Download Your Rectal Road Map to AIDS 2012

The AIDS 2012 Rectal Road Map put together by IRMA is a quick guide to rectal microbicide-related research and advocacy content + other selected sessions of interest at the International AIDS Conference in Washington, DC.

It's a big conference - you don't want to get lost, or miss any of these really great sessions!

IRMA's Rectal Road Map

Click "View on slideshare" - bottom left of the document - to download a copy of the Road Map.

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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.

Rectal microbicides become a high priority in the fight against HIV in Africa

IRMA launches African-inspired, African-led initiative that says 'yes' to rectal microbicides

SYDNEY – Today IRMA (International Rectal Microbicide Advocates) will officially release "On the Map: Ensuring Africa's Place in Rectal Microbicide Research and Advocacy" at a special evening reception at the international Microbicides 2012 conference at the Sydney Convention and Exhibition Center.

The report can be found here.

A cornerstone of IRMA's Project ARM (Africa for Rectal Microbicides) initiative, the strategy document developed by African advocates, researchers, and global allies outlines priority actions to ensure Africa fully engages in rectal microbicide research and advocacy activities, including the integration of safe anal-sex messaging into HIV prevention programs.

"For far too long the operating principle concerning the HIV epidemic in Africa has been that it is solely heterosexual, and that sexual transmission is entirely driven by unprotected vaginal intercourse between men and women," said Jim Pickett, IRMA chair. "But an increasing body of evidence tells us quite clearly that unprotected anal intercourse is happening all across the continent – amongst heterosexuals as well as gay men, other men who have sex with men (MSM), and transgender individuals. Unprotected anal intercourse is not uncommon in Africa," he continued, "and compared to unprotected vaginal intercourse, it is 10 to 20 times more likely to result in HIV infection. We absolutely need to be concerned about this."

"We still face significant hurdles regarding human rights for gay men, MSM, and transgender individuals in Africa, but the collective, long-term efforts of advocates and scientists are indeed lifting the denial around anal sex in the African context," said Morenike Ukpong, New HIV Vaccines and Microbicides Advocacy Society in Nigeria, IRMA member, and one of the chief architects of the Project ARM strategy. "Great efforts have long been underway to develop safe and effective vaginal microbicides for African women. We need the same level of commitment and resources for the development of safe, effective, acceptable and accessible rectal microbicides for Africans regardless of gender identity or sexual orientation."

"Our diverse sexualities in Africa shouldn't be defined only by the prevention tools we have available. HIV prevention tools must be adapted to our sexualities." – Alliance Nikuze, Rwanda, IRMA member, as quoted in the report.

"On the Map: Ensuring Africa's Place in Rectal Microbicide Research and Advocacy" is the result of an intensive two-day consultation conducted with over 40 Africans and allies that took place in Addis Ababa, Ethiopia in early December 2011. It calls for a set of activities related to research and community mobilization designed to fully engage Africans, including a Knowledge, Attitudes and Behaviours study on anal sex, advocacy for increased condom-compatible lubricant access, and communication and education activities.

Even as this report is being released, Africa has already made great strides in rectal microbicide research and advocacy. A global Phase II rectal microbicide trial looking at tenofovir gel in gay men and transgender women, planned by the Microbicide Trials Network (MTN), includes the Desmond Tutu HIV Foundation in Cape Town, South Africa as one of its clinical trial sites.

As IRMA member and Desmond Tutu research assistant Brian Kanyemba says in the report, "I am incredibly proud to say we will be the very first African trial site for a rectal microbicide study. I hope the field will conduct rectal microbicide research in other African countries as well as South Africa!"

"Africans need rectal microbicides and they need to be part of the advocacy, research and development processes that are essential to creating products that are not only safe and effective but acceptable and accessible too. I pledge our full support for the efforts of Project ARM." – Dr. Ian McGowan, United States, MTN co-principal investigator and IRMA Scientific Vice Chair, as quoted in the report.

Funding and in-kind support for the launch of Project ARM and the development of "On the Map: Ensuring Africa's Place in Rectal Microbicide Research and Advocacy" was provided by the National Institutes of Health – Office of AIDS Research, the New Venture Fund, AVAC, and AIDS Foundation of Chicago.

The reception will take place in the Advocates' Corner 17/4/12 from 17:30 – 18:30 (AEST).


