Why the Porn Industry's HIV Problem is Our Problem, Too

From the Huffington Post, by Kellee Terrell

For the past two weeks, the media has been buzzing about the adult film performer in California who tested positive for HIV. The actor, inappropriately dubbed "Patient Zero," has been identified as a male actor who worked in both gay and straight porn, which appears to be a rarity with male performers. This discovery has prompted four studios, including Vivid Entertainment and Hustler Video, to shut down production while they test anyone who has had unprotected sex with him. As of yet, no one has tested positive, but given that it can take up to 90 days to seroconvert, retesting will most likely happen in the near future.

HIV infections in the porn industry are not a new phenomenon. While getting testing is voluntary, some studios require that their actors must be tested every 30 days and have documentation from the Adult Industry Medical Healthcare Foundation that they do not have HIV or any other STDs. But clearly, this method isn't fool proof, especially if the actor has had unprotected sex in between tests. In 2004, Darren James, who was unaware of his HIV status, unknowingly infected three other actresses. Twenty-two performers are reported to have tested positive for HIV since James, including a female performer who tested positive last year.

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MTV Drama Raising HIV Awareness in Africa

From CNN, by Tom Hayes

"It's the story of morning afters and sweet departures...and the stains we leave on each other." -From the trailer of Shuga, a cutting-edge MTV drama that's been a smash hit in Africa.

For many young Africans, the three-part TV series about a group of students in Nairobi living under the constant specter of HIV/AIDS is the story of their own lives -- and is the reason "Shuga" took the continent by storm when it debuted late last year.

Actress Sharon Olago, who played promiscuous party girl Violet in "Shuga," believes the Kenyan show has been so successful because it mirrors the complexities of modern young life, without falling into a moralistic, conventional narrative on safe sex.

"'Shuga' did not exaggerate anything, it relived what Kenya is," says Olago. "That is why it got the fame it did, that is why people jumped into it, because people saw themselves in it."

Set and filmed on location in Nairobi, the soap opera came about after UNICEF teamed up with MTV to create a health campaign to impact the lives of youths in Kenya, where an estimated 6.5 percent of its population lives with HIV.

Read the rest and watch a clip

Venezuela to Guarantee Access to HIV Medications, Says Health Ministry

From Venezuela Analysis, by James Suggett

Starting next year, the Venezuelan government will guarantee antiretroviral medication to people with HIV, and will expand the use of a Cuban-made medicine to treat diabetic foot ulcers nation-wide, according to recent announcements by the Venezuelan Health Ministry.

Venezuela’s HIV-positive patients “will have their treatment guaranteed next year; we have made preparations to acquire the medicines and cover the whole population free of charge,” said Venezuelan Health Minister Eugenia Sader in an interview with the state television station VTV last week.

Also this month, Venezuela participated in a meeting of Latin American Parliament representatives in Panama to discuss public policy on the prevention and treatment of HIV and AIDS. The meeting was sponsored by the United Nations Development Program.

Venezuela does not have a law governing HIV and AIDS policy, but the National Assembly is discussing the possibility of incorporating articles on the diseases, including treatment for HIV- positive prisoners, into the nation’s Health Law, according to Legislator Marelis Pérez, who participated in the Panama meeting.

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Cheeky! IRMA Chair Chats Up Microbicides, Lube Safety, and No Promo Homo

Rapid HIV testing: Australia's 'big embarrassment'
via SX and CityVoice (Sydney), by Brendan Bolger

...Anal sex could be playing an important role in (heterosexual) HIV transmission. Vulnerable women have unprotected anal sex. Anal sex is used as contraception...

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Adherence Key to Reducing Genital HIV Levels in Women

From aidsmap, by Michael Carter

Sub-optimal adherence to antiretroviral therapy is the single most important factor associated with genital shedding of HIV in women, investigators report in the online edition of the Journal of Infectious Diseases.

‘This is the largest prospective study of female genital HIV-1 shedding after ART [antiretroviral therapy] initiation that has been conducted to date”, comment the investigators, “adherence was the most important determinant of genital shedding during the women’s first 6 months of NNRTI-based ART and remained a significant predictor after adjustment for plasma viral load.”

Antiretroviral therapy lowers viral load in the blood and other bodily fluids, including genital secretions. Lower genital levels of HIV have been associated with a reduced risk of sexual transmission of the virus and there is currently significant interest in the use of antiretroviral treatment as a method of HIV prevention.

However, it is known that women taking HIV treatment may occasionally shed HIV in their genital fluids.

An international team of investigators wanted to see which factors were associated with this.In particular they wanted to find out whether factors associated with viral shedding in women not receiving treatment - such as infections - remained the most important predictors of viral shedding in women receiving antiretroviral treatment.

They therefore designed a study involving 102 Kenyan women starting antiretroviral therapy. Every three months, viral load was monitored in blood, cervical fluids, and vaginal secretions.

