In Africa, Anal Sex Goes Hetero

by IRMA advocate Bisi Alimi (pictured in purple, with IRMA advocate Kadiri Audu at the recent Project ARM - Africa for Rectal Microbicides meeting held in Addis Ababa, Ethiopia.)

While I was in secondary school, I was always told that anal sex is something between two men. Many anti-gay activists have used this sexual practice as a means of attacking the gay movement. It is the core of the sodomy law in Africa and the buggery law in other part of the world.

However, recent studies have shown an increasing number of heterosexual people in Africa, mostly young people, are practising anal sex on a daily basis.
While the notion of sex in itself is a very difficult topic to tackle in the African setting, the mere fact that more and more straight couples in Africa are embarking on a rectal sexual journey for pleasure gives a call for concern – because most of this is unprotected by condoms. An act of unprotected anal intercourse is 10 to 20 times more likely to result in HIV transmission compared to an act of unprotected vaginal intercourse, due to the different biological characteristics of the rectum which make it much more susceptible to infection.

What do we know?

According to Morenike Ukpong, at IRMA’s recently concluded Project ARM - Africa for Rectal Microbicides strategic meeting in Addis Ababa held in advance of the 2011 ICASA, over 12% of young people in Nigeria are practising anal intercourse. In different studies done across Africa on the prevalence of anal sexual practice among heterosexuals, similar results were found.

An anonymous survey of 2,593 men and 1,818 women in Cape Town conducted by Kalichman et. al (2009) found out that 14% of men and 10% of women have engaged in anal sex in the last 3 months. Of this, only 67% of the men and only 50% of the women used condoms.

Rates among truck drivers in South Africa are also very high (Ramjee et. al 2002).

A recent study found that 42% of truck drivers are consistently engaging in anal intercourse with female sex workers. Not surprisingly, a high percentage of female sex workers reported ever having practiced anal intercourse. A recent study in Kenya reports 40% of female sex workers said they had practiced anal intercourse at least once (Schwandt et. all 2006).

This is not the end of revealing data. In Lane et. all (2006) , results showed that young people between the ages of 15-24 in South Africa engage in anal sexual behaviour. There is only a small difference between the sexes, with 5.5% of young males engaging in anal sexual behaviour and 5.3% of females.

More interesting is Matasha (1998). This study found that among primary school pupils in Tanzania, 9% had anal sex as their first sexual experience.

Taken together, these studies show that there is previously unknown frequent anal sexual behaviour among heterosexuals. However, the focus on anal sex and health for many years has been the limited to gay/MSM communities.

What are we getting wrong?

The focus of HIV prevention in Africa has always been primarily targeted at vaginal sex, and thereby prevention messages have by and large been to use condoms. We are now finding though that as straight people engage in anal sex, the likelihood of using condoms diminishes. For many, anal intercourse may be a form of virginity protection, or as a means to prevent pregnancy, and there is a common belief that anal intercourse carries no risk for HIV infection.

Dr. Karim of the famous CAPRISA 004 study argued that this sexual behaviour- when unprotected - could be driving a sizable amount of new HIV infections in Africa. In agreeing with him, I asked the question “is it time for us to broaden our scope of what HIV transmission looks like in Africa?”

If we still argue that HIV transmission in Africa is mainly heterosexual, are we assuming that the risk is only from unprotected vaginal intercourse? Or are we going to acknowledge the prevalence of unprotected anal intercourse among heterosexuals and address heterosexual transmission more broadly and honestly?

Not only we are overlooking the reality and the prevalence of this sexual behaviour among the general heterosexual population, but we are also missing the chance to reassess our prevention strategy and provide safer anal intercourse education irrespective of gender or sexual orientation.

Coupled with the myth that only MSM practice anal intercourse is a troublesome lack of knowledge about the ways to practice safer anal intercourse. One area in particular where accurate knowledge is lacking is the safe use of lubricants. In a presentation at the Project ARM strategic meeting by Brian Kanyemba from the Desmond Tutu HIV Foundation, he said that many people were using all kinds of things as a lubricant: olive oil, Vaseline, Vicks and even mayonnaise - none of which are condom-compatible.

