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.

 
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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 1,200 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.

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Soooooooo..... Are Lubes Safe?

via Positive Lite, by Marc-André LeBlanc

"This situation is unacceptable. We’re in 2013, for the love of all that is wet and wild! How can we not know the answer to such a fundamental question—are lubes safe?" 

 Here I am again, standing in front of a giant wall of lube options at a local store.

• Water-based, silicone-based, oil-based, hybrid.
• Bottles, tubs, tubes, vats, vials, sachets, packets, pouches, pillows, mix-it-at-home kits.
• Pumpable, flippable, squeezable, scoopable, squirtable, spritzable, speadable.
• Regular, warming, cooling, tingling, numbing.
• Thick, thin, goopy, watery, greasy, sticky, slippery, silky, slick.
• Long lists of unpronounceable chemicals, claims of being organic or all-natural.
• Scents. Flavours. Colours.
• Formulated to look like cum!
• And of course, wildly varying prices.

I’m glad I’m not meeting that guy for another three hours. 

So which lube should I get? Which ones are safe? Which ones should I avoid? 

Who knows!

No, seriously. Who knows? If I don’t, I can only assume nobody else does. After all, I coordinate the global Lube Safety Working Group for IRMA—International Rectal microbicide Advocates. 

This is the shocking reality: more than 30 years into the HIV pandemic, we still have no clear answers on whether sexual lubricants (lubes) increase, decrease, or have no impact on the risk of acquiring HIV and other STIs sexually transmitted infections (STIs). 

Many men, women and transgender individuals all across the globe use sexual lubricants for both vaginal and anal intercourse. We have long promoted the use of male or female condoms with condom-compatible water-based or silicone-based lubes to prevent HIV and other STIs. Lubricants help ensure that condoms don’t break, and that condoms stay on during sex. So, it’s pretty critical we understand if any of these condom-compatible lubes could actually be putting people in harm’s way. 

One thing is clear: we will not get an answer to the lube safety question without advocacy.

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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IRIN PlusNews: Lack of lube hurts HIV prevention

via IRIN PlusNews

“Key populations - such as MSM and sex workers - who need the lubricant the most, often get their health-related services from local NGOs, which are not often included in [HIV/AIDS] policies or broader [health] programmes,” explained Bidia Deperthes, a senior HIV adviser with UNFPA’s Comprehensive Condom Programming division in New York.

KATHMANDU, 21 February 2013 (PlusNews) - Safer-sex messaging on condoms is universal but the generally poor availability of lubricants, and awareness of them, is hindering HIV prevention, health activists warn.

Some personal lubricant - or “lube”- has been shown to lower the risk of HIV transmission by decreasing the risk of condoms breaking.

Despite preliminary proof of lube’s efficacy, far less of the product is procured and distributed than condoms, leading people to use alternative, sometimes harmful, substances during intercourse such as butter or petroleum jelly; oil-based lubricants weaken latex, making the condom more likely to break.

Activists say, however, that a blind spot in research on lubricants as a part of HIV prevention programmes means not enough is known about their impact on HIV risk.

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.

  -------------------

Just Call Me Dylan

by Mike Peters
IRMA Intern

 Recently on the highly-active IRMA listserv we discussed the issue of "gay shame" and the increased depression, substance abuse, and suicidal tendencies that go along with that notion.  The original posting had to do with a sense of internalized homophobia within the gay community.  While members of our listserv debated the accuracy of the author's claims we questioned the author's own sense of internalized homophobia, the systemic nature of addiction and mental health, and how sexual health is packaged to the gay community, I felt conflicted about my own feelings on this piece.

Heterosexism is a systemic reality in many of our various social settings that each of us faces from time-to-time, and I can understand the sense of internalized homophobia.  It stands to reason that if we are socialized in a society that is systemically heterosexist, then the coming out process is not only a social endeavor but it also has to do with deconstructing one's own understanding of their self within the heterosexist system.  Perhaps a story will best illustrate this complicated notion.

