Rectal Microbicides Seen As Key in Preventing New HIV transmissions

By Chief K.Masimba Biriwasha | Global Editor At Large

Washington DC, US – Unprotected anal sex is a key driver of HIV transmission in many parts of the world. The practice is surrounded with much stigma and discrimination which is a key barrier to developing protective measures.

Microbicide research has gained momentum in recent years with focus largely on products to prevent HIV transmission during vaginal sex. However, there is a growing momentum to develop rectal microbicides for women, men, and transgender individuals around the world who engage in anal intercourse.

Rectal microbicides are products – that could take the form of gels or lubricants – being developed and tested to reduce a person’s risk of HIV or other sexually transmitted infections from anal sex. In spite of the public health need for rectal microbicide research, there is serious institutional, socio-cultural and political stigma around the issue.

According to estimates, the risk of becoming infected with HIV through anal sex is 10 to 20 times greater than vaginal sex because the rectal lining, the mucosa, is thinner and much more fragile than the lining of the vagina.  Because the rectal lining is only one-cell thick, the virus can more easily reach immune cells to infect.

Against this background, developing safe, effective, affordable rectal microbicides is key priority to turning the tide against HIV among populations that engage in anal sex, said Dr Ian McGowan, a leading rectal microbicide researcher.

“We are moving through the early and middle phases of the development of a rectal microbicide,” McGowan, adding that funding is part of the science and that more researchers are required as the research unfolds.

“We need mo people engaged, we need communities to take up the issue – we should follow the science.”

Jim Pickett, Chair of the International Rectal Microbicide Advocates (IRMA) and Directyor of Advocacy at AIDS Foundation of Chicago said that funding for rectal microbicides remains a key challenge for developing rectal microbicide. Pickett said that a total of US 100 million is required to engage in the next phase of studies.

“What is important in developing the next phase of studies is to develop a product that is about pleasure, intimacy, connection, emotion and love. The tools that are out there do not adequately fulfil this need,” he said. “Making the rectal microbicide safe, effective, affordable and acceptable for all who need them is a key priority.”

AIDS Vaccine Advocacy Coalition (AVAC) Executive Director, Michael Warren, said that money dedicated to rectal microbicide has been a blip on the map and a more strategic approach is required to attract additional resources.

“We need to articulate what exactly is required for the rectal microbicides; we need to build a comprehensive ask for what is required. It must come with a specific plan so that it does not appear like we are requesting for a blank. We need a clear strategy described scientifically and costed effectively in order to get support,” said Warren.

 

Carol Odada, a Kenyan AIDS activist said that rectal microbicides were not an innovation limited to men who have sex with men only.

“HIV has a woman’s faces, a woman is the main victim but nobody thinks. Every other prevention is other. Every prevention works differently works differently. There is a lot of anal sex going around. It’s unfortunate that some women are forced to engage in anal sex. Rectal micorbicide is not a gay issue. Women have to drive the call for rectal microbicide,” she said.

Rectal Microbicides Open New Frontier in Turning HIV Tide

By Chief K. Masimba Biriwasha | OpEd

Microbicide research has gained momentum in recent years with focus largely on products to prevent HIV during vaginal sex. However, there is a growing momentum to develop rectal microbicides for women, men, and transgender individuals around the world who engage in anal intercourse.

Microbicides are products designed to prevent or reduce the sexual transmission of HIV or other sexually transmitted infections when applied inside the vagina or rectum. Most vaginal microbicides are being tested as gels or rings, while rectal microbicides are primarily being tested as gels.

Rectal microbicides are products – that could take the form of gels or lubricants – being developed and tested to reduce a person’s risk of HIV or other sexually transmitted infections from anal sex. In spite of the public health need for rectal microbicide research, there is serious institutional, socio-cultural and political stigma around the issue.