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Read the full article

Laws Driving HIV Prevention Underground

from iRIN News


In a region where carrying a condom has been construed as evidence of illicit activity, 10 million women sell sex to 75 million men, who then have sex with another 50 million people, according to the multinational Independent Commission on AIDS in Asia. 

"The technology is there to prevent infections, but punitive laws get in the way," said Steve Kraus, regional director of UNAIDS Asia Pacific. 

Asia's AIDS epidemic is linked primarily to unprotected paid sex, according to the commission, but policies outlawing sex work are undermining HIV/AIDS prevention efforts by fragmenting and stigmatizing the sex workers and turning condom possession into an act that could lead to jail time, NGO officials say. 

Until recently, Cambodia was praised by the international community for its implementation of the 100 percent Condom Use Programme, which allowed for selective enforcement of anti-sex work laws and required condom availability and use for sex workers. But a national anti-trafficking law introduced in 2008 broadly criminalized sex work, and sent sex workers into hiding.


Read the rest

Read a report from Human Rights Watch on the subject

Is Homophobia a Factor in the HIV Racial Gap?

from Reuters, by Amy Norton

Among gay men in the United States, blacks are more likely than whites to believe that homosexuality is "wrong" - and these feelings might be contributing to the black men's higher risk of HIV infection, researchers suggest.

According to the U.S. Centers for Disease Control and Prevention, in 2006 African-Americans accounted for nearly half (45%) of new infections in the 50 states and the District of Columbia. Also, according to recent estimates, they account for a disproportionate 24 percent of reported HIV cases among gay and bisexual men in the U.S. The reasons are not clear. Studies have not found a higher rate of risky sexual behavior among black men versus white men -- but a range of factors are likely at work.

The current study was an attempt to look at one possible social factor: the stigma attached to homosexuality.

Using data from a U.S. health survey conducted periodically since 1972, the researchers found that, in general, African-Americans were more likely than whites to report a negative attitude toward homosexuality.

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FDA to Fast Track 1% Tenofovir (Press Release)

Press Release from CONRAD

October 25, 2010, Arlington, VA - - The U.S. Food and Drug Administration (FDA) held an end-of-Phase II meeting to determine the next steps required for U.S. licensure of 1% tenofovir gel, a microbicide product recently found to be effective at  reducing the rate of HIV and herpes infection in women when used before and after sex.

The meeting, held on October 20, 2010, was requested by CONRAD, a division of the Eastern Virginia Medical School in Norfolk, VA. CONRAD was one of the partners in the Phase II study, “CAPRISA 004,” which evaluated 1% tenofovir gel in prevention of male-to-female HIV transmission in 889 women in South Africa. USAID provided funding for the trial, conducted by the Centre for Programme Research for AIDS in South Africa and U.S. based FHI, which was the first study to show that a vaginal gel can reduce the risk of HIV and herpes infection in women. CONRAD manufactured and provided the tenofovir gel for the study.

Tenofovir gel was found to be 39% effective in reducing a woman’s risk of becoming infected with HIV during sex and 51% effective in preventing genital herpes infections in the women participating in the trial. Results of the CAPRISA 004 clinical trial were reported in July 2010 and represent the first “proof of concept” for a vaginal microbicide.

A number of key stakeholders contributed to the collaborative meeting with the FDA, including representatives from the U.S. National Institutes of Health, the U.S. Agency for International Development, Gilead Sciences, Microbicides Trial Network (MTN), South African clinical investigators, the International Partnership for Microbicides (IPM) and FHI.

During the meeting, the FDA stated their preference for two well-controlled studies to verify the safety and efficacy of 1% tenofovir gel prior to submission of a New Drug Application (NDA). The FDA furthermore stated that the NIH-sponsored Phase IIB study, MTN-003, known as VOICE (Vaginal and Oral Interventions to Control the Epidemic), represents a second adequate and well-controlled study that would, if successful, serve as the second pivotal trial together with CAPRISA 004 to support the submission of an NDA for 1% tenofovir gel.

In addition, the FDA has granted Fast Track approval designation for 1% tenofovir gel, which facilitates the development and expedites the review of drugs that are intended for treating serious diseases and fill an unmet medical need. With Fast Track designation, an NDA can be submitted as a “rolling review”, which allows a clinical trial sponsor to submit completed sections of its NDA for review by the FDA, rather than waiting until every section of the application is completed before the entire application can be reviewed.

The agency agreed that the current preclinical program for 1% tenofovir gel is sufficient to support a future NDA. However, they stated that additional safety data on adolescents would be needed and that information on in vivo drug interaction studies with commonly used vaginal products should be obtained. Also, the FDA will ultimately need data on post menopausal women. It was also agreed that a future meeting with the FDA would be held to address any outstanding discussions associated with product quality, including chemistry, manufacturing and controls (CMC). Since much of the clinical work on 1% tenofovir gel has been and will be conducted in South Africa, FDA officials indicated that they can work through the FDA’s “Office of International Programs” with the goal of coordinating the data and review processes with the South African Medicines Control Council.

