one fell asleep (well, one guy dozed…but it was late in the afternoon and the room was stuffy) and afterwards there were about 30 minutes of lively dialogue.  Some questions had to do with what the microbicide field should do in terms of acceptability work, making reference to the struggles other interventions have had in being fully accepted (e.g. the Female Condom). Another person, working in the area of medical history, wondered why RM research lagged behind vaginal microbicides and there was discussion of how homophobia may shape scientific discovery.

All-in-all, once I got into the presentation, I felt like “Hey, this is something I can do!” which leads me to the last thing I’ll say: being part of IRMA implies speaking up in each of our own ways about RM.  If you have the opportunity to speak, no matter how informally, give it a go!  Lots of organizations (community centers, universities, professional societies) are looking for people to give chats on a range of topics.

One thing I learned is that just the title itself – “Rectal Microbicides” – raises eyebrows and piques interest.  With IRMA’s excellent library of resources, you can easily put together a professional presentation with slides  that are up-to-date and easy to explain.  So, give it a go; there’s an advocate in all of us!


[IRMA references]

Community Presentations
Teleconference Materials
IRMA-Specific Materials(e.g. our reports)
Other Published Materials

We are always happy to help!

Send an IRMA Advocate to Pittsburgh!

Will you chip in?

by Roy Wadia, IRMA Steering Committee Member

I was one of the lucky recipients of the first round of John Shaw scholarships, to attend Microbicides 2008 in New Delhi. I'd been with IRMA (the former IRMWG) for a while by that time, and while I'd done a lot of HIV/AIDS advocacy and communications work during my time at WHO China and then at the BC CDC in Canada, I'd never really focused on microbicide issues until my introduction to this amazing group.

The more I delved into the subject matter, which initially seemed rather arcane, the more I realized its importance in the global response to the prevention and control of HIV/AIDS and STI. By focusing on rectal microbicides, an issue linked directly to the need to focus on anal sex and its role in the HIV/AIDS picture -- and yet one that is still not widely discussed or given its due in both scientific and advocacy circles -- IRMA and its membership has helped fill a conspicuous gap, prodding scientists, researchers and advocates alike.

The Delhi conference itself was an amazing chance to network, to meet some extraordinary individuals, and to experience that rather wonderful and long-overdue moment when the health minister of India, the conference host country, mentioned rectal microbicides as a weapon in the (if you'll pardon the unfortunate pun) arsenal to fight HIV/AIDS. It brought home the work that IRMA had been doing, and renewed our sense of mission and purpose. For this scholarship recipient it vindicated the work that's being done by so many of us, and I can only say that the John Shaw scholarship (named after a fearless advocate and lovely man) needs to continue and to be strengthened in the years to come.

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IRMA created the John Shaw Memorial Scholarship Fund in late 2007. John was a valued, enthusiastic and delightful member of the IRMA Steering Committee for over a year. He passed away Thursday, September 27, 2007. An LGBTQ/human rights advocate for over 20 years, John was also a Person With AIDS since at least 1990.

His fund helped rectal microbicide advocates attend the M2008 conference in New Delhi. Click here for a list of scholarship recipients.

TODAY - thanks to the generosity of the Elton John AIDS Foundation, we already have $3,000 in the Fund to help support IRMA advocates to attend the Microbicides 2010 conference this coming May in Pittsburgh.

We would like to bring that total to $10,000 - and here is where you come in. Will you chip in to help a rectal microbicide advocate attend M2010?

To donate to the John Shaw Memorial Scholarship fund, you may do so securely right here on this blog. In the upper left hand corner, there is a Chip In! box that allows you to donate whatever amount you would like via PayPal - securely.

The planners of M2010 are providing a large number of scholarships – so IRMA plans to fill in the gaps for rectal microbicide advocates who were unable to secure that support. We plan to release information on IRMA’s competitive scholarship process in December 2009. Microbicides 2010 will be announcing their scholarships on February 1 – and IRMA will announce recipients of our support by March 1, 2010. IRMA scholarship recipients are required to have applied for M2010 support to be considered.

Thank you for your support!

High prevalence of anal chlamydia in Swiss HIV-positive gay men

via Aidsmap, by Michael Carter

A large proportion of HIV-positive gay men in Switzerland have anorectal infection with chlamydia, investigators report in the November15th edition of Clinical Infectious Diseases. The researchers suggest that undiagnosed anal chlamydia infections could be contributing to the continued spread of HIV amongst gay men in Switzerland.

Gay and other men who have sex with men remain the group most affected by HIV in many industrialised countries, including Switzerland. Sexually transmitted infections also disproportionately affect gay men. If left untreated these infections, including chlamydia, can significantly increase the risk of acquiring HIV. As reported on aidsmap.com UK investigators found that many chlamydia infections in gay men were in the rectum, and that HIV-positive gay men were disproportionately affected by rectal chlamydia

Investigators from the Swiss HIV cohort therefore postulated that anorectal chlaymdia infection could be contributing to the ongoing HIV epidemic amongst gay men in the country.

They therefore screened 147 HIV-positive men who reported unprotected receptive anal sex in the previous two years for the infection. The aims of their study were to determine the prevalence and symptoms of anorectal chlamydia, and to see if they could identify any risk factors associated with the infection.

Read the rest.