'...And Lubes' in spotlight at AIDS 2012

Most men, women and transgender people who practice anal sex use some kind of a lubricant (lube) ranging from expensive and commercially marketed branded lubes to saliva or oil. According to the United Nations joint programme on HIV/AIDS (UNAIDS), anal sex considerably increases risk of HIV acquisition. People practicing anal sex are also at a high risk of other sexually transmitted infections (STIs) and condoms alone are not enough to protect them from HIV or other STIs. People practicing anal sex, for example, need condoms with safer, affordable, accessible lubes to protect them from HIV and STIs. Marc-Andre LeBlanc, Secretary of International Rectal Microbicides Advocacy (IRMA) who is also a member of Lube Safety Working Group, said to CNS before XIX International AIDS Conference (AIDS 2012) opened in Washington DC: "Many men, women and transgender people use lubricants (lubes) during sexual intercourse. Yet we know very little about their safety when used during anal intercourse."

Very few studies have examined the effect of lubes on human rectal tissue, but those that did showed mixed results. Most water-based lubes tested in these studies were shown to be damaging to rectal tissue. However, some lubes were more damaging than others. Furthermore, in one study the use of lube for anal sex was associated with the presence of rectal STIs.
Senior IRMA advocate Marc-Andre LeBlanc added: "More research is urgently needed to explore if there is a link between lube use and acquiring HIV and/or rectal STIs. It is unclear whether any particular type or brand of lube might increase, decrease or have no effect on acquiring HIV and/or rectal STIs. Using male or female condoms is still considered the best way to prevent acquiring HIV and STIs during anal sex. In addition, the use of condom-compatible lubes has been associated with a decreased risk of condoms breaking or slipping. It is not possible at this time to recommend for or against using lubes if having anal sex without condoms. Lube use on its own is not a proven method of HIV or STI prevention."

Lubricant safety has been a priority for IRMA since it was founded in 2005. No surprise that IRMA has been doing considerable work on lube safety. 

2-3 years ago, IRMA formed a Lube Safety Working Group that is a growing network of researchers involved with research on lube safety, advocates, policy makers, and other stakeholders who are interested in this issue. The Lube Safety Working Group keeps all IRMA members well informed about any research that is happening around the world on lube safety, helps in development of materials, and any IRMA message related to lube safety is approved by this Working Group for accuracy and appropriateness.

"IRMA had realized that if we wanted researchers to test lubricants for safety then there has to be some prioritization for products as there are hundreds of lubricants out there on the shelves. This is why IRMA conducted a survey to find out what are the most popular lubes people use when having anal sex. There were questions on issues such as which lubricants people used when they were receptive or insertive partners in anal sex, and which ones people preferred to use with or without condoms. The survey outcome is a good resource for future research that might happen on some of the lubricants for safety" said Marc-Andre LeBlanc.

IRMA conducted a global survey on rectal use of lube. A global web-based survey was conducted in 2007 to seek input on lube use, preferences, acceptability, characteristics of lubes, or substances that were added to the lube (such as saliva, water, vaginal fluids, oil among others) among nearly 9,000 men and women from over 100 countries. The overall survey results were described in IRMA's 2008 report and the analysis of the qualitative data from this survey was just presented at the International Microbicides Conference (M2012) in Australia.

Regulatory agencies in various countries classify lubes differently, as medical devices or cosmetics, for example. Typically they require no safety data on the rectal use of lubes in humans. "We have reached out to regulators not to urge regulations, as experience from other sectors such as reproductive health tells us that, engaging regulators is not necessarily the best choice and might end up limiting important choices people have in terms of products. So we are very careful about that. Right now we are on a fact-finding mission if lubricants are regulated in different countries and how they are regulated. Countries like South Africa don’t regulate lubricants, USA regulates them as medical devices, Canada regulates them as cosmetics, UK regulates them depending upon the claims made by the manufacturers either as medical devices or as cosmetics" said Marc-Andre LeBlanc.

The Lube Safety Working Group through in-country IRMA partners is currently looking at lube regulations in eight different countries: Peru, US, Canada, UK, France, Nigeria, South Africa and Australia. 

The Lube Safety Working Group also aims to approach manufacturers to get their thoughts and input too. "We have a handful of manufacturers who want to ensure that their products are safe. How can lubes be made safer, what are the obstacles in terms of product development perspective, are some of the many questions we need answers to," said Marc-Andre LeBlanc.

IRMA is helping develop a research agenda to identify some of the research priorities so that research and development of products that might eventually protect people who practice anal sex from HIV and other sexually transmitted infections (STIs) becomes a reality in near future.

Global Lube Access Mobilization (GLAM) 
IRMA's Lube Safety Working Group is doing much needed work on lube safety. But having safer lubes will not be enough unless policies and programmes start addressing access to lubes. This is how Global Lube Access Mobilization (GLAM) came into being. 

"If we provide condoms to people and not provide lubes then it is a big problem because then people use whatever they can find and at times they use lubricants or products that are not condom compatible. That is how Global Lube Access Mobilization (GLAM) came into being at the global level starting with a focus on Africa. GLAM has a tag-line ‘and lubes’ to remind people that when we mention ‘condoms’ we have to add ‘and lubes’ because they should be made available together.  

IRMA calls for more research into the safety of lubes for rectal use, including clarity on the impact of lube use on preventing or facilitating the acquisition of HIV and STIs, and which lubes/compounds to seek or avoid. IRMA is aware of the likelihood that some of the first rectal microbicides will be available in gels with lube-like properties. Therefore, avoiding confusing messages about lube safety is paramount to avoid delays in access and use of an important public health tool later.

Bobby Ramakant - CNS 

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