Gay and straight couples need to know the facts about anal intercourse, and need condoms and condom-compatible lubricants to engage in this behaviour in a safer way.

Hope, and the future

Anal sex is a pleasurable sexual activity, and it can be safe when certain conditions are met. One of these conditions is using condoms with condom-compatible lubrication.

Another answer to safer anal sex is rectal microbicides - which would be a lube or a gel with anti-HIV properties.

The development of a safe and effective rectal microbicides could help everyone engaging in anal sex have a more pleasurable and safer sexual experience.

It is important to know however that it is not a replacement for condom use, but could be used as an additional option for protection. Ideally, one day we will have rectal microbicides that not only protect against HIV, but other STDs as well.

This sounds very promising, but while there is ongoing research, there is no microbicide product out there in the market yet. That does not mean we should not be hopeful.

As we drive towards zero HIV infection, it is also important we started looking at other prevention technologies that will be very easy for people to use without actually affecting their established sexual behaviours.

As IRMA’s rectal microbicides advocates sat down to work at the Project ARM meeting in Addis, one of the interesting things that came out was the need to intensify advocacy for rectal microbicides in many ways. This includes engaging with our community to let people know that anal sex is a human behaviour, both homosexual and heterosexual.

There is increasing need for information on anal sex and health and active involvement of NGOs in Africa. This campaign should also include NGOs working with African communities all over the world. We should also start the discussion with women, both young and old, that there is a need for more education around safer anal sex.

Rectal microbicides are looking like the part of future of HIV prevention, but for this dream to be achieved there is the need for everyone to be involved in the process – on both the research and advocacy fronts.

From civil societies to clinicians, doctors to government officials, international organizations and funders the world over, we need to all join the fight.

But while we await the rectal microbicides reality, we should not forget that when we talk anal sex, we should also scream… AND LUBE!!

As without the right use of the right lube, anal sex will not only be painful and unpleasant, but also puts the receptive partner in greater danger of receiving sexually transmitted infections- including HIV.

Anal sex is great, condom use is pleasure, but don’t forget AND LUBE.




[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

IAS 2011: Day 3

Today is Day 3 of the exciting conference happening in Rome, and IRMA has a lot of interesting information to report. Here is the press release for Day 3, and below it are links to important and fascinating presentations from and articles about the conference.

Via IAS.

OFFICIAL PRESS RELEASE – DAY 3

                                                         EMBARGOED UNTIL 11.00 (CET), TUESDAY JULY 19

Plenary speakers address challenges in the delivery of sustained antiretroviral therapy in developing countries, call for social scientists to take their place at the HIV/AIDS policy- making table, and stress the need for a long-term response to AIDS

Tuesday, 19 July, 2011 (Rome, Italy) -- Researchers speaking in the second plenary session of the 6^th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011) have today provided insights into the future direction of HIV/AIDS policy making and alerted delegates to the challenges that developing countries continue to face in the delivery of large- scale antiretroviral therapy (ART) coverage.

The presentations reflect the breadth of expertise among the more than 5,000 researchers, clinicians and community leaders attending the conference, which runs from 17-20 July in Rome.

“The AIDS response up until now has led to unprecedented mobilization of populations and significant progress in terms of prevention and treatment,” said IAS 2011 International Chair and IAS President Elly Katabira. “However, given the projections we have made of infections over the next decade, together with the growing number of people living longer with HIV, it makes perfect sense to discuss whether a remodeling or fine-tuning of that response might more effectively meet the new challenges that lie ahead.”

“Discussion around the future direction of HIV/AIDS policy must begin to give a far greater voice to the social sciences,” said Stefano Vella, IAS 2011 Local Co-Chair and Research Director at the Istituto Superiore di Sanità (ISS).  “The social and political sciences are a vital element in helping us to improve prevention efforts, especially in developing countries where major challenges remain in the effective roll-out of ART.”

