Kenya: HIV prevention strategy that ignores anal health - "simply incomplete"

It struck us that in the 25 years that Kenya had been battling the HIV epidemic, no one had tried targeting anal sex 

for preventing HIV transmission...

Yet we knew it happens and not just in the homosexual community, but also among some heterosexual couples... 

... an HIV prevention strategy that does not encompass 

anal health is simply incomplete. 

via allAfrica.com  - Research - Country in Denial Over Homosexuals

Research about homosexuality in Kenya suggests it's not just a decadent foreign influence, and it's not confined to tourists at the Coast. And one thing is certain: pretending it doesn't exist has its consequences.

It's hard to imagine a Kenya where homosexuality is viewed as anything but a moral and religious abomination. The majority still link it to foreign influences or drug abuse, or dismiss it as a perverted habit practised in upper class social cliques.

As the national debate intensifies, interviews with a few gay Kenyans, and five years of research conducted by the Kemri/Wellcome Trust Research Programme in Kilifi, challenge these bedrock cultural and religious beliefs around homosexuality.

Read the rest.

HIV prevention for UK Africans should prioritise work with men

by Roger Pebody, via Aidsmap

Men were less likely than women
to have tested for HIV,
to have diagnosed HIV and

to know where to test for HIV. 

Men, not women, should be prioritised by health promoters working with African communities in England, researchers reported earlier this month. The findings from the latest BASS Line survey suggest that men are more likely than women to report sexual risk behaviours, to have lower levels of knowledge and are less likely to have been tested for HIV.

The researchers also recommend that work with men pays particular attention to the needs of men who have sex with both men and women, and those who only have sex with men. In addition, there are high levels of need among those with limited schooling.

Read the rest.

Concurrent sexual partnerships and the spread of HIV - ‘the evidence is limited’

by Roger Pebody, via Aidsmap

The theory that multiple, overlapping sexual partnerships are a key driver of generalised HIV epidemics in Africa has been attacked as being based on insubstantial evidence. The critics, writing in the journals AIDS and Behavior and The Lancet, argue that researchers lack a precise definition of concurrency or a standard way to measure it, and that the data do not show a significant association between concurrency and either HIV incidence or prevalence.

However this critique has stimulated a fierce debate in the United States. Proponents of the concurrency thesis argue that the critics’ analysis of the data is selective, that evidence from a wide range of sources supports the thesis, and that it would be irresponsible for prevention programmes in Africa to ignore this issue.

Read the rest.

"Less Noisy" Female Condom Promoted for Anal Sex in - Uganda?

"Less noisy" female condom proves a hit
via PlusNews 

We shall promote it among MSM

Ten months after being re-launched, a new brand of female condom has proven popular among a test group of Ugandan women, according to a study.

FC2 was launched in February; the government stopped distributing the original female condom, FC1, in 2007 on the grounds that women had complained it was smelly and noisy during sex.

"The new condom has improved features and will enable women to have a procedure within their control to give them more choices for prevention [of HIV and unwanted pregnancies]," said Vashta Kibirige, the coordinator of the condom unit at the Ministry of Health.

"The women [surveyed] say they like this version of the condom better and they are ready to use it," said Janeva Busingye, coordinator of the Most at Risk Populations Initiative project, which carried out the study in the capital, Kampala.

The UN Population Fund and the NGO, Programme for Accessible health Communication and Education, are spearheading the re-launch of the female condom, which is still in the sensitisation stage and will become available to the public in 2010.

The women questioned said the new condom was less noisy, more comfortable and well lubricated, increasing their sexual pleasure. It also has no smell and can be inserted in the vagina at least eight hours before sex, which the women liked a lot.

The Health Ministry and its partners have so far trained women in Kampala to teach other women the benefits of the female condom. According to Kibirige, they hoped the condom would become more popular in other regions after a situation analysis in 2008 revealed that cultural barriers and lack of proper education had prevented their use in some parts of the country.

Targeting MSM

According to an official at the sexually transmitted diseases clinic at Mulago Hospital, Uganda's largest referral facility, men who have sex with men (MSM) would also be taught about the female condom. Uganda has no official policy for prevention of HIV among MSM, and outlaws homosexual sex.

 Anyone for a female condom? "We shall promote it among MSM because when we were sensitising people they expressed a need for them; they use for them for anal sex after removing the ring," the official said.

