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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VOICE Lesson: It's Unfair to be Non-Adherent

This post by IRMA's Jim Pickett first appeared on the blog of the HIV Prevention Justice Alliance.


The VOICE results are extremely important to the field of new prevention technology research. I hope current/future/much-needed discussions about VOICE don’t get drowned out by the HYPE (yes, all caps HYPE) surrounding the “baby cure” story which has dominated coverage out of CROI so far.

If there is one VOICE lesson to focus on, it is adherence. Or in this case, the upsetting lack thereof. It is absolutely important to fully understand why so many of the women in the trial didn’t apply the gel, or take the pill. And it is critically important for scientists to develop things people actually WANT to use, and DESIRE. Perhaps a daily gel, or a daily pill, is simply not desirable for a lot of folks. Makes sense to me.

But here’s the rub. The field can’t move forward with product development when people don’t actually test-drive the product being investigated. Products can’t be improved without data from people who actually used the product. Sure, a daily gel or a daily pill may not be everyone’s idea of a good time… but the only way those ideas get translated from the clunky Model T Ford to a slick 2013 BMW is through a long, iterative process. Which requires trial participants to APPLY THE GEL and/or TAKE THE PILL.

I get that people join trials for all kinds of reasons, and that for many; it is their only access to healthcare. So, they may have no interest in actually participating in test driving anything, but are very excited about regular HIV and STD screening, counseling, access to condoms and lube, referrals to other services, etc. Can’t be mad at them for wanting those things. Right?

It’s a crime, really, or at the very least an outrage, that clinical trials end up being the only healthcare access point for too many folks. That needs to be addressed, on its own.

But…we simply can’t afford enrolling thousands of people into complicated and costly clinical trials to have them just forgo what they SIGNED UP to do. Let’s be brutally honest here, joining a trial to get health screenings and condoms is great for the individual – but it does NADA, NOTHING, NOOTCH for the community/communities fighting HIV who are desperate for new tools to prevent HIV.

Being in a clinical trial is a commitment to following the protocol as best as possible, and being honest when unable. Clinical trial participation necessitates a strong sense of altruism, a desire to help answer big questions for whole populations. I think it is unfair to everyone, especially highly impacted communities where HIV rates are soaring, and where the crisis is anything but over, for trial participants to sign informed consents and derive individual benefits from trials without fully engaging in the study protocols that would allow for potential population benefits.

There are not unlimited resources. In fact, they are shrinking (Hello Sequester!) We can’t continue to fund expensive, resource-intensive, multi-year trials in which most people only SAY they test drove the product.

Jim Pickett is the Chair of the International Rectal Microbicide Advocates (IRMA). This blogpost is part of our ongoing coverage of the 2013 Conference on Retroviruses & Opportunistic Infections (CROI). To read more perspective and analysis on the VOICE results at CROI, click here.

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

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

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

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263 Organizations and Individuals Have Endorsed the Call to Action on Lube Safety - HAVE YOU SIGNED ON?

Since we launched the Call to Action on Lubricant Safety on Valentine's Day, we have collected 84 organizational endorsements and 179 individual endorsements from every corner of the globe.

Thank you to ALL who have endorsed so far. The list of organizational endorsers is provided below. Is your organization on the list?

If you haven’t endorsed yet – now is your chance. Click here to endorse the Call as an organization. You may also endorse the Call to Action as an individual .

Please endorse the Call, and demand answers to our questions on lube safety.

Not knowing whether lubes are safe or not, and not knowing whether lubes potentially enhance HIV or STD acquisition or not, is not acceptable! We have enough lube safety data to be concerned, quite frankly, but we do not have enough data to really understand the implications of lubricant use.

We will continue to be in the dark, and never know if we don’t put pressure on other advocates, on scientists, on funders, on regulators, and on lube manufacturers to do their parts in addressing lube safety. We all have a role to play in ensuring the lubes we put in our bodies are safe.

Endorse the Call now.


