IRMA - Rectal Microbicide Advocacy

Meet Eva Westley: Our Newest Friendly Rectal Microbicide Advocate!

2012-02-10T10:06:00.001-06:00

“The fact is, lots and lots of people have anal sex, and rectal microbicides just make sense in this context. This isn’t about being gay or straight or kinky or conservative. This is about the fact that people have sex in many different ways for many different reasons and everyone deserves to protect themselves and their partners from HIV and other STIs.”

Eva is an IRMA advocate from Minneapolis, MN who now lives and works in Chicago. She is a grant writer at the AIDS Foundation of Chicago (AFC) - home of IRMA and Project ARM. Her efforts are a big reason IRMA and its initiatives, such as Project ARM, get funding to survive and thrive! Before this she was a Latin American Health Policy major and has travelled extensively through the region. She loves fried plantains, being a yoga teacher, and her book club!

Eva first became involved with IRMA as a grantwriting intern at AFC. She worked with Jim Pickett on a few IRMA grants and realized what an amazing advocacy group IRMA was! She has been on the listserv and looking for more ways to be involved since. Most recently, Eva attended the Project ARM meeting in Addis Ababa and provided critical on-the-ground logistics support. She says the meeting was successful beyond her expectations.

She is an advocate of rectal microbicides because the prevention options available today are not enough to protect everybody. “Rectal microbicides are important among new HIV prevention technologies not only because they would add to the diversity of prevention options, but because they would give people a way to protect themselves and their partners by building on a behavior that people already use during anal sex. Since a rectal microbicide might be developed as a lubricant, gel, or douche- and we know many people having anal sex use these types of products- they might be more acceptable prevention options,” she says. She also mentions that using these products could make anal intercourse more pleasurable, so adding rectal microbicides to them could really be very ideal!

Eva creates awareness of rectal microbicides by educating IRMA funders about their crucial role in combating HIV. She knows how important money is in the development of biomedical technologies and is excited about her role working with the key institutions that can provide it. Through AFC she also submits funding proposals for other great projects, such as female condoms, syringe exchanges, prevention justice advocacy, and more!

Eva encourages everyone to become an IRMA advocate. She says it is one of the most inspiring and rewarding aspects of her career, and she learns new things almost every day by reading the listserv. She understands that many people could face some stigma for supporting IRMA and rectal microbicides, but she knows it won’t go away until we keep talking about it and the world acknowledges sexual diversity. Her final advice for advocates: “Shine on, rectal stars!”

Thanks Eva for all that you do!

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Meet George Victor Owino: Our Newest Friendly Rectal Microbicide Advocate!

2012-02-09T10:06:00.001-06:00

“You should try being an IRMA advocate; you will love the energy and drive you get from it. If you can say rectal microbicides to over 100 people, you can sell anything to anyone on this earth!”

George is an IRMA advocate from Nairobi, Kenya. There he is the Project Coordinator and Health Educator at Ishtar MSM - a community based organization whose mission is to attain full sexual health rights and social well being for MSM in Kenya. He is also a Board Member at GALCK - the Gay and Lesbian Coalition of Kenya. His passions are to advocate for and research issues surrounding access to stigma and discrimination free healthcare for the LGBTI community, environmental conservation, and human rights in general. He also loves to watch horse racing!

He first became familiar with IRMA when a colleague sent him the application to apply for a scholarship to the Project ARM - Africa for Rectal Microbicides meeting in Addis Ababa this past December, in conjunction with ICASA. He was one of 16 people chosen and was surprised to see how vibrant the rectal microbicide movement in Africa had become! He had heard of rectal microbicides and IRMA before, but said he was not aware that such support existed for them in Africa.

George believes rectal microbicides are important to include in a comprehensive approach to combating HIV. He frequently hears stories of condoms bursting and allergies to latex in his work, and he thinks rectal microbicides would be able to help a lot in these situations. “A rectal microbicide would give human beings the power to have safer sex, protect themselves and their partners from infection, and reduce new infection and re-infection,” he said.

He talks about rectal microbicides any time he has the opportunity. He believes that we all have to integrate them into open forum discussion more to help lessen the stigma that surrounds them. The best way to deal with stigma is to face it head on.

Thanks George for all that you do!

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Meet Alliance Nikuze: Our New Friendly Rectal Microbicide Advocate

2012-02-08T09:27:00.001-06:00

“We are more than 7 billion people on this planet; we surely don’t and can’t have one way of having sexual intercourse. Our diversity is our wealth. Our sexuality as human beings is not supposed to be defined by the available prevention tools but all the HIV prevention tools have to be adapted to our sexuality.”

Alliance is an IRMA advocate who grew up in Goma, Democratic Republic of Congo. She since moved to Kigali, Rwanda where she has worked and studied, and is currently pursuing a public health degree in Sweden. She is actively involved in the discussions around HIV prevention research.

