Johns Hopkins: Studies Show the Likelihood of HIV Infection in Female Sex Workers

via Johns Hopkins School of Public Health

Female sex workers in low- and middle-income countries are nearly 14 times more likely to be infected by HIV compared to the rest of country’s population, according to an analysis by researchers at the Johns Hopkins Bloomberg School of Public Health. The findings suggest an urgent need to scale up access to quality HIV prevention programs in these countries. The study was published online in The Lancet Infectious Diseases.

“Although female sex workers have long been understood to be a key affected population, the scope and breadth of their disproportionate risk for HIV infection had not been systematically documented,” said Stefan Baral, MD, MPH, MBA, lead author of the study and associate director of the Bloomberg School’s Center for Public Health and Human Rights. “In addition to antiretroviral treatment and ongoing HIV prevention for sex workers, considerations of the legal and policy environments in which sex workers operate, and the important role of stigma, discrimination, and violence targeting female sex workers globally will be required to reduce the disproportionate disease burden among these women.”

For the study, Johns Hopkins conducted a meta-analysis of 102 previous published studies representing almost 100,000 female sex workers in 50 countries. Overall, HIV prevalence in female sex workers in low- and middle-income countries was found to be about 12 percent, which equated to an increased risk of infection for sex workers 14 times that of other women in these countries. In 26 countries where background levels of HIV were considered “medium” to “high,” approximately 31 percent of the female sex workers were found to have HIV and were 12 times more likely to be infected compared with women from the general population. Sex workers in Asia had a 29 percent increased risk for HIV infection compared to other women, which was the greatest disparity among the regions studied. Sex workers in Africa and Latin America were 12 times increased risk compared to other women in these regions.

This analysis was conducted as part of a larger project entitled, "The Global Epidemics of HIV among Sex Workers: Epidemiology, prevention, access to care, costs, and human rights" led by Johns Hopkins researchers Deanna Kerrigan, PhD, MPH, and Chris Beyrer, MD, MPH. The larger project assesses not only the epidemiology of HIV among sex workers in low- and middle-income countries, but also documents the current state of HIV prevention interventions and the social context surrounding sex work in different settings, and uses mathematical modeling and cost-effectiveness analysis to assess the potential impact and resources necessary to scale up of comprehensive HIV prevention, treatment and care services among sex workers.

“Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis” was written by Stefan Baral, Chris Beyrer, Kathryn Manning, Tonia Poteat, Andrea L. Wirtz, Michele R. Decker, Susan G. Sherman, and Deanna Kerrigan.

 
[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 our Newest Friendly Rectal Microbicide Advocate: Abimbola Onigbango Williams!

“Rectal microbicides are an important priority that need to be fully explored to provide males and females who engage in anal sex a way to protect themselves from HIV and perhaps other sexually related infections.”

Abimbola is an IRMA advocate from Lagos, Nigeria. There she is a public health researcher and advocate. She has a Master’s Degree in Public Health from the University of Ibadan in Nigeria, and is currently a Fulbright Scholar/ Hubert Humphrey Fellow at the Johns Hopkins Bloomberg School of Public Health. At Johns Hopkins her fellowship is focused on Public Health and Policy Management with an emphasis on Health Systems Strengthening.

Abimbola first became involved with IRMA when she attended the Project ARM meeting in Addis in December. The meeting gave her the opportunity to understand new ideas and perspectives on how to integrate anal health and rectal microbicides into her work as a researcher and advocate. It was also a great place to find common ground with meeting participants from all over the world on issues related to rectal microbicides. She thought the meeting was a huge success and left feeling inspired!

She believes rectal microbicides are a top priority, and we need to dedicate more time and resources to their development. She is already creating a greater awareness of rectal microbicides by educating individuals and key stakeholders through advocacy visits, information sharing, and helping them disseminate research materials.

