Adherence to rectal microbicide use among mainly ethnic minority young MSM: lessons from a 3-month placebo gel trial at three US sites [IAS 2013]

Oral paper presented by Alex Carballo-Diéguez at IAS 2013.

 

Click for slides.

Abstract:

Background: Adherence to product use is the cornerstone of microbicide studies. This is the first study to assess how frequently mainly ethnic minority MSM, ages 18-30, with a history of unprotected receptive anal intercourse (RAI) in the prior year, would self-administer gel using a rectal-specific applicator prior to RAI in their everyday lives.

Methods: Recruitment took place in Boston, MA; Pittsburgh, PA, and San Juan, PR. Participants received 40 applicators prefilled with 4mL of hydroxyethylcellulose placebo gel that they could use over 12 weeks. They were asked to self-administer a dose within 90 minutes prior to RAI and report RAI and gel use at least weekly through an interactive voice response system (IVRS). At week 12, they responded to a Computer Assisted Self Interview (CASI) and underwent an in-depth interview. Participants were repeatedly counseled that the study focused on product adherence and that the gel would not protect against HIV.

Results: 124 MSM were enrolled (Mean age 23.1; 41% White, 40% Latino, 8% African American, 11% mixed/other). 95 participants completed the trial (18 were lost to follow up and 11 withdrew). Based on the IVRS, (n=94, 1 missing data), 88 participants had RAI (Median 10 occasions) using gel on 81.1% of occasions (SD 23.3, range 0-100). Based on CASI, (n=86, 9 refused to answer RAI question) 83 participants had RAI (Median 12 occasions) using gel on 81.7% of occasions (SD 26.7; 0-100). Based on CASI, 69% of men typically applied gel immediately before RAI; 40 inconsistent users gave as reasons not having gel with them (85%), forgetting to use it (48%), not wanting to use it (13%), partner refusal (10%) and gel messiness (10%).

Conclusions: Ethnically diverse young MSM with a history of unprotected RAI showed high adherence to gel use. Adherence to product use could potentially be enhanced by improving portability, facilitating the development of routines to counteract forgetfulness, and improving motivation and partner negotiation skills. Participant retention was challenging and needs further study. Two different self-report methods provided convergent results. Limitation: A product of known efficacy could have different uptake than the placebo used in this study.


Click for slides.

 
-------------------

*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,200 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.

  -------------------

TIME SENSITIVE: Have You (or Your Organization) Endorsed Our Global Call to Action on Lubricant Safety Yet?

Have you and/or your organization endorsed the Global Call to Action on Lubricant Safety yet? (lists or endorsers in formation below.)

We are going to be closing the call soon, so please make your move on lube safety NOW.

Click here to read the Call and to endorse.

We must KNOW whether water-based and silicone-based lubricants used during sex are safe or not, whether they cause harm, or not. Right now we don’t know – but we DO have some data that has raised some concerns. These concerns must be addressed through research, the questions we have must be answered.

Make your voice heard – endorse the Call.

