New study finds gay and bisexual men have varied sexual repertoires

via Indiana University

"The data revealed some interesting information on the types of sexual behavior that MSM reported, including that less than 40 percent of men engaged in anal intercourse during their most recent sexual event."

"Of all sexual behaviors that men reported occurring during their last sexual event, those involving the anus were the least common," Rosenberger said. "There is certainly a misguided belief that 'gay sex equals anal sex,' which is simply untrue much of the time."

A new study by researchers at Indiana University and George Mason University found the sexual repertoire of gay men surprisingly diverse, suggesting that a broader, less disease-focused perspective might be warranted by public health and medical practitioners in addressing the sexual health of gay and bisexual men.
 
The study, published online ahead of print in the Journal of Sexual Medicine, tapped the largest sample of its kind in the United States to examine the sexual behaviors of gay and bisexual men. In collaboration with the OLB Research Institute at Online Buddies, Inc., researchers were able to include feedback from nearly 25,000 men. While gay study participants reported 1,308 unique combinations of behaviors, the most commonly reported behavior was kissing a partner on the mouth.

From a public health standpoint, say the researchers, this study provides professionals with data on the behavior of men having sex with men (MSM) that was missing from the sexual health discussion.

Read the rest.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

IRMA Survey On Rect Douching and Enemas in 5 Languages - Please Participate!

IRMA and researchers at the University of California, Los Angeles (UCLA) School of Public Health are conducting a brief survey to help better understand the types of products people use rectally for anal sex including lubricants and enemas or douches.

Take the survey in English, Spanish, French, Chinese, or Russian.

We're trying to gain a better understanding of rectal practices and behaviors that may affect the risk for sexually transmitted infections among people who practice anal intercourse and hope you - yes YOU - will fill out this brief anonymous survey (estimated time to complete: less than 15 minutes).

Please take the survey NOW and share this link widely!

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Optimal Rectal Microbicide Design

via AIDS: Official Journal of the International AIDS Society, by Herrera, Carolinaa; Cranage, Martina; McGowan, Ian; Anton, Peter; Shattock, Robin J

Objective

Receptive anal intercourse in both men and women is associated with the highest probability for sexual acquisition of HIV infection. As part of a strategy to develop an effective rectal microbicide, we performed an ex-vivo preclinical evaluation to determine the efficacy and limitation of multiple combinations of reverse transcriptase inhibitors (RTIs).

Design

A nucleotide, PMPA (tenofovir), a nucleoside, FTC (emtricitabine), RTIs and two nonnucleoside RTIs, UC781 and TMC120 (dapivirine), were used in double, triple and quadruple combinations against a panel of CCR5-uing and CXCR4-using clade B HIV-1 isolates and against RTI-escape variants.

Methods

Indicator cells and colorectal tissue explants were used to assess antiviral activity of drug combinations.

Results

All combinations inhibited the isolates tested in a cellular model and in colorectal explants and produced, for at least one of the compounds, a change in the dose–response curve. Double and triple combinations incrementally augmented activity, even against RTI-escape mutants, whereas quadruple combinations conferred little further advantage.

Conclusion

The colorectal explant model may be used to identify the best candidate molecules and their combinations at the preclinical stage. Furthermore, this study demonstrates that combinations based on RTIs with different HIV-1 inhibitory mechanisms have potential as colorectal microbicides.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Get Real! I'm a Guy Interested in Receptive Anal Sex: Does That Mean I'm Gay?

via RH Reality Check, by Heather Corinna

bobwilkins asks:

I'm a 16 year old boy, and for as long as I can remember I have been attracted to girls and yet rarely able to feel comfortable around them and get to know them. I've always been a nice person (the friendly guy) but without that many actual close friends who are girls. Recently I've noticed I am turned on (and everything that follows that) with the thought of receiving anal. Yet when I actually tried to see what anal was like through porn (I know this isn't realistic) I really didn't like it (to be polite). People have sometimes quietly thought of me as homosexual as I've never had a girlfriend and now I'm really not sure about myself? There are so many bad stereotypes and public jokes about gays I don't think its worth considering? I guess if I could fall in love with a girl and kiss her I would be far more confident...but I shouldn't need this! Advice please?

Heather Corinna replies:

There are gay or bisexual men who love or like anal sex, it's true. But there are also gay or bisexual men who don't like it, or who just aren't interested in it. There are heterosexual men who don't like anal sex or aren't interested in it, either. There are also heterosexual men who like or love it. And for all of these groups, all of that goes for being on either end of anal sex, as it were, and for people with partners of any or every gender. Human sexuality is incredibly diverse, and all someone liking a given kind of sex can usually tell us by itself is that someone likes that kind of sex. That's it.