LIST OF ORGANIZATIONAL ENDORSERS - IN FORMATIONList updated February 22, 2013
1. Abra Advanced Research International Pte Ltd, Singapore
2. Act for Change, Ghana
3. Act Up/East Bay, USA
4. Adhikaar, India
5. Affirmative Action, Cameroon
6. African Alliance for HIV Prevention, South Africa
7. African Men for Sexual Health and Rights (AMSHeR), South Africa
8. Afrique Arc En Ciel, Togo
9. AIDS Community Research Initiative of America, USA
10. AIDS Foundation of Chicago, USA
11. AIDS United, USA
12. AKPAKA Axel, Benin
13. ALTERNATIVE CÔTE D'IVOIRE, Cote D’Ivoire
14. Anova Health Institute, South Africa
15. AVAC, USA
16. Blue Diamond Society, Nepal
17. Caribbean Association of Midwest America, USA
18. Case/UH Microbicide Clinical Trials Community Advisory Committee, USA
19. Center for Applied Research on Men and Health (CARMAH), Vietnam
20. Centre for Human Rights and Rehabilitation (CHRR), Malawi
21. Chicago Female Condom Campaign, USA
22. COCQ-SIDA, Canada
23. Desmond Tutu HIV Foundation, South Africa
24. DUH Demonstration for Universal Healthcare, USA
25. Epicentro, Peru
26. Equal Opportunities, Tajikistan
27. Family Planning Council, USA
28. Fenway Institute at Fenway Health, USA
29. Freedom and Roam Uganda, Uganda
30. Fundacion Manodiversa Bolivia, Bolivia
31. Gay Men’s Health Crisis, USA
32. Gel Works Pty Ltd, Australia
33. Global Forum on MSM & HIV (MSMGF), USA
34. GrenCHAP Inc., Grenada
35. GWLmuda, Indonesia
36. Health Digest Foundation, Ghana
37. Heroes Project, India
38. HIV Prevention Justice Alliance, USA
39. Hyacinth AIDS Foundation, USA
40. India HIV/AIDS Alliance, India
41. Interagency Coalition on AIDS and Development, Canada
42. International Center for Advocacy on Right to Health, Nigeria
43. International Rectal Microbicide Advocates (IRMA), USA
44. International Rectal Microbicides Advocates – Nigeria, Nigeria
45. Jamaica AIDS Support for Life, Jamaica
46. Joint Adherent Brothers and Sisters Against Aids, Uganda
47. Los Angeles County HIV Drug & Alcohol Task Force, USA
48. MAACA, INC, USA
49. Men For Health and Gender Justice Organisation, Botswana
50. MUSC/Lowcountry AIDS Services Consumer Advisory Board, USA
51. NAM Publications (Aidsmap), UK
52. National Black Gay Men's Advocacy Coalition, USA
53. National Minority AIDS Council, USA
54. New HIV Vaccine and Microbicide Advocacy Society, Nigeria
55. Okaloosa AIDS support & Informational Services, Inc. (OASIS), USA
56. PEMA Kenya, Kenya
57. Penitentiary Initiative, Ukraine
58. PeterCares House, USA
59. POCAAN (People of Color Against AIDS Network), USA
60. Presbyterian AIDS Network, USA
61. Pride Equality, Sierra Leone
62. Pro Health Initiative, Nigeria
63. Professionals in Pride Kenya (PPK), Kenya
64. Project Inform, USA
65. PT Foundation, Malaysia
66. Queer Alliance Nigeria, Nigeria
67. San Francisco AIDS Foundation, USA
68. SIBALT, Russia
69. Society Against Sexual Orientation Discrimination (SASOD), Guyana
70. SOMOSGAY, Paraguay
71. START at Westminster, USA
72. Stichting AidsCare, The Netherlands
73. Tamba Pwani, Kenya
74. Test Positive Aware Network, USA
75. The Initiative for Equal Rights, Nigeria
76. The Mpowerment Project, USA
77. The Yes Yes Company Ltd, UK
78. Treatment Action Group, USA
79. UNITED AND STRONG INC, Saint Lucia
80. Vivir. Participacion, Incidencia y Transparencia, A.C., Mexico
81. We For Civil Equality NGO, Armenia
82. Womenplus Against TB and HIV in Kenya, Kenya
83. World AIDS Forum, Australia
84. Youth Voices Count, Thailand

Endorse the Call now.

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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.

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HIV home tests – how will they be used?

[This article was inspired by the lively discussion and debate on IRMA's highly active moderated listserv for its members. Interested in signing up? Send IRMA a note at rectalmicro@gmail.com.]

Attempts to overly mediate how I receive information about my body amount to little more than a paternalistic view of what I can handle.

via aidsmap, by Roger Pebody

This week the OraQuick In-Home HIV Test, which will be sold over the counter and used without medical supervision, received its final approval from the Food and Drug Administration (FDA), meaning that it can be legally sold in the United States. Similar approvals may follow for other countries. But who is likely to use it and in what circumstances? And will the increased accessibility of HIV testing make any difference to the epidemic?