According to estimates, the risk of becoming infected with HIV through anal sex is 10 to 20 times greater than vaginal sex because the rectal lining, the mucosa, is thinner and much more fragile than the lining of the vagina.  Because the rectal lining is only one-cell thick, the virus can more easily reach immune cells to infect.

Although the rate of new infections is stabilizing in many countries around the world, HIV continues to disproportionately affect racial minorities and men who have sex with men. It is estimated that five to ten percent of the world’s population engages in anal sex.

Globally, men who have sex with men are 19 times more likely to be infected with HIV than the general population. Unprotected anal sex is the primary driver of the HIV epidemic among this population.

For decades, the primary approach to HIV prevention for anal sex has been consistent and correct use of male condoms. Male condoms are an extremely effective method to prevent HIV, but many people are unable or reluctant to use them.

Rectal microbicides are products – that could take the form of gels or lubricants – being developed and tested to reduce a person’s risk of HIV or other sexually transmitted infections from anal sex.

If proven effective, rectal microbicides could protect against HIV in people who are unable or reluctant to use condoms. Unlike condoms, they could provide an alternative way to reduce risk that is not controlled by one’s sexual partner and possibly enhance sexual pleasure, helping to motivate consistent use.

Rectal microbicides could offer both primary protection in the absence of condoms and back-up protection if a condom breaks or slips off during anal intercourse. Such an alternative is essential if we are to address the full spectrum of prevalent sexual practices and the basic human need for accessible, user-controlled HIV and STD prevention tools

Rectal microbicides research is in the early phase of clinical development due in part to scientific challenges related to the biology of the rectum, and cultural reluctance to address anal sex.

Most critically testing the safety and acceptability of microbicides designed specifically for rectal use is key to ensuring their effectiveness in preventing HIV infection among people who engage in anal sex.

Researchers need to first be sure rectal microbicides are safe and then conduct additional studies to find out whether they are effective against HIV.

Gender Based Violence Drives HIV Epidemic Among Women: US Study

By Chief K.Masimba Biriwasha | Global Editor At Large

Washington DC, US – One out of every four people living with HIV in the US is a woman according to a new study by the University of California, San Fransisco (UCSF). Further, it is estimated that 30 percent of women living with HIV in the country experience post traumatic stress disorder compared to 5,2 per cent in the general population.

The study has broad implications to efforts to turn the tide against the AIDS epidemic across the world in that its expected to shape the discussion on the impact of violence on women’s vulnerability to the disease.

“Women are dying unnecessarily. They can live with HIV, but are dying from the effects of violence in their homes and communities. HIV policies and programmes must prevent and address the effects of gender based violence that weave through women’s lives,” said Gina Brown, a woman openly living with HIV.

 

According to the study, which focused on approximately 6,000 women living with HIV, intimate partner violence is a disproportionately high cause of death for HIV positive women in the US.

The study concluded that traumatized  women fare worse in AIDS treatment more than women who have not suffered traumatic stress. Trauma also puts women in situations where they are more likely to spread the virus.

“For a long time we have been looking for clues as to why so many women are becoming infected with HIV and why so many are doing so poorly despite availability of effective treatment. This work clearly shows that trauma is a major factor in the HIV epidemic among women,” said Edward Machtinger, Director of the Women’s HIV Programme at UCSF in an interview.

Specifically, the study demonstrated that HIV positive women who report recent trauma had more than four times the odds of experiencing virologic failure, a situation where the HIV virus becomes detectable in the blood despite being on antiretroviral mediations.

The study also revealed that women who had suffered recent trauma were almost four times more likely to have had sex with someone without the virus or whose HIV status was unknown to them, and to not always use condoms with these partners.

“Women who report experiencing trauma often do not have the power or self-confidence to protect themselves from acquiring HIV. Once infected, women who experience ongoing abuse are often not in positions of power to effectively care for themselves or to insist that their partners protect themselves. Effectively addressing trauma has the potential to improve the health of HIV positive women and that of the community.”