Her advice to other IRMA advocates is to keep up the robust discussion on the listserv and continue advocating for healthy anal intercourse regardless of peoples’ sexual orientations. She also has a great tactic for combating stigma she faces for standing up for rectal microbicides. She first tries to educate people about health and anal health to create a safe space for a healthy discussion. Then, she brings up the idea of rectal microbicides. She finds this is especially helpful if someone isn’t very familiar with anal intercourse.

In her free time she loves travelling, playing badminton, and knitting.

Thanks Abimbola for all that you do!


[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 Stefan Baral: Our Newest Friendly Rectal Microbicide Advocate!

“Though linked geographically, there is extreme diversity in the dynamics of transmission of HIV and potential structural interventions to mitigate transmission. Let the local community lead the way in terms of messaging and strategy, and progress will be made while staying on terra firma.”

Stefan Baral is an IRMA advocate from Baltimore, Maryland. He is a physician, epidemiologist and researcher on the faculty of Johns Hopkins Bloomberg School of Public Health focused on creating more community tailored programs, services, and policies for different communities throughout the world.

Stefan first became involved with IRMA while preparing for the Project ARM - Africa for Rectal Microbicides meeting in Addis Ababa this past December, in conjunction with ICASA. He says it was a natural partnership given the communities he works with across Africa, and believes the meeting got a great start on developing a plan for increased advocacy around rectal microbicides and the accessibility of condom-compatible lubricants. He is excited for everything to be moving forward!

He believes rectal microbicides are such a promising new prevention technology due to encouraging evidence from early studies and the likelihood that people would use them. He is hopeful that rectal microbicides will be in the form of a lubricant to increase the chance that people will use them during anal intercourse.

Stefan is also an advocate for other evidence-based prevention strategies. He loves researching them and advocating for those in which he sees potential. Though he believes rectal microbicides will likely be an important prevention strategy moving forward, he says it is crucial to implement services and strategies in the meantime that are already supported by evidence. He also realizes that though advocacy is key in the fight against HIV/AIDS, service provision is just as important to fully serve different communities.
His advice for combatting stigma associated with standing up for rectal microbicides is short, but important: “Focus on the evidence.”

Thanks Stefan, for all that you do!


[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.]

World Bank Study: Better HIV/AIDS Programs for Men Who Have Sex with Men Could Significantly Slow Global Epidemic

Source (press release, dated June 8, 2011)

On the eve of a UN summit to renew global efforts to reverse the HIV/AIDS pandemic, 30 years after the first discovery of the HIV virus, a new World Bank study urges governments and their development donors to provide better HIV prevention, care, and treatment services for men who have sex with men (MSM) as an essential step toward reversing the global epidemic. More than 25 million people have died of HIV/AIDS since the virus was first clinically identified in 1981.

Written in close partnership with the United Nations Development Programme (UNDP) and the Johns Hopkins Bloomberg School of Public Health, the new study―Global HIV Epidemics Among Men Who Have Sex with Men (MSM): Epidemiology, Prevention, Access to Care and Human Rights―provides the first comprehensive economic analysis of evidence that MSM are at significantly higher risk for HIV infection than other groups in many low- and middle-income countries, where fewer than 1 in 10 MSM worldwide have access to even basic HIV/AIDS prevention, care, and treatment services.

Research among MSM has been limited by social discrimination and the criminalization of their behavior, along with limited funding for HIV/AIDS programs that help MSM. The study suggests that these social factors make MSM vulnerable to HIV infection as well as limiting their access to HIV/AIDS treatment and care.

“We see that in many developing countries, the HIV/AIDS epidemic today looks like the early years of the epidemic in the West in the 1980s, when ignorance and stigma were rampant,” said David Wilson, Global HIV/AIDS Director at the World Bank. “This study provides the best evidence yet that failure to address MSM will continue to thwart efforts to reverse the global HIV/AIDS epidemic.”

The study authors identify four scenarios that describe the current state of the HIV epidemic among MSM in low- and middle-income countries, and assess the cost to improve the situation for MSM. The authors conclude that achieving high rates of coverage of HIV/AIDS prevention and treatment services among MSM has a significant positive impact on the overall trajectory of a country’s HIV epidemic.