Whereas French research suggests that men who are secretive about their homosexual behaviour will have a particular interest in home testing, a study from New York indicated that some gay men will use it to test sexual partners, sometimes as a prerequisite for unprotected sex. And a rich discussion between HIV prevention advocates and researchers, which recently took place on the email forum of International Rectal Microbicide Advocates (IRMA), highlighted the key issue of whether people who test positive at home will subsequently connect with health services. While some participants had concerns about the potential for coercion and abuse, others felt that home testing could increase choice and autonomy.

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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POZ: David Evans Gets Practical About PrEP

[IRMA highly recommends this one. Brilliant, strategic, thoughtful, sober, forward-thinking - a must read]

via POZ, by David Evans

Excerpt:

Give people the facts--the whole picture--and let them decide whether PrEP is right for them

Let's tell people how effective the drug is when they actually take it as prescribed--over 90 percent effective--and stop quoting statistics from the clinical trials where they averaged all of the people together whether or not they were actually taking the drugs. People are going to need motivation to adhere well to PrEP and telling them that it will only cut their chance of becoming infected by 42 percent (the iPrEx study) or 75 percent (Partners PrEP) is not only dishonest, it could significantly undercut their willingness to take a pill every day. How would people feel if we said that condoms were only 30 or 40 percent effective and never revealed that this figure is true only because we counted all of the people who never used condoms in the first place?

Let's also stress that in the clinical studies, PrEP was used with condoms, at least some of the time by some of the participants, and that it shouldn't be seen as a complete substitute. That said, the fear that people will forgo condoms for PrEP is a reasonable one. Therefore, I believe strongly that we should be targeting PrEP to those who are struggling most with condom use, for whatever reason.

Let's also emphasize that while side effects were rare, and not immediately serious in the vast majority of PrEP-takers in trials, we honestly don't know what long-term side effects will look like. People who ultimately end up taking PrEP for more than two years are entering new territory, as are people who might have greater underlying risks for kidney or bone disease.

PrEP is not benign, but neither is HIV; let's strive for balance and accuracy in describing both. We all have a responsibility to correct inaccurate information where we find it, whether in our community publications or blogs, local planning meetings or in our groups of friends. We can never know who's in most desperate need of PrEP and who might be swayed inappropriately one way or the other by misleading or cherry-picked information.

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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U.S. Policy Addresses HIV Epidemic in the LGBT Community

via HuffPost, by Charles Stephens

We finally are starting to scratch the surface of the depth of the HIV crisis among young black men who have sex with men (MSM). Late last summer the Centers for Disease Control and Prevention (CDC) announced the most recent HIV incidence numbers, indicating that young, black MSM were the only population in the United States that showed an increase. In the three-year period between 2006 and 2009, there was an almost 50-percent increase in HIV incidence in that group.

This information was startling. Those of us working in the field had suspected that the HIV incidence numbers among young, black MSM would be disproportionately high. But to know it, to hear it confirmed, was shocking. For a few months after the updated HIV incidence numbers were announced, there seemed to be a collective gasp, even as we struggled to crank out solutions. And since then there has been a persistent conversation among many sectors of the HIV prevention realm about next steps. Just what are we going to do next?

So it was this spirit of persistence to find answers that many of us brought to the White House LGBT Conference on HIV/AIDS in Atlanta, Ga. on April 19. Held at the Morehouse School of Medicine, the conference was as well attended as it was ambitious. On the campus of a historically black college, in a historically black community, the symbolism was as rich as it was breathtaking. Those of us who attended assembled dutifully, with both grace, because we were called, and urgency, because of the calling. Several White House officials, including Dr. Grant Colfax, the new director of the Office of National AIDS Policy, as well as numerous HIV experts, gathered to talk about the HIV epidemic today in LGBT communities.

Two groups that entered almost every conversation were young MSM and transgender populations. Dr. Kevin Fenton, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, shared his insights about the social and structural drivers of HIV, particularly among vulnerable populations and sexual minorities. He affirmed the commitment of the CDC to LGBT communities and announced some of the agency's next steps, including a roll-out of additional social marketing campaigns.