At each end of the female condom is a flexible ring; at the closed end of the sheath, the flexible ring is inserted into the vagina or anus to hold the condom in place - this ring is sometimes removed during anal sex to reduce the possibility of rectal injury.

A 2003 study of the acceptability and safety of a brand of female condom for anal sex between men found incidents of condom breakage, semen spillage and rectal bleeding to be similar for the male and female condom, but slippage was more frequent with female than male condoms. The authors recommended design modifications and training in the use of the female condom for anal sex.

Microbicides 2010 Announces Deadline Extensions

Good News! There is still time to submit your abstract and scholarship application. All conference deadlines have been extended.

M2010 Key Date Extensions

January 22, 2010 at 6PM EST

    * Deadline for submission of scholarship applications and abstracts

February 12, 2010 at 6PM EST

    * Early registration ends

February 15, 2010 at 6pm est

    * Notification of scholarship awards and abstract acceptances

April 15, 2010 at 6PM EST

    * Deadline for submission of late breaker abstracts

Visit the M2010 website.

Get inspired by Kadiri and help an IRMA advocate attend Microbicides 2010

Will you chip in?

TODAY - thanks to the generosity of the Elton John AIDS Foundation, and IRMA members, we already have $3,485 in our John Shaw Memorial Scholarship Fund to help support IRMA advocates attend the Microbicides 2010 conference coming up in Pittsburgh, May 2010.

We would like to bring that total to $10,000 - so we can help as many people as possible attend this important conference - and here is where you come in.

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 (just like the one right in this post) 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 early January 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.

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, including Kadiri Audu of IRMA Nigeria, who went on to become Community Vice Chair of IRMA's Steering Commitee. He wrote about his Delhi/Microbicides 2008 conference for the IRMA blog - which we have republished below.

We hope he will inspire you to chip in - anything at all helps!

----------------------

Correspondence from IRMA advocates
by way of India

M2008 memories and the path forward

Taking rectal microbicide advocacy
to the next level in Lagos

by Kadiri Audu, Lagos. Nigeria
[read Kadiri's bio]

First, I want to thank the organizers of Microbicides 2008, IRMA, AIDS Foundation of Chicago and the John Shaw Memorial Scholarship fund that gave me the opportunity to attend the M2008 in New Delhi.

New Delhi is beautiful and the weather was just alright. I do not know if there is any better place to have hosted the conference in India, the conference was exciting and wonderful. It was interesting to have met new advocates from other parts of the world, and it was also interesting to know that people from the developed world like the USA and Canada are actually leading the research on rectal microbicides. Also, the Advocates Corner was a splendid idea because it gave the John Shaw Scholarship recipients, new advocates, and other IRMA members the chance to meet one another and build networking links among ourselves. My favorite memory was the chance to meet other advocates and the dinner organized for the conference participants.

I have been sharing my experience of the conference with members of the various networks that I belong to in our meetings. In addition to sharing my experience, I also share some materials that I collected at the advocates corner, i.e. stickers, pens and posters carrying the message about the conference.

In taking rectal microbicide advocacy to the next level, we have already formed Lagos IRMA, the aim is to mobilize more advocates in line with IRMA research and activities. We have even started e-mailing in that regards - our email address is lagosirma@yahoo.com, myself and Abdullrahaman formed it. He is also a new advocate that attended the conference and we operate from the same city. As of today we have 21 new members from our community.

Presently we are looking at reaching out to more people and groups like the youth leaders, the artisan groups like the hair dressers association, barbers association, the auto mechanic association, etc within our locality.

I would also like to suggest that we have training opportunities for us and our new members so as to be able to carry on the work effectively.

Thanks once again.
Kadiri Audu E

Prevalence of Seroadaptive Behaviors of Men Who Have Sex With Men

via U.S. Centers for Disease Control and Prevention Medical News, posted December 10, 2009

Prevalence of Seroadaptive Behaviors of Men Who Have Sex With Men, San Francisco, 2004

The researchers set out to define and measure the prevalence of HIV seroadaptive behaviors among men who have sex with men (MSM). Time-location sampling was used to recruit a community-based, cross-sectional sample of 1,211 HIV-negative and 251 HIV-positive MSM in San Francisco in 2004.

To define seroadaptive behaviors, all episodes of anal intercourse were enumerated and characterized by partner type, partner HIV serostatus, sexual position, and condom use for up to five partners in the preceding six months.