The four regional scenarios are: 1 – Where MSM have the most numbers of HIV infection in the population (South America); 2 – Countries with large numbers of infections among intravenous drug users, in which infections among MSM are also substantial (Eastern Europe and Central Asia); 3 – MSM risks of infection occur within widespread HIV epidemics among heterosexuals (sub-Saharan Africa); and 4 – MSM, intravenous drug users, and heterosexual transmissions all contribute significantly to the HIV epidemic (Southeast Asia).

“In too many countries, the neglect of HIV epidemics among men who have sex with men has undermined the effectiveness of HIV responses,” said Jeff O’Malley, Director of UNDP’s HIV Group. “These new data offer development partners an opportunity to refocus their planning efforts and to ensure that HIV responses are in line with the burden of HIV in their countries.”

In Peru, for example, the study authors project that if coverage of MSM interventions and antiretroviral therapies (ARVs) remain constant, the number of new HIV infections in the general population will result in nearly 20,000 new infections by 2015. Increasing MSM-specific interventions to 100% coverage and providing HIV-positive MSM with full access to ARVs may dramatically decrease the epidemic in the entire population.

“This report demonstrates the scale, scope, and intensity of the HIV epidemics now underway among MSM in too many countries,” said Chris Beyrer, Director of the Center for Public Health and Human Rights at Johns Hopkins University and lead co-author of the study. “But the findings also make clear that responding to these epidemics can have powerful impacts on global AIDS. It is time to act."

To better protect MSM from HIV risks, the authors recommend a minimum package of essential services, including: counseling, distribution of condoms and other safe sex measures, community-based prevention efforts, HIV testing, and increased use of antiretroviral therapy treatment or ARV. Equally important are policy efforts to decriminalize MSM behavior, institute anti-homophobia policies, and programs to educate health care workers and reduce stigma in health care settings.

The authors also recommend careful evaluation of mainstreaming MSM programs, since laws and policies designed to promote universal access and gender equality for HIV services often do not adequately protect MSM and other sexual minorities. Ensuring community participation in providing essential services for MSM is also critical to producing policies that promote the human rights of MSM and expand their access to HIV testing, treatment, and care.

Summary and full report

Click to learn more about the Center for Public Health and Human Rights at Johns Hopkins

[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.]

Putting My Ass On The Line…..Literally!

I feel as though I am working “with them” and not “for them”. We have the same common goal in mind, the hope that someday HIV will just be a memory.

Scott Wilfong describes his experience in rectal microbicide studies at Johns Hopkins

an IRMA exclusive

[IRMA Steering Committee Member Ed Fuchs and IRMA member Dr. Craig Hendrix ran the studies Scott describes in his piece. Read Ed and Craig's bios on the IRMA website here.]

Let me begin by saying, if you are looking for a really good conversation topic, especially on a first date, get yourself involved in the rectal microbicide studies at Johns Hopkins.

It is a quick and easy way to gage one’s comfort level in talking about anal sex and more importantly, research development that may, in fact, save the lives of others someday in the future.

What’s not to be excited about!?

If only I had a snapshot photo of everyone’s first expression upon telling them the in’s and out’s (no pun intended) of my experience with rectal microbicide research. Some people laugh immediately, some cringe, some have a shocked look, and others stare at me with total disbelief, inquiring about actual proof to something that seems so out of the box for them. For many, it is the first time they have ever heard the word microbicide, let alone microbicide research. Believe me my knowledge is somewhat limited when specifically talking about the medical component of this particular research. So, I try to explain it the best I can with a lean towards the importance of this type of research, the extraordinary doctors that are the so passionate about this research, and the extremely important benefits of microbicide development for the lives of many people in the future.