[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.]

Acceptability of coitally-associated versus daily use of 1% tenofovir vaginal gel among women in Pune, India

via International Health, by Sanjay Mehendale, Swapna Deshpande, Rewa Kohli, Sharon Tsui, Elizabeth Tolley

Abstract

This study reports on the acceptability of 1% tenofovir microbicide gel among participants randomised to the coitally-associated use (n=50) or daily use (n=50) arms of a Phase II clinical trial in Pune, India. In a 6-month follow-up study, information on behavioural domains was collected on a 6-point Likert scale and gel acceptability was measured on a 5-point Likert scale. Random intercept logistic modelling was performed to examine the simultaneous effects of study arm, follow-up time, sociodemographic factors and behavioural domains on gel acceptability. The mean age of female participants was 32.7 years. Women in both study arms had similar sociodemographic profiles. Women liked features such as easy use of the gel and its protective effect against HIV. Messiness was the most disliked feature. Gel acceptability increased during subsequent follow-up visits in both arms, especially in the coitally-associated use arm. Non-acceptability of the gel was almost two and a half times higher in daily users (adjusted odds ratio 2.55, 95% CI 1.18–5.51; p=0.017). Acceptability differed significantly between the two study arms at 2 months (68% vs 40%; p=0.006) and 6 months (64% vs 46%; p=0.07). Acceptability was significantly lower in those participants who reported ‘messiness’ as the most disliked feature (odds ratio 2.42, 95% CI 1.02–5.72; p=0.045). In conclusion, microbicides were more acceptable in coitally-associated users than in daily users. Leakage was a problem that requires attention. Positioning of the product in a setting such as India where the majority of decision-making is done by men would need extensive and systematic education of men.


[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.]

Has anal sex gone out of vogue? What does this mean for HIV prevention?

via the HIV MSM blog

So the Advocate recently reported the findings of a large-scale survey on sexual behaviors.  Apparently, only 37.2% of over 24,000 gay and bisexually identified men indicated that their last sexual encounter consisted of anal sex.   The most practiced activities were kissing (almost 75%) and mutual masturbation (73%).

The survey, entitled  ‘The Gay and Bisexual Men’s National Sex Survey’ was sponsored by Manhunt,  its sexual health affiliate Manhunt Cares (see my past post here about them) and  its research partners, present the findings in a cutesy interactive graphical form which can be accessed from clicking on the picture on the left (i.e. I found out that 80.8 % of surveyed men have eaten cum at some point in their lives!) The abstract of the study, which appears in the Journal of Sexual Medicine can be found here.

Now before we give up our lube and condoms and other devices we find makes our anal sex experience more comfortable, there a few things to keep in mind.  For some reason, the majority of respondents in this latest conducted by researchers from Indiana University and George Mason University were Caucasian males.  Perhaps results would be changed if there was some diversity in the subject pool.  Also, one should note that the respondents were “self identified” gay or bisexual.  Perhaps if behaviors of non-identified men who have sex with men, (i.e. heterosexual identifying men) were recorded the results would also show a higher indication of anal sex.  However, I like the point that one of the commentators made:   Anal sex does require a lot of effort (much like vaginal penile sex as well) and perhaps people don’t want to go through such effort simply to get off.

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.]

Sexual Pleasure is Key for Successful Microbicides

via WeNews, by Amy Littlefield

Participants in Kate Morrow's [IRMA Steering Committee Member] recent study may not have felt like they were fighting the global HIV epidemic.

In fact, what they were literally feeling were gels of various consistencies inside their vaginas.

The women in Morrow's Project LINK answered questions after handling the gels, inserting them vaginally, walking around and simulating intercourse with a fake phallus. Did the gel leak out? Did it inhibit the experience . . . or did they actually enjoy it?

Morrow has developed a set of scales to show the range of sensations and experiences women reported. Her goal now is to connect those sensations to data about which gels women would use to prevent HIV. Do they prefer gels that are smooth, thin or thick like hair gel? The answers to those questions could help lead to a microbicide that women will tolerate--and perhaps even enjoy.

For decades, women's health advocates have known that women need a way to protect themselves from HIV that is not dependent on a male partner. Vaginal microbicide gels are among an array of options--including pills, rectal microbicides and vaginal rings--that may one day help. Advocates hope microbicides could even be combined with birth control and help prevent other sexually-transmitted illnesses.