Alliance’s primary advocacy has been centered on female empowerment and prevention tools which could prevent penile-vaginal transmission, but she has become increasingly interested in the need for rectal microbicides as well. While involved in efforts to engage civil society organizations in medical male circumcision rollout, she became more aware of different sexual practices- particularly anal intercourse. She then heard of IRMA at the Microbicides 2010 conference in Pittsburgh and decided to become an advocate to meet others with a similar interest in rectal microbicides. She has been satisfied beyond her expectations!

Alliance advocates for both male and female use of rectal microbicides. Recently she had what she calls a “wake up call” while talking with a few African women who indicated they really enjoyed anal intercourse. Previously she had believed that women only did this to please their male partners. This exchange reinforced her understanding that women all over Africa need rectal microbicides in order to help prevent HIV.

Alliance attended IRMA's Project ARM - Africa for Rectal Microbicides meeting in Addis Ababa this past December, in conjunction with ICASA, and was excited about the opportunity for everyone there to shape the advocacy and research agenda for rectal microbicides in Africa. She hopes Project ARM will help to dispel the marginalization and discrimination towards those who practice anal intercourse in Africa.

Her advice for HIV prevention advocates is to keep expanding our prevention toolbox. She believes that if you are truly committed to ending HIV, why wouldn’t you stand up for rectal microbicides? If we continue talk about them whenever we can, it will help lessen the stigma, and each time you may be saving someone’s life. She hopes IRMA can reach out to more policy makers, researchers, and advocates so that they know about rectal microbicides and can add them to their discourse and agenda.

In her free time she enjoys reading, watching TV, and spending time with friends and family.

Thanks Alliance for all that you do!

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Meet Olumide Makanjuola: Our Newest Friendly Rectal Microbicide Advocate!

2012-02-07T09:53:00.000-06:00

“Rectal microbicides are a very important new prevention technology. They bring attention to anal intercourse and provide protection for those who practice it, regardless of their sexual identities.”

Olumide is an IRMA advocate from Lagos, Nigeria. He works at TIERs (The Initiative for Equal Rights) for the rights of LGBT people and sexual health rights. He loves his job and the inspiring people he works with.

Olumide first became involved with IRMA when he visited the AIDS Foundation of Chicago (AFC) for a week and worked with the IRMA crew (IRMA is housed at AFC.). He joined the IRMA listserv and has since been following the conversations and information shared by members every day. At first he was not sure how this would be helpful to the people he serves in Nigeria, but now he says he sees how valuable rectal mircobicides can be for the gay/MSM community and others who practice anal intercourse.

Olumide was excited to participate in the Project ARM - Africa for Rectal Microbicides meeting held in Addis Ababa this past December, in conjunction with ICASA, which brought together so much expertise and many different community perspectives to help design a road map for rectal microbicides in Africa. He says that it is a long road ahead and implementation of the agenda will be difficult, but he is confident and knows Project ARM’s goals are “surely achievable.”

Throughout his career as an advocate he has faced much stigma and discrimination; anyone standing up for the MSM or LGBT communities in Nigeria does. Sometimes in Nigeria, people think IRMA is promoting homosexuality. Olumide has to fight this stigma as well.

His advice for IRMA is to continue promoting and educating people about rectal microbicides in Africa at the grassroots level, as the Project ARM meeting concluded.

Thanks Olumide, for all that you do!

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Meet Stefan Baral: Our Newest Friendly Rectal Microbicide Advocate!

2012-02-06T10:38:00.001-06:00

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

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

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

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

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

Thanks Stefan, for all that you do!

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

An Interview with Professor Salim Abdool Karim about VOICE Trial Setbacks

2012-02-03T14:00:00.001-06:00

viaAllAfrica, interview with Professor Salim Abdool Karim

Professor Salim Abdool Karim, director of the Centre for the AIDS Program of Research in South Africa (Caprisa) at the University of KwaZulu-Natal and Columbia University in the United States, spoke to AllAfrica's Julie Frederikse about the unexpected halt of a study into tenofovir vaginal gel. This followed a finding that the microbicide failed to prevent HIV transmission, in contrast to the positive result in a previous study conducted by his Caprisa team.

What happened when you heard the findings of the new study that contradicted your results?

We were surprised and very disappointed. We know that science doesn't always give you the answers you want and hope for, but when you look at the totality of the evidence, we know that there's still pretty strong evidence, whether from the laboratory or in monkeys or in humans, that tenofovir gel is effective in preventing HIV. This is rationale for why the Caprisa and Voice (Vaginal and Oral Interventions to Control the Epidemic) studies were conducted in the first instance. So now we need to understand why the Voice trial produced a different result.

Is this a big setback to Caprisa's research?

The Voice trial is an important result. We now need to understand it. It doesn't take us completely off track - it's a temporary setback - and understanding this result would put us in a better position to move forward again. Science grows not only from success, it also grows from failure.

Has the suspension of this study demoralised your team?

That's the nature of science. In a series of studies, it is seldom that every study shows the same thing. But we'll stay on track, and try and understand why the Voice result is different. Whether the women in the study were not using the gel correctly, or there were other underlying problems, we don't know yet. It's too early to tell.

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.]