While my previous blog post had to do with openly discussing anal sex with the soon-to-be in-laws, I can admittedly say that I have not always been the "open, silence-breaking feminist" that I am today.  I grew up in a small, conservative Ohio city in a religious household.  My parents are Christians of the Protestant, evangelical variety so there was very little discussion of sexuality outside the realm of heterosexual procreative norms.  That is to say, my brother and I were raised to be manly, upstanding Christian men that would make faithful husbands, providers, and fathers.  While my brother was much more interested in the typically "male past times" like baseball and martial arts courses, I was much more interested in drawing, photography, cooking, and swimming – so most of my parents' time was spent invested in my brothers activities as I spent more time drawing alone in the basement.  I was certainly a quiet child and would occasionally confide in my mother about my feelings, but was very fearful of upsetting my father.  Yes, stark contrast to the talkative activist of today.

By the time I had reached adolescence, I knew that I liked guys.  I didn't quite understand it and certainly couldn't talk to my parents because I thought that it was wrong.  I had heard my father talk about gays and lesbians before, describing them as "disgusting" and people that "should be dragged out into the streets and shot", so my fears were well-founded.  Plus, the images of homosexual men that I had seen, as discussed by my father and the church, presented them as promiscuous drunks that were only interested in sex and nothing substantial – they were something to avoid and be afraid of.  Things got even more difficult for me as I started to have feelings for another boy.  He ran cross country, so I joined the team to be around him.  We became quick friends and soon I learned that his home environment was very similar to mine, so it was nice to have someone that I could relate to.  We started to hang out with each other outside of cross country practice and soon I found out that he had feelings for me as well.  Neither of us really knew what to do with these feelings, so we dated secretly as we tried to understand ourselves.  We were conflicted, our families and respective church bodies had certainly hammered a less-than-favorable image of homosexuals into our minds and we didn't want to be like those images.  In fact, neither of us could even vocalize a simple "I am gay" out loud, because we just couldn't bring ourselves to that.  We just liked each other, that's not "gay"… we were just two guys that liked each other, that's it – at least that was how we tried to understand ourselves.

Perhaps I was a more daring teenager than my boyfriend, but when I was nearing the end of my sophomore year of high school and on the verge of turning sixteen, I decided that I wanted to start to feel connected to the gay community.  The problem was that my and his understanding of the gay community was that they were all bar-hopping, promiscuous folks, but I wanted to experience that.  He wanted nothing to do with it, so without his knowing I obtained a fake ID that said I was eighteen and gave me the fake name "Dylan Sanders".  Immediately I started going to the hole-in-the-wall gay bar downtown so I could go and dance.  I was a terribly awkward teenager, and I know that I couldn't dance to save my life, but I wanted to be a part of the gay community, so I figured that I would learn.  Soon I found myself getting free drinks from all kinds of guys and dancing for tips and under-the-table payments.  Honestly, I didn't like that I was going out and drinking so much, but I felt like that is what I had to do to be a part of the gay community – so I kept going and drinking down my feelings.  During my junior year of high school I started showing up to school hung over and attempting to do assignments for classes in the class before it was due.  Obviously, my grades were slipping and I continued to get more distant from my family.  My relationship with my boyfriend was getting more strained because he wasn't interested in going out to the bar.  We both were unhealthily assuming that to be gay we had to go out and drink and engage in other illicit activities, I was drinking dangerous amounts of alcohol and he was bottling up all of his emotions.  Even though we were following different paths, both of us continued to feel more and more conflicted about who we were and therefore more and more depressed.