The Social Barriers to Effective HIV Prevention

In her plenary remarks, Susan Kippax (Australia), Emeritus Professor at the Social Policy Research Centre, University of New South Wales, Sydney, suggested that in understanding HIV prevention efforts, people’s behaviours cannot be separated from their social, cultural and political structures, and the biomedical cannot be distinguished from the non-biomedical. Kippax argued that there is a need for social scientists to be at the table when it comes to discussing what many experts currently consider to be the greatest challenge to HIV/AIDS policy making - prevention.

Irrespective of whether prevention programmes or interventions advocate the use of condoms, clean needles and syringes, microbicides, pre- or post-exposure prophylaxis, or treatment as prevention - all prevention requires that people change their social practices: changes which cannot be effectively sustained unless they are supported by broader social transformation.

Challenges of Antiretroviral Therapy (ART) in Developing Countries

Serge Eholié (Ivory Coast) Professor of Tropical and Infectious Diseases at the Medical School of the University of Abidjan, focused on the challenges of sustaining antiretroviral therapy initiatives in developing countries.

A decade after the first antiretroviral therapy initiatives were initiated in developing countries, the number of HIV-infected individuals receiving ART has significantly increased. Recent data estimate that six million HIV-infected patients started ART and four and a half million of them (75 per cent) live in sub-Saharan Africa, and significant results have been obtained in decreasing mortality and morbidity.

Seven areas were identified as challenging in the ongoing delivery of ART in developing countries:

• financing the sustainability of ART-programmes, particularly in the context of the current adverse economic climate and with insufficient contributions from national governments;
• the high incidence of mortality and severe mortality during the first year following ART-initiation;
• the adaptation of programmes, physicians, countries and partners to the WHO 2010 revised guidelines for adults and adolescents;
• an increasing number of HIV-infected patients failing first-line treatment: the cost of second line treatment is four to five times higher than first line regimes. It is challenging for countries and partners to afford second line treatment, and difficult for physicians to detect first-line failure early enough;
• detectingfirst-line treatment failure earlier and prescribing an effective and safe second line regimen in light of the expense of the latter;
• management, diagnosis and treatment of side effects; 
• retention of patients: data for cohorts studies show that 25%-30% of HIV patients starting treatment are lost to follow up after 12-24 months;
• socio-political instability and humanitarian crisis and natural disasters

 AIDS: The Need for a Long-term Response

Peter Piot (Belgium), Director of the London School of Hygiene & Tropical Medicine, London, concluded the plenary session by reflecting that given the enormous mortality and human suffering caused by the AIDS epidemic, the nature of the global response to the AIDS epidemic has been framed as an emergency. Yet the ultimate duration of the emergency has rarely been discussed.

In spite of a recent decline in interest and funding for AIDS, UN member states recently adopted a "Political Declaration on HIV/AIDS: intensifying our efforts to eliminate HIV/AIDS" with ambitious goals for the next five years. Projections from aids2031 and UNAIDS estimate that over the coming two decades,  there may still be one to one and a half million new infections and one million deaths annually, with resources required to curb infections well in excess of currently available funds.

The combination of these developments, as well as the longer life expectancy of many people infected with HIV, provides a compelling argument for the need for a long term view on the AIDS response. In addition, resource constraints dictate that effective investments leading to the best possible outcomes in both the short and long term are necessary, and right now.

 ---

 Session abstracts and presentations for "Novel Approaches to Prevention Interventions and Measurement" can be found here. Especially of note for rectal microbicide advocates is this presentation.

Also of interest is this abstract of work done by IRMA - Nigeria: "Mobilizing MSM community in Nigeria to support rectal microbicides development", and the abstracts/powerpoints in this session: "Treatment Is Prevention: The Proof Is Here".


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Meet Margaret Onah - a Friendly Rectal Microbicide Advocate

via IRMA

 Margaret Onah believes that rectal microbicides are an important priority among new HIV prevention technologies because so many people, both males and females, engage in anal sex and the society pretends that it is not real, and so do not want to be associated with it.