Homophobia must frame how we think about the devastating impact of HIV. This was a key insight to the entire conference. Anti-gay stigma, HIV stigma, and environments that dehumanize and demean sexual minorities and gender-nonconforming people create a perfect storm for HIV and other public health disparities. Young, black MSM and transgender people are vulnerable in a variety of ways, including to physical and psychic homophobic violence, familial and community rejection, discrimination, and a litany of other kinds of social stigma. These vulnerabilities fuel health disparities, particularly with regard to HIV. As Dr. Patrick Sullivan, an Emory University professor and researcher, stated, "homophobia is a public health hazard." In this sense, the scientific and social, negative health outcomes and human rights and, by extension, sexual rights, are not separate spheres but are intricately connected within a wider spectrum of issues we must work on together, and not separately.

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.]

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.


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.]

Dr. Grant Colfax: New Director of White House Office of National AIDS Policy

via PR Newswire

San Francisco AIDS Foundation applauds President Obama's selection of Dr. Grant Colfax to become director of the White House Office of National AIDS Policy. Dr. Colfax is uniquely suited to continue the momentum established under his predecessor, Mr. Jeffrey Crowley, in advancing the ambitious goals outlined in the president's National HIV/AIDS Strategy and moving us closer to an AIDS-free generation.

"Dr. Colfax has been instrumental in the decline of new HIV infections in San Francisco in recent years," said San Francisco AIDS Foundation CEO Neil Giuliano. "His unique blend of experience serving on the front lines of the epidemic, implementing the national strategy at the local level, working as a direct service provider within the Ryan White CARE system, and conducting cutting-edge research makes him the right person at the right time to lead the Obama administration's efforts to end HIV/AIDS in the United States."

The Office of National AIDS Policy provides essential leadership in addressing the U.S. HIV/AIDS epidemic. As director, Dr. Colfax will be required to take a fresh look at how resources can be targeted to reduce HIV infection rates, increase access to treatment, and decrease HIV-associated health disparities related to sexual orientation, race, gender, and socio-economic status in hard-hit communities across the country. His track record in San Francisco demonstrates he is well suited for this challenge.

"Dr. Colfax will play a critical role over the next several years to ensure the implementation of the Affordable Care Act and HIV service integration to address the health care needs of people living with HIV," said Ernest Hopkins, director of legislative affairs at San Francisco AIDS Foundation. "Having worked closely with him on complex issues and having seen his consensus-building skills among diverse populations, including communities of color, I am confident that the AIDS community will have a strong advocate within the administration. I know Dr. Colfax will work to ensure that the coming changes to our health care system are made thoughtfully, carefully, and with a strong focus on improving the health status of the most vulnerable people."

As director of the HIV Prevention and Research Section at San Francisco Department of Public Health, Dr. Colfax elevated the role of community-based health research in local planning and funding decisions and instituted innovative, evidence-based HIV prevention tools, such as measuring and mapping community viral load and enhancing HIV testing and linkage to care, making San Francisco's HIV prevention planning and service system a model for jurisdictions across the nation. When developing the city's most recent HIV prevention plan with diverse stakeholders, Dr. Colfax was mindful to ensure its consistency with the emerging National HIV/AIDS Strategy. Throughout his career, he has maintained his role as a physician at Ward 86 at San Francisco General Hospital, the nation's first HIV/AIDS-specialized clinic.

San Francisco AIDS Foundation stands ready to work with Dr. Colfax, the White House, and other community partners across the country to reduce new HIV infections, increase access to care for all people living with the disease, and reduce HIV-related health disparities.



[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.]

MSMGF's Top 10 Policy Developments for Gay Men and Other MSM in 2011

via MSMGF, by George Ayala, Jack Beck, Krista Lauer, Mohan Sundararaj

Dear all,

The year 2011 saw a number of events that changed the global landscape for advocates working on issues concerning HIV among men who have sex with men (MSM). From groundbreaking epidemiological research to the collapse of Global Fund Round 11, the past 12 months have brought valuable opportunities and daunting challenges. Taking stock of these developments is essential for strengthening our response to the epidemic and enhancing our advocacy for MSM health and human rights worldwide.

With this in mind, the MSMGF has released a new report highlighting the top ten policy developments of 2011. Entitled, “Top 10 in 2011: Key Global Policy Developments Concerning MSM & HIV,” the document details the successes and failures of the past year in an effort to help chart a course forward.
The document can be found on the MSMGF’s website at: http://www.msmgf.org/files/msmgf//Publications/TopTen_2011.pdf

We hope you find this document useful. We look forward to working together with you over the coming year to build the new victories of 2012, achieving a higher standard of health and human rights for MSM.