No time to give up on microbicides

2012-02-03T10:07:00.000-06:00

via allAfrica.com, by Julie Frederikse

Africans tracking the worldwide HIV epidemic have not found much to celebrate since Aids began ravaging the continent 30 years ago, but researchers are optimistic that they are learning as much from their failures as their successes.

Sub-Saharan Africa still carries the biggest burden of HIV worldwide, and while there has been a significant improvement in access to antiretroviral treatment in recent years, scientists searching for a gel or vaccine that can prevent HIV infection ride a rollercoaster of hope and disappointment.

Take the case of a husband and wife team from the University of KwaZulu-Natal in South Africa. Professors Salim Karim and Quarraisha Abdool Karim head up a research unit that has been at the forefront of clinical trials to find a safe and effective microbicide to protect women from HIV.

In July 2010, delegates at the last World Aids conference gave the couple a standing ovation when they announced the results of one of the most promising studies on HIV prevention to date. Their team at the Centre for the Aids Program of Research in South Africa (Caprisa), showed that a vaginal gel called tenofovir was able to reduce sexual transmission of the virus by 39 percent overall and 54 percent in women who used it consistently.
But the euphoria over this breakthrough has dissolved into disappointment, with the unexpected finding of a wider sub-Saharan African study that the microbicidal gel, when prescribed daily, does not prevent HIV infections. This has led to the suspension of tenofovir in the Vaginal and Oral Interventions to Control the Epidemic (Voice) trial.

Read the rest.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

MSM in Africa: Highest Risk Group?

2012-02-02T11:20:00.002-06:00

via Aidsmap, by Gus Cairns

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

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

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

The study

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

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

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

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

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

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

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

Read the rest.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Tia IRMA Launches Her First Video with Besos Negros and Love

2012-02-01T08:00:00.001-06:00

Hola! Soy la Tia IRMA!

Introducing Tia IRMA (Auntie IRMA), a character created by IRMA's South American chapter IRMA-ALC (housed at Epicentro) to create awareness about rectal microbicides in a fun way.

This is the first of a group of videos that will try to explain, in a very colloquial way, everything you might want to know about rectal microbicides, PrEP and many other subjects.

In this episode, Tia IRMA and Tony (her nephew) promote her blog Canal Anal , where visitors will find useful information, tips and other relevant news on sex and HIV written by Tia IRMA and her friends. A group that includes a transgendered neighbor, a gay nephew and a very straight husband, since the idea is clear: Everybody is having anal sex, so don´t be shy!

A real, live, in-the-flesh Tia IRMA is going to participate in most of the LGBT community events this year in Peru (where she was born) and she expects to become more popular than Kim Kardashian, with a bigger and wiser butt ;)

Besos negros!

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

In Africa, Anal Sex Goes Hetero

2012-01-31T13:00:00.000-06:00

by IRMA advocate Bisi Alimi (pictured in purple, with IRMA advocate Kadiri Audu at the recent Project ARM - Africa for Rectal Microbicides meeting held in Addis Ababa, Ethiopia.)

While I was in secondary school, I was always told that anal sex is something between two men. Many anti-gay activists have used this sexual practice as a means of attacking the gay movement. It is the core of the sodomy law in Africa and the buggery law in other part of the world.

However, recent studies have shown an increasing number of heterosexual people in Africa, mostly young people, are practising anal sex on a daily basis.
While the notion of sex in itself is a very difficult topic to tackle in the African setting, the mere fact that more and more straight couples in Africa are embarking on a rectal sexual journey for pleasure gives a call for concern – because most of this is unprotected by condoms. An act of unprotected anal intercourse is 10 to 20 times more likely to result in HIV transmission compared to an act of unprotected vaginal intercourse, due to the different biological characteristics of the rectum which make it much more susceptible to infection.

What do we know?

According to Morenike Ukpong, at IRMA’s recently concluded Project ARM - Africa for Rectal Microbicides strategic meeting in Addis Ababa held in advance of the 2011 ICASA, over 12% of young people in Nigeria are practising anal intercourse. In different studies done across Africa on the prevalence of anal sexual practice among heterosexuals, similar results were found.

An anonymous survey of 2,593 men and 1,818 women in Cape Town conducted by Kalichman et. al (2009) found out that 14% of men and 10% of women have engaged in anal sex in the last 3 months. Of this, only 67% of the men and only 50% of the women used condoms.

Rates among truck drivers in South Africa are also very high (Ramjee et. al 2002).

A recent study found that 42% of truck drivers are consistently engaging in anal intercourse with female sex workers. Not surprisingly, a high percentage of female sex workers reported ever having practiced anal intercourse. A recent study in Kenya reports 40% of female sex workers said they had practiced anal intercourse at least once (Schwandt et. all 2006).

This is not the end of revealing data. In Lane et. all (2006) , results showed that young people between the ages of 15-24 in South Africa engage in anal sexual behaviour. There is only a small difference between the sexes, with 5.5% of young males engaging in anal sexual behaviour and 5.3% of females.

More interesting is Matasha (1998). This study found that among primary school pupils in Tanzania, 9% had anal sex as their first sexual experience.