ORGANIZATIONS who have endorsed the Call = 159 to date

1.  Abra Advanced Research International Pte Ltd, Singapore
2.  ACON, Australia
3.  Act for Change, Ghana
4.  Act Up/East Bay, USA
5.  ActionAIDS, USA
6.  Adam's Love, Thailand
7.  ADEFHO, Cameroon
8.  Adhikaar, India
9.  Affirmative Action, Cameroon
10. African Alliance for HIV Prevention, South Africa
11. African Men for Sexual Health and Rights (AMSHeR), South Africa
12. Afrique Arc En Ciel, Togo
13. AIDES, France
14. AIDS Community Research Initiative of America, USA
15. AIDS Foundation of Chicago, USA
16. AIDS Project Los Angeles, USA
17. AIDS Services for the Monadnock Region, USA
18. AIDS United, USA
19. AKPAKA Axel, Benin
20. ALPHA Pittsburgh, Inc., USAALPHA Pittsburgh, Inc.
21. ALTERNATIVE CÔTE D'IVOIRE, Cote D’Ivoire
22. Anova Health Institute, South Africa
23. Asia Pacific Coalition on Male Sexual Health, Thailand
24. Asia Pacific Network of Sex Workers, Thailand
25. Astitva - An Organisation for the Support and Development of Sexual Minorities, India
26. Australian Federation of AIDS Organisations, Australia
27. AVAC, USA
28. Blue Diamond Society, Nepal
29. Canadian AIDS Society, Canada
30. Canadian AIDS Treatment Information Exchange (CATIE), Canada
31. Canadian HIV/AIDS Legal Network, Canada
32. Caribbean Association of Midwest America, USA
33. Case/UH Microbicide Clinical Trials Community Advisory Committee, USA
34. Center for Applied Research on Men and Health (CARMAH), Vietnam
35. Centre for Human Rights and Rehabilitation (CHRR), Malawi
36. Centre for the Development of People, Malawi
37. Chengdu Tongle, China
38. Chicago Female Condom Campaign, USA
39. Chicago Women's AIDS Project, USA
40. Citizen News Service – CNS, India
41. Club des 7jours, Togo
42. C-NET+, Belize
43. Coalition Internationale Sida PLUS, France
44. COCQ-SIDA, Canada
45. COMMUNITY AND FAMILY AID FOUNDATION-GHANA, Ghana
46. Community Information Center, USA
47. CONCEPTO VIH-SIDA E ITS, Mexico
48. Davryan Laboratories, Inc (Probe lubricants), USA
49. Desmond Tutu HIV Foundation, South Africa
50. Diversity And Solidairty Trust, Sri Lanka
51. DUH Demonstration for Universal Healthcare, USA
52. Epicentro, Peru
53. Equal Opportunities, Tajikistan
54. Evolve, Cameroon
55. Family Planning Council, USA
56. Fenway Institute at Fenway Health, USA
57. Freedom and Roam Uganda, Uganda
58. Fundacion Manodiversa Bolivia, Bolivia
59. Gala Initiative Uganda, Uganda
60. GALAEI, USA
61. Gay City Health Project, USA
62. Gay Men’s Health Crisis, USA
63. Gay Men's Sexual Health Alliance, Canada
64. Gel Works Pty Ltd, Australia
65. Global Forum on MSM & HIV (MSMGF), USA
66. Global Network of People Living with HIV, North American (GNP+NA), USA
67. Global Network of Sex Work Projects, UK
68. Global Research and Advocacy Group (GRAG), Senegal
69. GlobalGayz.com, USA
70. GrenCHAP Inc., Grenada
71. GWLmuda, Indonesia
72. Health Digest Foundation, Ghana
73. HealthHIV, USA
74. Heroes Project, India
75. HIV Prevention Justice Alliance, USA
76. House of Joe, USA
77. Housing Works, Inc., USA
78. Humanity First Cameroon, Cameroon
79. Hyacinth AIDS Foundation, USA
80. India HIV/AIDS Alliance, India
81. Interagency Coalition on AIDS and Development, Canada
82. International Center for Advocacy on Right to Health, Nigeria
83. International Planned Parenthood Federation, UK
84. International Rectal Microbicide Advocates (IRMA), USA
85. International Youth Council-Nigeria, Nigeria
86. IRMA ALC - América Latina y el Caribe, Peru
87. IRMA Nigeria, Nigeria
88. ISHTAR-MSM, Kenya
89. Iskorak, Croatia
90. Jamaica AIDS Support for Life, Jamaica
91. Johns Hopkins Center for Public Health and Human Rights, USA
92. Joint Adherent Brothers and Sisters Against Aids, Uganda
93. Los Angeles County HIV Drug & Alcohol Task Force, USA
94. Louisiana Latino Health Coalition for HIV/AIDS Awareness, USA
95. MAACA, INC, USA
96. Maritime Life Precious Foundation, Ghana
97. Men Against AIDS Youth Group, Kenya
98. Men For Health and Gender Justice Organisation, Botswana
99. Microbicide Trials Network, USA
100.  Minnesota AIDS Project, USA
101.  MUSC/Lowcountry AIDS Services Consumer Advisory Board, USA
102.  NAM Publications (Aidsmap), UK
103.  National Black Gay Men's Advocacy Coalition, USA
104.  National Minority AIDS Council, USA
105.  Naz Male Health Alliance, Pakistan
106.  New HIV Vaccine and Microbicide Advocacy Society, Nigeria
107.  Okaloosa AIDS support & Informational Services, Inc. (OASIS), USA
108.  PEMA Kenya, Kenya
109.  Penitentiary Initiative, Ukraine
110.  People Like Us (PLUS) Kolkata, India
111.  PeterCares House, USA
112.  POCAAN (People of Color Against AIDS Network), USA
113.  Positive Mind & Body Support Group Network, USA
114.  Positive Women's Network USA, USA
115.  Presbyterian AIDS Network, USA
116.  Pride Equality, Sierra Leone
117.  Pro Health Initiative, Nigeria
118.  Professionals in Pride Kenya (PPK), Kenya
119.  Project Inform, USA
120.  PT Foundation, Malaysia
121.  Puerto Rico Community Network for Clinical Research on AIDS, Puerto Rico
122.  Queer Alliance Nigeria, Nigeria
123.  QUEEROCRACY, USA
124.  Rainbow Community Kampuceah, Cambodia
125.  Rainbow Sunrise Mapambazuko, DR Congo
126.  Rainbow-Ethiopia in Exile (REE), USA
127.  Real Opportunities Network, Ghana
128.  San Antonio AIDS Foundation, USA
129.  San Francisco AIDS Foundation, USA
130.  SEA-AIDS (Asia Pacific eForum on HIV), India
131.  SIBALT, Russia
132.  SID'ADO, Cameroon
133.  Society Against Sexual Orientation Discrimination (SASOD), Guyana
134.  SOMOSGAY, Paraguay
135.  START at Westminster, USA
136.  Stichting AidsCare, The Netherlands
137.  Tamba Pwani, Kenya
138.  Tanzania Sisi Kwa Sisi Foundation, Tanzania
139.  Terrence Higgins Trust, UK
140.  Test Positive Aware Network, USA
141.  The Center for Sexual Pleasure and Health, USA
142.  The Initiative for Equal Rights, Nigeria
143.  The Mpowerment Project, USA
144.  The Yes Yes Company Ltd, UK
145.  Total Health Empowerment and Development (THEDI), Nigeria
146.  Treatment Action Group, USA
147.  Trigg Laboratories, Inc., USA
148.  Uganda Health and Science Press Association, Uganda
149.  UNITED AND STRONG INC, Saint Lucia
150.  Vivir. Participacion, Incidencia y Transparencia, A.C., Mexico
151.  Vote For Health Campaign, India
152.  We For Civil Equality NGO, Armenia
153.  William Way LGBT Community Center, USA
154.  Women`s Health, HIV and AIDS Southern Africa, Zimbabwe
155.  Womenplus Against TB and HIV in Kenya, Kenya
156.  Women's Health and Equal Rights Initiative, Nigeria
157.  Woodhull Sexual Freedom Alliance, USA
158.  World AIDS Forum, Australia
159.  Youth Voices Count, Thailand

Endorse.

