HIV infection awareness and willingness to participate in future HIV vaccine trials across different risk groups in Abuja, Nigeria
The purpose of this survey is to generate baseline data on the level
of HIV infection awareness and willingness to participate (WTP) in
hypothetical vaccine trials, ahead of any trial conduct in Nigeria. In a
cross-sectional survey, 500 respondents were interviewed, including sex
workers, male motorcycle taxi drivers,
students, and the general public. About 153 (30.6%) of the respondents
did not believe that correct and consistent use of condom can protect
people from getting HIV,
while about 66 (13.2%) respondents believed it is possible to get HIV
by sharing meal with an infected person. Population groups considered at
high risk for HIV
were less aware of the disease, however, they were more willing to
participate in HIV vaccine trials compared those at low risk of the
disease. A total of 55% expressed WTP in a hypothetical vaccine trial after they were informed about it. Age, population group, and ethnicity were significantly associated with WTP.
for full text, visit http://www.informaworld.com/smpp/section?content=a924584150&fulltext=713240928
French doctors find unprotected sex leads to repeated bouts of hepatitis C.
In some high-income countries and regions, an outbreak of
hepatitis C virus is occurring among gay and bisexual men, particularly
among men who are co-infected with HIV and appears to be spread through
unprotected anal sex and other high-risk activities. French doctors
recently reported details on two gay men who engaged in repeated bouts
of unprotected anal sex with other men and contracted HCV or both HCV
and HIV infections.
Circumcision and its potential impact on the spread of HIV among gay and bisexual men.
In light of the resurgence of HIV infections, researchers and
health policy planners in high-income countries are assessing different
opportunities for interventions that might have an impact on the HIV
pandemic in these countries. In this CATIE News
bulletin, we review recent evidence about the possible impact of male
circumcision in gay and bisexual men in high-income countries.
HIV infections in gay men 'increasing in homophobic countries Rates of HIV
infections in gay men are increasing in countries which have homophobic
attitudes, the chief of the UN AIDS agency has said.
Michel
Sidibe told journalists at a lunch yesterday that rates of infection
among gay men were rising in areas such as Africa, where many countries
have laws against homosexuality.
He said that in Africa and
China, around 33 per cent of new HIV infections were being found in gay
men, which he said was a significant increase.
AP reports that on
new laws being introduced in countries such as Uganda, he said: "You
have also a growing conservatism which is making me very scared.
"We
must insist that the rights of the minorities are upheld. If we don't
do that … I think the epidemic will grow again. We cannot accept the
tyranny of the majority."
Mr Sidibe said that, in contrast,
between six and nine per cent of new infections are found in gay men in
the Caribbean, which has fewer laws against homosexuality.
He
blamed the rising infection rates on infected people being too scared to
seek help and fearing they will be punished.
He also cited
rising infection rates in drug users and prostitutes in countries which
have stringent laws against drug use and prostitution.
Uganda's
proposed anti-homosexuality law will impose the death penalty on those
caught having gay sex while infected with HIV.
The bill's
sponsor, David Bahati MP, claims it will reduce HIV infections in the
country, although health experts say it will have the opposite effect.
Mr
Sidibe also mentioned HIV infections in the US, saying it was
"shocking" that more than 50 per cent of new infections in 2009 occurred
in gay men.
He said: "It seems like we have come full circle.
After almost no cases a few years ago we are seeing again this new peak
among people who are not having access to all the information, the
protection that is needed."
What are transgender men’s HIV prevention needs? Who are transmen?
Transgender (‘trans’) is an umbrella term for people
whose
gender identity and expression do not conform to norms and expectations
traditionally associated with their sex assigned at birth. Transgender
men, or
transmen, are people who were assigned ‘female’ at birth and have a male
gender
identity and/or masculine gender expression. Transgender people may
self-identify and express their gender in a variety of ways and often
prefer
certain terms and not others. Some who transition from female to male do
not
identify as transgender at all, but simply as men. In general, transmen
should
be referred to with male pronouns. However, if you are unsure it is best
to
respectfully ask a person what terms and pronouns they prefer.
