Unprotected anal sex has long been regarded as a key driver of HIV transmission in many parts of the world, especially among men who have sex with men. In many contexts, the practice is surrounded with stigma and discrimination which is a key barrier to developing protective measures, and largely pushes affected populations to go underground far from the reach of public health services as well as HIV prevention tools.
There is a growing recognition that to turn the AIDS tide and avoid uneccessary deaths, there is a need to develop new HIV prevention tools such as rectal microbicides for women, men, and transgender individuals around the world who engage in anal intercourse.
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. Dr McGowan also serves as the co-principal investigator of the Microbicide Trials Network (MTN), an HIV/AIDS clinical trials network established in 2006 by the National Institute of Allergy and Infectious Diseases, part of the U.S. National Institutes of Health (NIH).
Rectal microbicides (currently under research) 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.
“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 Director 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.”
Mitchell Warren, Executive Director, AVAC - Global Advocacy for HIV Prevention, 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. 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 only a gay issue. Women have to drive the call for rectal microbicide as well,” she said.
(The author, born in Zimbabwe, is an Editor, a children's writer, poet, playwright, journalist, social activist and publisher. He has extensively written on health. His first published book, 'The Dream Of Stones', was awarded the Zimbabwe National Award for Outstanding Children's Book for 2004)