The results showed that 37.6 percent of HIV-negative MSM engaged in some form of seroadaptive behavior: pure serosorting (24.7 percent), seropositioning (5.9 percent), condom serosorting (3.9 percent), and negotiated safety (3.1 percent). Some form of seroadaptation was noted for 43.4 percent of HIV-positive men -- including pure serosorting (19.5 percent), seropositioning (14.3 percent), and condom serosorting (9.6 percent). Consistent use of condoms was reported by 37.1 percent of HIV-negative men and 20.7 percent of HIV-positive men.

"In aggregate, seroadaptive behaviors appear to be the most common HIV prevention strategy adopted by MSM in San Francisco as of 2004," the authors concluded. "Surveillance and epidemiological studies need to precisely measure seroadaptive behaviors in order to gauge and track the true level of HIV risk in populations. Rigorous prevention research is needed to assess the efficacy of seroadaptive behaviors on individuals' risk and on the epidemic."

Check out other IRMA posts on this topic:
seroadaptation, serosorting 

Anal cancer prevention in HIV-positive men and women

Abstract - Current Opinion in Oncology, September 2009
by Joel M. Palefsky
Department of Medicine, University of California, San Francisco, San Francisco, California

Purpose of review:
The incidence of human papillomavirus-associated anal cancer is unacceptably high among HIV-positive men who have sex with men, and possibly in HIV-positive women. Unlike most other malignancies occurring in the HIV-positive population, anal cancer is potentially preventable, using methods similar to those used to prevent cervical cancer in women. This review discusses the issues around screening to prevent anal cancer.

Recent findings:
Recent studies show that the incidence of anal cancer has increased since the introduction of highly active antiretroviral therapy in this population and now exceeds the highest incidence of cervical cancer among women reported anywhere in the world.

Summary:
The high incidence of anal cancer among HIV-positive individuals must not be ignored, since it may be preventable. Given the current evidence and analogy with the cervical cancer prevention model, many clinicians believe that identification and treatment of high-grade anal intraepithelial neoplasia to prevent anal cancer are warranted. When the expertise to do so exists, this is a reasonable approach, particularly if coupled with efforts to optimize further screening and treatment approaches, as well as efforts to document the efficacy of high-grade anal intraepithelial neoplasia treatment to reduce the incidence of anal cancer.

Read more on this topic on the IRMA blog.
Key word:
Anal cancer
HPV

January 4 Deadlines for Microbicides 2010

The Scientific Program Committee for the 2010 International Microbicides Conference (M2010) invites papers of high quality in the areas of HIV prevention research.  Abstract submissions are peer-reviewed for scientific content, logical presentation, timeliness, and current interest of the topic to the scientific community. IRMA members are highly encouraged to submit.

DEADLINE FOR ABSTRACT SUBMISSION
Authors should submit abstracts no later than 6:00 p.m. (eastern time) on January 4, 2010.

Click here for more info on submitting an abstract. Please let IRMA know if you submit something.

Click here for scholarship information. Scholarship applications are also due January 4, 2010. IRMA members are highly encouraged to submit an application. IRMA will have limited funds to help members attend the conference as well - but will be predicated on an individual  unsuccessfully applying for M2010 support. More info on IRMA's scholarship program will be rolled out in the new year. In the meantime, please support the program and chip in via the widget located on the upper left hand side of this blog. Thanks to the Elton John AIDS Foundation, we have $3,000 already secured for IRMA scholarships. Anything you can chip in will supplement that amount. THANKS! Read more about this here.

Click here to register.

We look forward to seeing you there.

Attitudes towards new HIV biomedical prevention technologies among HIV- gay men

[This paper has important implications for IRMA. It is very interesting to note the researchers found that previous  knowledge of rectal microbicides was significantly associated with unwillingness to participate.]




Abstract via HIV Medicine, December 2009

Attitudes towards new HIV biomedical prevention technologies among a cohort of HIV-negative gay men in Sydney, Australia

IM Poynten 1 , F Jin 1 , GP Prestage 1 , JM Kaldor 1 , J Imrie 2 , and AE Grulich 1

1 National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, New South Wales, Australia and 2 National Centre in HIV Social Research, University of New South Wales, Sydney, New South Wales, Australia

Correspondence: Dr Mary Poynten, National Centre in HIV Epidemiology and Clinical Research, Level 2, 376 Victoria Street, Darlinghurst, NSW 2010, Australia. Tel: +61 2 9385 0900; fax: +61 2 9385 0920; e-mail: mpoynten@nchecr.unsw.edu.au


Objectives
The aim of the study was to explore the awareness of rectal microbicides, the use of pre-exposure prophylaxis (PREP) and the willingness to participate in biomedical HIV prevention trials in a cohort of HIV-negative gay men.