CONRAD and its partners appreciate the contributions and detailed recommendations put forth by the FDA, which have helped clarify the next steps required for testing and licensure of 1% tenofovir gel.

In 2006, CONRAD and IPM obtained a co-exclusive, royalty-free license from Gilead Sciences to develop 1% tenofovir gel as a topical microbicide for use by women in developing countries to prevent HIV.

Dignity Denied: Violation of the Rights of HIV-Positive Women

From the Center for Reproductive Rights

More women than ever before are living with HIV around the world, and too many of them suffer cruel reproductive rights violations. The Center's newest fact-finding report, Dignity Denied: Violations of the Rights of HIV-Positive Women in Chilean Health Facilities, reveals the extent of the problem through the stories of 27 HIV-positive women in Chile.

As our report makes clear, Chilean women living with HIV are routinely denied care, verbally abused, given misleading or inaccurate health information, and pressured to agree to sterilization—or sterilized without their consent. Of the sixteen women we interviewed who were sterilized, only four said that they made a fully informed and voluntary choice to have the procedure.

Their testimonies echo that of our client Francisca*, an HIV-positive Chilean woman who was sterilized without her consent during a Cesarean section. The Center and our Chilean partner Vivo Positivo filed a case on behalf of Francisca, F.S. v. Chile, at the Inter-American Commission on Human Rights in February 2009.

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Read the full report

Via IPS Kenya: "More Men Preventing HIV Transmission to their Unborn Children"

From IPS, by Isaiah Esipisu

Pastor Joseph Muhembeli and his wife, Beatrice, queue at the Vihiga health centre with their six-month-old daughter for their prevention of mother-to-child treatment (PMTCT). But before long, as per the clinic’s policy, the couple are whisked to the front of the line – all because Muhembeli has accompanied his wife for the treatment.

The couple tested HIV-positive four years ago. But thanks to the Muhembeli’s involvement with the PMTCT programme, their six-month-old daughter has tested HIV-negative.

"For two years now, we have been encouraging male participation in the prevention of mother-to-child treatment of HIV. And that is why we give special treatment to all men who accompany their wives to either pre- or postnatal clinics," said Martha Opisa, the nurse in charge at the health centre.

Opisa said the Vihiga health centre used to receive about 40 clients a month seeking PMTCT services before men got actively involved in the pre- and postnatal clinics. "But now we now receive between 60 and 70 clients per month, almost doubling the original figure," she said.

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Report from the Front Lines

This week IRMA's own, Jim Pickett, spoke about the National HIV/AIDS strategy, gay men and, of course, microbicides on Late Night Live, an Aussie radio program with Phillip Adams.

He was joined by Alan Whiteside, the Director of Health Economics and HIV Research Division at the University of KwaZulu Natal, Durban, South Africa and Bill Bowtell, Director of the HIV AIDS Project at the Lowy Institute.

Listen to the program here

Jim Pickett speaks at the Australasian HIV/AIDS Conference 2010

Today AFC Advocacy Director Jim Pickett gave a plenary presentation at the Australasian HIV/AIDS Conference 2010 in Sydney, Australia. His talk, “Yes, There is a Gay Agenda: The need to re-conceptualize HIV prevention in the epidemic’s third decade” was part of the session titled “Re-Thinking Prevention.”

Pickett discussed HIV prevention in the United States context and provided insights into the U.S. Gay Men’s Health Agenda, Chicago’s “How are you healthy?” campaign, the U.S. National HIV/AIDS Strategy, sexual health, and biomedical prevention. Click here to view his slide set.

Yesterday Pickett co-chaired a symposium called “Political, Cultural, and Logistic Realities of Microbicides for Australasia and the Pacific” and sat on a number of panels discussing STI prevention and gay men’s health.

Read more about the Australasian HIV/AIDS Conference 2010 and invited speakers.

No condom use after recent viral load test safer than intermittent condom use

From aidsmap, by Roger Peabody

In stable gay couples, where one partner is taking HIV treatment and the other is HIV-negative, the risk of HIV transmission is relatively low if condoms are not used following a recent undetectable viral load test result. However, using condoms on a few more occasions but without reference to viral load substantially increases the risk of HIV transmission.  These are the findings of a mathematical modelling study, drawing on detailed data on viral loads in Dutch gay men, published online ahead of print in Sexually Transmitted Infections.

The model suggests that during the entire period that a first-line treatment regimen is taken, the risk of HIV transmission would be 1% if condoms are used all the time, 3% if condoms are not used after an undetectable viral load test in the past six months, 17% if condoms are used 30% of the time, and 22% if condoms are never used.

The model was designed to test the proposition put forward in the Swiss statement: that in long-term, serodiscordant couples, a decision to give up using condoms can be safely made as long as the HIV-positive partner is adhering to HIV treatment and has had an undetectable viral load for at least six months.