INDIVIDUALS who have endorsed the Call = 310 to date

1.  Adam Fairris, UK
2.  Ako Cyriaque Yapo, Senegal
3.  Alan Johnson, USA
4.  Alapini Max, Benin
5.  Alberto Abello, USA
6.  Alex Carballo-Dieguez, USA
7.  Alicia Gauvin, USA
8.  Allison Boyd, USA          
9.  Amoussou Damien, Togo
10.  Andrew Reynolds, USA
11.  Angel Luis Hernández, Puerto Rico
12.  Ann Jones, USA              
13.  Ann Joseph, USA
14.  Anna Forbes, USA         
15.  Anna Saeger, USA
16.  Anne Lehocky, USA      
17.  Antonio Gonzalez, USA
18.  Arick Buckles, United States
19.  Ben Bavinton, Australia
20.  Ben Clapham, USA
21.  Ben Wilcock, Australia
22.  Bertram Johnson, United States
23.  Beth Galaska Burzuk, USA          
24.  Bi Petex, Uganda
25.  Bisi Alimi, United Kingdom
26.  Blake Smith, UK
27.  Bobby Ramakant, India
28.  Brian Kanyemba, South Africa
29.  Brian M. Green, USA
30.  Brian White, South Africa
31.  Briana Morgan, United States
32.  Brooke Willis, USA         
33.  Butch McKay, USA                         
34.  Cameron Wolf, USA
35.  Caren Kirkland, USA      
36.  Carlos Vela, Peru            
37.  Carrie E .Foote, USA
38.  Cassandra Warren, USA              
39.  Cassie Bayside, Australia
40.  Celina Londono, USA
41.  Champion Phiri, South Africa
42.  Chanthorn Phorng, Cambodia
43.  Charlene Dezzutti, USA
44.  Charles, Uganda             
45.  Chheav Aphyra, Cambodia
46.  Chiranjivi Amgai, Nepal
47.  Chris Bartlett, USA
48.  Christian Rumu, United States
49.  Christopher B. Duerkes, USA
50.  Chull Sesugh Stanley, Nigeria
51.  Clare Collins, USA
52.  Clayton Ruley, USA
53.  Collins Seymah Smith, Ghana
54.  Cory Silverberg, Canada              
55.  Courtney McCrellias, USA
56.  Dahlia Ferlito, USA
57.  Dan Kilbane, USA
58.  Dana Loxley, Australia  
59.  Dana Nelson, USA
60.  Daniel MacDonald, USA
61.  Daramola Christianah, Nigeria
62.  Darrel Johnson, United States
63.  David Acosta, USA
64.  David G Ostrow, USA
65.  David Kuria, Kenya
66.  David Phillips, USA         
67.  Deb Tolenaar, USA
68.  Deirdre Grant, USA       
69.  Denis Efremov, Russia
70.  Derrick Mapp, USA
71.  Don Pults, USA
72.  Donald MacIver, USA
73.  Donn Colby, Vietnam   
74.  Doug Brown, UK
75.  Doug McColeman, Canada
76.  Douglas Masinde, Kenya
77.  Douglas Warzyn, USA   
78.  Douomong Yotta Serge, Cameroon
79.  Dr Stuart Koe, Singapore
80.  Dr. Michael W. Plankey, USA
81.  Dredge Kang, USA
82.  Drew  Nannini, United States
83.  Duncan Japhta Khothatso Moeketse, South Africa
84.  Durueke Florita, Nigeria
85.  Dustin Kight, USA
86.  Ed Wolf, USA
87.  Edie O'Connor, United States
88.  Edward Fuchs, USA
89.  Edward Iwanicki, USA
90.  Eniko Akom, USA
91.  Eric Arnold Fopossi, Cameroon
92.  Eric Evans, USA
93.  Eric M Glare, Australia  
94.  Erich Schneider Ormeño, Peru
95.  Erik Libey, USA
96.  Erik Streeter, USA
97.  Ernest MOSEKI, Botswana
98.  Essiomle Ethie, Togo
99.  Eva Westley, United States
100.  Fiona Hale, UK
101.  Gabriel Boichat, Spain
102.  Gail Broder, USA
103.  Garland Wood, USA      
104.  Garry Brough, UK
105.  Gary Paul Wright, USA
106.  Gbekou, Togo
107.  Gennady Roshchupkin, Russia
108.  George Kerr, USA          
109.  George Miller-Zauner, USA
110.  George Pappas, USA
111.  George Reginald Freeman, Sierra Leone
112.  George Victor O, Kenya
113.  Georges S., Togo
114.  Georges Sideris, France
115.  Gerard Nkundimana, Rwanda  
116.  Gina Brown, USA
117.  Glenn Kornblum, USA  
118.  Gregg Kimball, USA
119.  Hanna Hjord, USA          
120.  Hannah Graves, Canada
121.  Heidi Nass, USA
122.  Heidi Wesbrock, USA   
123.  Helen, USA
124.  Henrieese Roberts, USA
125.  Hugo Dann, Canada
126.  Ian Lemieux, US             
127.  Ivan Cruickshank, Jamaica          
128.  J. Jeff McConnell, USA 
129.  Jace Dyckman, USA
130.  Jack Cox, USA
131.  Jade Patten, USA
132.  James Carrington, United States
133.  James Komar, United States
134.  Jamie Roberts, USA
135.  Jamie Sims, USA
136.  Jason Jacobs, USA
137.  Jason King , USA             
138.  Jean-Michel Brevelle, USA
139.  Jeff Berry, USA
140.  Jeffrey Pope, USA         
141.  Jennifer A. Hawley, USA
142.  Jeremy Kwan, Malaysia
143.  Jerome Galea, USA       
144.  Jeton Ademaj, USA
145.  Jim Cosenza, USA
146.  Jim Eigo, USA
147.  Jim Merrell, USA            
148.  Jim Pickett, USA
149.  Joan Tallada, Spain
150.  John Andrews, USA
151.  John Hamiga, USA         
152.  John Kashiha, Tanzania
153.  John McAllister, Botswana
154.  John Peller, USA             
155.  Jorge Gutierrez, USA
156.  Jorge Yon, Peru
157.  Joseph Alfano, USA
158.  Joseph Walker, USA
159.  Joyce Hunter, USA
160.  Jules Eloundou Atamba, Cameroon
161.  Julian Sanjivan, USA      
162.  Julie Davids, United States
163.  Kadiri Audu, Nigeria
164.  Karen Creary, USA         
165.  Karon Stephen, France
166.  Kasha Jacqueline, Uganda
167.  Kate Alexander, USA
168.  Kate Morrow, USA
169.  Kay Marshall, USA
170.  Kees Rümke, The Netherlands
171.  Keith Gereffi, USA
172.  Kelly Curran, USA
173.  Kennedy Otieno Olango, Kenya              
174.  Kenny, USA
175.  Kent Klindera, United States
176.  Kevin DeLuca, USA
177.  Kevin McKenzie, USA
178.  Kieta D. Mutepfa, USA
179.  Krishna Stone, USA
180.  Kyon Saucier, USA
181.  Larry Baxter, Canada    
182.  Laurel Sprague, United States
183.  Laxmi Narayan Tripathi, India
184.  Leo Schenk, The Netherlands
185.  Lillibeth Gonzalez, USA
186.  Linda Watson, Canada
187.  Loren Jones, United States
188.  Luis Galarza, Ecuador    
189.  Mac-Darling Cobbinah, Ghana  
190.  Maheswar Satpathy, Australia 
191.  Marc-André LeBlanc, Canada    
192.  Marcelo Maia, USA       
193.  Margaret Onah, Nigeria
194.  Marie Camacho, USA   
195.  Marie Omorodion, USA
196.  Mark Hubbard, USA      
197.  Mark Ing, USA 
198.  Mark S. King, USA          
199.  Marlon Woodward, USA
200.  Martha Tholanah, Zimbabwe
201.  Mary Brewster, United States
202.  Mathew Rodriguez, USA
203.  Matt Bray, USA
204.  Matthew Franck, USA
205.  Matthew Rose, USA
206.  Matthew Vaughan, Thailand
207.  Melanie A Reese, USA
208.  Michael Louella , USA   
209.  Michael Luciano, USA
210.  Michael Moore, USA    
211.  Michael Trigg, USA
212.  Mike Kennedy, Australia            
213.  Mike Peters, USA
214.  Mombunza Azuba, DR CONGO
215.  Monique Newell, USA 
216.  Morenike Ukpong, Nigeria        
217.  Muriel Visser, France   
218.  Mykaila Ostrom, USA
219.  Mykal Welch, Belize
220.  N. Nash, USA
221.  Naigaga Lillian Mutengu, Uganda
222.  Nathan Solomon, USA 
223.  Nicholas Bates, Australia
224.  Nnamani Ikechukwu Sammy, Nigeria
225.  Olumide Makanjuola, Nigeria
226.  Omullo Paul, Kenya
227.  Orbit Clanton, USA
228.  Otis Richardson, USA
229.  Patricia Segura, Peru
230.  Patrick French, USA
231.  Paul Causey, Thailand
232.  Pedro Goicochea, USA
233.  Penny DeNoble, USA
234.  Pham Thi Hanh Van, Vietnam
235.  Phillis Washington, USA
236.  Pilot Mathambo, Botswana
237.  Prince N. Bahati, Kenya
238.  Ramon Nunez III, USA
239.  Rebecca Giguere, USA 
240.  Remigus Emodi, Nigeria
241.  Rev. Charles Straight, USA
242.  Ricardo Jimenez, USA
243.  Richard Coover, USA
244.  Rita Lisa Labbett, US     
245.  Rob Camp, Spain
246.  Robert Aponte, USA
247.  Robert Birch, Canada
248.  Roger Cunha, USA
249.  Roger Pebody, UK         
250.  Roger Prasad, Canada
251.  Roger Tatoud, UK          
252.  Roy Wadia, India            
253.  Rukia Ahmed, Kenya
254.  S. Wakefield, USA
255.  Santiago Palomino, Peru
256.  Sasha Gear, South Africa
257.  Scot More, USA
258.  Scott Robertson, Zambia             
259.  Sedar, Benin
260.  Sergio Farfan, USA
261.  Shawn Decker, United States
262.  Shayna Buhler, Canada
263.  Shivani Thaker, USA
264.  Shreena, India 
265.  Sibusiso, South Africa
266.  Simon Odiwuor, Kenya
267.  Siobhan Fee, UK
268.  Solomon, Kenya
269.  Srun Srorn, Cambodia
270.  Steave Nemande, Cameroon
271.  Stephen Karpiak PhD, United States
272.  Stephen McGill, Liberia
273.  Stephen Miller-Zauner, USA
274.  Steve Miralles, Peru     
275.  Steven S. Muchnick, PhD
276.  Stuart Koe, Singapore
277.  Sue Saltmarsh, USA      
278.  Suman Nepal, Nepal
279.  Suraj Madoori, USA
280.  Susan Forrest, USA       
281.  Susan Lloyd Yolen, USA
282.  Susie Hoffman, USA
283.  Sylvie Rouby, France  
284.  Tendai F Mbengeranwa Mhaka, Zimbabwe
285.  Terence Roethlein, United States
286.  Teresa Springer, USA
287.  TG Green, USA
288.  Thandi Maluka, South Africa
289.  Theresa Rubin, USA      
290.  Thomas Haig, Canada
291.  Tiedjou Joseph Achille, Cameroon
292.  Timothy Frasca, USA     
293.  Timothy Kee, United States
294.  Titcha Ho, USA
295.  Trenado, France
296.  Trevor Pearson, USA
297.  Troy, USA
298.  Tung Duy Bui, Thailand
299.  Udom Likhitwonnawut, Thailand
300.  Vanessa Smith, USA
301.  Victor Rollins, Bahamas
302.  Vikram, USA
303.  Wanda Brendle-Moss, USA
304.  Wanda Commander, USA
305.  Will Wilson, USA
306.  William Booth, Canada
307.  Wolf Graf, Australia
308.  Yolanda, USA   
309.  Zoe Duby, South Africa
310.  Zoran Dominkovic, Croatia