Sincerely,
The Global Forum on MSM & HIV (MSMGF)

Read the full report 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.]

Open Letter from HIV-Positive Prevention Advocates Rejects Misinformation about PrEP

Close to 100 openly HIV-positive gay and bisexual men from across the United States and around the world have signed a new letter (http://tinyurl.com/pozPrEPletter) calling for an open discussion, “based on facts rather than on fear or misinformation,” of the challenges and opportunities presented by pre-exposure prophylaxis (PrEP) for HIV prevention in gay and bisexual men and transgender women. The new open letter is designed in part to urge FDA review of PrEP and to clarify facts about important PrEP research that advocates say have been misrepresented in a paid ad campaign sponsored by the AIDS Healthcare Foundation (AHF).

Pre-exposure prophylaxis, or PrEP, is a new HIV prevention method in which an uninfected person takes a daily HIV medication to reduce HIV infection risk. Data from an international study released in November, 2010 called iPrEx found that men and transgender women who have sex with men who received a daily single-tablet dose of the HIV drugs tenofovir and emtricitabine along with condoms and safe sex counseling had an average of 42% fewer HIV infections than those who received condoms and counseling alone. Much higher rates of protection were achieved among participants who took PrEP consistently.

Most of the HIV prevention community welcomed the news of a new tool that could significantly reduce infections in the populations at highest risk for HIV in many parts of the world. One HIV treatment provider, however, the AIDS Healthcare Foundation, has taken out an extensive series of full-page advertisements in gay papers around the country claiming that gay and bisexual men will act recklessly and will spread HIV if they are allowed to use PrEP. The AHF ad campaign claims that it is supporting gay and bisexual health by urging the U.S. FDA to ignore the PrEP study.

Today’s open letter challenges both the tone and content of the AHF communications and encourages “a full and factual discussion of the pros and cons of PrEP... based on facts, not misinformation.” Reminding the world that “gay and bisexual men invented safer sex…and have worked tirelessly to prevent new HIV infections,” the letter also points out that gay and bisexual men account for more than half of new HIV infections in the United States and are in particular need of new HIV prevention approaches.

"As an HIV positive gay man I signed this letter because I learned from experience we need all credible options to stop this epidemic. I owe my life to the fact that advocates and activists have pushed hard for decades to make effective AIDS drugs available to HIV-positive people,” said Kali Lindsey.  “Now we know that AIDS drugs can also play an important role in the health and well-being of HIV-negative gay men, how could we not move forward to reap the benefits of this research. It is not an option to ignore these findings.”

In July of this year the results of two addition studies, Partners PrEP (led by the University of Washington Department of Global Health) and TDF2 (led by the U.S. Centers for Disease Control and Prevention) demonstrated that PrEP is also safe and effective in heterosexual women and men. The Partners study found that participants who received PrEP experienced an average of 62-73% fewer HIV infections than those who received placebo. The TDF2 trial, conducted by the U.S. Centers for Disease Control found that the risk of HIV infection dropped by an average of 63% among those who received PrEP in addition to condoms and counseling. Data expected from the FEM-PrEP trial, which was stopped in April after it was determined that the trial would not be able to provide an efficacy result, will also provide additional information about PrEP use among women.

The new letter acknowledges that the PrEP, “is no magic solution to the HIV crisis,” and that research, “raises important questions…includ(ing) how to best support regular PrEP use; how to ensure the continued use of condoms and other precautions for those who decide to take PrEP; how to target PrEP to those who will benefit most; and how to pay for this new HIV prevention tool.”  Its signers express their commitment “to promoting safer sex and the open exchange of accurate information on HIV prevention,” and to “clarify the facts about PrEP, open up community discussion and make clear our belief that we are entitled to respect, accurate information and new HIV prevention tools.” The letter concludes by calling on all interested parties to “get the facts about PrEP, seek information, and express opinions…but to do so based on real information, not fear of the scientific process or prejudice against gay/bi men.”

The letter was coordinated by a group of U.S.-based AIDS advocacy organizations, including AIDS Foundation of Chicago, AVAC, International Rectal Microbicide Advocates (IRMA), and Project Inform.

Openly HIV-positive gay and bisexual men who wish to add their name to the letter can do so at: http://tinyurl.com/pozPrEPletter.