Accurate information about the diversity of
transmen’s
bodies is not widely available. Transmen have different types of bodies,
depending on their use of testosterone and gender confirmation surgeries
(which
may include chest reconstruction, hysterectomy, metoidioplasty, phalloplasty, 1
etc.;
see www.ftmguide.
org for further information) . Transmen use a broad range of
terms and language to identify their sex/gender, describe their body
parts, and
disclose their trans status to others. For instance, some transmen are
not
comfortable with the terms ‘vagina’ and ‘vaginal sex’ and may prefer
‘front
hole’ and ‘front sex’ or ‘front hole sex’, although this is not true for
all
transmen. This diversity creates unique needs and barriers for
negotiating and
adhering to safer sex practices that are not addressed by current HIV
prevention programs.
What do we know about HIV and transmen?
The transgender community is diverse and not enough
research
has been conducted with trans people in general. We have very limited
information about transmen in particular. To date, research related to
HIV
among trans people has almost exclusively focused on transwomen (people
who
were assigned ‘male’ at birth and have a female gender identity and/or feminine
gender expression). However, there is evidence that there is a
significant
subgroup of transmen that engage in unprotected sex with non-trans men
(trans
MSM), including some transmen who engage in sex work.
Several cities have conducted needs assessments
that focus
on or are inclusive of transmen and HIV risk, such as Philadelphia,
Washington
D.C, San Francisco,
and the province of Ontario. The few published studies that
report HIV rates among samples of transmen have reported 0–3%
prevalence.2- 4
These rates are self-reported, however, and are based on small,
non-representative samples, so we do not have conclusive data about the
actual
rates. Due to the assumption of low rates of HIV among transmen relative
to
other high-risk groups, there has not been much research on risk
behaviors
among transmen.
We do know that HIV prevention messages are not
reaching
most transmen.5 We also know that many trans MSM seek services at gay
men’s
organizations, where there is little to no education for transmen and
their
non-trans male partners.4 Providers are generally not trained to
identify or
serve gay and bisexual transmen in culturally sensitive ways or
understand
their specific risks and prevention needs.
What don’t we know about HIV and transmen?
We do not have enough information about HIV and
transmen.
Data collection methods at testing sites do not accurately identify and
track
transmen or capture their experiences, which contributes to the lack of
clarity
around HIV rates among transmen.
Rates of HIV and sexual risk behaviors among
transmen are
also not well understood because transmen are often assumed to be
primarily
having sex with non-trans women. However, transmen, like other men, can
be of
any sexual orientation and may have sex with different types of
partners,
including (but not limited to) non-trans men, transgender women, and
transgender men.6,7
What puts transmen at risk?
In one study, a majority of trans MSM reported not
using
condoms consistently during receptive anal and/or frontal (vaginal) sex
with
non-trans male partners and low rates of HIV testing and low perception
of
risk.4 In urban areas where HIV prevalence rates among non-trans MSM are
estimated to be 17-40% and STI rates are increasing, trans MSM who
engage in
unprotected receptive anal and/or frontal (vaginal) intercourse with
non-trans
MSM may be especially vulnerable to HIV/STIs.8,9
Transmen may face complicated power and gender
dynamics in
their sexual relationships with non-trans men.4 For some trans MSM,
having sex
with a non-trans gay male partner is a powerful validation of their
gay/queer
male identity, especially in the early years of transition, and may be
more
important than insisting on condom use. Some transmen who use
testosterone have
reported increased sex drive and increased interest in sex with
non-trans men
after beginning hormone use, which may contribute to their willingness
to take
sexual risks.4,10 Transmen on testosterone and/or who have had a
hysterectomy
may have frontal (vaginal) dryness, which increases their risk for
frontal
(vaginal) trauma during penetration, thus increasing their risk for STIs,
including HIV.10
Low self-esteem may contribute to sexual
risk-taking among
transmen. Rates of depression, substance use, and suicide attempts are
high in
this population, but multiple barriers exist to accessing culturally
competent
support and treatment.3, 11
Drug and alcohol use is a major risk factor for
every
community, regardless of their gender identity. Transmen may use alcohol
or
drugs to enhance sexual experiences or help to relieve anxiety about
their
bodies during sex.4 Some transmen may feel pressure to use drugs in
order to
fit into some gay men’s communities or subcultures. Although we have
very
little information about needle sharing for hormone or drug use among
transmen,
it may also be a risk factor for some.