Endorse. 

-------------------

*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,200 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.

-------------------

Three Organisations Receive Support to Improve Lubricant Access in Africa

IRMA*, amfAR*, and AVAC* are delighted to announce that IRMA Nigeria (in partnership with International Center on Advocacy for the Right to Health), Stop AIDS in Liberia (SAIL), and an organisation in Zambia** have been awarded Global Lube Access Mobilisation (GLAM) funding to campaign for access to safe, condom-compatible lubricants in their communities.

Throughout the world, and especially in Africa, safe, condom-compatible lubricant (water- and silicone-based) is inaccessible for most people who engage in anal intercourse.  It is also inaccessible for women who engage in vaginal intercourse.  A number of analyses in various settings indicate that the use of oil-based products is the most common form of lubrication - and is known to significantly reduce condom effectiveness.  Faced with the lack of condom-compatible lubricants, people often resort to such products as body lotion, soap, cooking oil, spit, pre-cum, antibiotic creams, and even motor oil to provide lubrication during anal intercourse. This lack of appropriate lubricant products for people who practice anal and vaginal intercourse is unacceptable, when we know that they can keep condoms from breaking and slipping.

In December 2012, IRMA, amfAR, and AVAC launched "The GLAM Toolkit - Advocacy to improve access to safe, condom-compatible lubricant in Africa, Version 1.0".  The Toolkit is available here and offers tools and ideas for civil society and government partners to secure affordable and sustainable condom-compatible lubricant.  Tools include a fact sheet, case studies, the results of a review of African National and Strategic Plans on HIV/AIDS, and a list of proposed advocacy activities.

After the Toolkit launch, the group released a request for proposals targeted to community advocates and organisations in Africa interested in improving lube access.  Eighteen proposals were submitted from 11 African countries.

IRMA Nigeria, SAIL, and a Zambian organisation received the highest scores in a thorough evaluation process and began their lube access advocacy projects in April.  We wish them the best, and will keep you apprised of their efforts.  It is the hope the other groups will be able to learn from their work, and that one day all Africans who need safe, condom-compatible lubricants have easy, unfettered access to these critical commodities.

In the meantime, download a copy of the GLAM Toolkit to see what activities you can implement now in your own community.  Charting a course now for condom-compatible lube will assist in reducing the spread of HIV and other STIs, as well as pave the way for the eventuality of rectal microbicide access.