[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 Latest Treatment Action Campaign (TAC) Briefing - Antiretrovirals and Prevention

via the Treatment Action Campaign (TAC), by Catherine Tomlinson and Nathan Geffen

Exciting new evidence has demonstrated the potential of antiretroviral medicines (ARVs) to prevent HIV from being sexually transmitted. This TAC briefing explains the evidence and then discusses policy implications.

Our recommendations

1.The WHO must release its guidelines on serodiscordant couples.
2.People living with HIV should be offered highly active antiretroviral treatment (ART) when their CD4 counts fall below 350 cell/mm3, or if they have an AIDS illness or TB.
3.HIV-positive people in serodiscordant couples should be offered ART irrespective of their CD4 count.
4.For serodiscordant couples trying to conceive, both partners should be offered ARVs until conception is confirmed, after which the HIV-positive partner should continue on ART.
5.Pre-exposure prophylaxis (PrEP) should be made available to sex workers.
6.In other cases, pre-exposure prophylaxis should be made available to HIV-negative people who request it or who will --in the opinion of their nurse or doctor-- likely benefit from it.
7.The rollout of ARVs for prevention must not divert funding away from treatment programmes. Achieving universal access for people with HIV must remain the priority for governments, policy makers and funders.
8.Effective prevention interventions such as voluntary medical male circumcision and ensuring availability of male and female condoms continue to be critically important.

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.]

Pleasure as "Key Motivator" for Safe or Unsafe Sex

via The Pleasure Project, by Revati

I've been at the Asia Pacific AIDS conference for a week and so far, in all the sessions I have attended, only one person has spoken about pleasure and the need to recognise pleasure as a key motivator for safe or unsafe sex and that was a question from the audience.

But hurrah. At last I found someone who confronted the elephant in the room. Dr Malonzo, from Brokenshire College in The Phillipines, please step forward and take a bow.

Dr Malonzo’s study looks at why men having sex with men choose not to us condoms, or have “intentionally condom-less sex” aka “bare-backing”. bare- backing was initially a description used in the 1990′s by HIV positive men who declared their intention to have sex with other HIV positive men without condoms. It has now become the term used to describe condom less sex in a more generic view, regardless of HIV status. So for example, there are pornography studios who specialise in bare back films, sex workers or dating sites who use the term. Dr Malonzo studies the current phenomenon in Davao City in The Philippines in interviews with 40 young gay men.

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.]

How Much Would it Cost to End AIDS?

via Bloomberg, by Simeon Bennet

Michel Kazatchkine and Eric Goosby may be able to halt the spread of HIV. They just need the money.

The two men control the funds that buy drugs for most of the world’s AIDS patients. Studies in July provided the strongest evidence yet that medicines used since 1994 to treat HIV can almost eliminate the chance an infected person will pass the virus to a sex partner. Given to healthy people, the treatments can also protect against infection, offering the potential to end a pandemic that has killed 30 million people in 30 years.

Governments are now planning projects to assess whether those findings can be replicated in the real world, and what that might cost. Getting the drugs just to those patients who should be treated under existing guidelines would cost another $6 billion a year, according to the United Nations. Treating all those infected, in some of the world’s poorest countries, would cost tens of billions more.

Finding more money will be difficult with economic growth stalling and nations including the U.S., the biggest donor to the AIDS fight worldwide, trying to curtail overall spending to rein in debt. Funding for AIDS in poorer nations fell 10 percent to $6.9 billion in 2010 from 2009 levels, according to the UN.

“We may well be able to overcome AIDS,” Kazatchkine, the director of the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria, said in an interview. Still, “the gap between what the science is telling us we can achieve and what we would be able to achieve is at risk of increasing.”

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.]

San Francisco First U.S. City to Offer PrEP

via Bay Area Reporter, by Matthew S. Bajko

San Francisco is expected to become the first city in the country to offer gay men an anti-HIV pill that has proven successful in stopping transmission of the virus that causes AIDS.

Officials with the National Institutes of Health and San Francisco public health officials are close to finalizing an agreement to launch in early 2012 a demonstration project for usage of pre-exposure prophylaxis or PrEP. The combination pill contains tenofovir and emtricitabine (Gilead Science's Truvada) and has proven to be highly effective during clinical trials studying its efficacy.

Under the contract, up to 300 men who have sex with men at high risk for contracting HIV would be enrolled in the pilot study. City Clinic would administer the program while Magnet, the gay men's health center in the Castro, would help identify suitable participants for the study.