An advocate from Calabar, Nigeria, Margaret is the Director for Safe Havens International and is a member of IRMA and IRMA Nigeria. She provides support services to vulnerable women and girls (female sex workers, teenage mothers and widows) and communities by educating and informing them on issues of sexual & reproductive health rights. Her mission as an advocate for human rights and health issues is to enhance the well-being of her community and its most vulnerable members with a participatory approach.

Margaret was introduced to IRMA when she became a member of the Global Campaign for Microbicides and the New HIV Vaccine and Microbicides Advocacy Society (NHVMAS), the "steering wheel" for microbicide advocacy in Nigeria. She began her advocacy with IRMA because she is concerned about the stigma and discrimination associated with anal sex, which she knows prevent people from seeking diagnosis and treatment, further compounding the problem. "If we are soliciting for vaginal microbicides, we should do the same for rectal microbicides because sex is sex no matter what form."

When she's not working Margaret enjoys reading biographies, dancing, and Christian books and music.

Read about other friendly rectal microbicides advocates.
Newly featured advocates include Brian Kanyemba, Paul Semugoma, and Ian Lemieux.

Want to join the best e-mail discussion list on new prevention technologies on the planet? Send a note to IRMA here - rectalmicro@gmail.com - and we will get you signed up. Joining the list makes you an automatic IRMA member too!

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

It's not if, it's when: IRMA's Jim Pickett on Rectal Microbicides in Africa

Writing for  the September - December 2010 issue of Echoes, a publication of the Nigerian HIV Vaccine and Microbicide Advocacy Society, IRMA chair Jim Pickett discusses the need for rectal microbicides in Africa.

Excerpt:

Until recently, rectal microbicides have simply not been part of the HIV prevention agenda in Africa, due in part to the denial of anal sex among heterosexuals and pervasive homophobia and criminalization that has denied and vilified the existence of gay men/MSM.

IRMA diligently addresses these issues, leading efforts to put rectal microbicides on the African map. These efforts are now bearing fruit - due in no small part to the significant engagement of hundreds of African advocates across the continent and extraordinary leadership by IRMA Nigeria with Kadiri Audu, IRMA Community Vice Chair, at the helm.

Read the whole thing.

While you are there, be sure to also check out the report on a rectal microbicide training for MSMs in Abuja!

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

IRMA Nigeria: Report on MSM Training in Abuja

via IRMA Nigeria
Prepared by Kadiri Audu
IRMA Community Vice Chair, IRMA Nigeria Coordinator

Report:
NEW PREVENTION TECHNOLOGY TRAINING FOR MSM IN ABUJA
22 OCTOBER 2010


Introduction

International Rectal Microbicides Advocates (IRMA) Nigeria held one day training on New Prevention Technology (NPT) – Rectal Microbicides- The Basics, the training was facilitated by the Steering Committee Community vice Chairman and the leader of the Nigerian Chapter of the International Rectal Microbicides Advocates (IRMA) – Mr. Kadiri Audu, with support from IRMA International office in Chicago. The training was attended by twenty (23) peer educators, six (6) outreach coordinators, and four (4) program staff, making a total of thirty (33) participants. All participants are volunteers and staff in the Integrated Men’s HIV Prevention Project (IMHIPP), a project funded by Heartland Alliance for Human Needs and Human Rights (HA) with support from USAID.

Objectives

1)    To increase the awareness of the MSM community in Abuja on New Prevention Technologies
2)    To mobilize the MSM and Peer Educators in the IMHIPP project in FCT Abuja on the need for Rectal Microbicides
3)    To build a team of MSM advocacy group for rectal Microbicides in Nigeria
4)    To update the community members on the development and progress made on new prevention technologies and research to reduce the spread of the virus.
5)    To provide participants with information for personal and professional growth.

Presentations

a)    Who is IRMA,
b)    Overview of the HIV epidemic,
c)    New Prevention Technologies (NPTs),
d)    What are Microbicides,
e)    The basics of Rectal Microbicides research,
f)    IRMA goals and Objectives and
g)    Rectal Microbicides advocacy & you.