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.]

Study - Addressing Social Drivers of HIV/AIDS for the Long-Term Response: Conceptual and methodological Considerations

Via MSMGF.

A key component of the shift from an emergency to a long-term response to AIDS is a change in focus from HIV prevention interventions focused on individuals to a comprehensive strategy in which social/structural approaches are core elements. Such approaches aim to modify social conditions by addressing key drivers of HIV vulnerability that affect the ability of individuals to protect themselves and others from HIV. The development and implementation of evidence-based social/structural interventions have been hampered by both scientific and political obstacles that have not been fully explored or redressed. This paper provides a framework, examples, and some guidance for how to conceptualise, operationalise, measure, and evaluate complex social/structural approaches to HIV prevention to help situate them more concretely in a long-term strategy to end AIDS.

Conclusion:

After nearly 30 years of the HIV/AIDS pandemic, there have been woefully few examples of truly successful HIV prevention initiatives conceived and implemented by national policy makers and programme planners. To ensure measurable HIV prevention success by 2031, the 50th anniversary of the epidemic, it will be necessary to move beyond the limited, individualistic, urgency-based approaches of the past. Shifting from an emergency framework and mounting a long-term response to AIDS requires new approaches that engage with underlying social-structural drivers of patterns of practices that influence vulnerability and facilitate the spread of HIV, as part of comprehensive, strategic programming (or ‘combination prevention’).

Patterns of behaviour and practices arise from combinations of drivers, operating in specific social, economic, and political contexts. As such, no single causal pathway can be drawn from a social driver to a set of practices or behaviours; rather, a range of potential outcomes may arise. Making causal inference about correlations between social drivers and HIV burden involves identifying ‘sociologically plausible’ pathways drawn from extant social science and epidemiological data. Engaging with social drivers requires methods and approaches beyond traditional conceptualisations that seek to identify and intervene on single, causal determinants or universal mechanisms of influence. HIV prevention researchers and advocates should reject and resist over-simplified language for social drivers. Statements that particular social-structural factors ‘do’ or ‘do not’ lead to HIV transmission are almost always too simplistic; language should shift to discussing how, in what circumstances, and for whom particular combinations of factors contribute to HIV vulnerability (or, conversely, resilience). In order to be rigorous, design of HIV prevention programmes and interventions aiming to address social-structural factors should:

• Begin with an assessment of the social and structural factors that may be
• increasing HIV vulnerability in targeted populations and settings.
• Identify (hypothesise) sociologically plausible causal chains between distal structural factors and specific individual or group practices.
• Identify levels of possible influence, in line with the HIV prevention programme’s or intervention’s scope and aim.
• Articulate any assumptions about such influences and aims including potential expected and unexpected consequences of the programme or intervention (including other social impacts).
• Build in evaluation mechanisms that are both feasible and appropriate to the aim, level, scope and method of the programme or intervention as a way to enable validation of assumptions, investigation of the mechanisms by which structures affect risk and vulnerability, and appropriate assessment of outcomes and impact.

Find the whole 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.]

Risk factors for HIV vary between African cities, need tailored responses

Via AIDSMap, by Carole Leach-Lemens.

A comparative study in three large cities in southern Africa has found big differences in risk factors for acquisition of HIV infection, emphasising the importance of locally tailored HIV prevention strategies and up-to-date information on local risk factors.

The study looked at behavioural risk factors associated with acquiring HIV infection in 5000 sexually active women in Harare, Durban and Johannesburg who took part in a large trial of an HIV prevention method based on use of the diaphgram.

Sue Napierala Mavedsnege and colleagues report the findings of their prospective cohort analysis in the advance online edition of the Journal of Acquired Immune Deficiency Syndromes.

A total of 309 incident HIV infections were identified. Durban reported the highest incidence rate, followed by Johannesburg and then Harare (6.75 per 100 person years, 95% CI: 5.74-7.93; 3.33 per 100 person years, 95% CI: 2.51-4.44; 2.72 per 100 person years CI: 2.26-3.26, respectively).

Having more than one partner in the last three months was the only common factor associated with HIV incidence.

The majority of the estimated 35 million people living with HIV live in sub-Saharan Africa where 70% of all new infections occur. Women represent over 60% of all infections. Southern Africa, with the highest regional prevalence, reflects different phases of the epidemic.