"We are anticipating we will be the first municipality to implement a PrEP demonstration project and things are moving forward toward that goal," Dr. Grant Colfax, the city's director of HIV prevention, told the Bay Area Reporter this week. "We are hoping the demo project would be implemented in the first quarter of 2012."


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.]

Treatment and Prevention: Interview w/Uganda's Dr. Patrick Ndase

via The Observer, by Shifa Mwesigye

Excerpt:

"Uganda has participated just like several other African countries; [in research] you must go where infection is happening. The majority of HIV research in the early stages happened in Uganda because Uganda was heavily infested with the virus. As you remember we had prevalence rates of above 20% and then we had the so called Uganda success story after the zero grazing campaign.

"At the time, the countries in southern Africa which largely [depend on] tourism were silent on HIV infection. Now the countries that are laden with infection are Swaziland, Botswana, Zimbabwe, Zambia and South Africa. So majority of HIV prevention research is not happening in Uganda anymore. In fact it is difficult to get someone who wants to do HIV research to come to Uganda."

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.]

When addressing the challenge of changing behavior, it's "easy to blame the victim"

via Huffington Post, by Simon McCormack

When addressing the challenge of changing behavior, Marjorie Hill says it's easy to blame the victim.

"There's always a tendency to look at the person and say, 'why don't you just stop smoking or eating red meat or start exercising?'" The Gay Men's Health Crisis CEO and HuffPost blogger says.

But when it comes to dealing with HIV and AIDS, Hill says, it's more complicated.

"We think that personal responsibility is important and we certainly encourage it," she said. "But when you look at the numbers and understand the epidemiology, the most common factor that those 33 million people who have the disease share is poverty. Poverty doesn't transmit HIV, but certainly being in a situation where someone has less access to information, resources, education and power -- those are factors that influence HIV."

That's what GMHC, the world’s first provider of HIV and AIDS prevention, care and advocacy, works to change, Hill said.

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.]

HIV Experts Create the Roadmap for Providing PrEP to Uninfected Individuals to Reduce the Risk of HIV Infection

Press release via Forum for Collaborative HIV Research

To stem the estimated 2.6 million new HIV infections that occur worldwide each year, more than 200 representatives from the scientific and HIV/AIDS communities took an important step in assessing the safety and public health implications of providing antiretroviral drugs to uninfected men and women exposed to HIV through sexual contact – a strategy called pre-exposure prophylaxis, or PrEP.

Assembling August 19 at an open public meeting and interactive webcast convened by the Forum for Collaborative HIV Research, these researchers, HIV/AIDS advocates, members of industry and representatives from National Institutes of Health, the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA) and state public health departments applied the findings from a number of large trials to discuss a roadmap for FDA and CDC to develop guidance on the safe use of PrEP in otherwise healthy individuals at high risk of acquiring HIV. Held with the encouragement of FDA, this meeting has important implications for medical practice in the U.S. because recent data strongly support the efficacy of antiretroviral intervention for this purpose.

Although FDA has not yet approved PrEP to reduce HIV acquisition in uninfected individuals, one form of PrEP recently studied for use in healthy men or in couples where one partner is HIV positive –a daily pill containing tenofovir plus emtricitabine (TDF/FTC) – is FDA-approved for the treatment of HIV infection. In women, studies have also demonstrated the efficacy of prophylactic treatment with tenofovir applied as a vaginal gel.

“We now have findings from large studies that support a conclusion that PrEP is effective in gay and bisexual men, who represent more than half of new HIV infections in the U.S., and now, there is evidence that PrEP may reduce HIV infection in heterosexual men and women, the population hardest hit by HIV worldwide,” said Jur Strobos, MD, Deputy Director of the Forum. “We must however, apply these promising data to develop workable strategies that mitigate risk that may be associated with the prophylactic use of antiretrovirals. These include both medical and socio-behavioral risk. We must ensure that people at greatest risk for acquiring HIV receive a comprehensive package of prevention services, including regular HIV testing, condom provision, risk reduction counseling and management of other sexually transmitted infections. The purpose of our meeting was to help identify what the components of a complete package should be.”

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.]

My Summer with IRMA

By Aldona Martinka, IRMA Intern

Today is my last day at the AIDS Foundation of Chicago, where I had the pleasure of interning this summer. I am one of the last summer interns remaining, and the empty intern “sweatshop” surrounds me. I had the opportunity to work with AFC and IRMA, as well as with Mapping Pathways and Project CRYSP for the summer at this desk, facing a window with blinds that are always closed. The closed blinds never bothered me, though, because whenever I was at my desk my eyes were fixed on my computer screen. I know that statement does little to separate me from the rest of my generation, but there is a good reason that I did not often look away from my work: I was fascinated.