Taken together, these studies show that there is previously unknown frequent anal sexual behaviour among heterosexuals. However, the focus on anal sex and health for many years has been the limited to gay/MSM communities.

What are we getting wrong?

The focus of HIV prevention in Africa has always been primarily targeted at vaginal sex, and thereby prevention messages have by and large been to use condoms. We are now finding though that as straight people engage in anal sex, the likelihood of using condoms diminishes. For many, anal intercourse may be a form of virginity protection, or as a means to prevent pregnancy, and there is a common belief that anal intercourse carries no risk for HIV infection.

Dr. Karim of the famous CAPRISA 004 study argued that this sexual behaviour- when unprotected - could be driving a sizable amount of new HIV infections in Africa. In agreeing with him, I asked the question “is it time for us to broaden our scope of what HIV transmission looks like in Africa?”

If we still argue that HIV transmission in Africa is mainly heterosexual, are we assuming that the risk is only from unprotected vaginal intercourse? Or are we going to acknowledge the prevalence of unprotected anal intercourse among heterosexuals and address heterosexual transmission more broadly and honestly?

Not only we are overlooking the reality and the prevalence of this sexual behaviour among the general heterosexual population, but we are also missing the chance to reassess our prevention strategy and provide safer anal intercourse education irrespective of gender or sexual orientation.

Coupled with the myth that only MSM practice anal intercourse is a troublesome lack of knowledge about the ways to practice safer anal intercourse. One area in particular where accurate knowledge is lacking is the safe use of lubricants. In a presentation at the Project ARM strategic meeting by Brian Kanyemba from the Desmond Tutu HIV Foundation, he said that many people were using all kinds of things as a lubricant: olive oil, Vaseline, Vicks and even mayonnaise - none of which are condom-compatible.

Gay and straight couples need to know the facts about anal intercourse, and need condoms and condom-compatible lubricants to engage in this behaviour in a safer way.

Hope, and the future

Anal sex is a pleasurable sexual activity, and it can be safe when certain conditions are met. One of these conditions is using condoms with condom-compatible lubrication.

Another answer to safer anal sex is rectal microbicides - which would be a lube or a gel with anti-HIV properties.

The development of a safe and effective rectal microbicides could help everyone engaging in anal sex have a more pleasurable and safer sexual experience.

It is important to know however that it is not a replacement for condom use, but could be used as an additional option for protection. Ideally, one day we will have rectal microbicides that not only protect against HIV, but other STDs as well.

This sounds very promising, but while there is ongoing research, there is no microbicide product out there in the market yet. That does not mean we should not be hopeful.

As we drive towards zero HIV infection, it is also important we started looking at other prevention technologies that will be very easy for people to use without actually affecting their established sexual behaviours.

As IRMA’s rectal microbicides advocates sat down to work at the Project ARM meeting in Addis, one of the interesting things that came out was the need to intensify advocacy for rectal microbicides in many ways. This includes engaging with our community to let people know that anal sex is a human behaviour, both homosexual and heterosexual.

There is increasing need for information on anal sex and health and active involvement of NGOs in Africa. This campaign should also include NGOs working with African communities all over the world. We should also start the discussion with women, both young and old, that there is a need for more education around safer anal sex.

Rectal microbicides are looking like the part of future of HIV prevention, but for this dream to be achieved there is the need for everyone to be involved in the process – on both the research and advocacy fronts.

From civil societies to clinicians, doctors to government officials, international organizations and funders the world over, we need to all join the fight.

But while we await the rectal microbicides reality, we should not forget that when we talk anal sex, we should also scream… AND LUBE!!

As without the right use of the right lube, anal sex will not only be painful and unpleasant, but also puts the receptive partner in greater danger of receiving sexually transmitted infections- including HIV.

Anal sex is great, condom use is pleasure, but don’t forget AND LUBE.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Identifying at-risk populations to enroll and maintain in HIV prevention trials

2012-01-31T10:00:00.001-06:00

via PubMed, by Price MA, Rida W, Mwangome M, Mutua G, Middelkoop K, Roux S, Okuku HS, Bekker LG, Anzala O, Ngugi E, Stevens G, Chetty P, Amornkul

"Finding, enrolling, and retaining risk populations for HIV prevention trials is challenging in Africa. African MSM are not frequently engaged for research, have high HIV incidence, need urgent risk reduction counseling, and may represent a suitable population for future HIV prevention trials."

Objective

To identify and describe populations at risk for HIV in 3 clinical research centers in Kenya and South Africa.

Design

Prospective cohort study.

Methods

Volunteers reporting recent sexual activity, multiple partners, transactional sex, sex with an HIV-positive partner, or, if male, sex with men (MSM; in Kenya only) were enrolled. Sexually active minors were enrolled in South Africa only. Risk behavior, HIV testing, and clinical data were obtained at follow-up visits.