Learn more about GLAM here.

*IRMA - International Rectal Microbicide Advocates
*amfAR - The Foundation for AIDS Research
*AVAC - Global Advocacy for HIV Prevention

**At the request of the grantee, the organisation wishes to remain anonymous.

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*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.

-------------------

GMHC presents: The Bottom Line on Rectal Microbicide Research - 1/23/13 in NYC

You are invited to a discussion and video presentation on rectal microbicide research and advocacy with IRMA and friends at Gay Men's Health Crisis in NYC, from 10am til noon on Wednesday, January 23, 2013.

View a special screening of the new video "The Rectal Revolution is Here: An introduction to rectal microbicide clinical trials."

Light refreshments will be provided. Event is FREE and open to the public.

For more details, click here for the fyer. Or click on the image below.

Click image to enlarge.

-------------------

*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

  *Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.

  -------------------

Rectal microbicide research takes giant leap forward with groundbreaking educational video

HIV prevention organizations debut The Rectal Revolution Is Here: An Introduction to Rectal Microbicide Clinical Trials in advance of first-ever Phase II rectal microbicide trial

 

[Press Release]

International Rectal Microbicide Advocates (IRMA), the Population Council, and the Microbicide Trials Network (MTN) today released a collaborative video project called The Rectal Revolution Is Here: An Introduction to Rectal Microbicide Clinical Trials. The jointly produced video, the first of its kind, is designed to educate communities affected by HIV about rectal microbicide development and the importance of participating in clinical trials to help speed the search for new HIV prevention options.

"The Rectal Revolution will be an excellent tool for education and recruitment for MTN-017, the first-ever Phase II safety trial of a rectal microbicide planned to launch soon. The video will be particularly useful because it's not protocol-specific and can be used in future rectal microbicide trials as well," said Clare Collins, MTN associate director of communications and external relations and video co-producer.

"There is an engaging mixture of animation and live action with beautiful footage from Thailand, South Africa, Peru, and the United States," Collins continued, "and we showcase interviews with scientists, advocates, and an exceptional rectal microbicide trial participant, Rig Rush, who is both eloquent and entertaining as he shares his personal experience as a study volunteer."

Produced by Paw Print Productions of Cape Town, South Africa, the video is available for viewing now on YouTube in English, Spanish, and Thai.

"This educational video is a groundbreaking tool to recruit volunteers and educate public health leaders for what may be one of the most promising new methods to fight HIV," said co-producer Barbara Friedland, associate in the HIV and AIDS program at the Population Council. "It was developed through an intense consultative process to ensure accuracy and relevance to the communities where this video will be shown," she said.

"We wanted the video to be educational and engaging, and to encourage audiences to get involved in efforts to prevent HIV," Friedland continued."So we worked with an advisory committee comprising staff at rectal microbicide trial sites, scientists, advocates, and other community experts to develop the script. We screened 'rough cuts' of the video with 80 professionals in the field and pre-tested it in 13 focus group discussions with over 100 gay men and transgender women in Thailand, South Africa, Peru, and the United States," she said.

"The insights and wisdom these individuals shared with us were absolutely critical to shaping the final version of the video," said Friedland.

Major funding and support for the project was generously provided by the MAC AIDS Fund, the MTN, and the Population Council, through a grant from the Swedish Ministry of Foreign Affairs.

The video debut precedes the soon-to-be launched landmark study being conducted by MTN to test a reduced-glycerin formulation of tenofovir gel among gay men, other men who have sex with men, and transgender women for safety and acceptability. MTN-017 is not only the first-ever Phase II study of a rectal microbicide, it is also the first time rectal microbicide research is expanding outside the United States and going global, with sites in Thailand, South Africa, Peru, and Puerto Rico.

"IRMA and the Population Council enthusiastically support the start of MTN-017," said Jim Pickett, IRMA chair. "The 186 individuals who will volunteer for the trial will more than double the total number of people who have participated in rectal microbicide clinical trials to date. The study will mark a giant leap forward for the field of rectal microbicides and will set the stage for future large-scale efficacy trials," he said.

Pickett continued, "the day we have a safe, effective, and acceptable rectal microbicide as a much-needed HIV prevention option for people who engage in anal intercourse is within our sights—these are truly revolutionary times and we couldn't be more energized."

Learn more about the MTN-017 trial here.

###


IRMA, the Population Council, and MTN encourage HIV prevention advocates and community educators to screen The Rectal Revolution Is Here in their own workshops and sensitization sessions and to share it widely. To receive a copy of the video in English, Spanish, or Thai, please contact IRMA at rectalmicro@gmail.com.

Editorial notes:

Currently in development, microbicides are products (gels, lubricants, films) that could be applied in the rectum or the vagina to reduce the risk of HIV infection.

Unprotected anal intercourse is 10 to 20 times more likely to result in HIV infection compared to unprotected vaginal intercourse. Unprotected anal intercourse—a common human behavior—is a significant driver in the global HIV epidemic among gay men and transgender women as well as among heterosexuals.

IRMA, based at AIDS Foundation of Chicago, is a global network of more than 1,100 advocates, scientists, policy makers, and funders from six continents working together to advance a robust rectal microbicide research and development agenda. The "bottom line in HIV prevention," IRMA addresses the institutional, socio-cultural, and political stigma around the public health need for rectal microbicide research, and advocates to increase funding and commitment within this field of inquiry.

The Population Council confronts critical health and development issues—from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world. Established in 1952 and headquartered in New York, the Council is a nongovernmental, nonprofit organization governed by an international board of trustees.

 

The Microbicide Trials Network is a U.S. National Institutes of Health-funded worldwide collaborative clinical trials network focused on preventing the sexual transmission of HIV. Recognizing the importance of microbicides research to HIV/AIDS prevention, the National Institute of Allergy and Infectious Diseases (NIAID), part of the U.S. National Institutes of Health (NIH), established the Microbicide Trials Network (MTN) in 2006, with co-funding from the NIH’s National Institute of Mental Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The MTN brings together international investigators and community and industry partners devoted to reducing the sexual transmission of HIV through the development and evaluation of products used orally or applied topically.

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*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.

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Introducing the GLAM Toolkit: Advocacy to improve lubricant access in Africa

Today, IRMA,  in collaboration with amfAR and AVAC, is delighted to officially release Version 1.0 of The GLAM Toolkit: Advocacy to improve access to safe, condom-compatible lubricant in Africa.