This story continues, and it continues to a much darker place which is perhaps a story for another day.  But the original point still remains – our understanding of the gay community was that of the commonly-used stereotype that portrays the gay community as promiscuous drunks that engage in risky behaviors.  Truly, I spent my teenage years engaging in some incredibly risky behaviors and hated nearly every second of it.  I engaged in these behaviors because I felt that that is who I had to be to be gay and assumed that all gay men were just like that.  Plenty of heterosexual people enjoy all those behaviors, but we don't assume that all heterosexuals are dangerous, promiscuous deviants.  Now, I am not saying that going out, having drinks, and dancing is wrong – if that's what you're into, then that's fine.  But that certainly wasn't for me.  However, when all people are cast into a light that portrays them all as deviant others, then those people are robbed of their subjectivity and become objects.  This is where the power of the systemic reality of heterosexism comes into play.  My own internalized sense of homophobia and stereotyping led me to believe that to be gay I had to be someone that I wasn't.  In an effort to become the proud gay man that I am today I had to deconstruct the notion that all gay men liked to drink and party and that was tough for me to do as that was the only image I ever had.  Did I feel ashamed of the behaviors I was engaging in?  Yes, but that's because it wasn't what I liked to do but what I felt that I had to do.  Perhaps the roots of "gay shame" weave a much more complicated relationship between the self and larger systemic heterosexism.  If the images of gay men that I had seen growing up had been different, even if my father and church continued to say such negative things, perhaps I would have known sooner that they were wrong about LGBT people and perhaps that would have spared me so much heartache that I, in turn, internalized as what being gay meant.

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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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What kind of prevention do gay men need?

 via aidsmap, by Gus Cairns

How do we stop the hyperepidemic in gay men?

A number of presentations at the 19th International AIDS Conference explored the 'hyperepidemic' of HIV amongst men who have sex with men, and especially black MSM.

A paper presented by Gregorio Millet (pictured above at a White House reception honoring people working in AIDS) showed that, at least in the USA, the extremely high incidence and prevalence of HIV in this group is not driven by higher levels of unsafe sex. Instead, very high prevalence, the ease with which HIV is transmitted during anal sex, and the fact that black men (and some other subpopulations of gay men) have sex within small and multiply-connected networks have created a situation in which HIV is hard to avoid.

Given this, what prevention methods would work in gay men? The one that has been talked about most keenly and which continued to generate a great deal of data and debate at Washington was pre-exposure prophylaxis (PrEP) - taking antiretrovirals (ARVs) to prevent, rather than treat, HIV.

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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Meet Toon - A Friendly Rectal Microbicide Advocate

Check out this interesting mini-bio of Wipas Wimonsate (Toon), the latest in IRMA's "Meet a Friendly Rectal Microbicide Advocate" series on the IRMA website here.  Toon is one of the six new bios just posted the other day, including individuals from Thailand, Kenya and the US.  Each will be featured on the blog, and you can read all of them here right now.


Wipas Wimonsate (Toon)
Bangkok, Thailand

"As nature is so diversified, why aren't HIV prevention technologies as well? People have different preferences, needs, and capabilities. If we are to be successful in HIV prevention, we have to understand and accept the nature of people, and that is diversity."

Toon is a medical and social researcher and community associate working with the Silom Community Clinic in Bangkok. The Silom Clinic will be a site for the Phase II rectal microbicide expanded safety and acceptability trial called MTN-017, which will be investigating a reduced-glycerin formulation of tenofovir gel applied rectally compared with oral Truvada among HIV-negative gay men, other men who have sex with men (MSM), and transgender women. His site is expected to begin enrolling volunteers in early 2013.

Outside of work, he enjoys playing badminton, reading, and watching television.

He first got involved with IRMA when he was asked to translate some materials on lubricant safety. "Safety of lubricants for rectal use: A fact sheet for HIV educators and advocates" is available in Thai thanks to Toon, as is the document Safety of lubricants for rectal use: "Questions and Answers for HIV educators and advocates."

Toon believes that rectal microbicides provide a protective option for those who choose not to utilize a condom. He also recognizes that rectal microbicides offer a different manner in which to encourage sexual health, and that the endeavor to develop safe, effective, acceptable and accessibile rectal microbicides will be a major contribution to humankind.

Toon has worked closely on the soon-to-be-released IRMA video ("The Rectal Revolution is Here: An Introduction to Rectal Microbicide Clinical Trials") being developed in partnership with the Microbicide Trials Network and Population Council. He is part of the team's Video Advisory Committee and has provided invaluable feedback on content, messaging and language. Translating from English into Thai is rather complicated, and Toon's guidance has been critical to ensure the team "gets it right." He also facilitated the video segments that were recorded in Thailand, and worked closely on the Thai focus groups which were designed and implemented to test the "rough cut" of the video.

