Arming Africa with rectal microbicides: Project ARM

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The following is a guest blog post by Jim Pickett, chair of International Rectal Microbicides Advocates (IRMA) and director of Prevention Advocacy and Gay Men’s Health at the AIDS Foundation of Chicago.

Chair of International Rectal Microbicides Advocates (IRMA) Jim Pickett.

Since 2005, our network of more than 1,000 scientists, advocates, policymakers, and funders from six continents that makes up International Rectal Microbicide Advocates (IRMA), has advocated for the accelerated research and development of safe, effective, acceptable and accessible rectal microbicides for the women, men, and transgender individuals around the world who engage in anal intercourse. In addition to pushing for scientific activity, IRMA works to confront the institutional, socio-cultural and political stigma around the public health need for rectal microbicide research, to increase funding and commitment within the field, and is the only global coalition with a focus on promoting the development of rectal microbicides. IRMA América Latina y el Caribe (IRMA ALC) and IRMA Nigeria help advance IRMA’s work in South America, the Caribbean and Africa.

Unprotected anal intercourse is 10 to 20 times more likely to result in HIV transmission compared to unprotected vaginal intercourse. Condoms are not always accessible, or desirable. And while condoms, when used consistently and correctly, are very, very good at preventing HIV, they aren’t good at all if they aren’t used. Because condoms are limited in these ways, people are excited and energized around the idea of a gel or a lubricant that could be applied rectally and provide a level of protection in the absence of condoms. Most people who have anal intercourse tend to use some form of lubrication. If that lube could safely inhibit HIV transmission, we’d surely have a potent new prevention tool, and one with a high level of acceptability. Importantly, it would be an option controlled by the receptive partner. It is possible a rectal microbicide could also be delivered in the form of a rectal enema or a douche.

About a decade behind vaginal microbicide development, the rectal microbicide field has completed two small Phase I safety trials and is currently conducting a third Phase I trial testing a rectal formulation of tenofovir gel. On the heels of the groundbreaking results from the South African CAPRISA 004 microbicide trial that showed a tenofovir-based gel could provide protection against HIV when applied vaginally, it is critical for the entire field – community members, advocates, scientists and policy makers – to prepare for advanced-stage effectiveness trials of rectal microbicides. In fact, the National Institutes of Health-funded Microbicide Trials Network is currently developing a protocol (MTN 017) for a Phase II rectal microbicide safety trial that would take place at sites in Thailand, South Africa, Peru and the United States, with a launch date sometime in 2012.

Africa needs more of our attention in terms of rectal microbicide advocacy. While IRMA has hundreds of active African members across the continent, until recently rectal microbicides have simply not been part of the larger HIV prevention discussion in Africa. This is partly due to the denial of anal sex among heterosexual men and women and the pervasive homophobia that has denied and criminalized the very existence of gay men and other men who have sex with men (MSM). It had long been incorrectly assumed that the primary (read: only one that matters) means of HIV transmission on the continent was through unprotected vaginal intercourse. The truth is much more complex than that – unprotected anal intercourse DOES play a role in the African epidemic – a significant percentage of heterosexual Africans most certainly engage in anal intercourse, and gay men and other MSM exist in every country, and in most, bear a much higher HIV burden when compared to the general population.

IRMA’s efforts have thankfully flipped the script. Leading scientists, including luminaries like Dr. Salim Abdul Karim, Principal Investigator of CAPRISA 004,  are now openly acknowledging the need for safe, effective, acceptable and accessible rectal microbicides for African women and men, to complement a similar need for expanded access to existing prevention interventions, vaginal microbicides, oral prevention, vaccines, and other innovative tools to combat the epidemic. The IRMA Nigeria chapter of our network includes some of the most dynamic advocates we have anywhere in the world, and it is their leadership that helped bring about such an awakening.