The Toolkit provides background on the status of lubricant (lube) access in Africa and strategies for civil society and government partners to secure and distribute sustainable supplies of safe, condom-compatible lube. Global Lube Access Mobilisation (GLAM) is a campaign of IRMA’s Project ARM (Africa for Rectal Microbicides) initiative.

It is also available on the IRMA blog here (where you can also learn more about Project ARM.)

And can be downloaded here as well.

Condom- compatible lube is associated with a decreased risk of condoms breaking or slipping. Simply put, condoms work better with condom-compatible lube, especially during anal intercourse. That said, men, women and transgender individuals - whether they have anal interourse, vaginal intercourse, or both, need and want safe, condom-compatible lube.

However, throughout the world, and particularly in Africa, condom-compatible lubricant is inaccessible for most people. The GLAM Toolkit (Version 1.0) is designed to encourage advocates to engage Ministries of Health, UN agencies, funders, non-governmental organizations, and other partners to make the provision and distribution of safe, condom-compatible lubricant a priority by positioning lubricant as an absolute necessity, along with male and female condoms.

The Toolkit contains six sections including:

·         Background and introduction
·         Lubricant—Basic Facts on Access and Safety
·         Review of African National Strategic Plans on Inclusion of Lubricant
·         Lube Procurement National Case Studies
·         Findings from Survey on Lube Distribution and Access
·         Advocacy Steps for Improving Access to Lubricant

As the Toolkit is a “living” document, it will be updated regularly by IRMA and partners to keep it timely and relevant. Hence, this Version 1.0 will be replaced by updated versions as the work progresses with new information to report. Please share your successes.

And remember, when you hear anyone say the word "condoms" - we say AND LUBE!

PS - While The GLAM Toolkit is focused on Africa and is embedded in our Project ARM initiative, we recognize that lube access is a serious issue all over the world. The ideas in the Toolkit can and should be adapted for other contexts - and we hope you will do that in yours. We also hope to secure resources to expand our lubricant access work beyond Africa. Stay tuned. And Lube!

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*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro. *Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.

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[Project ARM] GLAM Lube Distribution Survey

via Survey Monkey, for [Project ARM] GLAM Lube Distribution Survey

Thank you for taking a few minutes to complete this survey on lubricant distribution in your country.

International Rectal Microbicide Advocates (IRMA) has launched a special initiative called "Project ARM - Africa for Rectal Microbicides" to ensure rectal microbicide research and advocacy are on the African map.

The top priority of Project ARM is lube access for people who engage in anal intercourse.

Condoms and safe, condom-compatible lubricant should be used during anal intercourse to provide protection against HIV and other STDs. Safe, condom-compatible lubricants are also used by many women who desire extra lubrication during vaginal intercourse. Condoms used without proper lubricant can break.

With partners amfAR and AVAC, Project ARM has developed the GLAM campaign (Global Lube Access Mobilisation) in an effort to improve access to safe, condom-compatible lubes for individuals in Africa and other countries where lube access is poor.

Your answers to these questions will inform a "tool kit" that is being developed to support lube access advocacy and implementation.

Access the survey here.


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*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.
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Rectal Microbicides Seen As Key in Preventing New HIV transmissions

[Citizen News Service and IRMA are collaborating to amplify rectal microbicide research and advocacy, as well as IRMA-led initiatives, throughout AIDS 2012.]

via Citizen News Service, by Chief K.Masimba Biriwasha

Unprotected anal sex has long been regarded as a key driver of HIV transmission in many parts of the world, especially among men who have sex with men. In many contexts, the practice is surrounded with stigma and discrimination which is a key barrier to developing protective measures, and largely pushes affected populations to go underground far from the reach of public health services as well as HIV prevention tools.

There is a growing recognition that to turn the AIDS tide and avoid uneccessary deaths, there is a need to develop new HIV prevention tools such as rectal microbicides for women, men, and transgender individuals around the world who engage in anal intercourse.

Read the rest.

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*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.
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Slides from "Rectal Microbicides - Making HIV Prevention Gel" satellite session at AIDS 2012

Earlier today at the International AIDS Conference (AIDS 2012), IRMA co-hosted a well-attended satellite session on rectal microbicides with their partners Microbicide Trials Network (MTN) and AVAC.

Ian McGowan from the MTN and Jim Pickett from IRMA presented on the science and advocacy (respectively) and were then joined by panelists from the United States, Kenya, and South Africa (Damon Humes, Rig Rush, Mitchell Warren, Carol Odada and Brian Kanyemba) for a conversation with the attendees.

Ronald Johnson of AIDS United moderated.

Below you will find Ian and Jim's slides.

The Science of Rectal Microbicides Can We Make Them And Will People Use Them? 

Rectal Microbicide Advocacy From Here to There... And Especially in Places Where the Sun  

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*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

  *Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.

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So You Want to be a Sex Writer? Tristan Taormino on Activism, Anal, and Quitting Law School

via SF Weekly, by Vanessa L. Pinto

Excerpt:

"I sent them a proposal for a book I called The Ultimate Guide to Anal Sex for Women. This was a book I wanted to have on my shelf. I'm someone who started having anal sex in college. I really loved it, and I knew I couldn't possibly be the only person out there that liked it."

Read the rest.

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*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.

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Age at First Anal Sex and HIV/STI Vulnerability among Gay Men in Australia

via bmj.com, by Anthony Lyons

ABSTRACT

Objectives To determine whether there is a link between age at first anal intercourse (AFAI) and gay men's HIV/sexually transmissible infection (STI) vulnerability, including tendencies to engage in higher risk sexual behaviour.

Methods A nationwide cross-sectional survey was conducted online involving 845 Australian gay men born between 1944 and 1993.

Results Median AFAI fell from 35 years for men born between 1944 and 1953 to 18 years for men born between 1984 and 1993. Of those who reported having had anal intercourse (N=822), HIV-positive men were found to be significantly younger on average when they first had anal intercourse compared with HIV-negative men (18.5 vs 21.3 years, p<0.001). Men with a history of other STIs were also significantly younger. Engaging in higher risk sexual behaviour is a likely factor, with AFAI generally younger among men who reported >10 sexual partners in the past year (p<0.001) and who engaged in group sex (p<0.001), receptive anal intercourse (p=0.008) or were drug or alcohol affected (p=0.06) during their most recent sexual encounter.

