Wednesday, August 11, 2010

New City, Real Job, Same Old IRMA Advocate

by Becca Cadoff
Hi, my name is Becca and I’m a Rectal Microbicide Advocate.

Wait, no, that’s not the right way to introduce myself at my new job… I was on the train to the first day of my new job, thinking about the best way to introduce myself to my new co-workers…

After graduating from Northwestern University in Evanston, IL, I moved to New York to work for a civil rights litigation organization.  But growing up in a bubble-town in New Jersey left me naïve, but working in Chicago at an AIDS advocacy organization during college opened my eyes to a host of problems with our communities.  I’m no longer the bright-eyed girl from a preppy east coast town, but a college educated graduate, well-versed in some of the most difficult problems facing the world.  So, with all of that, how do I convey my experiences and who I am at my core without talking about my internship at the AIDS Foundation of Chicago?  Without talking about IRMA?  Without talking about rectal microbicides?  I really didn’t know…

When I started my AFC/IRMA internship in January, I was passionate about HIV care, treatment, and prevention, but I knew close to nothing about microbicides, much less rectal microbicides.  I knew that risk of infection via anal sex was higher than via vaginal sex, but I couldn’t really tell you why.  I knew that lubricant use was important in anal sex, but I didn’t know that some lubricants may actual be harmful to the anal canal.  I knew that some people were having anal sex – all over the world and all types of couples – and I knew that other people were afraid of anal sex, but I didn’t know that the people who were afraid (and ignorant) were actually making anal sex more potentially dangerous for those who were having it. 

Engage your friend, family, coworkers in a conversation about how important it is to continue research on rectal microbicides and other types of HIV prevention.

Before my internship, I was interested in HIV prevention, but I knew a lot about behavior modification and only a little about other ways to prevent new HIV infections.  My senior thesis proposal focused on condom negotiation, and asked whether women with better condom negotiation skills could lower their risk of infection, and help teach other women how to more effectively get their partners to use condoms.  But I slowly realized that the results of my study would not be of use until eons from now.  Even once the data had been collected, it would have taken years to develop a program to integrate the results, and much more time after that for women to actually bring their new condom-negotiation skills into the bedroom.  Yes, behavior change can be effective, but if you ask anyone who has ever tried to diet, it takes a really long time and, to put it plainly, it is just so freaking hard!  Without careful monitoring, encouragement, and focus, it’s all too easy for one cookie to turn into a whole cake, and for one instance of unprotected sex to turn into night after night of high risk for HIV infection. 

So why spend time on trying to change individuals’ behavior when it is possible to develop ways to protect people within the constraints of their normal behavior?  Look at this: We know that many women take a daily birth control pill.  So what about a daily pill that a woman could take WITH her birth control that would also prevent HIV?  She doesn’t have to set a different alarm, or remember to do something else.  (A man could easily take the same pill, and there are many trials of this method – called PrEP – going on throughout the world.  Women are just better for this example because so many already take oral contraceptive pills and thus adding a pill wouldn’t change their daily routines.) 

Just like we know thousands of women take the Pill, we know that many of the thousands of individuals worldwide who engage in anal intercourse use lubricant, or clean out the rectum before sex.  Adding some kind of HIV fighting agent to the products that are already widely used turns regular lube into a microbicide.  It also means that we only have to convince people to use a different but very similar product, not to change their routine all together.  A miniscule effort compared to a total behavior 180.  It’s much more effective to get lube-users to switch to microbicides than to put condom use where condom use doesn’t already exist. 

But don’t worry, I’m not done with behavior modifications as a method of HIV prevention.  For some people, it can work - so we should stick with it!  But we need to protect EVERYONE from HIV infection, not just the people who are able to change their daily activities.  We desperately need to develop a more comprehensive toolkit that we can use to complement the behavior modification, and the condoms, and the PEP, and all the other methods of HIV prevention that are floating out there.  And the best way to get this toolkit full is to ask donors to fund the research, scientists to do the research, and everyone else to make sure that rectal microbicides become a reality.    

That’s where I – and you – come in as an advocate.  Advocacy is so very unbelievably important.  And it can be really easy too: read one article on microbicides every day, and tell someone what you read.  Engage your friend, family, coworkers in a conversation about how important it is to continue research on rectal microbicides and other types of HIV prevention.  Spreading the knowledge makes a big difference.  I’m sure you’ve heard never to underestimate the power of stupid people in large groups.  What about the power of informed, knowledgeable people in large groups?  I’d say if the analogy holds, things look good on our end.  Rectal microbicides aren’t too distant a reality if we really make an effort to ask for them. 

Hm, so maybe I should take my own advice and tell my co-workers about rectal microbicides.  In that case, I guess “Hi, my name is Becca and I’m a Rectal Microbicide Advocate” isn’t such a bad introduction after all!

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