In 1999, after graduating with a degree in Sociology and the first Gay and Lesbian studies minor in my home state of MD, I was well on my way to bigger and better things. I was working in a local coffee shop, contemplating the meaning of life and wondering what options lie ahead on the job front. I was approached by a friend of mine and offered a job as a Field Supervisor for a research study being conducted by Johns Hopkins School of Public Health, entitled, The Young Men’s Survey. Of course, I knew the basics of HIV prevention and how HIV had affected the global community and particularly, the gay community, but I did not know anything about counseling or research.

I was informed that part of the job entailed learning how to do a blood draw. Yikes! I ran the other direction. Getting my blood drawn had always caused me much stress and, in fact, a few fainting spells as a young child. To my shock and to those that knew me, I decided to take the job and thus throw myself into the world of HIV prevention and research. Needless to say, the more I learned, the more blown away I was. For a year or so, we went to the streets and gay clubs of Baltimore City every Thurs, Fri, and Sat in search of those that were willing to participate. This was perhaps, the biggest learning experience to date, as it opened my eyes to the serious issue of HIV in my community. Though this job was extremely rewarding, it often posed ethical dilemmas for us as we lived, played, and worked in these same settings. Also watching community members you know test positive and not return for their results. With my hands tied to a confidentiality contract, I had to sit back and watch many people we tested continue their lives without the knowledge of their status.

I often felt like I was watching the disease spread right before my eyes.

By 2001, our contract with the CDC ended and I was offered a position as Program Director for a small, Baltimore based non-profit, AIDS Action Baltimore. Thus, I jumped on the opportunity. This time I was away from HIV research and could now focus on prevention. In the three years I was with AIDS Action Baltimore, I was able to learn much from the gay community and what specific HIV prevention methods were working and those that weren’t. It was at this time that I attended the International AIDS Conference in Barcelona, Spain. Saying that this conference was an “eye-opener” would be a huge understatement. I was painfully aware of the little gay bubble I was living in Baltimore’s HIV prevention community, and although extremely important, I realized the magnitude of how HIV was affecting the global community.

It was at this conference that I first heard of rectal microbicides and this possibility that someday we would actually have one developed that would kill HIV and other STD’s as well. Upon my return to Baltimore, I began to get disheartened by the choices that many in my community were making. It became clear to me that condom use wasn’t always the norm and that something else was needed if we were going to stop the spread of HIV. In fact, our lives as gay men had become infiltrated with safer sex messages which touted simple truths, kitchy slogans, and the idea that just wearing a condom would be the answer. What I realized was that gay men were, in fact, sick of the old messages, tired of being handed condoms upon leaving their community hangouts, and frankly, burnt out on being told what and what not to do before, during, and after sex. What was once an act of love had become potentially harmful, what was once clean had become dirty, and what should be an act without barriers had become a prison for many.

We all know sex is hardly as simple as asking someone their HIV status or asking someone to wear a condom, lubricant, dental dams, flavored, colored, ribbed, etc. What would a world be like where we didn’t have to wear condoms? Where the act of sex between adults could be just that? Where women in third-world countries wouldn’t have to spare their safety and their lives at the whims of their husbands that refused to wear condoms? Is it possible that someday we may never have to wear condoms again? Thus began my need to know more about what was being done globally. What exactly were microbicides? What would it mean to me? What would it mean to my community?

Will microbicide development save the lives of gay men, women, and anyone (yes, this includes all of my heterosexual friends) that engages in anal sex?

It was at this time, that my friend, the same one who had offered me my first job at Johns Hopkins, came to me with a proposal. He told me about two doctors at Hopkins that were looking a bit further than just researching a new microbicide. I was told that there had never been research like this done in the past as the topic of anal sex was too taboo to even mention, much less, get funding to study where lubricant and body fluids actually go once in someone’s ass.

To be honest, I almost couldn’t believe it? I was floored by the lack of knowledge that the medical community had regarding anal sex! My friend told me about the possibility of a research study through the CDC, in which participants would have a “faux” microbicide injected into their anus, followed by sex with a dildo! What!? Yes, believe me, I was stunned, excited, and wanted to hear more! Really, could this be true? Did the medical community finally wise up to the fact that not only gay men, but many “straight” folks had anal sex too!?