Methods
In a community-based cohort study, HIV-negative homosexually active men in Sydney, Australia were questioned about awareness of rectal microbicides, use of PREP, and willingness to participate in trials of such products. Predictors of awareness and willingness to participate were analysed by logistic regression. Use of PREP was examined prospectively.

Results
Overall, 14% had heard of rectal microbicides. Older (P=0.05) and university-educated men (P=0.001) were more likely to have knowledge of rectal microbicides. Almost one-quarter (24%) of men reported that they were likely/very likely to participate in rectal microbicide trials. Among those men with definite opinions on participation, awareness of rectal microbicides was significantly associated with unwillingness to participate [odds ratio (OR) 0.78, 95% confidence interval (CI) 0.65–0.93, P=0.007]. Willingness to participate in trials using antiretroviral drugs (ARVs) to prevent HIV infection was reported by 43% of men, and was higher among those who reported unprotected anal intercourse (UAI) with HIV-positive partners (OR 1.88, 95% CI 0.99–3.56). There was no evidence of current PREP use.

Conclusions
This study demonstrates that Australian gay men have had little experience with PREP use and rectal microbicides. About half would be willing to consider participation in trials using ARVs to prevent HIV infection. Extensive community education and consultation would be required before PREP or rectal microbicides could be trialled in populations of gay Australian men.

Aidsmap - Disappointment as microbicide fails to protect against HIV

via Aidsmap, by Keith Alcorn

A South African trial participant commented: “Even though the gel proved not to be effective, we played a role in the fight against HIV. We learnt a lot about caring for ourselves, such as using condoms. We also learnt to encourage others to test for HIV and we gained confidence in helping those who were already infected.”

PRO 2000 microbicide gel failed to protect women against HIV infection in the largest microbicide study to date, partners in the Microbicide Development Programme’s 301 study have announced.

PRO 2000 had appeared to reduce the risk of HIV infection by around 30% in a smaller study, HIV Prevention Trials Network study 035, but this result was just outside the bounds of statistical significance, and could have been due to chance.

Researchers and advocates for microbicide development have been awaiting the results of the much larger MDP 301 study to judge whether the compound truly had any protective effect.

Read the rest.

Related:

Offical statement from the Microbicides Development Programme (MDP)

Materials from the MDP

  MDP 301 General Q&A (PDF)

  MDP 301 Results Q&A (PDF)

  MDP 301 Quick Facts (PDF)

  MDP 301 Technical Fact Sheet (PDF)

  Women’s Voice (PDF)

AVAC statement. ["MDP 301 Microbicide Trial Results Disappointing, but Researchers and 9,400 Trial Volunteers Deserve Praise for Successful Trial"]

Male sex workers: Are we ignoring a risk group in Mumbai, India?

Source

Santosh Shinde¹, Maninder Singh Setia², Ashok Row-Kavi³, Vivek Anand³, Hemangi Jerajani<sup>4

1</sup> Department of Dermatology, LTM Medical College, Mumbai; The Humsafar Trust, Mumbai, India,
² McGill University, Montreal, Canada,
³ The Humsafar Trust, Mumbai, India,
⁴ Department of Dermatology, LTM Medical College, Mumbai, India,

Background: Male sex workers (MSWs) have recently been recognized as an important risk group for sexually transmitted infections (STIs) including human immunodeficiency virus (HIV) infection. Although there are global studies on MSWs, few such studies describe the behavioral patterns and STIs among this population in India.  

Methods: MSWs were evaluated at the Humsafar trust, a community based organization situated in suburban Mumbai, India. We report on the demographics, sexual behaviors, and STIs including HIV of these sex workers.  