Toon was greatly influenced by Dr. Frits van Griensven, the pioneer of HIV studies among Thai gay men, other MSM and transgender individuals. He is very excited for the upcoming studies in Thailand, and is eager to work towards zero new HIV infections rate gay men, other MSM and transgender individuals, locally and internationally.

Thank you, Toon, for all that you do!



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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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Meet Amber - A Friendly Rectal Microbicide Advocate

Check out this interesting mini-bio of Amber Rucker, the latest in IRMA's "Meet a Friendly Rectal Microbicide Advocate" series on the IRMA website here.  Amber is one of six new bios just posted the other day, including individuals from Thailand, Kenya and the US.  Each will be featured on the blog, and you can read all of them here right now.


Amber Rucker
Boston, Massachusetts

"I truly respect an organization like IRMA that does not shy away from talking about sex and pushing for more research in the rectal microbicide field. This is really important work."

Amber is the Senior Research Associate at Fenway Health. Outside of work, she loves cooking and baking new and exciting recipes.

Amber became involved in IRMA through her current position and was intrigued by IRMA's ability to talk about sex and push for more research into the rectal microbicide field. She also believes that rectal microbicides are important because "receptive anal intercourse carries the highest risk of sexual HIV transmission. Providing individuals with other methods of protection against HIV and other STIs is vital for community safety."

She hopes that in time, the stigma associated with receptive anal intercourse will diminish, and men and women will feel more comfortable this very common behavior with health care providers.

Currently, Amber is working on a vaginal ring study called MTN-013/IPM 026. She is very excited about her studies, and is eager to see her research and work evolve.

With the upcoming MTN-017 trial, Amber will be involved in site activation activities, and will be conducting study visits. MTN-017 is the very first Phase II rectal microbicide expanded safety and acceptability study in the field and will recruit gay men, other men who have sex with men, and transgender women who are HIV negative. U.S. sites will launch later in 2012, and international sites are expected to begin enrolling in early 2013. The study will be investigating a reduced-glycerin formulation of tenofovir gel applied rectally compared with oral Truvada.

Amber's mother has been her greatest influence. Her mother has demonstrated leadership, strength, and compassion, and encourages Amber to pursue all her passions and goals fearlessly.

Thank you, Amber, for all that you do!


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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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Meet Ben - A Friendly Rectal Microbicide Advocate

Check out this interesting mini-bio of Ben Perkins, the latest in IRMA's "Meet a Friendly Rectal Microbicide Advocate" series on the IRMA website here.  Ben is one of the six new bios just posted the other day, including individuals from Thailand, Kenya and the US.  Each will be featured on the blog, and you can read all of them here right now.


Ben Perkins
Boston, Massachusetts

"Always remember that prevention takes place within a socioecological context, and that no matter how effective the biomedical intervention, if we don't respect this context, the prevention modality is doomed to fail."

Ben is the Associate Director for Community Engagement at the Fenway Institute at Fenway Health in Boston. Outside of work, Ben enjoys running, cooking, and reading non-fiction.

Ben first got involved with IRMA through IRMA chair Jim Pickett. He asserts that rectal microbicides are important among new HIV prevent technologies because men and women require a variety of tools when engaging in their sexual lives.

Ben advises IRMA to "remember that rectal health discussions should be far more comprehensive than HIV prevention—HPV, for example, is an increasing cause for concern. Thus, IRMA needs to insist that rectal health should be part of a holistic approach to health and wellness."

He has played an important role on the soon-to-be-released IRMA video ("The Rectal Revolution is Here: An Introduction to Rectal Microbicide Clinical Trials") being developed in partnership with the Microbicide Trials Network and Population Council. He is part of the team's Video Advisory Committee and has provided invaluable feedback on content and messaging. He also worked closely on the focus groups (especially those conducted in Boston) which were designed and implemented to test the "rough cut" of the video with different populations to help ensure the proper messages are coming through.

