Rectal Microbicide agenda setting, talking about sex and the anus: armed with lube! : Operationalising the "own, scale up and sustain" in answer to ICASA 2011 and the 1st UNAIDS Political Declaration target.

Published: December 5, 2011

Project-ARM (ARM is short for Africa for Rectal Microbicide) and Addis-Ababa Ethiopia is the venue where over 30 international Rectal microbicide Advocates gathered to deliberate on three thematic objectives: 1. Setting the stage and context; promote a common understanding of how rectal microbicides (RM) research is proceeding, the potential role that African RM research and advocacy could play and the various African contexts within which RMs would be introduced. 2. Capacity-building; to enhance the capacity of African community advocates participating in RM agenda setting, research and mobilisation efforts. 3. Setting the agenda; to stimulate strategies for community mobilisation and more African (led) involvement in RMs; to put RMs on the research agenda in Africa and; to develop an African RM research agenda that is part of a global RM research agenda. Evidence that anal sex is practiced, anal sex is perceived as a non-HIV transmission route, anal sex is practiced by heterosexual and same sex/ gender loving partners is rife among Men-who-have-sex-with-men as well as among heterosexual persons. Information on anal sex practices comes from different sources in Uganda contributing to this fact. I have had an opportunity to seek guidance from persons who have worked with MSM in Uganda with foremost knowledge and skills of service delivery and have read progressive insights from such persons in Uganda like Semugoma who has worked tirelessly as a physician, community-key informant, researcher, activist, caregiver and counsellor. He also initiated the KULHAS an intervention for same gender loving persons who are also living with HIV on top of popularising the internet and social networking. My work takes me to various parts of Uganda at grass-roots and this is very involving and experiential. The work involves popularising long term programming, provides power-talks/ sessions that empower marginalised with skills to engage in critical analysis and eventually take initiative independently as a precursor for community actions. This kind of work calls for the physician, counsellor and community trainer in all of us. This is the core of the undying passion to lay bear issues that are summed up as all forms of discrimination, stigma, abuse, violence and violations. Many others out there can do the same or even more. It therefore, was no surprise that Project-ARM saw in me a potential to carry the flame further. For two interactive days using participatory learning/sharing/planning and pedagogy at some points with the help of renowned authorities in HIV prevention methods it was possible to deliberate on the objectives. It was highlighted that sex-talks should include themes on: anal sex; protected sex and; the use of protective prophylactics whether in form of condoms, gels or pills. This therefore, showed the underlying risks in unprotected sex of all forms. Anal sex is a high risk predictor of HIV infection with approximately 14 (10 – 20) times higher risk of HIV transmission when compared to penile-vagina sex. It is following exposure to flush blood among IDUs. The probability of HIV infection transmission in penetrative anal sex is about 1.4% per sex act both in heterosexual and homosexual relationships. The Project-ARM-2011 team developed a template on which various strategies, actions and outputs were highlighted. The strategies ranged from: advocating for decriminalisation; advocacy for non-discrimination due to one’s orientation, sexuality, gender, identity and HIV status; action to improve on awareness and skills in risk reduction and; plan for systematic inclusion of marginalised in designing what works for them. As this short report is concluded, two points albeit in question form are posed: what is a rectal microbicide? What is anal sex? A rectal microbicide is a product that could be available in a form of lubricant, gel, douche or an enema. It is administered rectally and this application, primarily, ensures protection that reduces a persons’ risk of HIV infection. Anal sex is when the genitals are/is inserted in the anus or fingers or some object is placed in/ around the anal-genital area as a means of stimulation. Where there is penetration, it may involve stimulation of the g-spot, clitoris and prostate. Where there is peripheral penetration it may involve pleasurable rimming. Because the anus has a fragile mucosa there is need for lubrication in all forms of penetrations. This is where the connection to risk and exposure arise. The first UNAIDS political target calls for ending sexual transmission by 50% by 2015. Anal sexual transmission is to influence the way one packages information for risk reduction. Anal sex is practiced by various persons who include: PLHIV, heterosexual partners, same gender/sex partners and sex-workers (male and female). Policy-makers, programme level actors, government departments, law-enforcers, CSOs/NGOs/ CBOs, Development partners, Human Rights organisations, MSM/LGBTIQQ sub-population groups, PLHIV, in-mates, students, sports-camps and uniformed services should be targeted as a means of providing them information that will eventually promote risk perceptions around unprotected anal sex. Rectal Microbicides is to be the bedrock for action on risky anal sexual intercourse.

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