I joke with my friends that I read about sex all day for work, but it’s true. In my work with HIV, and especially in my work with IRMA, I am constantly exposed to sex. My days are spent absorbing information about it: clinical studies showing the effectiveness of antiretroviral-based prevention methods, laws that criminalize and stigmatize high-risk groups, public health efforts in deeply-affected areas, or even sexual advice for HIV-positive people looking for love in modern America. Not only that, but for IRMA much of my reading was about the sexual act that is perhaps the most taboo, anal sex, because of the high risk of transmission and the sociocultural issues surrounding it. For a shy girl from a Catholic family this was a lot to take in. I quickly adjusted, though, and as my internship comes to a close I can discuss lubricant distribution in the rectum with a straight face and a confident smile. Though initially kind of shocking, I learned so much in these past several months, and what I learned has crystallized so much for me.

I learned that there are more HIV prevention tools even than there were 4 years ago when I took sex ed in high school. Rectal and vaginal microbicides, PrEP, and treatment as prevention represent real methods of preventing HIV that should be added to condoms as tools in the global prevention toolbox. Not only are they effective enough to warrant more exploration and consideration, but they provide protection in the wide variety of cases where condoms are a less desirable option, or not an option at all. With these prevention methods sex workers, wives in patriarchal societies, members of sero-discordant couples, and many other at-risk people can be protected that may not want to or be able to use condoms for a variety of reasons.

I learned just how inextricably HIV/AIDS is linked to my other passion: human rights. I learned about how government and cultural views toward sex workers, women, and LGBT people affects everything from the availability of condoms to the accessibility of treatment, and can create many difficulties in between. I also learned about the criminalization and stigmatization of HIV-positive individuals, something which surprised and horrified me, and how the continuation of these only obstructs public health efforts.

I learned so much, but I learned one last thing of personal significance to me. I was chattering excitedly at my father about the internship portion of my upcoming semester abroad in India, and how I hoped to work with an organization there that fights HIV. He asked if I wanted to look at other internships as well, to broaden my areas of knowledge in public health. While answering that question, I realized that everything I’ve learned in this internship, all of the related issues and exciting science, had led me to this seemingly unexceptional question. “No,” I said, “I want to continue to work with HIV.” Everything about it, the human right issues, the new advances in prevention and treatment, and my personal experiences with advocacy work, have captured my attention and drawn me to the fight against AIDS. I hope to continue in the field of HIV prevention and advocacy, and my time at the AIDS Foundation of Chicago with IRMA has provided me with invaluable experience. Thank you to all of the IRMA community for allowing me this opportunity. With a bit of luck and a lot of hard work, hopefully someday no one will have to go without a way to prevent HIV, for any reason.

[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.]

‘Confront legal and policy barriers to HIV’: Sub-Saharan Africa Regional Dialogue on HIV and the Law

Via UNAIDS.

In Sub-Saharan Africa, the region most heavily affected by HIV, legal, policy and social barriers, including stigma, discrimination, gender inequality and the criminalization of key populations at higher risk of HIV infection, continue to make people vulnerable to HIV and hamper the ability of individuals, communities and states to respond to the epidemic. This was the conclusion of the Regional Dialogue for sub-Saharan Africa, part of the Global Commission on HIV and the Law, held at the beginning of August in Pretoria, South Africa.

No taboo should be left unchallenged

A significant breakthrough came from the pledge of participants to highlight and discuss all aspects of the legal environment relating to HIV, including laws and practices related to stigma and discrimination, access to affordable treatment, children and adolescents, women’s rights and gender-based violence.

“This regional dialogue is a great opportunity for us, as Africans, to confront the difficult issues including discriminatory and punitive laws that target sex workers and men who have sex with men, and other populations vulnerable to HIV,” said Bience Gawanas, African Union Commissioner for Social Affairs.

The criminalization of drug use, sex work and same-sex sexual relations was also confronted by the participants in a bid to challenge all taboos. This is remarkable as recent punitive legal and policy developments in a number of countries in sub-Saharan Africa relating to the situation of members of key populations has raised concerns about the readiness of stakeholders in the region to confront this issue. Some 31 countries in the region criminalize sex work, and same-sex sexual relations constitute a criminal offence in at least 30 countries.

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.]