Results: Of the 75 MSWs, 24 were men and 51 were transgenders. The mean age of the group was 23.3 (+ 4.9) years. About 15% were married or lived with a permanent partner. Of these individuals, 85% reported sex work as a main source of income and 15% as an additional source. All the individuals reported anal sex (87% anal receptive sex and 13% anal insertive sex). About 13% of MSWs had never used a condom. The HIV prevalence was 33% (17% in men vs 41% in transgenders, P = 0.04). The STI prevalence was 60% (58% in men vs 61% in transgenders, P = 0.8). Syphilis was the most common STI (28%) in these MSWs. HIV was associated with being a transgender (41 vs 17%, P = 0.04), age > 26 years (57 vs 28%, P = 0.04), more than one year of sex work (38 vs 8%, P = 0.05), and income < Rs. 2000 per month (62 vs 27%, P = 0.02).

Conclusions: The MSWs have high-risk behaviors, low consistent condom use, and high STI/HIV infections. These groups should be the focus of intensive public health interventions aimed at reduction of risky sexual practices, and STI/HIV prevention and care.



Introduction

The organized sex trade has been a focus of intense discussion within the context of the human immunodeficieny virus (HIV) epidemic in Maharashtra as well as in India. [1] The female sex workers and their clients represent a high-risk group for acquisition of sexually transmitted infections (STIs) including HIV. Maharashtra's, and especially Mumbai's, organized brothels and various commercial sex sites are frequently visited by men native to the city, and also by the massive number of individuals migrating to the highly developed state in search of employment. Also, the sex workers themselves come from both within and outside the state.

Since the first case of HIV/AIDS was identified, prevention programs have recognized the importance of understanding the sex work industry. This included collecting systematic and reliable data on sex work, and contextual issues around selling of sex. [2],[3],[4] While research on female sex workers is extensive, comparatively less information exists on male sex work. Yet we cannot simply assume that the pattern and characteristics of the female sex industry will be the same as that of the male sex work industry. Coupled with sex trade and industrialization, social marginalization of groups such as male sex workers (MSWs) which include men who have sex with men (MSM) make prevention efforts with these extremely vulnerable groups all the more difficult. [5]

MSM are a diverse and often hard-to-reach group, spanning all age groups and socioeconomic backgrounds. [6],[7],[8] MSM in India can be divided into various subgroups: self-identified MSM (gay identified, kothis, panthis ), behaviorally MSM with no identity, bisexual men, and male-to-female transgenders ( hijras ).Other groups include subpopulations who are vulnerable because of their occupations/profession, and often engage into 'survival sex'; work is often intermittent and irregular for these men and they may actually have to offer sex in exchange for money. [9]

This study aims to understand the prevalence of sexual behaviors and STIs including HIV in MSWs. We further aim to understand the association of sociodemographics and HIV in this risk group.


Read more.

"Most people think they can't get HIV through anal sex"

Uganda's Anti-Gay Bill: Inspired by the U.S.

via TIME/CNN online, by Zoe Alsop

The late-November afternoon sun bore down on the park in downtown Kampala, and all along the benches, Ugandan office workers took their siestas. There could have been no less likely setting for criminal conspiracies to topple an East African state. Still, the doctor's voice dropped a notch when an office worker in a brown suit settled in close by. The medic shifted a battered fedora over his eyes. "I am the gay doctor," the physician whispered to me, making sure nobody around heard. He talked about the gay and lesbian couples who go to his office to avoid ridicule in public hospitals. "They know they can trust me, and trust is a big issue," he said. "There is the stigma of being gay, but also the stigma of being [HIV] positive. They are such hidden communities. Nobody wants to deal with their problems."

Read the rest.

U.S. and WHO guidelines call for earlier HIV treatment

via Bay Area Reporter, by Liz Highleyman

To coincide with World AIDS Day, the U.S. Department of Health and Human Services and World Health Organization both released revised guidelines calling for earlier initiation of antiretroviral therapy (ART) for HIV.

The updated DHHS "Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents," issued December 1, raise the CD4 T-cell threshold for starting treatment from 350 to 500 cells/mm3.

The revision also adds the first integrase inhibitor, raltegravir (Isentress), as a "preferred" drug for first-line therapy. Efavirenz (Sustiva), ritonavir-boosted atazanavir (Reyataz), and boosted darunavir (Prezista) are the other three preferred options – all used with tenofovir plus emtricitabine (the drugs in the Truvada combination pill) – while lopinavir/ritonavir (Kaletra) has been demoted to an "alternative."

Read the rest.