IRMA’s newly-launched Project ARM, or Africa for Rectal Microbicides, aims to expand African mobilization and enhance community capacity around rectal microbicide advocacy in order to ensure broad participation in research activities and well-informed community input into the development of an African rectal microbicide agenda. The end goal is expanded rectal microbicide research and advocacy activities in Africa – including clinical trials. And of course, when rectal microbicides become available, we want them to be within arm’s reach of every single human being on the continent who wants to use them.

In December of this year, Project ARM will bring African community advocates, scientists, policymakers, and other key actors together to discuss anal sex in Africa and craft an African rectal microbicide agenda at a meeting in conjunction with the ICASA 2011 conference in Addis Ababa, Ethiopia.

There is a great need for culturally competent educational materials with an African context. As part of Project ARM activities, IRMA is working with Population Council – which has provided seed money for pre-production activities currently underway – to develop a 15-minute video as a tool to provide education on anal intercourse and to create awareness around rectal microbicide development in Africa. The plan is to screen a rough-cut of the video at the December meeting, obtain feedback, and finalize the video in the first quarter of 2012. We have yet to identify a funder to pay for production, testing, and post-production activities, but we are optimistic we can find the support necessary.

We recognize a discussion around gay men, MSM, anal sex between men and women, and rectal microbicides can be a very fraught, and even dangerous, one in Africa. These conversations are about nothing less than life and death – they ARE dangerous in a number of ways. But all Africans, all people at risk for HIV, regardless of their identity, gender, profession or sexual expression, deserve an array of tools to protect themselves. We won’t make those tools a reality if we whisper too softly.

Where there is a will, there is a way. We see Project ARM as both the will, and a way forward. Will you join us?

7 thoughts on “Arming Africa with rectal microbicides: Project ARM

  1. Doreen Hardy

    I am so glad to see anal sex risk mentioned specifically and that it will be addressed in a new video. Kudos.

    Reply
  2. Davis Mac-Iyalla

    Thanks for your good works, I am interested in your Africa project and support for black LGBT community.

    Reply
  3. Thomas Muyunga, CEO MARPS IN Uganda

    The main deterrent is not homophobia in Africa but the way we have been socialised to talk about sex. My culture has what is supposed to be silent and taboo. A big cultural vault indeed that continues feeling with NON-STARTERS!!!! I wonder if it is not fear that makes one fail to take initiative.

    Reply
  4. Thomas Muyunga, CEO MARPS IN Uganda

    MOST AT RISK POPULATIONS’ SOCIETY IN UGANDA (MARPS IN UGANDA embarked on a sustained organisation development and with the support from friends and volunteers raised USD 200.000 used to: establish and travel with a team of health/social workers to 172 social/community spaces all over Uganda where 12 health fares have been conducted with HCT services that reached 18,000 beneficiaries (MSM, Male sex workers, substance users, PLHIV, Fisher folk, truckers and others);oriented leaders to MARPs issues; Linked 40 MSM living with HIV to ART support; provided 35,000ml of water based lubricant as a Preventive SRH commodity for MSM and sex-workers; provided condoms; provided counselling services through a hotline to 560 beneficiaries (Young People);Conducted 14 talk sessions on HIV/HPV/STIs and risk reduction; conducted 3 holiday SRH retreats (Young people); mapped out stakeholders doing anything about MARPs; generated a MARPs analysis matrix (to inform national policy on MARPs); designed violence, abuse, discrimination and stigma (VADS) safety nets; conducted a country-wide study into characteristics of MARPs leading to a Uganda MARPs’ Profile;linked with 5 national NGOs/CSOs (UNASO, RHU, AIC, NGO-Forum, and World Changers) and various stakeholders; documented experiences; paid for office space up to December 2011; linked with FPD( South African Medical Council) to improve on staff understanding of MARPs through intensive short courses; designed training kits for “handling MARPs”; generated 30 conference materials/abstracts on MARPs in Uganda; generated proposals soliciting funding; paid for a transitory home up to December 2011 and; maintains a resource center/Office.We have established interface with men/women and young people through interactive social spaces and managed to conduct conversation on: Delaying sex; negotiated sexual intercourse; anal sex practices; substance use; MSM behaviour (4000 MSM have been reached);sex-work (male/female); violence, abuse, discrimination and stigma (VADS); Recreation; Competitive sports; responsible Citizenship; Poverty; IGAs and; exploration into best practices. We have generated abstracts on our experiences in the various communities. We are now in position to cause lasting, enduring durable solutions against HIV, Health, Human Rights violation,Development and poverty. The enduring thrust and cardinal points are: Protection, Lasting sexual-reproductive health practices, Empowerment, Attitude change, Social integration and Education- shortened as PLEASE.We have put in our proposal to Ministry of Health/Global fund round 11 and hopefully with this support we shall be able to consolidate our work. Indeed once we get this funding we shall be able to conduct conversation, raise awareness, improve decisions on uptake of microbicides, circumcision, cancer examination and HPV vaccination as some of the targeted programming addressing MARPs issues.