What can help?
Online dating. Many transmen meet their non-trans
male
sexual partners on the Internet. Meeting partners through personal ads
may allow
transmen to describe their body and gender identity upfront (if they
choose to
do so) and discuss safer sex with potential partners before meeting in
person.4
Educational materials for non-trans partners.
Transmen’s
non-trans male partners often do not have experience with transmen nor
access
to education about sex with transmen, which can lead to misconceptions
about
safer sex. For non-trans gay men, safe sex often simply means condom use
with
anal sex and they may not be aware of the risks associated with frontal
(vaginal) sex. See the next section for information on available
materials.
Greater visibility in the gay community. Gay and
bisexual
men need to be educated about the presence of transmen in their
community.
Increasing visibility and knowledge about transmen may help create a
welcoming
environment, help increase inclusivity, and help transmen feel more
powerful in
their relationships with non-trans men.7
What’s being done?
tm4m (tm4m.org)
is a San Francisco-based project for
transmen who play with men (or want to). They provide information,
education,
and support to transmen who have sex with men through monthly
educational
workshops and discussion groups, informational materials and
continuously
working to foster acceptance and build community. tm4m is a
collaborative
effort co-sponsored by Eros, Trannywood Pictures and TRANS:THRIVE (a
program of
the API Wellness Center).
The Gay/Bi/Queer Trans Men’s Working Group in
Ontario has conducted a
needs assessment with trans MSM, developed a sexual health resource,12
and a
website at www.queertransmen. org. They are
also providing training and
consultation about trans MSM inclusion for prevention workers serving
gay men
across the province.
All Gender Health Online (www.allgenderhealth .org)
is a
study exploring the sexual health of non-transgender men who have sex
with
transgender people. The results will be used to develop an online
intervention
to prevent the spread of HIV and promote the sexual health of
transgender
people and their partners.
The STOP AIDS Project in San Francisco, CA
strives to include transmen in their programming and community
education. They
include transgender men in their mission statement and have changed
their data
collection methods to better reflect varying bodies and gender identities in
gay men’s communities.
What needs to be done?
We need to implement more inclusive data collection
methods
to better capture subgroups of transgender people. HIV prevention and
care
providers should not assume that all men they see were assigned ‘male’
at
birth. You cannot tell if a guy is trans just by looking at him. The
best
method for data collection is a two-part question: 1) ask about current
gender
identity and 2) ask what sex was assigned at birth.13 If unsure,
programs
should ask transmen for their preferred name and pronoun and use those
terms.
If rates of HIV among transmen are indeed low, we
now have
the opportunity to engage in true prevention work to keep those numbers
low.
Gaining a better understanding of transmen’s risk behaviors and the
different
ways that they protect themselves will aid in providing appropriate and
effective HIV prevention education to transmen and their sexual
partners. |
Understanding New Research on Lubricant Use During
Anal Intercourse
Two studies about the safety of lubricant use during anal
intercourse were presented last week at the 2010 International
Microbicides Conference in Pittsburgh. The data from the studies has yet
to be published, but there have already
been several
write-ups about the
research , which at first blush seem to suggest that
using lubricant might be found to be associated with an increased risk
of STDs. As Jim
Pickett, the chair of the International
Rectal Microbicide Advocates (IRMA) one of the organizations
involved in putting on the conference, said to me in an email, what is
key is that this research be discussed and interpreted without
hyperbole. If you're confused by what you've read so far, you're not
alone. Let's start with the research itself.
One was a laboratory study of six popular lubricants used during
anal intercourse. Actually only five of them are popular for anal
intercourse (Astroglide, Elbow Grease,
ID Glide, KY Jelly
and Wet Platinum), the sixth (Pre) was used because it is isotonic
(more on that below). The popular lubricants were chosen based on a
large global survey which asked over 9,000 people about lubricant use
during anal sex. Researchers did not report on which specific style of
each product was used in the research, but in one write up I read that
the "basic formulation" was used from each brand. (Interesting side note
from my years in sex shops: the lubricant Pre is a lubricant made
specifically for women trying to conceive. In addition to being
isotonic, it is the only lubricant on the market that is specifically
designed not to harm sperm).