Results

From 2005 to 2008, 3023 volunteers were screened, 2113 enrolled, and 1834 contributed data on HIV incidence. MSM had the highest HIV incidence rate of 6.8 cases per 100 person-years [95% confidence interval (CI): 4.9 to 9.2] followed by women in Kilifi and Cape Town (2.7 cases per 100 person-years, 95% CI: 1.7 to 4.2). No seroconversions were observed in Nairobi women or men in Nairobi or Cape Town who were not MSM. In 327 MSM, predictors of HIV acquisition included report of genital ulcer (Hazard Ratio: 4.5, 95% CI: 1.7 to 11.6), not completing secondary school education (HR: 3.4, 95% CI: 1.6 to 7.2) and reporting receptive anal intercourse (HR: 8.2, 95% CI: 2.7 to 25.0). Paying for sex was inversely associated with HIV infection (HR: 0.2, 95% CI: 0.04 to 0.8). 279 (13.0%) volunteers did not return after the first visit; subsequent attrition rates ranged from 10.4 to 21.8 volunteers per 100 person-years across clinical research centers.

Conclusions

Finding, enrolling, and retaining risk populations for HIV prevention trials is challenging in Africa. African MSM are not frequently engaged for research, have high HIV incidence, need urgent risk reduction counseling, and may represent a suitable population for future HIV prevention trials.

[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.]

Oral HPV More Common in Men Than Women

2012-01-30T08:50:00.000-06:00

via The New York Times, by Anahad O'Connor

About one in 15 Americans is infected with oral human papillomavirus, a sexually transmitted virus that causes throat cancers, and the disease is especially common among men, new research shows.

The research is the first major study to document the nationwide prevalence of oral human papillomavirus, or HPV, a disease that has drawn growing attention from public health experts because it has fueled a rise in oropharyngeal cancers affecting the back of the tongue and the throat. Researchers showed last year that throat cancers caused by a particular strain of the virus, HPV Type 16, have tripled in the last 20 years. But it was unclear exactly how many people over all were carrying HPV, which exists in more than 40 forms.

By looking at thousands of people across the country, the authors of the new report found that 6.9 percent of adults and teenagers are infected with oral HPV of any kind. The virus was about three times as common in men as it was in women. And the scientists identified several behaviors that significantly raised the risk of becoming infected: increasing age, greater sexual activity and smoking cigarettes.

But the study, which was published in The Journal of the American Medical Association, also revealed some reassuring findings, said Dr. Maura L. Gillison, the chairwoman of cancer research at Ohio State University and senior author of the paper. While the overall prevalence of HPV was about 7 percent, only 1 percent, or roughly two million people, were infected with HPV 16, the strain linked to throat cancers and many cases of cervical cancer. Fewer than 10,000 cases of throat cancer caused by HPV 16 are diagnosed every year, indicating that most people with the virus do not develop cancer.

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.]

Concerns about Gilead's Truvada used as HIV Prevention

2012-01-26T09:30:00.000-06:00

via Financial Times, by Christine Livoti

Gilead Sciences’ (NASDAQ: GILD) once-daily Truvada pill has seen only tepid interest for adoption in the HIV prevention setting, despite treatment guidelines by the Centers for Disease Control (CDC), experts told Biopharm Insight. This is largely related to issues around feasibility, cost and historical evidence for other prevention strategies, which may not be remedied even with the FDA label Gilead is seeking, infectious disease experts said.

Last December, the company announced a supplemental NDA (sNDA) regulatory application for its currently marketed HIV drug Truvada, a potential therapy to reduce the risk of acquiring HIV, commonly described as pre-exposure prophylaxis (PrEP). Truvada has been approved since 2004 for use in combination with other antiretroviral drugs to treat HIV infection.

Truvada has not been approved yet as a preventative therapy in HIV.

Results from the Phase III iPrEx study reported in the New England Journal Of Medicine in December 2010 showed prophylactic effect from Truvada given orally among men who have sex with men (MSM). In January 2011, the CDC issued interim guidance on the use of PrEP in this population.
While HIV therapy is much more manageable than previously, with fewer pills and side-effects, experts in recent years have begun to initiate therapy in earlier stages of the viral infection, and most recently in uninfected individuals to prevent infection. While multiple PrEP studies have reported encouraging data, multiple hurdles to adoption still remain.

Slow uptake thus far

This news service reported in December 2010 that uptake of Truvada as an HIV prophylaxis therapy would likely be slow, as non-HIV specialists would largely be responsible for prescriptions. Infectious disease specialists reported few, if any, prescriptions in this indication, when interviewed by this news service.

The University of North Carolina division of infectious disease has not been prescribing PrEP, said Dr Christopher Hurt, clinical assistant professor. He added there has been some talk in the medical community that primary care providers and potentially ob-gyns would be responsible for PrEP prescription, similar to how they are responsible for oral contraceptives.

He noted in some urban areas, particularly San Francisco, Boston, New York and Washington, DC, with stronger healthcare settings for MSM, have probably been prescribing PrEP more frequently as they regularly see those individuals at risk of HIV infection. He noted his clinic had some discussion about offering PrEP to partners of current patients, but no decision was finalized. Those partners need to be in care somewhere, where potential side effects can be monitored, he added.