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  5. Thomas Muyunga, CEO MARPS IN Uganda

    Thanks for bringing to the forefront an issue that if not tackled will still make Africa move a step forward and three steps backwards. If we do want to move forward ever and backward never on issues of HIV and poor health we also have to look into how we as humans treat each other, how we genuinely pursue our public health, how we allocate resources, how we educate our citizens, how we look after the aged/disabled, how we balance majorities/minorities, how we conduct our governance and how we engage in sex. These areas in Africa, are the very roads to development but also the very roads that are abused. First, how do we treat our next door neighbours? How do we allow others to see us in a better light? How do we treat those categorised as marginalised ( and going population-wise: these are big numbers now-sub populations)? How do we pass on knowledge to others geared at eradicating HIV, poor health practices, poverty, intolerance, Violence, violations, abuse, discrimination and stigma? Secondly, how are our homes set as the first-line of defence against HIV, Violence, violations, abuse, discrimination and stigma? How are our own nurturing communities the second line of defence against HIV, Violence, violations, abuse, discrimination and stigma? How are societies ( in form of schools, work place, religious spaces, rehabilitation centers..) the third line of defence against HIV, Violence, violations, abuse, discrimination and stigma ? Fourthly, how is policy and programming lined to eradicate HIV, Violence, violations, abuse, discrimination and stigma that applies to all ? How are the marginalised allowed to integrate durably in communities/societies and homes? Fifthly, what are the silences, loudnesses and science around sex, gender, identity and sexual intercourse? How then cane we use the science to influence silence to become loud enough? This and more is why we formed the NETWORK AGAINST VIOLATIONS, VIOLENCE, ABUSE, DISCRIMINATION AND STIGMA-AFRICA ( NAVADS-AFRICA). This network is existent in Tanzania, Ghana, Uganda, Kenya, Rwanda, Burundi, Malawi, Zimbabwe, Ethiopia at present but we are still expanding.
    MOST AT RISK POPULATIONS’ SOCIETY IN UGANDA IS FISCAL HOST TO THE NETWORK AGAINST VIOLENCE, ABUSE,DISCRIMANTION AND STIGMA (NAVADS)-AFRICA
    http://www.marpsinuganda.org
    Plot 22 KAMPALA ROAD
    LUBAGA DIVISION, KAMPALA, UGANDA

    Reply
  6. Thomas Muyunga, CEO MARPS IN Uganda

    Organisations such as MOST AT RISK POPULATIONS’ SOCIETY IN UGANDA (www.marpsinuganda.org) have consistently worked with MSM in Uganda and presently over 5,000 MSM have been reached with targeted services. Over 2700 MSM are between 17-26 years. Over 1700 are bisexual, above 22 years and in some form of work. Over 1500 MSM are in sex-work.

    Reply

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