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Read the article in Sexually Transmitted Infections

'Hang them': Uganda paper publishes photos of gays

from The Washington Post, by Godfrey Olukya and Jason Straziuso

The front-page newspaper story featured a list of Uganda's 100 "top" homosexuals, with a bright yellow banner across it that read: "Hang Them." Alongside their photos were the men's names and addresses.

In the days since it was published, at least four gay Ugandans on the list have been attacked and many others are in hiding, according to rights activist Julian Onziema. One person named in the story had stones thrown at his house by neighbors.

A lawmaker in this conservative African country introduced a bill a year ago that would have imposed the death penalty for some homosexual acts and life in prison for others. An international uproar ensued, and the bill was quietly shelved.

But gays in Uganda say they have faced a year of harassment and attacks since the bill's introduction.

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Consortium assembled to design human trials of mosaic HIV vaccine

From EurekAlert.org

Duke University Medical Center vaccine experts have assembled an international team of investigators to design and implement the first human trial of a mosaic HIV vaccine candidate, a novel strategy that attempts to counter one of the most daunting challenges in HIV vaccine design: the virus's extensive genetic diversity.
Traditional HIV vaccines are designed to stimulate the body's immune system to recognize naturally occurring stretches of specific amino acids in the virus's proteins. In contrast, mosaic vaccines are composed of many sets of synthetic, computer-generated sequences of proteins that can prompt the immune system to respond to a wide variety of circulating HIV strains.
Such vaccines have already been studied in animals and have shown some success in enhancing the breadth of immune responses. Now, Barton Haynes, MD, director of the Duke Human Vaccine Institute and the Center for HIV/AIDS Vaccine Immunology (CHAVI), says a newly formed research coalition has begun designing an early phase safety trial to assess mosaic vaccines in humans. The trial will test the mosaic concept and could possibly lead to the next generation of HIV vaccine candidates.

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Studies Tout Alternative HIV Regimens for Women, Babies

From Bloomberg Businessweek, by Randy Dotinga

New research suggests that alternative drug regimens in poor countries could help HIV-infected mothers and their infants more effectively fight off the virus that causes AIDS.

Currently, doctors lower the risk of transmission of mother-to-baby HIV infection by giving a drug to mothers right before birth and to babies right after. About half of the babies avoid getting HIV, but mothers and babies who do get infected often develop resistance to the drug, which is typically given to them later in life.

Enter the alternatives. "We now have a very effective treatment for women who've taken a specific drug and for babies at risk," said Dr. Shahin Lockman, lead author of one of two studies about the regimens in the Oct. 14 issue of the New England Journal of Medicine.

There's a big hitch, however: the alternative regimens are much more expensive than the current drug regimen, although the study authors weren't able to give an estimate of the difference in costs between the regimens.

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Read the full articles in the New England Journal of Medicine

Sudan: Stigma Continues to Hold Back Darfur's HIV Fight

From All Africa

There are nine voluntary counselling and testing centres in the Sudanese state of South Darfur, but rather than risk being recognized at one of them, many people travel to a different state to seek HIV testng or treatment.

"My best friend is HIV-positive and every month travels to El-Fasher (capital of North Darfur) to get ARVs," a young tea seller living in Kalma camp for internally displaced people (IDPs), South Darfur, told IRIN/PlusNews. "She could get the drugs in Nyala (capital of South Darfur) but doesn't want people to know she is sick- she hasn't told anyone else but me."

"I don't blame her; she thinks she would be excluded by the entire community and family if she disclosed her status," she added.

In 2007 an association of people living with HIV was created in Nyala to encourage HIV-positive people to exchange experiences and take the lead in advocacy, but three years on, only 25 people are members.

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Ten Years Fighting HIV/AIDS and Reaching Out to Gays

From IPS News, by Dalia Acosta

Raul Regueiro remembers every detail about the creation, 10 years ago in Cuba, of the project for the prevention of HIV/AIDS among men who have sex with men, and the way the initiative crossed the boundaries of purely health-related concerns to address the question of social inclusion.

"Although homosexuality had been mentioned before, up to that point no work had been done with men," Regueiro told IPS. A co-founder of the project, Regueiro's idea is now applied in 14 provinces on the island and involves around 1,700 volunteer health outreach workers who act as direct links with Cuban communities.

"It was the first time the people most affected by HIV/AIDS participated in a programme that was focused on educating people and on other aspects as well," recalles Regueiro, who is now assistant to the United Nations Development Programme's (UNDP) programme to combat HIV in this Caribbean island nation.

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China Awaits Verdict in Precedent-Setting Case on HIV

From CNN

China awaits a verdict in a precedent-setting discrimination case, with an HIV-positive man suing over being rejected for a teaching job, state media said.