Currently, Ben is investigating the role of racial discrimination in medication adherence for HIV-positive black gay men and other men who have sex with men. and is working with a community coalition on a structural intervention for at-risk adolescents called Connect to Protect.

Ben is also part of the Fenway team working on the MTN-017 trial, the very first Phase II expanded safety and acceptability trial in the rectal microbicide field which will have sites in the U.S. (Boston, San Francisco and Pittsburgh) as well as international sites in Lima, Peru; Cape Town, South Africa; and two Thai sites - Bangkok and Chiang Mai. The U.S. sites will begin enrolling later in 2012, and the international sites will start up in early 2013. HIV-negative gay men, other men who have sex with men, and transgender women will be asked to volunteer.

Coming out as a gay man had the biggest influence on Ben's life. It continues to be a process, and still challenges him in every area of life.

Thank you, Ben, for all you do!


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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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Meet Pedro - A Friendly Rectal Microbicide Advocate

Check out this interesting mini-bio of Pedro Goicochea, the latest in IRMA's "Meet a Friendly Rectal Microbicide Advocate" series on the IRMA website here.  Pedro is one of six new bios just posted today, including individuals from Kenya,Thailand and the US.  Each will be featured on the blog, and you can read all of them here right now.




Pedro Goicochea
San Francisco, California

"It took us more than 30 years to realize that there is not one unique strategy to prevent HIV acquisition, and that combination prevention is key, and rectal microbicides must be part of the prevention toolbox."

Originally from Lima, Peru, Pedro is in charge of communications and community relations for the iPrEx OLE study, the open-label continuation of the iPrEx trial. iPrEx is the study that showed daily oral use of the ARV drug Truvada among gay men, other men who have sex with men (MSM), and transgender women worked to prevent HIV.

He enjoys his work because of the invaluable opportunities it provides for him to meet interesting people who are working really hard on finding ways to stop this epidemic. He takes pride in the sensitivity his team shows to community members and for highlighting their needs with scientists and stakeholders. Besides iPrEx OLE, Pedro also just finished a couple of other projects related to the feasibility of voluntary circumcision for HIV prevention in gay men and other MSM, and neonatal male circumcision for HIV prevention, in the jungles of Peru.

In his spare time Pedro loves to ride his bike. He enjoys "having destinations that I reach through the effort of pedaling." Pedro's biggest life influence was his mother, but he is also blessed to be surrounded by excellent people that have been an inspiration. In addition, he has lost several friends to HIV and this motivated him to do something about it.

He was introduced to rectal microbicides and IRMA when he met IRMA chair Jim Pickett through IRMA steering committee member and IRMA-ALC co-founder Jerome Galea. He believes that any strategy to help end the epidemic is useful and thinks that rectal microbicides are an important prevention technology because anal sex is the primary mode of HIV transmission among gay men and other MSM, and that women practice anal sex more than is reported or fully understood.

Pedro has played an important role on the soon-to-be-released IRMA video ("The Rectal Revolution is Here: An Introduction to Rectal Microbicide Clinical Trials") being developed in partnership with the Microbicide Trials Network and Population Council. He is part of the team's Video Advisory Committee and has provided invaluable feedback on content and messaging. He also worked closely on the focus groups (especially those conducted in Lima, Peru) which were designed and implemented to test the "rough cut" of the video with different populations to help ensure the proper messages are coming through. He says it has been a very inspirational expereince and he is really looking forward to see the final release. IRMA plans to release the final version of the video in early September, 2012.

Thanks Pedro, for all that you do!


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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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Kenya's HIV Challenge: Easing Stigma For Gay Men

via NPR, by Jason Beaubien

Health officials in Kenya say reducing the transmission of HIV among gay men is a central part of their national AIDS strategy. But they face serious challenges, including the fact that homosexuality is still a crime in the East African nation.

