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.
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.
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