In Zimbabwe, with an estimated prevalence of 14.3%, the epidemic began early, peaked in 1998 with a subsequent decline in incidence and prevalence.

From 1990-1998 South Africa had an exponential increase followed by a moderate increase until 2004 when apparent stabilisation began. In 2008 estimated provincial prevalence rates ranged from 5.3% to 25.8%.

In Gauteng province, with Johannesburg its largest city, prevalence appears to have peaked in 2002 at 20.3% and declined to 15.2% in 2008. In contrast, Kwa Zulu Natal province where Durban is the largest city, estimated prevalence rose from 15.7% in 2002 to 25.8% in 2008.

While cross-sectional studies looking at risk factors associated with HIV have taken place in Zimbabwe and South Africa, few have looked at risk factors for HIV incidence in women. A better understanding of these factors within local contexts will help develop targeted interventions so reducing transmission.

The authors looked at factors associated with differences of HIV incidence among women in Harare, Johannesburg and Durban enrolled between September 2003 and September 2005 in the Methods for Improvement of Reproductive Health (MIRA) study, a randomised clinical trial to look at the effect of the diaphragm plus lubricant gel for the prevention of HIV. The intervention did not reduce HIV incidence.

The authors undertook a prospective cohort analysis of trial participants who were followed for a median of 21 months (12-24 months).

Socio-demographic, biological and behavioural data were collected at baseline and at quarterly visits. Testing for HIV and STIs were conducted at each quarterly visit.

Each location had distinct characteristics as well as different patterns of individual risk factors.

In Harare women were more likely to live with their partner, be employed and not use alcohol or drugs but more likely to wipe inside their vagina. While they had a later sexual debut and fewer partners than in Durban or Johannesburg there was more transactional sex (for money, food, drugs or shelter) within the last three months.

Early sexual debut was more common in Durban, while in Johannesburg consumption of alcohol within the last three months, multiple sexual partners and sex under the influence of drugs or alcohol were more likely.

Read the rest 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.]

NYT: For a Sex Survey, Privacy Goes a Long Way

via New York Times, by Nicholas Bakalar

It is not easy to ask people about their sex lives, and getting honest answers may be even harder. But there are ways to do it. One good method is to have a computer ask the questions, while the interviewee listens through earphones and enters the answers on the screen — without the intervention, or even the presence, of another hum

Last month the Centers for Disease Control and Prevention published a report on sexual behavior that used this technique with laptops to gather data on Americans’ sexual behavior, attraction and identity by age, marital status, education and race. Anjani Chandra, the lead author, said the process was developed to assure total anonymity for the respondents.

Dr. Chandra, a demographer with the agency, explained: “The computer tells the interviewees what key to press to lock away the responses. When they return the laptop to the interviewers, they can’t get in. It’s transmitted to a central place where the data processing happens without names or addresses. We get a file that can’t be linked back to the person.”

The researchers got a 75 percent response rate, very high for a household survey, when they interviewed more than 13,000 people ages 15 to 44 from 2006 to 2008.

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.]

Belief in AIDS origin conspiracy theory and willingness to participate in biomedical research studies: findings in whites, blacks, and Hispanics

HIV Clin Trials. 2011 Jan-Feb;12(1):37-47.

Belief in AIDS origin conspiracy theory and willingness to participate in biomedical research studies: findings in whites, blacks, and Hispanics in seven cities across two surveys.

Russell SL, Katz RV, Wang MQ, Lee R, Green BL, Kressin NR, Claudio C.

Department of Epidemiology and Health Promotion, New York University, New York, NY, USA. stefanie.russell@nyu.edu

Abstract

PURPOSE: The purpose of this study was to determine whether a belief in the AIDS origin conspiracy theory is related to likelihood or fear of participation in research studies.

METHODS: The Tuskegee Legacy Project Questionnaire was administered via random-digit-dialed telephone interview to black, white, and Hispanic participants in 4 cities in 1999 and 2000 (n = 1,133) and in 3 cities in 2003 (n = 1,162).

RESULTS: In 1999, 27.8% of blacks, 23.6% of Hispanics, and 8% of whites (P ≤ .001) reported that it was "very or somewhat likely" that AIDS is "the result of a government plan to intentionally kill a certain group of people by genocide." In 2003, 34.1% of blacks, 21.9% of Hispanics, and 8.4% of whites (P ≤ .001) reported the same.