Conclusions There appears to be a strong link between AFAI and infection with HIV/STIs, as well as tendencies to engage in higher risk sexual behaviour. While further research is needed to understand this link, these findings highlight a need for sexuality education aimed at gay-identified youth to ensure their sexual debut does not lead to poorer sexual health outcomes.

Read the rest.


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*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.
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Characteristics Qualifying Gay Men for Intermittent PrEP

via AllAfrica.com, by Michael Carter

Older, better-educated gay men who use sexual networking sites and have sex outside the context of committed relationships may be appropriate targets for intermittent pre-exposure prophylaxis (PrEP), US research published in the online edition of the Journal of Acquired Immune Deficiency Syndromes suggests.

The investigators found that individuals with this profile were more likely to plan their sexual encounters and to have anal sex fewer than three times per week.

“Our study serves to better characterize MSM [men who have sex with men] who may most benefit from event-based intermittent PrEP,” comment the authors.

The iPrEX study involving gay and other MSM showed that PrEP significantly reduced the risk of acquiring infection with HIV.

However, adherence is a major barrier to the success of PrEP. There are also concerns about its cost and potential side-effects. Intermittent dosing has been proposed as a way of overcoming these limitations. A recently published study showed that adherence was also challenging when an intermittent dosing strategy was used.

This treatment strategy involves taking a dose of antiretroviral therapy before a risky sexual encounter, with a second dose taken shortly after.

This strategy will only be suitable for people who engage in risky sex fewer than three times per week, and who plan their sexual encounters.

Investigators in the US wished to establish a better understanding of the characteristics of gay men and other MSM who fulfilled these criteria.

HIV-negative gay men were recruited to the study using social networking sites in late 2010. All were sexually active (defined as anal sex within the previous month). The men supplied demographic data, as well as information about their sexual risk behaviour, how they planned their sexual encounters, their use of sexual networking media and their relationship status.

A total of 1013 men participated in the research. Their median age was 28 years. Most (56%) participants reported that their last anal sex was unprotected.

Read the rest.


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*Join IRMA's robust, highly-active. moderated, global listserv addressing rectal microbicide research and advocacy as well as other interesting new HIV prevention technologies by contacting us at rectalmicro@gmail.com. Joining our listserv automatically makes you a member of IRMA - a network of more than 1,100 advocates, scientists, policy makers and funders from all over the world.

*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

 *Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.
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The Risks Caused by Unprotected Anal Sex

via Australian Federation of AIDS Organisation, by Eric Glare

This article describes the biological role of anal mucus and its association with the gastrointestinal immune system, which harbours a persistent reservoir of HIV that potentially leads to infectious anal mucus. ERIC GLARE argues that all HIV prevention discussions should highlight the role anal mucus plays in HIV transmission.

Strategic positioning, where an HIV-negative man takes the insertive role inunprotected anal intercourse with an HIV-positive partner in order to reduce his risk of infection, has been associated with an intermediate incidence of HIV in cohorts of Sydney men who have sex with men (MSM).

Circumcision of the insertive partner and an undetectable blood plasma viral load in the receptive partner are two factors often cited as contributing to risk reduction in strategic positioning practices, despite there being a paucity of data on HIV transmission by anal intercourse in men who take the insertive role in male-to-male sex.

Men who practise strategic positioning are attempting to take perceived risks into account to form personalised boundaries around anal intercourse but, until recently, a comprehensive understanding of HIV transmission through insertive unprotected anal intercourse has not been widely canvassed in research literature.

A 2008 study of risk factors associated with HIV seroconversion in gay men in England identified that some men taking the insertive role in anal intercourse contracted HIV because they did not perceive that they were at risk of infection. GMFA, a gay men’s health charity based in the UK, responded with a campaign called Arse Facts that identified anal mucus as a body fluid containing HIV at potentially infectious levels.

Anal mucus is increasingly being mentioned in Australian campaigns as the infectious body fluid potentially infecting the insertive partner during unprotected anal intercourse. At times, the explanation of the role that anal mucus plays in transmitting HIV to the insertive partner has been relegated to in-depth discussions of topics such as risk reduction, but is frequently left out of more introductory information about HIV transmission (e.g. Whereversexhappens.com),and some campaigns discuss the risk of insertive anal intercourse without mentioning any body fluids involved.

Some campaigns warn that even if an HIV-positive person has an undetectable blood plasma viral load they might have higher viral load in anal mucus, particularly if they also have another STI. However, it should also be noted that a recent study, looking at men who have sex with men, found that plasma and rectal viral load were correlated, and that STI in the rectum did not increase the likelihood of detecting HIV in anal mucus, including those that had low or undetectable levels of HIV in their blood. This study suggests that a lower HIV viral load in blood plasma would also mean a lower viral load in anal mucus.

Read the Rest.



[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.]

Researchers Stress the Importance of Screening Women for Precancerous Anal Lesions

via AIDSmeds, by Tim Horn

Results from a study conducted in the Bronx, New York, serve as an important reminder to HIV care providers: Comprehensive screening for precancerous anal lesions isn’t of importance only to HIV-positive men who have sex with men (MSM). According to the Journal of Acquired Immune Deficiency Syndromes report by researchers at Albert Einstein College of Medicine in the Bronx, precancerous lesions are also common among women living with HIV—and testing for them using anal swabs alone may not be sufficient to rule out problems requiring biopsies.

Numerous studies have noted high rates of anal cancer among MSM. According to one study cited by June Hou, MD, and her colleagues at Albert Einstein, the incidence of anal cancer among MSM is 10 to 50 times that of the general population and comparable to cervical cancer incidence rates before the implementation of now-routine screening practices.

Among HIV-positive women, some studies put the incidence of anal cancer at seven to 28 times greater than the general population. Though the incidence of anal cancer has not been nearly as well studied in HIV-positive women compared with HIV-positive MSM, the confirmed higher rates of precancerous lesions—which can occur among women living with HIV, even if they’ve never engaged in anal sexual intercourse—remain a concern.

Yet there is no consensus between national and local groups on anal cancer screening among people living with HIV, either male or female. “Since 2007,” Hou and her colleague explain, “the New York State Department of Health (NYS DOH) has recommended annual anal cytology”—Dacron swabs analyzed by a laboratory—“in HIV-infected subjects with a history of [anal warts] or with abnormal cervical/vulvar histology, along with referral for high resolution anoscopy (HRA) in those with abnormal anal cytology or abnormal findings on anal exam. In contrast, the Department of Health and Human Services guidelines discourage screening and treatment programs for [anal intraepithelial neoplasia, or AIN] due to a lack of complete understanding of the relative harms and benefits of anal cytology screening.”