Why Rectal Douches May Be Acceptable Rectal-Microbicide Delivery Vehicles for Men Who Have Sex With Men

Abstract via Sexually Transmitted Diseases

Carballo-Diéguez, Alex PHD; Bauermeister, José PHD; Ventuneac, Ana PHD; Dolezal, Curtis PHD; Mayer, Kenneth MD

Rationale: To explore age of onset of rectal douching among men who have sex with men (MSM) and reasons leading to and maintaining douching behavior; and to consider whether rectal douches containing microbicidal agents might be acceptable for men at HIV risk.

Methods: In stage 1, we used qualitative methods to explore douching behavior in a sample of 20 MSM. Subsequently, we developed a structured questionnaire that was administered in stage 2 to 105 MSM.

Results: More than half of participants who completed stage 1 douched during the trial despite having been advised not to do so. Of the 105 human immunodeficiency virus uninfected participants in stage 2, 51% reported using rectal douches in the prior 6 months; 47% douched before and 25% after anal intercourse. Most participants reported douching frequently or always. On average, men reported douching about 2 hours before or 1 hour following intercourse. Average age of onset was late 20s. Most men who douched wanted to be clean or were encouraged to douche by their partners. Some men thought douching after sex could prevent sexually transmitted infections.

Conclusion: Rectal douching appears to be a popular behavior among men who have receptive anal intercourse. It is necessary to identify harmless douches. If human immunodeficiency virus or sexually transmitted infections preventive douches can be developed, rectal douching before or following sexual intercourse could become an important additional prevention tool. To reshape an existing behavior to which some men strongly adhere, like douching, by suggesting use of 1 type of douche over another may be more successful than trying to convince MSM to engage in behaviors they never practiced before or those they resist (e.g., condom use).

(C) Copyright 2009 American Sexually Transmitted Diseases Association

IRMA Member Testifies to Obama's AIDS Czar on Rectal Microbicides

Yesterday, on December 3, 2009, Bob Bucklew, Outreach Coordinator for the Cleveland AIDS Clinical Trials Unit and proud IRMA member gave the following testimony to the U.S. Office of National AIDS Policy. He spoke with regard to the National HIV/AIDS Strategy being being developed in the United States. In his allotted 90 seconds, which you can find below, he discussed anal sex and rectal microbicides. 

Way to speak rectal truth to power Bob! You are an inspiration to us all!

I would like to thank the Office of National AIDS Policy for coming to Ohio to hear what we have to say.  I must admit that I am coming to this hearing with a good deal of skepticism.  The history of governmental policy in reaction to the AIDS epidemic has been primarily judgmental of those most at risk for HIV infection, counter to scientific research, and often simply mean-spirited.  

If we are finally to have a National AIDS Policy, one which will actually make an impact, I believe these things must be included: 

The first is the need for universal access to needle exchange programs.The federal ban on needle exchange programs must be lifted immediately.   As people should not be placed at higher risk in red states than blue states, the federal government should insist that states alter their laws to permit needle exchange programs.  

The second is the nonjudgmental acceptance that anal sex is a common, quite natural and normal sex act between two people.   Repeal the ban on federal funding for effective prevention materials for men who have sex with men.    

Increase the priority and funding for the development of rectal microbicides.  Rectal microbicides should no longer be treated simply as an adjunct to the development of vaginal microbicides.  The development of new HIV prevention tools for anal sex is a goal that can stand alone.

Background:

Throughout this fall, the Office of National AIDS Policy has been hosting town hall community discussions in cities throughout the U.S. to provide opportunities for individual citizens to provide White House staff and other policy makers with their recommendations for achieving the President’s three goals for the National HIV/AIDS Strategy: 1) Reducing HIV incidence; 2) Increasing access to care and optimizing health outcomes; and 3) Reducing HIV-related health disparities.  The administration has been hearing from consumers, advocates, providers, and community members in Ohio and scheduled a Town Hall Meeting on Thursday, December 3, 2009 in Cleveland.

HIV-positive men at high risk for anal cancer

via EDGE Boston, by Matthew S. Bajko

Cancer researchers have found that since the introduction of highly active antiretroviral therapy HIV-positive men’s chances of having human papillomavirus (HPV) related anal cancers have increased. Yet many are not only unaware of their heightened risk but also do not know to seek HPV screening.