CONCLUSIONS: Whereas blacks and Hispanics were more than 3 times more likely than whites to believe in this AIDS origin conspiracy theory, holding this belief was not associated with a decreased likelihood of participation in, or increased fear of participation in, biomedical research.

[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.]

2011 Spending Deal Spares NIH Major Cuts

via ScienceInsider

Just as White House officials promised over the weekend, the 2011 funding bill agreed to by Congress and the White House last Friday spares biomedical research from major cuts.

Details released today indicate that the National Institutes of Health (NIH) would receive $30.7 billion, or $260 million below the 2010 level. The 0.8% cut includes $210 million spread across all 27 NIH institutes and centers and the director's office, and $50 million from a buildings account. (Adding a 0.2% across-the-board cut in all non-defense agencies, the total cut will be about $300 million, says David Moore of the Association of American Medical Colleges.)

By contrast, an earlier House bill, H.R. 1, would have slashed NIH's budget by $1.6 billion to $29.5 billion.

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.]

High HIV risk behavior among men who have sex with men in Kigali, Rwanda: making the case for supportive prevention policy

AIDS Care. 2011 Apr;23(4):449-55.

Chapman J, Koleros A, Delmont Y, Pegurri E, Gahire R, Binagwaho A.

Futures Group International, Washington, DC, USA.

Abstract

Rwanda has responded strongly to HIV/AIDS, but prevention among men who have sex with men (MSM) has not yet been addressed due to a strong cultural resistance to homosexuality, and a lack of data showing the public health value of attending to the sexual health needs of this group. We conducted an exploratory study on HIV risk among MSM in Kigali using snowball sampling involving peer leaders. The 99 respondents were demographically, socially, and sexually diverse. Respondents reported relatively high numbers of male and female partners, and considerable HIV risk behaviors including commercial sex with men and women, low condom use during anal and vaginal sex, and high mobility. Many respondents reported verbal and/or physical abuse due to their sexuality. This first study of MSM in Rwanda has brought attention to a previously neglected HIV risk group and their potential driving role in the Rwandan epidemic, demonstrating the need for sensitive and targeted interventions.

[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.]

Slate: Why are bisexual women more likely to have tried anal sex?

via Slate.com, by William Saletan

Have you heard the latest report on Americans' sex habits? The study, Sexual Behavior, Sexual Attraction, and Sexual Identity in the United States, comes from the National Survey of Family Growth, the country's most respected periodic sex survey. Media reports about the study have noted what seems to be a resurgence of virginity. But the data also show something more surprising: Compared with women who are totally straight, women who are slightly bisexual are more likely to have tried various sex acts with men. In fact, compared with totally straight women, women who are fully bisexual or lesbian are more likely to have tried anal sex.

Why?

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.]

Case Study: Alcohol Consumption and HIV Risk in Chennai, India

Alcohol Consumption and HIV Risk
A Peer Education Strategy for Bar Patrons

via AIDSTAR-ONE, by Reshma Trasi

In a busy neighborhood in Chennai, cars, motorcycles, bicycles, and pedestrians jostle for space on the narrow streets. Small shops line the sidewalks, offering everything from bright silk saris to auto parts. From a nondescript storefront comes the sound of clinking glasses and loud voices. Inside, one wall has shelves stocked with beer and hard liquor. In a back room are groups of men at counters and tables, laughing with friends or arguing about politics or cricket. Each has a glass and sometimes an entire bottle of alcohol in front of him.

One of the largest cities in South India, Chennai attracts men from all over the country seeking seasonal, unskilled, or hourly wage work. Away from their families, these men go to bars to socialize. Establishments that sell alcohol in Chennai range from holes-in-the-wall offering home-brewed toddy to high-end clubs selling expensive foreign alcohol. Somewhere in the middle of this spectrum are more than 600 wine shops, popular among men of all ages.

But the wine shops offer more than just a chance to relax and drink. Female sex workers also frequent many of the shops; at some locations, younger boys and hijras (transgendered persons) solicit sex. As male customers consume alcohol, inhibitions loosen, peer pressure builds, and the temptation to engage in high-risk commercial sex becomes harder to resist.