My friend assured me that yes, in fact, this study was legit and that the two doctors who were hoping to do this research were both heterosexual and had been pushing for research funding for a few years now. They were ready to take things to the next level and so I was asked to find a few friends that would be interested in attending a focus group to get more information regarding the study and to help the doctors understand more about gay sex, including different sexual positions, length of sexual acts, sizes of penises, sizes of dildos, kinds of lubricant and who was using what? when? why? and how?

The wanted to know everything!

I was able to get a few of my close friends who jumped on board immediately, to attend this information gathering session. Needless to say, we spent the better part of the meeting laughing! What seemed so uncomfortable to talk about with complete strangers was suddenly out on the table for us all to see. It was absolutely amazing and quite refreshing to watch two adult, heterosexual doctors, ask us questions that are, often times, only discussed in the bedroom, including handling different sized dildos.

For the first study we were told that the CDC would not fund a study that used an actual dildo, as they believed it would certainly be “too much fun”! The CDC required us to use a vaginal dilator, roughly the length of a standard six inch dildo but with no veins, penis “head”, or balls. So, yet again Johns Hopkins was eager to push the boundaries even further by funding their version of the study with the dildo, simultaneously with the CDC study using the vaginal dilator. This way they would know if the actual shape of the penis would change the movement of the lubricant.

We reflected upon all the possible scenarios that could occur during the study, including the possibility of becoming aroused during the procedure.

LOL! That possibility seems quite amusing in retrospect!

Note: This study IS NOT intended to sexually AROUSE, STIMULATE, OR REPLACE actual sex with a partner! LOL! Regardless, we were all on board! None of us knew what we were getting ourselves into really? We all knew that it was something spectacular and that we wanted to be a part of something that would potentially save many people’s lives. So began the rectal microbicide studies at Johns Hopkins. Within the next year we would find ourselves face-to-face with the doctors we only sort of knew, a pair of stirrups, a lubed dildo, a timer, and extremely large medical equipment that were getting a view of something for the first time!!!!!

I think the first time I was admitted to the hospital I was a bit nervous, to say the least. I sort of knew what to expect but as I had never done something like this before, I had nothing to compare it to. Yes, I had a dildo in my ass before but obviously under much different circumstances. The first few protocols involved fasting prior to admission and the use of enemas. Having someone give you an enema in the middle of the night after waking from a deep sleep was just the start of it. This was one of many things that would make most people want to reconsider their involvement in the study. I’m not even sure how well I slept those first few times at Hopkins? Knowing that I would have to “perform”, I mean, “participate” so early in the morning didn’t lend to a good night’s sleep.

I was awoken by a nurse at 7am, after having been given an enema mid-sleep. The first few protocols were grueling as we had to lie on a little mattress looking pad. Once in place, the Study Coordinator would use a vacuum like device used to suck all the air out of the mattress s it would mold exactly to our body and hold us in place. Seemingly ok at first, later turned into a test of our patience as participants, as we had to stay in the same position for many hours without moving. The only time we were allowed to move was to turn over a bit and pee in a jug. Yet, this was just another thing that would send most people running. I’m sure my friends that participated would agree that this little pad was almost unbearable as my back would almost spasm due to being in the same position. Little did I know that lying down would cause so much pain after many extended hours.

After the air was sucked out of the little blue pad and I was set in place, we were ready to go. I was wheeled down many long hospital hallways to a room in the basement of Johns Hopkins Hospital. I always wondered, as I stared at the tiles in the ceiling, if the doctors and patients I was passing had even the slightest idea of what was about to take place? After getting hoisted from one hospital bed to something more stationary, I noticed the stirrups for the first time. Why would I need those I asked? Who has sex with their feet in stirrups I wondered? Well, to my shock, they indeed, were for me! I believe it was at this point that I realized the clinical aspect of this entire research study. Even though I knew much about the study from participating in the original focus group, it was becoming clearer to me that I was in a medical study and everything we did was in writing somewhere, with big money behind it.