HIV rates among gay and bisexual men in Kenya are far higher than the national average.

Mutisiya Leonard, who runs an HIV prevention, treatment and support program for men who have sex with men in northwestern Kenya, says homosexuality is so stigmatized in Africa that many men don't want to refer to themselves as gay. This makes reaching them with safe-sex messages and HIV-prevention campaigns difficult. These men are reluctant to seek medical care for sexually transmitted diseases, he says, and they don't want to get tested for HIV.

Nationwide, roughly 6 percent of adults in Kenya are infected with HIV. But the rate among men who have gay sex is more than three times the national average. Among male prostitutes in the capital, Nairobi, 41 percent are infected.

In order to address HIV in any community, health workers need to be able to get people to talk frankly and honestly about their sex lives. But Leonard says gay men in Kenya face stigma, discrimination, violence and even jail if they come out of the closet. "The fear of the law, the fear of arrest makes it difficult for people to be open about it," he says.

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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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.

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

*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.

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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.

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 *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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aidsmap: HIV treatment may be stabilising HIV epidemic in Danish gay men

via aidsmap, by Michael Carter

Excerpt:

Danish safe-sex poster from '89

“While unsafe sex among MSM [men who have sex with men] has increased substantially and the number of HIV-positive MSM living in Denmark has enlarged, the incidence of HIV diagnoses in this population has remained stable for more than a decade,” write the authors. “Our findings indicate that this paradox is due to effective antiretroviral therapy and not increased awareness of safe sex.”

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U.S HIV Funding for Gay and Bisexual Men May Cause Concerns

via Funders Concerned About AIDS, by Sean Cahill



Over the past few years we have witnessed a number of advances in science-based HIV prevention and care policy and LGBT health policy in the U.S.

We have a first-ever National HIV/AIDS Strategy that prioritizes reducing the disparity affecting gay and bisexual men—who were 64% of new infections in 2009, although just 2% of the adult population.

We repealed a number of counterproductive policies dating back to the dark days of the 1980s and Senator Jesse Helms, such as ending the HIV entry ban, ending the ban on using federal funds for syringe exchange, and ending funding for abstinence-only-until-marriage education. Unfortunately, the latter two changes were short-lived. And we’ve seen long overdue increases in funding for Ryan White care, the AIDS Drug Assistance Program, HIV prevention through the CDC, and research at NIH, including promising biomedical prevention research.

In LGBT health policy—an overlapping area of concern as about 600,000 people living with HIV in the U.S. are gay and bisexual men and transgender women—we’ve got a public health strategy, Healthy People 2020, that prioritizes for the first time ending LGBT health disparities. President Obama has guaranteed hospital visitation rights for same-sex partners, offered domestic partner health insurance to civilian federal employees, and Secretary Sebelius is adding a sexual orientation question to the National Health Interview Survey. This is all great news, and we are grateful to our allies in government who have worked with community leaders to accomplish these important advances.

However, as the HIV epidemic among gay and bisexual men, and especially Black gay men, rages—with 30,000 gay men newly infected each year, 60% of them Black and Latino—federal government funding targeted toward gay and bisexual men and transgender women is not matching the demographics of the epidemic. Furthermore, critically needed, bold policy initiatives that address key structural drivers of vulnerability among gay men are lacking.


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[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 Population May Be Neglected From HIV Funding

via Funders Concerned About AIDS, by Owen Ryan

At a community meeting in Atlanta, Georgia on March 20th, Kevin Fenton, director of Centers for Disease Control & Prevention’s (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention said, “Our own stigma, our own homophobia, cascades down in our funding and allocations…” Dr. Fenton was recognizing a reality in the United States that has become increasingly apparent to health policymakers throughout the world: that despite high prevalence rates of HIV among gay men and other MSM, funding for HIV prevention, treatment and care consistently neglects these populations, often due to stigma and discrimination.