In 2002, the Y.R. Gaitonde Center for AIDS Research and Education (Y.R.G. CARE), a nonprofit known internationally for its comprehensive HIV prevention, care, and treatment programs, initiated a five-year research intervention to study alcohol consumption and risky sex among male patrons of Chennai's wine shops. The Collaborative HIV/STD Prevention Trial identified, recruited, and trained peer outreach workers called Community Popular Opinion Leaders (CPOLs). CPOLs disseminated HIV prevention messages to their peers, delivering them as personal endorsements of risk-reduction and health-seeking behaviors. The Research Triangle Institute and Johns Hopkins University partnered with Y.R.G. CARE on the research, which was funded by the U.S. National Institute of Mental Health.

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.]

Self-reports of sensitive sexual behavior, a review

via International Journal of Epidemiology, by Phillips et al.

A new study finds unexpected variations in reporting between traditional face-to-face interviews and non-interviewer-administered interview methods.



From the abstract:

Studies identifying risks and evaluating interventions for human immunodeficiency virus (HIV) and other sexually transmitted infections often rely on self-reported measures of sensitive behaviours. Such self-reports can be subject to social desirability bias. Concerns over the accuracy of these measures have prompted efforts to improve the level of privacy and anonymity of the interview setting. This study aims to determine whether such novel tools minimize misreporting of sensitive information.

Systematic review and meta-analysis of studies in low- and middle-income countries comparing traditional face-to-face interview (FTFI) with innovative tools for reporting HIV risk behaviour. Crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Cochran’s chi-squared test of heterogeneity was performed to explore differences between estimates. Pooled estimates were determined by gender, region, education, setting and question time frame using a random effects model.

We found and included 15 data sets in the meta-analysis. Most studies compared audio computer-assisted self interview (ACASI) with FTFI. There was significant heterogeneity across studies for three outcomes of interest: ‘ever had sex’ (I² = 93.4%, P < 0.001), non-condom use (I² = 89.3%, P < 0.001), and number of partners (I² = 75.3%, P < 0.001). For the fourth outcome, ‘forced sex’, there was homogenous increased reporting by non-FTFI methods (OR 1.47; 95% CI 1.11–1.94). Overall, non-FTFI methods were not consistently associated with a significant increase in the reporting of all outcomes. However, there was increased reporting associated with non-FTFI with region (Asia), setting (urban), education (>60% had secondary education) and a shorter question time frame.

Contrary to expectation, differences between FTFI and non-interviewer-administered interview methods for the reported sensitive behaviour investigated were not uniform. However, we observed trends and variations in the level of reporting according to the outcome, study and population characteristics. FTFI may not always be inferior to innovative interview tools depending on the sensitivity of the question as well as the population assessed.

Read the article

[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.]

Differences in HIV-1 prevalence not linked to sexual behavior, study finds

via Journal of the International AIDS Society, by Mapingure et al.

A new study concludes that higher HIV-1 prevalence among pregnant women in Zimbabwe compared with Tanzania cannot be explained by differences in risky sexual behaviour.

From the abstract:

Substantial heterogeneity in HIV prevalence has been observed within sub-Saharan Africa. It is not clear which factors can explain these differences. Our aim was to identify risk factors that could explain the large differences in HIV-1 prevalence among pregnant women in Harare, Zimbabwe, and Moshi, Tanzania.

Cross-sectional data from a two-centre study that enrolled pregnant women in Harare (N = 691) and Moshi (N = 2654) was used. Consenting women were interviewed about their socio-demographic background and sexual behaviour, and tested for presence of sexually transmitted infections and reproductive tract infections. Prevalence distribution of risk factors for HIV acquisition and spread were compared between the two areas.

The prevalence of HIV-1 among pregnant women was 26% in Zimbabwe and 7% in Tanzania. The HIV prevalence in both countries rises constantly with age up to the 25-30 year age group. After that, it continues to rise among Zimbabwean women, while it drops for Tanzanian women. Risky sexual behaviour was more prominent among Tanzanians than Zimbabweans. Mobility and such infections as HSV-2, trichomoniasis and bacterial vaginosis were more prevalent among Zimbabweans than Tanzanians. Reported male partner circumcision rates between the two countries were widely different, but the effect of male circumcision on HIV prevalence was not apparent within the populations.