Methodology

a)    Facilitation
b)    Presentations
c)    Story telling

Questions Raised

a)    Can rectal Microbicides be used to prevent re-infection among two infected sexual partners?
b)    Can Rectal Microbicides be applied on the penis for oral sex? And how safe is it for human consumption
c)    Can two sexual partners use Rectal Microbicides as a double protection?
d)    Can ARV based Microbicides be used by a people not infected with HIV?
e)    How effective will microbicides be in controlling the virus in a plenty cum situation?
f)    Will microbicides push away condoms?
g)    Can microbicides be used as a lubricant?
h)    When will an effective microbicides be available?
i)    I will like to participate in the rectalmicrobicides (RM) trials, how can I participate?

Key Achievements

a)    Participants now have enhance knowledge on the need for rectal Microbicides for the MSM community
b)    This training has helped the participants to improve their knowledge on the use of Microbicides as a new HIV prevention technology
c)    Participants are determined to disseminate the information about Microbicides to other members

Lesson Learned

•    Most of the participants were just hearing about the word Microbicides for the first time
•    The participants now know the reasons why the MSM community is 19 times more vulnerable to HIV infection than the heterosexual population
•    Community Literacy program on Rectal Microbicides for the MSM Community should be encouraged and sustained.

Challenges

•    Most of the participants do not have email addresses that can ensure their mobilization to the IRMA link serve.
•    The training seems to be too technical to some of the participants who were hearing about Microbicides for the first time
•    Some of the participants are not educated

Conclusion

The participants want such a training to be a continuous training so that more community members can be informed about the existence and progress made globally on Rectal Microbicides and other New Prevention Technologies. The participants also want to see posters and IEC materials on rectal Microbicides.



[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

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

New HIV Vaccine and Microbicide Advocacy Society releases new report on MSMs

The New HIV Vaccine and Microbicide Advocacy Society (NHVMAS) released its "Report on the 5 days training on HIV Prevention,Treatment, Research Literacy for MSMs" on March 29, 2010.

Read the whole report here.

Executive summary

A five days training for MSMs in Lagos on HIV prevention, treatment and research literacy was organised for 25 participants. The training ran for 5 days with 28 participants participating in the five days training.

Prior the training, a one day planning meeting was held between NHVMAS and IRMA on the 19th of March 2010. The meeting addressed selection of participants, venue of the training, timing of the training and facilitators. Email and telephone communications between NHVMAS, NARN, NACA and Population Council had also gone on for one week prior to the planning meeting date.

The NACA draft MSM training manual was used for the training. The training served as a pilot for the training manual. Lessons from the training would feed into the review process. At the end of the training, the pre and post test analysis showed that there was a significant improvement in knowledge and understanding about HIV as a whole. Most importantly, people did come to better understand the need to use condom consistently and correctly. The exercise of having trainees share information with peers and bring feedback on their peer outreach to the meeting also helped practically feed into the last session of the training meeting.

Lessons learnt include:

1. Focus of MSM training should emphasis on correct and consistent use of condoms. MSMs will always have multiple sexual partners for multiple identified reasons.

2. The use of peers as trainers also makes a lot of difference. Peers are able to identify with and share their own life experiences with the trainees. This helps to create an interactive environment and much more learning for the participants.

3. This training had VERY little didatic sessions. Having peers share made a significant difference to as everyone of them learnt from each other thereby enabling them see themselves as possible peer leaders.

4. Collaboration is possible and enriches programmes. NHVMAS collaboration with IRMA helped with reaching out to persons NHVMAS will not have hitherto being able to reach out too. Collaboration with NARN and Population Council also ensured that the training did not lead to a dead end – trainees will be absorbed into the Pop Council and NARN MSM peer education training programme in the Near future.

