IRMA - Rectal Microbicide Advocacy: The whirlwind of anal lubricant news

There has been a TON of press in the last day stemming from the Microbicides 2010 conference regarding two new studies on the safety of lubricants used for anal sex.

Below is IRMA's press release, an audio recording of the press conference where this information was presented to the media, and a number of good, non-hyperbolic stories.

Following that is a note from Marc-André LeBlanc:
IRMA Steering Committee Member and Chief Lubricant Safety Expert

Next is a synopsis from our new report regarding IRMA priorities and activities regarding lube safety, and finally, a selection of the media coverage on this topic.

Researchers Charlene Dezzutti and Pamina Gorbach at M2010 the press conference

IRMA Press Release - Research on lubricant safety very past due

M2010 press conference on lubricants and rectal sex - audio recording courtesy of Bobby Ramakant

Rectal lubricants may enhance the risk of STIs - Aidsmap,by Gus Cairns
Some Sexual Lubricants Linked to Increased Risk for Chlamydia, Gonorrhea, by Bob Roehr on Medscape
Lubricants' use may put individuals at higher risk of HIV - by Bobby Ramakant for Citizen News Service
Understanding New Research on Lubricant Use During Anal Intercourse, by Cory Silverberg for About.com

Dear IRMA members,

Imagine our excitement to see such an explosion of interest in lube safety!

As many of you know, this has been a core objective of IRMA's work for 5 years, and one of the reasons we formed at all. The whole idea behind the huge survey we launched in 2007 was to obtain data that would allow the field of lube safety research to move forward. We published the results of the survey -- to our knowledge the world's largest survey on anal sex and lubes with nearly 9,000 partiicpants in over 100 countries -- in our 2008 report Less Silence, More Science. And we are thrilled to report that the results have just been accepted for publication in a peer reviewed journal and should be available very soon. Watch this space!

We will send out a notice for an IRMA call very soon, where we will provide an overview of the studies announced at M2010 this week, provide background on research done so far, and discuss plan for future research. This will also provide all of us with an opportunity to discuss messaging in relation to rectal safety of lubes.

In the meantime, we will continue to share information as it becomes available. For instance, you can check IRMA's lovely new report From Promise to Product for some background information -- including section 2.11 for some background information on testing of lubes, and section 4.4 for a description of IRMA's work in this area. The two sections are copied below for your reference.

It is truly wonderful to be poised for true progress on this critical issue and we welcome everyone's thoughts and efforts!

Sincerely,

Marc-André LeBlanc
IRMA Steering Committee Member and Chief Lubricant Safety Expert

Excerpts from report

What do we know about the rectal safety of sexual lubricants?

In addition to the studies released at M2010, a few others have assessed the relative safety of sexual lubricants, though not always looking at rectal safety specifically. These studies looked at:

    * Using in vitro and mouse assays to determine cellular toxicity, increased risk of HSV-2 infection, and epithelial sloughing caused by lubricants
    * Testing the osmolarity of lubricants
    * Using slug mucosal irritation assays to evaluate mucosal irritation caused by lubricants

The question remains: what do all of these studies tell us? We’re not sure. We still don’t know what assays should be used to determine the rectal safety of lubricants. Furthermore, even when studies find a wide range of values for their safety markers, we still don’t know to what extent—if any—some of these markers might indicate a higher risk of HIV transmission.

Relatively high levels of cellular toxicity, mucosal irritation, cell damage caused by hyperosmolar or hypo-osmolar products, inflammation, or epithelial sloughing could in theory increase the risk of HIV infection. However, this remains to be proven.

It is important to keep in mind that:

    * Some level of inflammation and irritation occurs naturally in rectal mucosa, even among healthy individuals;
    * Anal intercourse itself, as well as enemas and douching, causes some transient damage; and
    * Rectal epithelium regenerates quickly after minor damage or sloughing.

We must be able to compare normal levels of inflammation, irritation, cell damage and epithelial sloughing that occur among healthy individuals and those that are a result of AI. The question then becomes: does AI with lubes cause increased levels, similar levels, or lower levels of these markers compared to AI without lubes? Even if we were to find that some lubes cause higher levels of disruption, we would still need to investigate whether this translates into a higher risk for HIV transmission.

These questions remain to be answered, and we are still left with little data that can be translated into useful information that the public can use to make choices about lubricants. One thing to consider: if lubricants increase the use of condoms, that is probably a more important factor in preventing HIV transmission than any potential risk from lubes. For the moment, the use of lubes compatible with condoms is still considered to be an important risk-reduction tool for rectal transmission of HIV, and is likely to remain so. One day we may have valuable information on the relative safety of different lubricants, allowing users to make better informed decisions about which products they use.

IRMA’s advocacy on the safety of lubricants used for anal sex

Many men and women use sexual lubricants during AI, yet we know very little about the relative safety of these lubes. Obtaining safety data on products used as sexual lubricants for anal sex would be valuable for public health reasons.

Accordingly, IRMA prioritises advocacy for data collection on the rectal safety of lubricants. Wholly absent in current HIV prevention activities, a translation of this type of data into useful information for users, funders, programme directors, and policy makers would be of significant benefit to the field. Lessons learned in this undertaking will also provide valuable insights into message development on the safety and efficacy of vaginal and rectal microbicides, when these products become available.

Due to the paucity of this type of information, IRMA launched a global web-based survey in 2007 (see an overview of the results from this survey in IRMA’s previous report: Less Silence, More Science: Advocacy to Make Rectal Microbicides a Reality). The survey provided valuable information on lube use, preferences, and acceptability among nearly 9,000 men and women from over 100 countries, establishing a prioritised list of the most widely-used lubes to test for rectal safety.

A working group comprised of advocates and researchers was convened by IRMA to discuss the feasibility of testing sexual lubricants for rectal safety. While the working group identified significant scientific challenges that remain unaddressed to this day, there has been some progress.

IRMA’s action on lubricant safety includes the following activities:

    * Encouraging researchers to test lubes for rectal safety and to share their findings;
    * Facilitating dialogue among leading researchers and advocates within the working group on rectal safety of lubricants;
    * Compiling articles and studies related to lube safety, particularly for rectal use, and maintaining an updated background document on this issue;
    * Making IRMA’s list of most widely-used lubes available to anyone interested in testing lubes; and
    * Keeping IRMA membership updated on developments in this area.

Here is just a SAMPLE of some of the news stories

generated on this issue -last updated July 5, 2010. Most recent coverage is at the bottom of the list.

IRMA - Rectal Microbicide Advocacy

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Thursday, May 27, 2010

The whirlwind of anal lubricant news - let's get a grip!

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