The lack of attention paid to HPV infections among HIVers has led to an incidence rate of anal cancer among HIV-positive men that now exceeds the highest incidence of cervical cancer among women reported anywhere in the world, recent studies have found.

"The incidence of human papillomavirus-associated anal cancer is unacceptably high among HIV-positive men who have sex with men, and possibly in HIV-positive women. Unlike most other malignancies occurring in the HIV-positive population, anal cancer is potentially preventable, using methods similar to those used to prevent cervical cancer in women," wrote Dr. Joel M. Palefsky, the co-leader of the cancer and immunity program at the Helen Diller Family Comprehensive Cancer Center at the University of California, San Francisco, in an article this year in the medical journal Current Opinion in Oncology. "The high incidence of anal cancer among HIV-positive individuals must not be ignored, since it may be preventable."

Read the rest.

Are We Bored with AIDS?

I hate to be a scold, especially when I'm as curious as the next guy about Tiger Woods' alleged girlfriend. Still, when we're done with all the gawking, can we take a moment for something more important?

Via NPR, by Harold Pollack

Almost six thousand people died of AIDS Monday. An even greater number became HIV-infected, though most of these men and women won't know this for months or even years. As far as we know, Monday wasn't any better or worse than any other day in this regard. That it happened to be World AIDS Day was almost incidental.

AIDS was certainly incidental to much of the mainstream media. Scanning the nation's three leading national newspapers, HIV and AIDS were virtually absent from the front pages. The health sections included some good stuff, including one story about South Africa's decision to treat all children living with HIV; that was pretty much it in the area of AIDS. There was apparently no room for further AIDS stories, though there was ample space for stories about how loneliness may spread from person to person, how venting at the office is good for your heart, and more. I saw some good reporting on health reform. Not one of these stories examined how the 2009 reforms might address HIV/AIDS. I'm not sure I have seen any such story this entire year. The rest of the paper included other stories. Some concerned Afghanistan. Many involved a golf club wielded by Mrs. Tiger Woods.

Read the rest.

Sunil Pant: Nepal's rainbow revolutionary

via Fridae.com, by Nigel Collett

Fridae.com’s Hong Kong correspondent, Nigel Collett, talks to Sunil Babu Pant, MP, founder of Nepal’s Blue Diamond Society and pioneer of the development of Nepal’s new human rights.

Quietly, unobtrusively, there’s been a revolution going on up in the Himalayas. It’s not the political turmoil that has engulfed Nepal repeatedly over the last decades of which I write, but a more astonishing social upheaval. Coming back from trekking in the hills of West Nepal, I sought out Sunil Babu Pant, MP, the man almost single-handedly behind this, and over tea at the Shangri-la Hotel in Kathmandu he spoke to me about his life and his successful struggle to bring change to what outsiders have traditionally regarded as one of the most conservative places in Asia.

Let me place his amazing work in some context with a few words about Nepal’s attitudes to diversity to illustrate where Nepal was before he started work only eight years ago in 2001. Sex, gender and sexuality were not something politely discussed in those days. Despite a very tolerant attitude to the sexual act itself, everyone got married and was expected to produce an heir. There was nothing approaching any recognition of the west’s current rigid differentiations of gay and straight and certainly no identifiable gay lifestyle. Instead, there was a much more traditional acceptance of a third gender of men who adopted women’s dress and who, in accordance with Hindu tradition, danced and sang at weddings, births and festivals to bring good fortune and to entertain. These could be either castrated hijeras, as in India, or uncastrated men from hill tribes, marunis in the hills of the west, notwas among the peoples of the plains, or metis in the hills of the east.

The traditions behind these stretch back for aeons; Hindu texts some 6,000 years old mention ‘persons of the third nature’. Alongside all these existed a fascinating custom of ritualised friendship called mit, in which men, though usually wed to women in traditionally arranged marriages, were able to choose a male life partner and to undergo a ceremony to mark their relationship, after which they shared most things in their lives, including a bed. These relationships were formally recognised by the families of both sides and brought honour, not disrespect, to all.

As a result, Nepal, despite the fact that exposure to western religious-based ethical systems has tended to submerge open discussion of local culture, has always had a more pragmatic view of human gender and sexual orientation than most of us would have supposed.

Read the rest.

Related:

Nepal MP offers honeymoon package to gay Indian prince via the Times of India

World AIDS Day and Rectal Microbicides in the Media

Rectal microbicides were mentioned several times in the news yesterday in conjunction with World AIDS Day. Here are a couple of  items that caught our eye - a rectal sampler as it were.