IRMA NIGERIA holds Microbicides Sensitization Forum

SENSITIZATION PROGRAM FOR HIV/AIDS SUPPORT GROUP, SEX WORKERS AND SOME HEALTH WORKERS IN ALIMOSHO LOCAL GOVERNMENT, LAGOS STATE, NIGERIA.

IRMA NIGERIA organized a sensitization program on Microbicides development on the 6th of June, 2009.

Report by Kadiri Audu
IRMA Steering Committee member




Attendance:

HIV/AIDS Support group 32 people

Sex workers 20 people

Health workers 9 people

Total 61 people



Aim: To create awareness about Microbicides Development and to encourage the participants to get involved in the process.

Analysis: Questionaires were administered at the event to estimate the level of awareness of participants about Microbicides Development.

o 57% of the participants have never heard about Microbicides.
o 15% heard about it but require more information
o 15% heard about it but do not know what it is or how it works.
o While 13% are familiar with Microbicides development.

Some of the questions asked at the event were:
o When would Microbicides likely to be available?
o How much would it cost?
o Would it be supplied for free?
o How are trial volunteers recruited?
o What if I want to volunteer?

Outcome: The outcome was quite encouraging because all the participants showed a level of understanding and 38 people joined IRMA NIGERIA.

Presentation: The paper presented at the event is below.


PAPER PRESENTATION: MICROBICIDES SENSITISATION SYMPOSIUM

ORGANISED BY IRMA NIGERIA

WHAT IS MICROBICIDES?
Microbicides are products that could be applied vaginally and that would reduce the transmission of HIV during sexual intercourse. A Microbicides could take the form of a gel, film, suppository, sponge, cream, vaginal ring or other delivery method that releases the active ingredient gradually.

THE NEED FOR MICROBICIDES:
Giving women power over AIDS. The power for women to enjoy safe sex, without negotiating with a sex partner.

KEY ISSUES IN MICROBICIDES DEVELOPMENT:
• Timing – if the handfuls of Microbicides candidates that are currently in advanced clinical trials prove to be effective, a Microbicides could be ready by the end of 2010.

DRUG DEVELOPMENT:
Drug development generally, is a long and complicated process. It takes 10 – 15 years between discovery of a promising lead and its availability on the market.
• Many candidates fail before one ever proves both safe and effective.
• The development stage needs many different candidates which use different mechanisms of action.

MAKING MICROBICIDES AVAILABLE TO PEOPLE LIVING IN THE DEVELOPING WORLD:
• The Microbicides field is committed to making the product available to firstly, those who need them most.
• Public sector developers and advocates are working hard to ensure that innovative vaccines and Microbicides will be accessible and affordable to the people who need them most.
• It is possible that Microbicides would be licensed first in a country where HIV prevalence rate is high rather than countries with low risk.

NATURE OF CLINICAL TRIALS:
• Pre-clinical trials – This is a stage where identified Microbicides candidates pass through a series of rigorous tests in a laboratory and animals before they are allowed to be tested on human beings.

Clinical trials:
• Phase I – phase I trials are conducted to determine whether the product is safe if used by a small number of volunteer participants over a few weeks, usually 1-3 weeks with 20 – 30 participants
• Phase II – phase II also test for safety of the product but over a longer period of time and with a larger number of participants; 6-18 months, 200-400 participants
• Phase III – phase III trials measures effectiveness; that is weather or not Microbicides actually works in the course of normal use to prevent HIV and STIs. 1-2 years, thousands of participants are enrolled at this stage.
NOTE:
• Frequently, clinical trials need to be repeated to confirm their result or to test the findings in different population.
• The product must be reviewed and licensed for use by at least one drug regulatory agency.

RECTAL MICROBICIDES:
These are products that could be applied rectally and that would reduce the transmission of HIV during anal intercourse and prevent infection.

THE NEED FOR RECTALMICROBICIDES:
• Vaginal Microbicides might not be safe for rectal use
• There are people who engage in anal sex world over

ISSUES AROUND RECTALMICROBICIDES:
• Stigmatization
• Human rights
• Rectal safety of vaginal Microbicides