Every action and every second was accounted for.

After getting in position on the bed, feet in stirrups, and on my back, I had to keep reminding myself that this was for the greater good. Even while in position and ready to go, I was still shocked by the mere fact that this was actually a funded study. I kept thinking to myself that these doctors are so “cutting edge” and that even I was somewhat still perplexed by what was happening.

As I watched the doctor lube the dildo, I noticed him uncomfortably handle it, as if it was the first time he had held a dildo, covering it oh so carefully with the gel.

My first thought was a bit of fear as I realized that there would be no foreplay, no pre lube in my anus, and obviously no finger to loosen me up a bit. I took a deep breath as the doctor handed me the dildo. Keep in mind that the lubricant or “faux” microbicide had been injected with a small amount of radioactive substances for use with imaging scans, thus we both had to wear gloves that were later placed in a bag to test for amount of lubricant left on them during the procedure. The goal was to use imaging to map out exactly where the lubricant would go in my anal cavity, specifically how far into my body. Remember, this is had never been done before, so everything we did was somewhat “trial and error”.

After handing me the lubricated dildo, I was instructed to wait until the 2 doctors and study coordinator went behind the door at which point they would tell me when to insert the dildo into my ass. This was probably the most difficult part and somewhat nerve wracking knowing that they were just standing feet away from me on the other side of the door and in later studies just a curtain. Pressure was on. I had to insert he dildo in my ass with barely the amount of lubricant it would normally take to have a “pain-free” insertion. I had to take a deep breath and basically just shove the dildo into my ass.

Ouch!

If only they could see the expression on my face. I tried to be as quiet as possible.

The doctors provided a metronome which ticked back and forth. No, this was not like the piano lessons I used to take as a child, although I was immediately reminded of them. For each tic-toc back and forth I had to insert the dildo in and out of my butt with the beat of the metronome until 5 minutes were completed.

Then the doctors came back in the room and we dropped the dildo, our gloves, and any other radioactive materials into a bag for later examination. Yes, all of this would be devastating to most folks, even to many of my gay friends. I really had to keep reminding myself of the ultimate goal.

There I was naked, cold, wet from lube, asshole hurting, with three people I barely knew.

I have to admit that all of my previous training in HIV counseling etc. had paid off. I am not the fearful type when discussing sex and usually make things into a comic scenario to deal with any uncomfortable feelings, often times how many of us have dealt with situations that are not so pleasant. It was this first moment that I began a friendship with the doctors and other staff involved with the study. I had to keep things “light” and fun in order to deal with the actual weirdness of the entire procedure.

Upon finishing the procedure, I was wheeled around for most of the day, sometimes in and out of sleep, as I often had to stay still for hours at a time strapped in an MRI or other scanning device to get the results they needed. I figured out by the 3rd or 4th admission to the hospital that staying up as late as possible the night before was to my benefit as I could sleep through many of the procedures following my sexual intercourse with the dildo. MRI machines are extremely loud and trying to stay still in them for an hour, sometimes a couple of times a day were less than pleasurable.

So, I often drifted off into another world with visions of “dildos and doctors” dancing in my head.

As the months and years went by, many specific protocol requirements changed and evolved. We no longer had to use the little pad that hurt our back, although we still had to stay in the same position. Endoscopies were added to the procedure a few years into the studies and were used to get specifics from the lining of my anal cavity as to the permeability of the microbicide gel. I was the first patient to consent to this procedure. The first time we did an endoscopy, I was surrounded by at least a dozen people in a very small room. Everyone on the medical team seemed fascinated with the work these doctors were doing. They had even presented some of their findings at conferences and by this time, word had spread about what exactly they were doing with us and what they were looking for.