Whether or not someone of any gender is curious about, wants, fantasizes about or takes part in anal sex in any way doesn't tell us a darn thing about their orientation. Now, if and when a guy fantasizes about it, wants or or engages in it with other men, then that is an indication that guy probably is attracted to other men (though maybe not just men: being attracted to other men doesn't always mean only being attracted to men), but that's still not about anal sex specifically. That same guy might also feel that way about kissing and who he kisses, but if he told people he was interested in kissing -- just kissing, not kissing any given gender of people -- you wouldn't hear anyone suggesting that probably means he's gay, right?

Read the rest.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

POZ love for IRMA - The Anal Dialogues

The July/August 2011 issue of POZ Magazine belongs to IRMA and rectal microbicides. Check it out for a nice history of our work and a snapshot of the science, including important information on lubricant safety.

via POZ.com, by Trenton Straub

Excerpt:

Perhaps IRMA’s most visible work is three game-changing reports it published in conjunction with the biennial International Microbicides Conference. The first, Rectal Microbicides: Investments & Advocacy in 2006, compiled what research was being done and where—a tricky task. “A lot of researchers were concerned that if ‘anal’ or ‘rectal’ appeared in research proposals or reports, they wouldn’t get funded, so they’d scrub their papers so those words wouldn’t show up,” LeBlanc says. “Instead, they would refer to ‘topical use of products’ or other language.” And because of the dangers surrounding the subject—male-to-male sex is illegal in many countries, including 31 in sub-Saharan Africa—IRMA first had to gain researchers’ trust, proving they were not raging advocates who would alienate and antagonize. Their professionalism paid off, and the report was a hit. “It showed we were serious,” Pickett says, “and we got hundreds of new members.” 


Read the rest.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

HIV Risk of Anal Sex Misunderstood Among Heterosexuals

This news article features our very own Zoe Duby, an IRMA advocate and valued member of our community! Congratulations to Zoe, and thank you for working so hard as an advocate for rectal microbicides and HIV prevention in South Africa and worldwide.

Via PlusNews.

Vaginal sex, thigh sex, even armpit sex - people have sex in lots of ways, but in heterosexual anal sex, HIV prevention programming is silent about the high risk of infection that goes with it, and people may have mistaken this silence for safety.

The risk of contracting HIV through unprotected receptive anal sex is almost 20 times greater than the HIV risk associated with vaginal intercourse.

While this fact is often a focus in HIV prevention programming aimed at men-who-have-sex-with-men (MSM), it has been largely left out of programmes for heterosexuals, according to Zoe Duby of the University of Cape Town, South Africa, and the Desmond Tutu HIV Foundation.

Duby presented the findings of her study, which interviewed almost 400 people in Tanzania, Uganda and Kenya, at the 1st HIV Social Sciences and Humanities Conference held recently in Durban, South Africa.

“Safer sex programming has, in my opinion, failed to take into account varying definitions of sex. The omission of anal sex in safe sex messaging has been interpreted as meaning that anal sex is safe,” she told IRIN/PlusNews.

“What people preach out there, it’s just vaginal sex - not information on anal [sex],” said a young woman from Salgaa, Kenya, who was quoted in the research. “So somebody thinks, ‘if I do [sex] this other way, then I will not get HIV.’”

Even more worrying was that research showed healthcare workers often held similar views, and some incorrectly believed HIV was only present in vaginal fluid. The virus is, in fact, also present in male sperm and blood.

“Me, I do not want to practice vaginal sex because that is the highest [risk] sex that transmits HIV, so it is a belief… that non-vaginal sex does not transmit HIV,” one Kenyan healthcare worker reported.

A nurse in Malaba, Uganda, said: “As you go and have sex vaginally you can get HIV, but these other methods, they do not expose you [to HIV].”

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Circumcision Does Not Protect MSM of Peru and US From HIV

via International AIDS Society, by Mark Mascolini

Circumcision did not protect men who have sex with men (MSM) from acquiring HIV infection, according to an analysis of more than 1800 men in Peru and the United States. The findings confirm results of earlier studies. Three randomized trials in Africa showed that circumcision does lower the risk of HIV infection in heterosexual men.

This analysis involved 1824 MSM, 1362 (75%) of them from Peru and 462 (25%) from the United States. All men were negative for HIV and positive for herpes simplex virus type 2 (HSV-2). They were enrolled in a randomized placebo-controlled trial of HSV-2 suppression to prevent HIV infection. That study found treating HSV-2 did not lower the risk of HSV-2 acquisition.