"I know my case may take a relatively long time, since it is believed to be the first case in China about discrimination against HIV carriers in the job market. But I will try to remain positive about my chance of winning," the job applicant said, according to China Daily.

He goes by the alias Xiao Wu to protect his identity in a country where HIV discrimination is widespread. The case making its way to court is notable, because China's legal system tends to avoid sensitive suits.

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Oprah Misses the Mark on HIV/AIDS

From the Huffington Post, by Kellee Terrell

Oprah Winfrey devoted the Oct. 7 episode of her talk show to HIV/AIDS. But instead of it being about anything substantial, eye-opening or educational, Oprah decided to focus on issues that distort the epidemic.

"Why She Sued Her Husband for 12 Million and Won" opened with beautiful, educated Bridget, who had met and married the love of her life. It was a fairytale-- until the day that, 10 years ago, she found out that she was HIV positive. Later, she learned that her husband was HIV positive, too. And that he had slept with men without using condoms. And that he was the one who had given her HIV. She later sued her husband for $12 million and won.

Yes, it's the "woman as innocent victim duped by the sinister gay down-low brother" narrative again.

To be clear, I don't want to belittle or devalue Bridget's experiences, because what happened to her is horrible. Putting your trust (and your health) in the hands of a spouse, only to be lied to and later diagnosed with HIV, is devastating. And I admit that it's hard to create and implement condom negotiation strategies geared for married women and women who believe they are in monogamous relationships.

But why does the down low continue to dominate most media stories about HIV in America, when study after study shows that closeted gay men having unprotected sex with both men and women is not fueling the epidemic?

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Reclaiming the Wronged Body

"I am not in a wrong body. I am in this body just like how you are in your body. I am not trapped by my body. I am trapped by your beliefs."

From a speech delivered by Ms. Sass Rogando Sasot to a Social Science 3 on Gender and Sexuality Class at the University of the Philippines-Dillman

The parade of nations of the 2009 Copenhagen Outgames had just finished. Naomi Fontanos, my friend and the current Chairwoman of STRAP, and I decided to skip the programme and to go back to our hostel to rest. Naomi, who served as the muse of the Philippine contingent, was wearing a traditional Filipino dress, while I was wearing a 50's dress.

While we were walking towards the train station we encountered two bulky tall guys. One of them approached us and casually asked me, "Why is your chest so flat?" Then they walked away laughing. I was stunned by his rudeness. Before I could say anything, Naomi stopped me, and said "Sassy, don't mind them! Assholes!" Scared, we ran towards the train station.

I understand that an explanation of our existence by some expert opinion can be our lifeline against the different forms of violence and discrimination wielded against us by those who are disturbed by our existence. There are different scientific and religious theories that have been offered to explain us. I find that all of them seep to revolve around that famous statement that "We were born in the wrong body" or its other form "Trapped in the wrong body."

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Beyond 2010: Gaps, Challenges and Priorities for the Future of PrEP

From AIDS Research and Human Retroviruses, by Veronese, Turpin and Feuer

A workshop entitled Beyond 2010: Gaps, Challenges, and Priorities for the Future of Preclinical HIV Pre-Exposure Prophylaxis (PrEP) was sponsored by the Division of AIDS (DAIDS) of the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), on October 20-21, 2009, in Bethesda, Maryland.

The objective of the workshop was to identify the main gaps in current knowledge, challenges, and priorities for the establishment of a PrEP preclinical pipeline and to also provide guidance for future directions of the field and DAIDS activities in this area. This 2-day workshop, through various presentations and breakout group discussions, specifically addressed four main topics that will be critical in identifying and advancing the next generation of PrEP candidates for clinical testing. The topics were (1) drug discovery, (2) pharmacokinetics (PK) and pharmacodynamics (PD), (3) animal models, and (4) delivery systems for prologed activity.

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Circumcision Gains in Popularity

From the Financial Times, by Andrew Jack

When a Muslim and a Jewish surgeon travel to KwaZulu Natal later this month to help local healthcare teams develop high-volume adult male circumcision programmes, they are expecting considerable interest. Operation Abraham, an Israel-based group, has tapped into the traditional experience of two faiths in circumcision to offer guidance in a region where the practice was long in abeyance but recently resumed. "Young men are proving very receptive," says Inon Schenker, who led a first training team in August dubbed Shesha (Zulu for swift), based on earlier pilot schemes in Swaziland.

South Africa has long been at the epicentre of the HIV epidemic, and a venue for innovation in tackling the disease. Now, the change in political leadership is allowing some of the findings to be put into practice, albeit more slowly than many advocates would like. Two decades after anecdotal and observational data highlighted lower HIV rates in circumcised men, it was in Orange Farm, near Johannesburg, that Bertran Auvert, a French researcher, conducted a systematic clinical trial proving that the procedure could reduce infection by 60 percent.