Our own research at amfAR, the Foundation for AIDS Research, in partnership with the Center for Public Health and Human Rights at Johns Hopkins University has drawn similar conclusions. In our report, “Achieving an AIDS-Free Generation for Gay Men and Other MSM”, we found that MSM are neglected and marginalized by national HIV responses throughout the world, even in countries where MSM are a significant proportion of all HIV infections. For example, in Guyana where MSM account for a large majority of infections, funding to this population was as little as .05% of overall HIV funding from the Global Fund (a major donor in that country).

However there is an even larger reality that is more pernicious than budget cuts. In many settings, MSM are completely neglected by epidemiological surveillance, the data that informs funding flows. In countries like Ethiopia and Mozambique, which have received billions of dollars in aid for their HIV response, epidemiological surveillance of HIV deliberately excludes MSM and other key populations leading to a dearth of programming; this despite several reports that have shown significant epidemics among gay men throughout Africa. Our data reflect a simple truth: if MSM aren’t counted, they aren’t funded.


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[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 Report that PrEP May Be Accepted as HIV Prevention in UK's Gay Men

via AIDSmap.com, by Roger Pebody

Pre-exposure prophylaxis (PrEP) would be an acceptable HIV prevention strategy for large numbers of gay, bisexual and other men who have sex with men in major UK cities, according to two studies presented to the British HIV Association (BHIVA) conference in Birmingham this week.

The conference also heard details of a small pilot PrEP study, likely to start recruiting later this year.

A cross-sectional survey of 842 HIV-negative gay and bisexual men, recruited at bars, clubs and saunas in London, suggested that half the respondents would be interested in taking PrEP.

Respondents were given information about pre-exposure prophylaxis and asked: “If PrEP were available, how likely is it that you would take a pill (oral dose) on a daily basis to prevent HIV infection?”.

Half said yes, with 16% saying they were likely to take PrEP and 34% saying they were very likely to. Men interested in PrEP were slightly more likely to be under the age of 35 (AOR adjusted odds ratio 1.58), have attended a sexual health clinic in the past year (AOR 1.59) and to have previously taken post-exposure prophylaxis (PEP) (AOR 1.96). After statistical adjustment, various measures of risky sex were no longer associated with interest in PrEP.

In this survey, 17 men (2.1% of those answering the question) said that they had previously taken antiretroviral drugs to reduce their risk of HIV infection.

Secondly, clinicians at the Manchester Centre for Sexual Health surveyed HIV-negative men attending their service who reported unprotected receptive anal intercourse. Of the 121 men who responded, 36% said they would be “very willing” to take PrEP while only 14% said they would not take the treatment. Daily dosing was perceived as a better option by four fifths of respondents – just one fifth would prefer taking a dose before sexual activity.

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[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 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.

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[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 Investigate Acceptability for PrEP in Chinese MSM

via PLoS ONE, by Feng Zhou

Introduction

In pre-exposure prophylaxis (PrEP), antiretroviral (ARV) drugs are given to HIV-negative people to decrease their chance of becoming infected. Several studies conducted among men who have sex with men (MSM) have shown that PrEP awareness was very low, and few participants reported having the experience of PrEP use, even in some countries where it is available. Although strategies including abstinence, being faithful, and condom use (ABC) have been proved to be effective for prevention of HIV transmission, the virus still prevails among MSM. It was estimated that 2.6 million individuals were newly infected in 2009 worldwide, which 19% fewer than the 3.1 million in 1999. China had about 740,000 people living with HIV and 105,000 with AIDS by the end of 2009. Homosexual intercourse has become a major mode of HIV transmission since 2009, and the prevalence of HIV in MSM has increased significantly from 2.5% in 2006 to 8.6% in 2009. A sociological study has estimated that there are 1.8–2.4 million homosexual or bisexual men in mainland China. In China, high-risk behavior, such as multiple partners and unprotected sex, have been reported to be common in this group. Also, recent studies have reported rapid transmission of HIV in this specific population from various geographic areas in China, despite the efforts made by the national and local governments and non-governmental organizations in the past few years. New effective approaches are urgently needed for this population.

