Preaching to the choir? Advocating condoms and lubes at AIDS 2012

At the recently concluded XIX International AIDS Conference (AIDS 2012), the 'And Lubes' campaign that brought attention to the fact that condoms should be distributed along with lubricants (or lubes) to meet the needs of those practicing anal sex, was certainly not 'preaching to the choir.' Reality was grimmer with AIDS 2012 rightly promoting 'condomize' campaign but without lubes! The way condoms were in the spotlight when AIDS 2012 began lubes weren't. Only until mid-way into the conference when And Lubes campaign repeatedly raised the issue of non-availability of lubes on-site, we could then find more lubes being distributed along with male and female condoms. Even condoms along with lubes in the same sachet were made available!

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. 

“Lubes are not really accessible or affordable to most people in Africa who practice anal sex. Lubes if available are very expensive. Most people might be using water, oil, etc” said Abimbola Williams from Nigeria. Abimbola is an advocate with International Rectal Microbicides Advocates (IRMA).

Agreed Bhekie Sithole, Swaziland: “Lubes are not provided in Swaziland. Lubes are available in pharmacies but not available in healthcare centres and other services that are accessed by men who have sex with men (MSM) and other populations who might need it. Sex workers also need lubes for anal and vaginal sex. People use different things when they don’t get lubes, for example, oil based lubricants, Vaseline, lotions etc. Oil based lubricants are not compatible with condoms. We have spoken to UNFPA as it had requested African countries to send request to procure water based lubricants but unfortunately Swaziland is one of the countries that didn’t submit its requisition in time.”
In studies conducted so far there is strong evidence that a significant number of people who practice anal sex use some kind of lubrication. Dr Suwat Chariyalertsak, Director, Research Institute for Health Sciences (RIHES), Chiang Mai University, Thailand said: “We did a small study on lubricant use in transgender people and nearly 95% of study participants reported to use lubricants. Introducing rectal microbicides when found safe and effective for STI/HIV prevention in future might be easier in MSM and transgender people because they already are using lubricants and if lubricants have an added ingredient that provides protection against STIs including HIV that will be so good.”

Marc-Andre LeBlanc, Secretary of IRMA who is also a member of Lube Safety Working Group, said "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.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."

IRMA had 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. 

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.

I believe, one take home message from AIDS 2012 is to advocate for condom-compatible lubes to be included in targetted interventions or programmes for men who have sex with men (MSM) and transgender people in our own countries. Emphasizing on 'and lubes' when we distribute condoms in these programmes is important.

Bobby Ramakant - CNS