Statement from the National Institutes of Health on World AIDS Day 2009 

Excerpt:

The National Institute of Allergy and Infectious Diseases (NIAID) accounts for approximately half of AIDS-related spending at NIH. NIAID Director Anthony S. Fauci, M.D., notes that "despite the many advances against HIV/AIDS, much remains to be accomplished. In particular, we urgently need improved prevention strategies and a cure for HIV infection, and NIH is funding hundreds of studies to achieve these goals."

For example, numerous studies are under way to test topical microbicides — creams, gels or other substances for application to the vagina or rectal mucosa to prevent HIV infection. Clinical trials are also testing the efficacy of pre-exposure prophylaxis (PrEP), a daily regimen of one or two antiretroviral drugs that is designed to prevent infection in uninfected individuals who are at high risk for the virus. NIH also plans to test the feasibility of a potential HIV prevention strategy known as test and treat that involves community-wide HIV testing and immediate treatment for people found to be infected.

A vaccine against HIV remains a key NIH priority. The HIV vaccine field recently was encouraged by data from a large clinical trial in Thailand in which a two-stage HIV vaccine regimen demonstrated the first signal from any human study that a protective vaccine for HIV may be possible.

Read it all.

A Different Longtime Companion: Reflections on World AIDS Day 2009

Dr. David Fawcett's blog

Excerpt:

We need to remain vigilant about AIDS. We need to advocate for new treatment alternatives like rectal microbicides and redesigned prevention efforts. We need to remain informed and fight complacency. We need to end the stigma that surrounds AIDS to this day, undermining both prevention and treatment. Mostly, on this World AIDS Day, we need to remember the pain, the lessons, the courage, and the successes of the past and use them to renew and reenergize our continued work to end AIDS once and for all.

Read it all.

Do men who have sex with men use serosorting with casual partners in France?

Do men who have sex with men use serosorting with casual partners in France? Results of a nationwide survey 

Abstract:

We examined whether men who have sex with men (MSM) in France have adopted serosorting with their casual partners, serosorting being one strategy to reduce the risk of HIV transmission. We expected to see the same predictors of this practice with casual partners in France as in other similar MSM communities (HIV-seropositive, Internet dating). Data from a cross-sectional survey was used, based on a self-administered questionnaire conducted among readers of the gay press and users of gay websites in 2004. The study population consisted of MSM who reported their HIV status, as well as the practice of unprotected anal intercourse (UAI) with a casual partner at least once during the previous 12 months. Among 881 respondents included in the analysis, 195 (22%) had practiced serosorting: 14% among HIV-seropositive men and 26% among HIV-seronegative men. Serosorting was independently associated with the use of cruising venues (AOR 0.28, p=0.001) and Internet dating (AOR 2.16, p=0.051) among HIV-seropositive men, whereas it was independently associated with the use of cruising venues (AOR 0.59, p=0.013) and the fact of having less partners (AOR 1.50, p=0.046) among HIV-seronegative men. Serosorting requires an up-to-date knowledge of HIV serostatus for MSM and their UAI casual partners, and does not prevent from acquiring other sexually transmitted infections. Prevention campaigns are needed to underline the risks associated with serosorting.

Read the entire article.

Married people practicing homosexuality in Malawi says official

Malawi laws, which outlaw sexual intercourse between people of the same sex, contravene the nation’s constitution and international conventions that guarantee equality and non-discrimination based on sexual orientation.

via NYASA Times - Malawi

Secretary to the Office of the President, responsible for HIV/AIDS and Nutrition, Dr. Mary Shaba, has said homosexuality is practiced in Malawi by mostly married people who have “wives and children”.

Shaba was speaking on Capital Radio’s Straight Talk programme on Tuesday evening.

Radio host, Brian Banda who poses no hold-barred questions, asked Shaba if homosexuality exists in the country and what impact it has to HIV/Aids.

Read the rest.

World AIDS Day is Every Day

With about 2.7 million annual HIV infections across the globe - around 7,000 per day - every day is World AIDS Day. Yesterday was, and tomorrow will be. Just as much as December 1 is today.

IRMA works today, and everyday, to make new HIV prevention technologies like rectal and vaginal microbicides, PrEP and vaccines a reality - to help end the pandemic.

Please join us.