In South Africa's private sector, the findings soon began to have an impact. "As soon as we saw the data, we made sure adult male circumcision would become a funded benefit," says Jonathan Broomberg, head of Discovery Health, a large health insurance company that has also helped fund Shesha philanthropically. Yet if scientific, logistical, procedural and financial hurdles have helped explain the modest overall progress thus far in many countries, South Africa had a particular political challeng rooted in the ambivalence of Thabo Mbeki, the former president, towards tackling AIDS.

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NEW: Lube Safety Fact Sheet and QA for Advocates

IRMA urges more research on lube safety

After an extraordinary amount of work with IRMA's Lube Safety Working Group and members of the IRMA Steering Committee - led by IRMA Secretary Marc-André LeBlanc over the course of four months and many, many drafts - we are delighted to release two important documents to help you gain a better understanding of the safety issues around lubricants used for anal intercourse.

Many men, women and transgender people use lubricants (lubes) during sexual intercourse. Yet we know very little about their safety when used during anal intercourse (AI).

Very few studies have examined the effect of lubes on human rectal tissue, but those that did showed mixed results. Most water-based lubes tested in these studies were shown to be damaging to rectal tissue. However, some lubes were more damaging than others. Furthermore, in one study the use of lube for AI was associated with the presence of rectal sexually transmitted infection (STI).

Based on current evidence:

• More research is urgently needed to explore if there is a link between lube use and acquiring HIV and/or rectal STIs.
• It is unclear whether any particular type or brand of lube might increase, decrease or have no effect on acquiring HIV and/or rectal STIs.
• Using male or female condoms is still considered the best way to prevent acquiring HIV and STIs during AI. In addition, the use of condom-compatible lubes has been associated with a decreased risk of condoms breaking or slipping.
• It is not possible at this time to recommend for or against using lubes if having AI without condoms.
• Lube use on its own is not a proven method of HIV or STI prevention.

For more detailed information:

• Safety of lubricants for rectal use: A fact sheet for HIV educators and advocates (1-page)
• Safety of lubricants for rectal use: Questions & Answers for HIV educators and advocates (much more detail with research explained and citations)
• Read all blog posts on the topic of lubricants.
• Click here for an IRMA teleconference recording on lube safety (6/16.)

Testing African Couples for HIV is Cost-effective Prevention Strategy

From Emory University

As researchers and policy makers work toward an effective HIV vaccine in a constrained global economy, cost-effective prevention strategies such as Couples Voluntary Counseling and Testing (CVCT) must take a larger role in efforts to decrease the rates of HIV/AIDS in Africa, says Emory University HIV/AIDS vaccine researcher Susan Allen, MD, MPH. Allen presented her research on October 1 at the AIDS Vaccine 2010 international conference in Atlanta, sponsored by the Global HIV Vaccine Enterprise and locally hosted by the Emory Center for AIDS Research. Allen, who has worked to combat the AIDS epidemic in Africa for more than 25 years, highlighted the value of CVCT and other cost-effective HIV prevention strategies.

"The majority of new HIV infections are acquired from a spouse, and couples are the largest HIV risk group in Africa," says Allen, a professor of phathology and laboratory medicine in the Emory School of Medicine and adjunct faculty member in the Rollins School of Public Health. "By using CVCT to identify those people who do not share the same HIV status as their spouse or partner, we're in a better place to move forward efficiently and effectively once a vaccine does become available."

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TED: Mechai Viravaidya: How Mr. Condom made Thailand a better place

At TEDxChange, Thailand's "Mr. Condom," Mechai Viravaidya, walks us through the country's bold plan to raise its standard of living, starting in the 1970s. First step: population control. And that means a lot of frank, funny -- and very effective -- talk about condoms.

Since 1974, Mechai Viravaidya has been creating and running innovative family planning and poverty reduction programs throughout Southeast Asia.

Zambia: President Invites Four Ex-Presidents for AIDS Indaba

From the Times of Zambia

Four former heads of State and other high level African leaders who are the champions for a HIV/AIDS-free generation project are this month expected in the country for an accelerated meeting on response to the HIV epidemic. The champions are coming at the invitation of President Rupiah Banda and will meet Zambia's leaders from October 19 to 21 to share various regional experiences in response to HIV/AIDS.

National AIDS Council (NAC) spokesperson Justine Mwiinga said during a media breakfast that the champions would use the meeting to gain insight on progress and challenges towards the scaling up of HIV prevention initiatives in Zambia. He said the champions would further utilise the meeting to explore possible solutions to reduce new infections of HIV/AIDS. He said Zambia was still faced with six challenges in the fight against HIV/AIDS including low rate of condoms, low male circumcision and gender-based violence.

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International Rectal Microbicide Advocates cheers launch of world's third rectal microbicide trial

Calls for more funding to strengthen field

This brings us another step closer to the development of safe and effective rectal microbicides for use during anal intercourse.