Read the article

[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.]

Sphincter Riddles - why do women like anal sex?

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


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

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

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

Read the rest.

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

From PLoS One, by Larmarange et al.

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

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

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

Read the article

Sex survey: American heteros are having a lot of anal sex

America reveals its sexual secrets

Repressed? Hardly.

The most comprehensive survey of American sex lives in 20 years reveals what's really going on in bed

via The Guardian, by Jon Henley


Excerpt:

More surprisingly, perhaps, the reported rate of anal sex has also increased dramatically, effectively doubling since the National Health and Social Life Survey was carried out by researchers from the University of Chicago in 1988. That study suggested around 12% of American women in the 25-29 age group had experienced anal sex in the last year; that figure has now risen to 21% (and also applies to the 30-39 age group). Some 20% of American 18- to 19-year-old girls have had anal sex at least once in their lifetimes, the new study shows, rising to more than 45% among 25-29 year olds.

Read the rest.

Elevated HIV Prevalence Despite Lower Rates of Sexual Risk Behaviors

from AIDS Patient Care and STDs, by Magnus et al.

The District of Columbia (DC) has among the highest HIV/AIDS rates in the United States, with 3.2% of the population and 7.1% of black men living with HIV/AIDS. The purpose of this study was to examine HIV risk behaviors in a community-based sample of men who have sex with men (MSM) in DC.

Data were from the National HIV Behavioral Surveillance system. MSM who were 18 years were recruited via venue-based sampling between July 2008 and December 2008. Behavioral surveys and rapid oral HIV screening with Western blot confirmation on positives were collected. Factors associated with HIV positivity and unprotected anal intercourse were identified. Of 500 MSM, 35.6% were black. Of all men, 14.1% were confirmed HIV positive; 41.8% of these were newly identified HIV positive. Black men (26.0%) were more likely to be HIV positive than white (7.9%) or Latino/Asian/other (6.5%) men. Black men had fewer male sex partners than non-black, fewer had ever engaged in intentional unprotected anal sex, and more used condoms at last anal sex. Black men were less likely to have health insurance, have been tested for HIV, and disclose MSM status to health care providers. Despite significantly higher HIV/AIDS rates, black MSM in DC reported fewer sexual risks than non-black.

These findings suggest that among black MSM, the primary risk of HIV infection results from nontraditional sexual risk factors, and may include barriers to disclosing MSM status and HIV testing. There remains a critical need for more information regarding reasons for elevated HIV among black MSM in order to inform prevention programming.

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Serosorting Is Associated with a Decreased Risk of HIV Seroconversion in the EXPLORE Study Cohort

via PlosONE

Philip SS, Yu X, Donnell D, Vittinghoff E, Buchbinder S (2010) Serosorting Is Associated with a Decreased Risk of HIV Seroconversion in the EXPLORE Study Cohort. PLoS ONE 5(9): e12662. doi:10.1371/journal.pone.0012662

Abstract

Background

Seroadaptation strategies such as serosorting and seropositioning originated within communities of men who have sex with men (MSM), but there are limited data about their effectiveness in preventing HIV transmission when utilized by HIV-negative men.

Methodology/Principal Findings

Data from the EXPLORE cohort of HIV-negative MSM who reported both seroconcordant and serodiscordant partners were used to evaluate serosorting and seropositioning. The association of serosorting and seropositioning with HIV seroconversion was evaluated in this cohort of high risk MSM from six U.S. cities. Serosorting was independently associated with a small decrease in risk of HIV seroconversion (OR = 0.88; 95%CI, 0.81–0.95), even among participants reporting ≥10 partners. Those who more consistently practiced serosorting were more likely to be white (p = 0.01), have completed college (p = <0.0002) and to have had 10 or more partners in the six months before the baseline visit (p = 0.01) but did not differ in age, reporting HIV-infected partners, or drug use. There was no evidence of a seroconversion effect with seropositioning (OR 1.02, 95%CI, 0.92–1.14).

Significance

In high risk HIV uninfected MSM who report unprotected anal intercourse with both seroconcordant and serodiscordant partners, serosorting was associated with a modest decreased risk of HIV infection. To maximize any potential benefit, it will be important to increase accurate knowledge of HIV status, through increased testing frequency, improved test technology, and continued development of strategies to increase disclosure.

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