More safety data needed on lubricants used in anal sex

There is a growing realization that there is a significant issue of HIV acquisition through anal intercourse not only for men who have sex with men (MSM) who are clearly very visible HIV high risk group but increasingly for women who may be exposed to the virus through anal intercourse with their male partners. Also in recent studies, most people (men and women) who practice anal intercourse reported using  some kind of a lubricant (such as gel, cream, or saliva among others). 

So when the ongoing rectal microbicides research yields a safe and effective rectal microbicide towards later half of this decade, then rectal microbicide could be added to these lubricants as most people practicing anal intercourse are already comfortable with using lubricants, said Professor (Dr) Ian McGowan, Co-Chair of International Microbicides Conference (M2012) in Sydney, Australia; Professor, University of Pittsburgh School of Medicine, and co-principal investigator, Microbicide Trials Network (MTN).

Rectal microbicides are products that could take the form of gels or lubricants – being developed to reduce a person’s risk of HIV or other sexually transmitted infections (STIs) through anal receptive sex. 

"What we have seen at this conference is that there is a growing evidence of MSM populations in African nations and HIV rates are alarmingly high in them" said Dr McGowan.

As per published data, not only MSM, there are number of women as well who reported to have anal sex. According to the data from a study in San Francisco, US, very high lubricant use was reported (89%) among those MSM who were practicing anal intercourse, said Dr Shauna Stahlman from Department of Epidemiology, University of California, Los Angeles (UCLA).

Despite high use of lubricants in anal sex, “there has been little research focused on lubricants” said Dr Stahlman. Dr Stahlman was speaking at the M2012 in Sydney.

According to another large study done in US, 59% of 6124 men and women participants who reported to practice anal intercourse were always using a commercial lubricant. 

Another Peruvian study assessed lubricant use during receptive anal intercourse among 843 Peruvian MSM and willingness to use a hypothetical rectal microbicide (RM) formulated as a lubricant to prevent HIV infection. 48% reported to use a lubricant with their last partner. Out of these MSM using a lubricant with their last partner, 54% used a gel (such as KY jelly), 9% used a Vaseline or oil, 13% used a cream and 24% had used saliva.

Despite high use of lubricant by those practicing receptive anal intercourse, very little data exists. However number of commercially available lubricant is very high in the market. “In a recent US survey we found that 188 lubricant products were available” said Dr Stahlman.

Agrees Jim Pickett, Director, International Rectal Microbicides Advocacy (IRMA) and Director of Advocacy, AIDS Foundation of Chicago. "We need more research on lubricants" said Jim.

What is of utmost concern is that there are studies to show that consistent lubricant use was associated with higher prevalence of sexually transmitted infections (STIs). For example, in another study in US, it was found that 2.2% of those using lubricants consistently had syphilis, compared to 0.4% of those who were not using lubricants consistently, said Dr Stahlman.

Douching (cleaning out the anal canal with water) was also widely practiced. In a Baltimore study, a significant number of men and women who were practicing receptive anal sex reported douching. In the same study it was found that 8.5% of those who were douching had rectal STIs compared to 3.4% of those participants who were not douching yet had rectal STIs.

In another study, some over-the-counter (OTC) lubricants were tested that HIV prevention advocates have identified or some which are commonly used by those who engage in rectal sex. These were some of the basic formulations of lubricants that one can buy OTC or through internet. In the study it was revealed that those lubricants that had higher concentration of salts were actually damaging the epithelial of the rectal tissue. Damage to rectal epithelial is supposed to up the risk of contracting HIV. Silicon based lubricants and the lubricants that didn't have too many salts in it didn't show any damage to the rectal epithelial.

Lubricants are not evaluated by the Federation Drug Authority (FDA) in the same way as the drugs are nevertheless some human data is showing there is some real potential health risk.

It is clear that not only we need more safety data on lubricants but also as rectal microbicide research progresses ahead, a safe lubricant could also be a good delivery vehicle for rectal microbicides to the populations who practice anal sex.

Bobby Ramakant - CNS

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