All study participants were assessed for circumcision status at enrollment and were tested for HIV every 3 months for up to 18 months. Researchers determined partner-specific sexual behavior for up to the last 3 partners during the previous 3 months.

Univariate analysis revealed no significant association between circumcision and HIV acquisition (relative risk [RR] 0.84, 95% confidence interval [CI] 0.50 to 1.42). Multivariate analysis that assumed a linear relationship between the proportion of insertive sex acts and effect of circumcision on HIV acquisition found that the interaction between circumcision and the proportion of insertive acts was not significant in lowering HIV risk (P = 0.11).

A third analysis that divided men into those who had fewer than 60 insertive acts with recent partners and those who had 60 or more partners determined that circumcision reduced the risk of HIV acquisition 69% (RR 0.31), but that association was not statistically significant (95% CI 0.06 to 1.51) among men who repeated at least 60% of insertive acts with recent male partners.

The researchers conclude that “circumcision does not have a significant protective effect against HIV acquisition among MSM from Peru and US.” However, they suggest “there may be reduced risk for men who are primarily insertive with their male partners” and they call for further investigation of this association.

Source: Jorge Sánchez, Victor G. Sal y Rosas, James P. Hughes, Jared M. Baeten, Jonathan Fuchs, Susan P. Buchbinder, Beryl A. Koblin, Martín Casapia, Abner Ortiz, Connie Celum. Male circumcision and risk of HIV acquisition among MSM. AIDS. 2011; 25: 519-529.

Click here for the study abstract.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Journal of Sexual Medicine: Study examines effect of water-based and silicon-based lubricant

via EurekAlert

A new study by sexual health researchers at Indiana University found that women who used lubricant during sex reported significantly higher levels of satisfaction and pleasure.

The study, involving 2,453 women, is the largest systematic study of this kind, despite the widespread commercial availability of lubricant and the gaps in knowledge concerning its role in alleviating pain or contributing to other health issues.

Read the rest.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

International Rectal Microbicide Advocates cheers launch of world's third rectal microbicide trial

Calls for more funding to strengthen field

This brings us another step closer to the development of safe and effective rectal microbicides for use during anal intercourse.

The world's third rectal microbicide trial launched in Pittsburgh, Pennsylvania today, with sites preparing to open in Boston, Massachusetts, and Birmingham, Alabama soon. Scientists will test the rectal safety and acceptability of tenofovir gel, a microbicide developed for vaginal use that has shown promise for preventing HIV through vaginal intercourse. Depending on the outcome of this new study, tenofovir gel could be further evaluated to determine if it can reduce the risk of HIV among both men and women who engage in receptive anal intercourse.

"International Rectal Microbicide Advocates (IRMA) congratulates the Microbicide Trials Network and its partners on the launch of this very important study – the third Phase I trial in history to look at the safety and acceptability of a microbicide gel applied rectally," said Jim Pickett, IRMA Chair and Director of Advocacy at AIDS Foundation of Chicago. "This brings us another step closer to the development of safe and effective rectal microbicides for use during anal intercourse," he said.

Condoms are considered the gold standard for the prevention of HIV and STDs during sexual intercourse, but not all receptive partners are able or willing to use condoms every time. An act of anal intercourse that is not protected by a condom is 10 to 20 times more likely to result in HIV transmission compared to an act of unprotected vaginal intercourse, due to the fragility of the rectal lining and the large presence of cells targeted by HIV. New methods to protect against the sexual transmission of HIV are urgently needed. Strategies beyond condoms – such as vaccines, oral prevention, and microbicides – will provide individuals with more prevention options.

Microbicides – substances applied topically on the inside of the rectum or vagina – could potentially help prevent the transmission of HIV. The research and development of vaginal microbicide candidates is much more advanced than research on rectal microbicides. Tenofovir gel, for example, is a candidate microbicide specifically developed to prevent vaginal transmission of HIV. In a recent study known as CAPRISA 004, tenofovir gel was found to significantly reduce the risk of HIV among at-risk women who were instructed to use the gel before and after vaginal intercourse. In an ongoing, large-scale effectiveness trial called VOICE – Vaginal and Oral Interventions to Control the Epidemic – researchers from the U.S. National Institutes of Health-funded Microbicide Trials Network (MTN) are testing daily use of tenofovir gel in African women, with results expected in 2013.