In recent decades, researchers have made great efforts to explore alternative biomedical interventions, such as male circumcision (MC), HIV PrEP and post-exposure prophylaxis (PEP), HIV vaccines, and microbicides. Among these potential strategies, PrEP is considered to be one of the most promising strategies in MSM. Several animal and human studies have suggested that ARV drugs might reduce the risk of HIV infection either by PrEP or by non-occupational PEP. A 12-month PrEP clinical trial of daily oral tenofovir disoproxil fumarate (TDF) for HIV prevention was performed among 400 HIV-negative Ghanaian women, and achieved good acceptability and >82% adherence. In November 2010, the US National Institutes of Health (NIH) announced the results of the iPrEx trial of PrEP conducted among 2499 HIV-seronegative MSM in six countries, which showed that daily oral Truvada, a combination of emtricitabine (FTC) and TDF, reduced risk of HIV incidence by 44%, with a median 1.2 years follow-up, compared with the placebo group, and >75% adherence was reached. These findings represent a major advance in HIV prevention research, providing the first evidence that PrEP, when combined with other prevention strategies, can reduce HIV risk among MSM. A further study is ongoing in HIV Prevention Trials Network (HPTN) 067 to evaluate the feasibility of intermittent dosing of PrEP. Recent results from Partners PrEP and CDC TDF2 have shown that PrEP with daily oral TDF/FTC or TDF was effective at reducing HIV risk in heterosexual men and women. However, the Fem-Prep program on Truvada, a closed clinical trial implemented by Family Health International (FHI) in partnership with research centers in Africa, does not support the theory of PrEP having an effect on HIV prevention. Therefore, some factors that might influence the efficacy of PrEP, including adherence, sexual behavior, or other factors still need to be determined.

The awareness and acceptability of new strategies are very important when they are recommended for use. Therefore, the objective of our study was to investigate the awareness and acceptability of PrEP among MSM and potential impact factors, which will provide suggestions and guidelines for future clinical trials in China.

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[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.]

Ugandan Gay Rights Activists Fight Against Anti-Homosexuality Bill

via Chicago Sun Times, by Frank Mugisha

The world listened last week as Liberian President Ellen Johnson Sirleaf defended her country’s laws that discriminate against its lesbian, gay, bisexual, transgender and intersex population. In an interview with the Guardian newspaper, she spoke of preserving Liberia’s “traditional values” and said in part, “We like ourselves the way we are.”

It’s a sad sentiment I hear in my own country of Uganda: the idea that homosexuality is somehow un-African and foreign to our culture, an import of the West that must be stopped. But it is not African to restrict another’s freedom. It is not African to spread lies and dissent and urge brutality against others. And it is certainly not African to deny fellow citizens basic human rights. No, these are ideas introduced and fostered by our colonizers, not by our ancestors.

My organization, Sexual Minorities Uganda, works against these forces of hate and division, and we live every day under the threats of violence that keep so many LGBTI Ugandans from coming forward. In 2010, a local newspaper published photographs and addresses of many of us under the headline “Hang Them.”

But still we work, because there is so much work to be done: gay men to be rescued from jail after arbitrary arrests and beatings. Lesbian women who need to be sheltered after curative rape assaults. Friends to be healed after being denied medical care.

The anti–gay groups call this struggle a campaign for gay rights. But there is nothing gay or straight about the right to worship, to assemble publicly or to live without fear of sanctioned brutality.

In Uganda today, bosses routinely fire employees suspected of being gay. We can be expelled from school or denied medical attention. Our friends and neighbors can be persecuted just for being seen with us.
The Ugandan Parliament is pushing a bill that is inspired by hateful ideas brought to us, not from within Africa, but by anti-gay activists like Scott Lively from the United States. The new law would equate gay people with pedophiles and call on the LGBTI population to stop “promoting homosexuality.”


The original version of the legislation even called for applying the death penalty to gay couples, and although it may be revoked from the final bill, even the more “palatable” version seeks to silence our voices, criminalize anyone who speaks on our behalf and encourage the wrongheaded stigmas that increase our nation’s rising HIV prevalence.
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[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.]