The world's third rectal microbicide trial launched in Pittsburgh, Pennsylvania today, with sites preparing to open in Boston, Massachusetts, and Birmingham, Alabama soon. Scientists will test the rectal safety and acceptability of tenofovir gel, a microbicide developed for vaginal use that has shown promise for preventing HIV through vaginal intercourse. Depending on the outcome of this new study, tenofovir gel could be further evaluated to determine if it can reduce the risk of HIV among both men and women who engage in receptive anal intercourse.

"International Rectal Microbicide Advocates (IRMA) congratulates the Microbicide Trials Network and its partners on the launch of this very important study – the third Phase I trial in history to look at the safety and acceptability of a microbicide gel applied rectally," said Jim Pickett, IRMA Chair and Director of Advocacy at AIDS Foundation of Chicago. "This brings us another step closer to the development of safe and effective rectal microbicides for use during anal intercourse," he said.

Condoms are considered the gold standard for the prevention of HIV and STDs during sexual intercourse, but not all receptive partners are able or willing to use condoms every time. An act of anal intercourse that is not protected by a condom is 10 to 20 times more likely to result in HIV transmission compared to an act of unprotected vaginal intercourse, due to the fragility of the rectal lining and the large presence of cells targeted by HIV. New methods to protect against the sexual transmission of HIV are urgently needed. Strategies beyond condoms – such as vaccines, oral prevention, and microbicides – will provide individuals with more prevention options.

Microbicides – substances applied topically on the inside of the rectum or vagina – could potentially help prevent the transmission of HIV. The research and development of vaginal microbicide candidates is much more advanced than research on rectal microbicides. Tenofovir gel, for example, is a candidate microbicide specifically developed to prevent vaginal transmission of HIV. In a recent study known as CAPRISA 004, tenofovir gel was found to significantly reduce the risk of HIV among at-risk women who were instructed to use the gel before and after vaginal intercourse. In an ongoing, large-scale effectiveness trial called VOICE – Vaginal and Oral Interventions to Control the Epidemic – researchers from the U.S. National Institutes of Health-funded Microbicide Trials Network (MTN) are testing daily use of tenofovir gel in African women, with results expected in 2013.

This new Phase I rectal microbicide study, known as MTN-007, aims to determine if rectal use of tenofovir gel is safe, and in particular, does not cause cells in the rectum to become more vulnerable to HIV. Investigators will also ask trial participants questions regarding the gel's desirability. MTN-007 will enroll 60 men and women at the University of Pittsburgh, the University of Alabama at Birmingham, and Fenway Health in Boston. Leading the study is Ian McGowan, M.D., Ph.D., of the University of Pittsburgh, who is also co-principal investigator of the MTN and serves as Scientific Vice-Chair of IRMA.

Little is known about tenofovir gel used rectally, but science is advancing our understanding. Laboratory and animal studies involving rectal application of tenofovir gel have suggested it's safe for testing in humans. In fact, MTN researchers have just completed the first Phase I trial with eighteen participants, called RMP-02/MTN-006, in collaboration with the Microbicide Development Program at the University of California, Los Angeles. While results of RMP-02/MTN-006 are not expected until early 2011, researchers have already recommended modifications to the gel's formulation. MTN-007 is evaluating the new formulation, which still contains the same amount of active drug – 1% percent tenofovir – but has a lower concentration of glycerin (an additive found in many types of products) to make it more amenable for rectal use.

"It is very encouraging to see the rectal microbicide field moving forward," said IRMA Community Vice-Chair Kadiri Audu, who also heads up the IRMA Nigeria chapter, "and I look forward to trials taking place in Africa as well." He continued, "Gay men and other men who have sex with men in Africa have high rates of HIV infection, and we know unprotected heterosexual anal sex is relatively common on the continent and contributes a sizable number of HIV infections. As much as we need vaginal microbicides to give women an extra prevention tool, rectal microbicides for the women, men, and transgender individuals who engage in anal intercourse are absolutely essential as well."

While the rectal microbicide field has gained significant momentum, more focus and resources are necessary. In 2010, U.S. $7.2 million is being spent globally on rectal microbicide research. IRMA has calculated that annual investments must increase by 40% from 2011 – 2014, to U.S. $10 million/year and must increase further to U.S. $44 million (a six-fold increase) in the years 2015 – 2020 to ensure a minimum of candidate products are moving through the research pipeline into advanced testing for effectiveness.

Read the press release from the MTN:
Promising HIV prevention microbicide tenofovir gel being tested for safety of rectal use

Sphincter Riddles - why do women like anal sex?

The Riddle of the Sphincter
Why do women who have anal sex get more orgasms?
via Slate, by William Saletan


Last week, I tried to figure out why more women are having anal sex and why it correlates so highly with orgasms. Since 1992, the percentage of women aged 20-24 who say they've tried anal sex has doubled to 40 percent. The percentage of women aged 20-39 who say they've done it in the past year has doubled to more than 20 percent. And 94 percent of women who received anal sex in their last encounter said they reached orgasm—a higher rate of orgasm than was reported by women who had vaginal intercourse or received oral sex.