Unfortunately, as I was the first to do this endoscopy procedure for the study, there was no sedation written into the protocol. As I uncomfortably rolled on my side and allowed the scope to go in my ass, I watched the entire thing on the monitor. Oh, what a view! I quickly realized that they were going much too far inside me for my comfort level and literally thought I was going to jump off the bed out of sincere pain and fear. I could actually feel the instrument poking from my inside out about half way up my torso.

Following this procedure, I explained to the doctors that I would not participate in that specific procedure again if they didn’t use sedation next time. I also told them that I would inform the other participants not to follow through with the study until the protocol was changed. That was not something I would ever want to do again or wish on someone else. In that moment laying n the table and ready to run with endoscopy tool hanging out my ass I realized that this was a research study and that, although I had become somewhat close to the doctors, I was still their guinea pig. I use that term lightly as I know that these doctors would never want me to consider myself a guinea pig. Nor would they want me to think that they didn’t have my best interest in mind. So, they willingly agreed to change the protocol and the many tests that followed involved light sedation which made the entire experience much more bearable.

Two other major aspects of the study changed over time as well. The doctors decided to move to the next level and insert another separate substance to my anus that would simulate semen. Thus, they would be able to see where exactly the “faux” microbicide gel would go and then upon inserting another substance, would see how far that particular substance went also. This way they would know what the barrier is for protection.

Would the gel go as far as they wanted?

Would it actually cover all areas?

Would the “faux” semen remain in that area or would it go beyond the “safe zone”, defeating the purpose of the protective microbicide?

So began what I call the second phase of the study. The doctors carefully rigged small “vein-like” tubes through the center of the dildo that would act as a pathway for the “faux” sperm. After my 5 minute dildo insertion was complete, I would call one of the doctors back in the room. I had to leave the dildo in my ass while the doctor used a syringe to shoot “faux” semen through the tubes, thus replicating or simulating a real ejaculation.

By this time I was rather comfortable with the doctors and my embarrassment level was certainly decreased from my previous experiences. The second, and for many, the most shocking twist in the study, involved actually collecting semen from myself three times. The doctors came to me and asked me if I’d be willing to have my own semen shot through the syringe into my ass, thus replicating a more precise rendition of what really occurs in anal intercourse. Of course what did I have to lose at this point? I agreed to do the procedure and so we moved forward. I will admit, many times I would smile during the procedure, laughing at the concept of having sex with myself. Of course, I share my study story with those I think would be interested and, in fact, most are, but this aspect was a bit too much for some and many expressed shock that I would follow through with the later part of the procedure.

Why stop there I thought?! Where is the line to be drawn? Is there a line?

Personally, I can’t imagine that there is a line. I believe this is just the beginning of the rectal microbicide studies. I also truly believe that until we get actual consenting couples to participate in real anal intercourse, then we don’t have the clearest picture of the workings of the anus and how lubricants, semen, and sexual anal intercourse all combine.

It’s interesting to look back over the last six years and see where we started. What began as passionate interest for these doctors at Hopkins has blossomed into some amazing research findings that have been shared at microbicide conferences around the world, including Cape Town, London, New Delhi as well as, many other small conferences. I do want to also note that we do get paid as participants. Unfortunately, this ends up being roughly a little more than five dollars an hour if you were to break down the actual hours spent at the hospital, including sleeping. So, I will assure you that none of us have done these procedures with the money as the main incentive.

Most of us that have participated firmly believe in the incredible work these doctors are doing. I can speak for myself in saying that every time I enter the hospital to admit myself to the study, I think about the future of sexual health.

I think about all of the people before me that have been infected and that have died from the disease of HIV and I imagine a world in which we can get back to the most natural feelings of skin to skin sex without the worries of having to wear a condom.

I am in constant awe of these doctors that push the envelope with medical research and have an eye towards our future. I consider myself to be friends with these doctors and I am aware of the genuine gratitude they have towards us as research participants.

I feel as though I am working “with them” and not “for them”. We have the same common goal in mind, the hope that someday HIV will just be a memory.

Putting my ass on the line is definitely worth it!