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.]

Open Letter to FDA Urging Immediate PrEP Review

2012-01-25T15:07:00.000-06:00

via AIDS Foundation of Chicago

This is an open letter to the Food and Drug Administration, urging the priority review of the drug Truvada for use in PrEP (pre-exposure prophylaxis). The AIDS Foundation of Chicago and 25 other organizations signed this letter to counter the AIDS Healthcare Foundation's protest of the FDA regarding this review. To read the PDF of the letter, with footnotes, click here.

Dear Commissioner Hamburg:

We write as a coalition of 25 leading HIV/AIDS and health organizations to request that FDA grant priority review of a supplemental New Drug Application1 (sNDA) for the approval of emtricitabine/tenofovir disoproxil fumarate (Truvada®) fixed dose combination for pre-exposure prophylaxis (PrEP) to reduce the risk of HIV infection among adults as part of a comprehensive prevention package including risk reduction counseling and condoms.

The rigorous priority review process applicable to efficacy supplements is the best means to promote public health by recognizing the potential of PrEP to offer a major advance in HIV prevention and deserving this priority “where no adequate alternate therapy exists or as a significant improvement compared to marketed products … including nondrug products or
therapies.”

Our organizations understand that granting priority review is not tantamount to a final approval. Nevertheless, we are hopeful that the full dossier of data on emtricitabine/tenofovir disoproxil fumarate fixed dose combination of PrEP from multiple clinical trials in different populations can lead to a responsible regulatory and marketing plan that allows safe use in the populations that may benefit from this innovative development.

The need for significantly improved safe and effective HIV prevention tools is clear. Despite many years of efforts to reduce HIV incidence using available counseling methods, some 50,000 new infections occur annually. Disparities persist so that incidence continues to concentrate among African Americans and Latinos, men who have sex with men (including transgender individuals), and the poor. These grim and stubborn facts led to the creation of the White House-directed National HIV/AIDS Strategy for the United States (NHAS), which lists enhanced prevention efforts as a primary objective. If emtricitabine/tenofovir disoproxil fumarate for PrEP satisfies FDA approval criteria, health programs and individuals will have improved choices to address a domestic priority and save lives.

The PrEP sNDA for Truvada® meets criteria set out in FDA’s Manual of Policies and Procedures for priority review. As organizations committed to ending the AIDS epidemic, we appreciate how the history of FDA’s regulatory tools for fast track approval or for accelerated and priority review introduced the current suite of HIV therapeutic drugs to treat active infection. In the present case, there is a clear unmet need for new effective methods for preventing HIV infection, a need that is as urgent today as was the need for HIV therapeutics over the past two and more decades.

HIV advocacy organizations made it possible to launch such regulatory procedures for the benefit of all patient disease groups when those tools were not yet available. We are not aware of any legitimate reason to thwart the faster introduction of medicines FDA determines to be safe and effective to stop HIV, nor should anyone turn back the pages of history and act against the interests of patients to do so now. Unfortunately, recent actions by the AIDS Healthcare Foundation regarding PrEP would introduce unwarranted roadblocks in the FDA process of making responsible decisions about potentially useful medicines and public health. Those actions also foster misunderstandings of the careful balancing of risk and benefits that informs a mature marketing permission based on all available data. Those actions would also set an unhelpful precedent as PrEP research evolves in the future and the FDA is asked to review non-tenofovir-based regimens (e.g. maraviroc), microbicide gels, and intermittent PrEP. We urge that FDA continue its public health promotion goals now in the service of the critical need to prevent, as well as treat, HIV and grant this priority review.

We would be happy to discuss the priority review process as applied to HIV prevention further at your convenience. Mitchell Warren, Executive Director of AVAC, acts as the contact person for the organizations signing this letter and can be contacted at 1-212-796-6423 and mitchell@avac.org.

Yours sincerely,

AIDS Foundation of Chicago
AIDS Legal Referral Panel
AIDS Resource Center Ohio
AIDS Research Consortium of Atlanta
AIDS United
amfAR, The Foundation for AIDS
Research
Asian & Pacific Islander Wellness Center
AVAC: Global Advocacy for HIV Prevention
Black AIDS Institute
Caracole, Inc.
Chicago Black Gay Men’s Caucus
Fenway Health
HIV Prevention Justice Alliance
International Rectal Microbicide Advocates
Justice Resource Institute
LA Gay and Lesbian Center
National Alliance of State and Territorial
AIDS Directors
National Black Gay Men's Advocacy
Coalition
National Latino AIDS Action Network
National Minority AIDS Council
Ohio AIDS Coalition
Project Inform
San Francisco AIDS Foundation
SisterLove, Inc.
Ursuline Sisters of Youngstown HIV/AIDS Ministry
Us Helping Us

Read the PDF of the letter (with footnotes) 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.]