This new Phase I rectal microbicide study, known as MTN-007, aims to determine if rectal use of tenofovir gel is safe, and in particular, does not cause cells in the rectum to become more vulnerable to HIV. Investigators will also ask trial participants questions regarding the gel's desirability. MTN-007 will enroll 60 men and women at the University of Pittsburgh, the University of Alabama at Birmingham, and Fenway Health in Boston. Leading the study is Ian McGowan, M.D., Ph.D., of the University of Pittsburgh, who is also co-principal investigator of the MTN and serves as Scientific Vice-Chair of IRMA.

Little is known about tenofovir gel used rectally, but science is advancing our understanding. Laboratory and animal studies involving rectal application of tenofovir gel have suggested it's safe for testing in humans. In fact, MTN researchers have just completed the first Phase I trial with eighteen participants, called RMP-02/MTN-006, in collaboration with the Microbicide Development Program at the University of California, Los Angeles. While results of RMP-02/MTN-006 are not expected until early 2011, researchers have already recommended modifications to the gel's formulation. MTN-007 is evaluating the new formulation, which still contains the same amount of active drug – 1% percent tenofovir – but has a lower concentration of glycerin (an additive found in many types of products) to make it more amenable for rectal use.

"It is very encouraging to see the rectal microbicide field moving forward," said IRMA Community Vice-Chair Kadiri Audu, who also heads up the IRMA Nigeria chapter, "and I look forward to trials taking place in Africa as well." He continued, "Gay men and other men who have sex with men in Africa have high rates of HIV infection, and we know unprotected heterosexual anal sex is relatively common on the continent and contributes a sizable number of HIV infections. As much as we need vaginal microbicides to give women an extra prevention tool, rectal microbicides for the women, men, and transgender individuals who engage in anal intercourse are absolutely essential as well."

While the rectal microbicide field has gained significant momentum, more focus and resources are necessary. In 2010, U.S. $7.2 million is being spent globally on rectal microbicide research. IRMA has calculated that annual investments must increase by 40% from 2011 – 2014, to U.S. $10 million/year and must increase further to U.S. $44 million (a six-fold increase) in the years 2015 – 2020 to ensure a minimum of candidate products are moving through the research pipeline into advanced testing for effectiveness.

Read the press release from the MTN:
Promising HIV prevention microbicide tenofovir gel being tested for safety of rectal use

HIV Transmission Risk Through Anal Intercourse: systematic review, meta-analysis and

Via International Journal of Epidemiology by Rebecca F Baggaley, Richard G White, and Marie-Claude Boily

Background
The human immunodeficiency virus (HIV) infectiousness of anal intercourse (AI) has not been systematically reviewed, despite its role driving HIV epidemics among men who have sex with men (MSM) and its potential contribution to heterosexual spread. We assessed the per-act and per-partner HIV transmission risk from AI exposure for heterosexuals and MSM and its implications for HIV prevention.

Methods
Systematic review and meta-analysis of the literature on HIV-1 infectiousness through AI was conducted. PubMed was searched to September 2008. A binomial model explored the individual risk of HIV infection with and without highly active antiretroviral therapy (HAART).

Results
A total of 62 643 titles were searched; four publications reporting per-act and 12 reporting per-partner transmission estimates were included. Overall, random effects model summary estimates were 1.4% [95% confidence interval (CI) 0.2–2.5)] and 40.4% (95% CI 6.0–74.9) for per-act and per-partner unprotected receptive AI (URAI), respectively. There was no significant difference between per-act risks of URAI for heterosexuals and MSM. Per-partner unprotected insertive AI (UIAI) and combined URAI–UIAI risk were 21.7% (95% CI 0.2–43.3) and 39.9% (95% CI 22.5–57.4), respectively, with no available per-act estimates. Per-partner combined URAI–UIAI summary estimates, which adjusted for additional exposures other than AI with a ‘main’ partner [7.9% (95% CI 1.2–14.5)], were lower than crude (unadjusted) estimates [48.1% (95% CI 35.3–60.8)]. Our modelling demonstrated that it would require unreasonably low numbers of AI HIV exposures per partnership to reconcile the summary per-act and per-partner estimates, suggesting considerable variability in AI infectiousness between and within partnerships over time. AI may substantially increase HIV transmission risk even if the infected partner is receiving HAART; however, predictions are highly sensitive to infectiousness assumptions based on viral load.

Conclusions
Unprotected AI is a high-risk practice for HIV transmission, probably with substantial variation in infectiousness. The significant heterogeneity between infectiousness estimates means that pooled AI HIV transmission probabilities should be used with caution. Recent reported rises in AI among heterosexuals suggest a greater understanding of the role AI plays in heterosexual sex lives may be increasingly important for HIV prevention.

For the full study click here.