Why? For obvious reasons—anatomical, evolutionary, and aesthetic—anal sex should, on average, be less attractive and satisfying than vaginal or oral sex. In last week's column, based on new survey data, I inferred that female orgasms caused anal sex rather than the other way around. The other acts reported by women who engaged in anal sex—vaginal intercourse, cunnilingus, partnered masturbation—delivered the orgasms. In turn, these women indulged their male partners' requests for anal sex.

Well, shame on me. Not for talking about sodomy—that taboo seems to be fading fast—but for doubting that women love it. These women are now coming forward to affirm that they're into it for their own pleasure, thank you very much. And they aren't alone. Bloggers, blog readers, and Slate commenters are offering lots of other theories to explain the orgasm data.

Read the rest.

Positive Feedback from Anti-HIV Gel Research

From The Standard, by Kudzai Chimhangwa

The success of tests into the effectiveness of anti-HIV gels to be used by women before engaging in sex has presented Zimbabwe with another chance of further reducing the rapid transmission of the virus. According to various presentations made at a feedback workshop organised by the United Nations Population Fund (UNFPA) and the National Aids Council (NAC) on Friday, the research on the gels has brought a lot of hope. One of the gels is based on the anti-retroviral (ARV) drug Tenofovir and recent research carried out in South Africa showed that it reduces transmission of Aids to women if used before sex.

Read more

Prisoners To Get Condoms in Zimbabwe?

From NewsDay, by Owen Gagare

Inmates in Zimbabwe's filthy prisons could soon be receiving condoms while in incarceration to prevent the spread of HIV, NewsDay has established. According to proposals by the Ministry of Health and Child Welfare and World Health Organisation (WHO), prisoners could soon benefit from initiatives to curb the spread of the deadly scourge.

The director of the Aids and TB programme, Owen Mugurungi, told journalists attending a workshop whose theme was "Understanding multiple concurrent partnerships and male circumcision" in Kadoma that his ministry was working with the Justice ministry to address health challenges in the country's prisons. He said there had been realisation that there was rampant homosexuality in the penitentaries and upon release the likelihood to affect spouses and girlfriends was high.

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Congressmen Introduce Repealing Abstinence-Only-Until-Marriage Act

From AIDS Action

Senator Frank Lautenberg (D-NJ) and Representative Barbara Lee (D-CA) just introduced the Repealing Ineffective and Incomplete Abstinence-Only Program Funding Act. This legislation would end the Title V abstinence-only-until-marriage programs that have used $1.5 billion in Federal funding since 1996, and transfer that funding to the Personal Responsibility Education Program (PREP) state-grant program.

The proposed change comes amid growing statistical evidence that abstinence-only-until-marriage programs have done little to decrease STD transmission among youth and has been ineffectual at reducing teen-pregnancy. In fact, teen-pregnancy actually rose by 3% in 2006 for the first time in more than a decade. A 10-year government study released in 2007 found that programs funded by Title V abstinence-only-until-marriage did not delay sexual initiation among youth.

PREP-funded programs offer a conmprehensive approach to sex education that includes information on both abstinence and contraception for the prevention of unplanned youth pregnancies and STD and HIV transmission. Programs must also provide sessions that cover healthy relationships, adolescent development, financial literacy, educational and career success, and healthy life skills. Various studies have shown that programs administered within this type of framework have been effective at cutting down on unintended pregnancies and STD transmission because participating youth are more likely to use some form of contraception at first intercourse even though rates of sex stay the same.

Read more about the issue and find links to the studies mentioned above

Read Representative Lee's press release

Read Senator Lautenberg's press release

Meet Kami, the HIV-positive Muppet

From CNN

Big Bird and the Cookie Monster have som new friends, but they're a long way from "Sesame Street."

One of America's best-loved children's shows, which began life on a fictional New York street over 40 years ago, is about to land in Nigeria under the title of "Sesame Square" --bringing with it some distinctly West African twists.

The show stars Kami, a girl muppet whi is HIV-positive, has golden hair and a zest for adventure; and Kobi, an energetic, furry, blue muppet whose troublesome escapades help others learn from his mistakes.

Read the rest

MSM and Condom Use: Factors Associated With Not Using A Condom

From PLoS One, by Larmarange et al.

Men who have sex with other men (MSM) are a vulnerable population in Africa that has been insufficiently explored. Given the high rate of bisexuality among MSM (73% in the past year), it is important to understand their risk-taking behaviors regarding both men and women.

This socio-behavioral survey was carried out in 2007 and recruited 501 MSM. The study explored why a condom was not used during last sexual intercourse with men and with women, and considered risk factors including having sex in a public place, participation in an MSM prevention program, age, employment and education.

The study concludes that participation in a prevention program specifically targeting MSM is a major factor in prevention, but that these programs must also address heterosexual practices and the associated risks.

Read the article