PrEP: Attitudes and Acceptance Among Potential User Groups

2012-01-25T12:55:00.002-06:00

via PLoS One, by Andreas B. Eisingerich, Ana Wheelock, Gabriela B. Gomez, Geoffrey P. Garnett, Mark R. Dybul, Peter K. Piot

Background

The use of antiviral medications by HIV negative people to prevent acquisition of HIV or pre-exposure prophylaxis (PrEP) has shown promising results in recent trials. To understand the potential impact of PrEP for HIV prevention, in addition to efficacy data, we need to understand both the acceptability of PrEP among members of potential user groups and the factors likely to determine uptake.

Methods and findings

Surveys of willingness to use PrEP products were conducted with 1,790 members of potential user groups (FSWs, MSM, IDUs, SDCs and young women) in seven countries: Peru, Ukraine, India, Kenya, Botswana, Uganda and South Africa. Analyses of variance were used to assess levels of acceptance across different user groups and countries. Conjoint analysis was used to examine the attitudes and preferences towards hypothetical and known attributes of PrEP programs and medications. Overall, members of potential user groups were willing to consider taking PrEP (61% reported that they would definitely use PrEP). Current results demonstrate that key user groups in different countries perceived PrEP as giving them new possibilities in their lives and would consider using it as soon as it becomes available. These results were maintained when subjects were reminded of potential side effects, the need to combine condom use with PrEP, and for regular HIV testing. Across populations, route of administration was considered the most important attribute of the presented alternatives.

Conclusions

Despite multiple conceivable barriers, there was a general willingness to adopt PrEP in key populations, which suggests that if efficacious and affordable, it could be a useful tool in HIV prevention. There would be a willingness to experience inconvenience and expense at the levels included in the survey. The results suggest that delivery in a long lasting injection would be a good target in drug development

Read the full study here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

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

2012-01-24T08:43:00.000-06:00

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.]

Reasons behind high risk behaviors in Chinese MSM

2012-01-23T09:37:00.000-06:00

via BMC Public Health, by Guanzhi Chen, Yang Li, Beichuan Zhang, Zengzhao Yu, Xiufang Li, Lixin Wang, Ziming Yu

Background

Men who have sex with men (MSM) have become a high-risk group of HIV infection in China. To date, little is known regarding the behavioral, social and psychological characteristics in Chinese MSM, which makes the implementation of preventive and therapeutic strategies for this high-risk subpopulation of people extremely difficult.

Methods

A total of 714 questionnaires were retrieved from the database of a Chinese government-sponsored National Key Research Project titled "Risk Analysis and Strategic Prevention of HIV Transmission from MSM to the General Population in China". The respondents were categorized into a high-risk group and a control group. Their behavioral, social and psychological characteristics were comparatively analyzed.

Results

Of the 714 MSM analyzed, 59 (8.26%) had high-risk homosexual behaviors. This sub-group of MSM had a higher in-marriage rate, a higher monthly income, heavier alcohol consumption and more serious problems with sexual abuse in childhood, intentional suicide attempts and mistaken assumption on condom's role in protecting HIV infection, as compared with the control group (P < 0.05). In contrast, the two groups did not differ significantly the sexual orientation, level of education, types of profession, drug use, condom use and experience of social stigma and discrimination (P > 0.05). A vast majority of the individuals in both behavior categories expressed support of legally protected gay clubs as well as gay marriage legislation in China. There was a strong correlation between high-risk behaviors and sexual abuse in childhood, alcohol drinking, income level and a mistaken belief in perfect HIV protection through the use of condoms.

Conclusions

MSM with and without high-risk homosexual behaviors have different social and psychological characteristics, which should be taken into account when implementing behavioral and therapeutic interventions aimed at preventing HIV/AIDS transmission among MSM as well as from MSM to the general population in China.

Read the full study here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Critical to fight stigma and discrimination faced by MSM

2012-01-20T08:44:00.002-06:00

via Inside Story, by Gregory Trotter

The dream of the AIDS-free generation will never be realized as long as there remain countries in the world that kill and imprison people for being gay.

Same goes for countries that won’t even acknowledge homosexuality exists within their national boundaries and therefore fail to provide targeted HIV prevention and treatment services. Such are the realities underscored by a new report, “Achieving an AIDS-free Generation for Gay Men and Other MSM,” released by amfAR and Johns Hopkins University on Wednesday.

The report studied the funding and implementation of HIV services targeted for MSM (men who have sex with men) in eight countries where same-sex intercourse is criminalized or heavily stigmatized: China, Vietnam, Ethiopia, Guyana, Mozambique, India, Nigeria and Ukraine. Among other findings, the study concluded that MSM are “deprioritized and marginalized by national HIV programs.”

In the report’s own words: “It will be impossible to achieve an ‘AIDS-Free Generation’ if MSM are left behind.”

(For those who may not know, the phrase “AIDS-free generation” has been a sort of battle cry for people and organizations involved in the ongoing efforts to stop the 30-year-old AIDS epidemic, gaining momentum since Secretary of State Hillary Clinton used it in her historic November 2011 speech.)