In turn, to better understand the incidence of precancerous anal lesions and the value of routine anal cytology, Hou and her colleagues conducted a study among women in the Bronx, which has one of the highest HIV prevalence rates in the country, representing 3 percent of the total U.S. HIV burden.

Read the Rest.


[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.]

The Role of Sexually Explicit Media (SEM) in the Transmission and Prevention of HIV Among MSM

via AIDS and Behavior, by B. R. Simon Rosser, Jeremy A. Grey, J. Michael Wilkerson, Alex Iantaffi, Sonya S. Brady, Derek J. Smolenski and Keith J. Horvath

Abstract

Although research has been conducted over the last half century to test the hypothesis that pornography, or sexually explicit media (SEM), influences behavior, information regarding usage and its effect on men who have sex with men (MSM) is limited. It is important for researchers studying online risk factors for HIV to consider the relationship between SEM consumption and risky sexual behavior, particularly given the exponential increase in SEM exposure as a result of the near-compulsory use of the Internet. In this commentary, we review findings regarding this relationship from studies of international and heterosexual populations. We then suggest future directions for research regarding MSM in the United States and practical applications of such research if the results from other populations extend to them. Research suggests there might be ways to use SEM to create innovative approaches to online HIV prevention, particularly among such at-risk populations as youth and MSM of lower socio-economic statuses.

Read the full study 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.]

Increased risk of anal cancer for all groups with HIV, not just MSM

via Aidsmap, by Michael Carter

Gay men are not the only group of HIV-positive patients who have an increased risk of anal cancer, according to North American research published in the online edition of Clinical Infectious Diseases. The researchers found that incidence of the cancer was also significantly higher in non-gay HIV-positive men as well as HIV-positive women when compared to individuals in the general population.

“We confirmed that HIV-infected MSM [men who have sex with men] experienced the greatest risk of anal cancer,” write the authors. “We also found that both HIV-infected other men and women had substantially higher rates than HIV-uninfected men and women, and that HIV-infected other men and women had similar rates.” They believe that their findings may have implications for anal cancer screening strategies.

Thanks to improvements in HIV treatment and care the prognosis of many HIV-positive patients is now near normal. However, HIV-positive patients appear more likely to develop certain malignancies, including anal cancer, compared to their HIV-negative peers.

Understanding the incidence of anal cancer in the different populations affected by HIV can help develop strategies to prevent the cancer.

Therefore investigators from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) analysed findings from 13 US and Canadian studies. Their aims was to determine incidence of anal cancer in HIV-positive patients, who were divided into three categories – MSM, other men and women.

Rates of anal cancer in these HIV-positive patients were compared to those observed in HIV-negative men and women. Analyses were also conducted to see if there were temporal trends in anal cancer incidence, and if any specific risk factors for the malignancy in HIV-positive patients could be identified.

A total of 34,000 HIV-positive patients (55% MSM, 19% other men, 26% women) and 110,000 HIV-negative controls (90% men) were included in the study.

Data gathered between 1996 (the year effective HIV therapy first became available) and 2007 were examined by the investigators.

Incidence of anal cancer in MSM was 131 per 100,000 patient years. Among HIV-positive other men incidence of the malignancy was 46 per 100,000 years, and incidence in HIV-positive women was 30 per 100,000 person years. Incidence was therefore significantly higher in HIV-positive MSM compared to other men (p < 0.01). However, incidence rates for HIV-positive other men and women did not differ significantly.

Read the rest.


[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.]

MSM in Africa: Highest Risk Group?

via Aidsmap, by Gus Cairns

Men who have sex with men may now be at considerably higher risk of acquiring HIV than other at-risk groups such as female sex workers or young people of either sex, if findings by the International AIDS Vaccine Initiative (IAVI) of HIV incidence at two centres in Kenya can be generalised to other populations.

The study, which compared the Kenyan populations with a largely heterosexual group from South Africa, also found lower-than-expected HIV incidence amongst female sex workers and their clients. The researchers also found that recruiting MSM into the study was easier than expected, but note that there was a particularly high dropout rate in MSM.

They comment that while MSM “need urgent risk reduction interventions, and may be a suitable cohort for future HIV prevention studies,” because African MSM face considerably legal and social hurdles in coming forward, “careful consideration of the counselling and clinical needs, follow-up schedule and social support is vital to ensure continuing research participation.”

The study

The aim of the study was to collect data on HIV and STI incidence and risk factors in three populations in Kilifi, a district north of Mombasa, and the Kangemi district of Nairobi, both in Kenya, and from Gugulethu township in Cape Town in South Africa, the better to target HIV vaccine trials.

The researchers recruited 716 people in Mombasa, 653 in Nairobi and 465 in Cape Town, The researchers primarily used participants to recruit their peers in South Africa, where background HIV prevalence at 28% is ten times higher than in Kenya, but in Kenya recruited attendees at HIV testing centres, via outreach work in bars and brothels, and via ‘snowball’ sampling (asking members of a particular group to recruit others from the same group). The original idea had been to collect data on high-risk heterosexuals including sex workers but, as the researchers comment, “it quickly became apparent that MSM were willing to come forward and participate in HIV prevention research”.

Somewhat different monitoring and follow-up criteria were used in the three centres. In Cape Town participants were monitored monthly and followed up for one year while in the two Kenyan cohorts participants were monitored quarterly for two to four years. In Mombasa participants were examined for STIs at every visit but in Nairobi and Cape Town only examined if they had symptoms. As a result annual STI incidence was much higher in Mombasa (23%) than in the other two centres (3.7% and 4.4%).

The average ago of participants was mid-20s (slightly older in Nairobi); nearly 70% were women in Cape Town, 50% in Nairobi and 36% in Mombasa. Participants in Capt Town were almost entirely heterosexual men and women and were not sex workers.

In Mombasa 56% of men (36% of the study population) was an MSM; 63% of men said they had sold sex (mainly to other men) and 54% had bought it.  Three-quarters of female participants said they were female sex workers while one in 20 women said they had bought sex.

In Nairobi nearly all women defined as a sex worker and 85% of the men had bought sex; 22.5% of the men had had sex with other men and 33% defined as a male sex worker.

There was a high dropout rate in the study: 13% did not return after their enrolment visit, 37% altogether left the study prematurely. Annual attrition rates were 22% in Cape Town, 20% in Mombasa and 10% in Nairobi.

Read the rest.


[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.]

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.]