The report rings true for Jim Pickett, director of prevention advocacy and gay men’s health for the AIDS Foundation of Chicago (AFC). Pickett is also chair of the International Rectal Microbicides Advocates, a group that does what its name suggests. His work takes him all over the world to advocate for microbicide research and other HIV prevention strategies.

“Sadly, it’s not new. It’s what we know. But … it’s really important for us to continue to put that message out there. It’s another way to have this discussion, to shine a light on these disparities and to move forward in the right direction,” Pickett said. “(This report) is a really important document.”
Pickett was in Addis Ababa, Ethiopia, just last month for a meeting with advocates for the launch of Project ARM (stands for Africa for Rectal Microbicides). Project ARM is an IRMA initiative. The conference coincided with the 2011 International Conference on AIDS and STDs in Africa.

It was wrought with tension from the get-go, as anti-gay religious groups caught wind of an African gay men’s health pre-conference satellite and began mounting a protest. Eventually, they were silenced by the Ethiopian government, Pickett said. But it was an uncomfortable learning experience: IRMA and Project ARM kept their own agendas low-profile and encountered no problems.

At the Project ARM meeting, advocates from Malawi, Uganda and other countries talked about the fear of being discovered gay after receiving threats of bodily harm and death.

“We acknowledge that in our quest for developing these new HIV prevention strategies like rectal microbicides, they are for naught if people aren’t safe, if they can’t be who they are wherever they are,” Pickett said. “If you are so deeply stigmatized or demonized that you have to be hidden, you’re not going to come up and go to the counter and get a rectal microbicide. You’re not going to get any services.”

As an example, Pickett pointed to the arrests of nine gay men in Senegal following the 2008 ICASA. Word quickly rippled through the gay community in Senegal.

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.]

Rectal Sexually Transmitted Infections and Lubricant Use

2012-01-17T11:06:00.000-06:00

via Sexually Transmitted Diseases, by Pamina M. Gorbach, DrPH, Robert E. Weiss, PhD, Edward Fuchs, PA-C, Robin A. Jeffries, MS, Marjan Hezerah, PhD, Stephen Brown, MD, Alen Voskanian, MD, Edward Robbie, MPH, Peter Anton, MD, and Ross D. Cranston, MD

Background

Use of lubricant products is extremely common during receptive anal intercourse (RAI) yet has not been assessed as a risk for acquisition of sexually transmitted infections (STIs).

Methods

Between 2006 and 2008, a rectal health and behavior study was conducted in Baltimore and Los Angeles as part of the University of California, Los Angeles Microbicide Development Program (NIAID IPCP# #0606414). Participants completed questionnaires, and rectal swabs were tested for Neisseria gonorrhoeae and Chlamydia trachomatis with the Aptima Combo 2 assay, and blood was tested for syphilis (for RPR and TPHA with titer) and HIV. Of those reporting lubricant use and RAI, STI results were available for 380 participants. Univariate and multivariate regressions assessed associations of lubricant use in the past month during RAI with prevalent STIs.

Results

Consistent lubricant use during RAI in the past month was reported by 36% (137/380) of participants. Consistent past month lubricant users had a higher prevalence of STI than inconsistent users (9.5% vs. 2.9%; P 0.006). In a multivariable logistic regression model, testing positive for STI was associated with consistent use of lubricant during RAI in the past month (adjusted odds ratio: 2.98 95% confidence interval: 1.09, 8.15) after controlling for age, gender, study location, HIV status, and numbers of RAI partners in the past month.

Conclusions

Findings suggest some lubricant products may increase vulnerability to STIs. Because of wide use of lubricants and their potential as carrier vehicles for microbicides, further research is essential to clarify if lubricant use poses a public health risk.

Read the full study here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Microbicides 2012 Conference Now Open for Registration!

2012-01-13T12:44:00.000-06:00

M2012 Registration is Open!

"To share in the latest developments in HIV prevention through microbicides and other technologies, this is the conference to attend. The conference is the key event in the microbicides world, where cutting edge research will be presented by world experts, and you will have a chance to interact with people involved at every level of microbicides development "

-Professor John Kaldor, The Kirby Institute and Conference co-Chair

Come to Sydney in April for the 2012 International Microbicides Conference - 'From Discovery to Delivery', with state of the art plenary lectures on microbicides and other aspects of HIV prevention research, cross-disciplinary symposia, oral abstracts, and poster sessions.

M2012 will be a global forum for the presentation and discussion of the latest information on microbicides and oral pre-exposure prophylaxis for HIV prevention and their interface with other prevention strategies. There will be a strong emphasis on the role of community in both research and implementation of scientific findings. The conference is interdisciplinary, and will include basic science, pharmacokinetics, formulation and delivery, clinical research, public health, prevention science, and social and behavioural research.

WHY SHOULD YOU COME?
1. LEARN... From experts from around the world who will speak on key issues in HIV prevention technologies.
2. NETWORK... with a cross-disciplinary group of researchers, community representatives and policy makers, to support you in applying new approaches and perspectives in your work.
3. PARTICIPATE... in sessions that will range from state of the art lectures, to debates on hot topics in microbicides development.

Click here to learn more.

[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.]