The overall purpose of the study was to see if lubricant might play
a role in increasing risk of STD transmission during anal intercourse.
To this end, the researchers wanted to understand what, if any, direct
damage lubricants might have on rectal and cervical tissue. They also
wanted to see how the lubricants might impact healthy bacteria that are
present in the rectum. There are, of course, many ways to damage rectal
tissue. In this study the researchers focused on one particular effect
which can damage the tissue in the rectum essentially by drying up
cells, causing them to die and slough off. This can happen if the lubricant
being used has higher concentrations of salts and sugars than are found
in the skin cells
it comes in contact with. The lubricant can draw water out of the cells,
resulting in damage that can increase risk of infection (the science
minded among you can find more detailed explanations here,
here, or here).
They found that the four water based lubricants that had higher
concentrations of salt (Astroglide, Elbow Grease, ID Glide, and K-Y
Jelly) did in fact damage the outer layer of skin cells of the rectal
and cervical tissue whereas the silicone lubricant and the water based
Pre lubricant did not. In terms of how the lubricants impacted the
healthy bacteria, they found that both Astroglide and KY Jelly had a negative effect
(KY much worse than Astroglide) and that the other lubricants did not
have a toxic effect.
A second study looked at the use of lubricants during anal
intercourse outside the laboratory. This study included 229 men who had
reported having receptive anal intercourse in the past month, and 192
women who reported having receptive anal intercourse in the past year.
Participants completed a computer assisted self-interview about sexual
behavior. Among other things, participants were asked about use (or
non-use) of lubricants and the particular brands they used during anal
sex. From that group, 302 participants also had rectal tests for
chlamydia and gonorrhea. Most of the participants reported using
lubricant the last time they had receptive anal intercourse. Of the 302
participants, 25 tested positive for an anal STD. More than two-thirds
of the people diagnosed with an STD reported using lube the last time
they had receptive anal intercourse, compared with one third of people
who had not used a lube. Read another way, people who reported
using lubricants the last time they had anal sex were about twice as
likely to have chlamydia or gonorrhea as those who did not use
lubricants.
Taken together, these two papers seem to be suggesting that using
lubricants, or at least some kinds of lubricants, might actually be a
bad idea when you're on the receiving end of anal intercourse. And if
you listen to the press conference
that followed the presentation of the data, it sounds like at least
some of the researchers are comfortable interpreting this very early
data with some significance.
But don't put away that lube bottle just yet (and probably you
won't be putting it away ever). Remember that collecting data,
interpreting it, and reporting on it are three very different
activities. While some blog posts have suggested this is radical news,
consider the fact that all of the reporting from the researchers
themselves and from IRMA makes it clear that this is very preliminary
research, and should be interpreted as such. It's actually the first
research of it's kind, and it involved sample sizes too small to draw
any significant conclusions from. It raises far more questions than it
answers. Here are just a few:
The clinical study of people based on recall of past anal
intercourse wasn't able to take into account which lubricants were used.
Participants reported using many different kinds of lubricants across
encounters, sometimes combining different lubricants in a given sexual
encounter. If, as the laboratory study suggests, some lubes are better
than others, we need to figure out which ones are better, and do they
need to be used every time, in full concentration, to be "safer"?
Risk is never absolute and it never exists in a vacuum. The
clinical study seems to suggest that using lubricant increases risk of
getting an anal STD. But it doesn't consider the risk of infection
without lubricant. Sex educators have said for years that
lubricant makes anal sex safer because it reduces friction and tearing,
and therefore reduces the risk of STD transmission. This new data
doesn't contradict that because it doesn't address it. It's looking at
only one aspect of safety, harm, and risk. It's useful data to have, to
guide further research. But alone it isn't data that should guide
practice, as it could just as easily be refuted in a replicated study or
as we begin to take a broader research snapshot of lubricant use during
anal sex.
Similarly, the lab study of lubricants, which does seem to draw
conclusions that some lubricants may be "safer" than others, needs to be
contextualized, lest we forget how slippery the term "safe" is. When a
researcher says that a silicone lubricant was found to be safe, what
they mean was that it didn't do the one or two bad things they were
looking at. It doesn't mean that if you use silicone lubricant you will
be safe, or even safer, if you don't also consider other factors.
As usual, sexual pleasure isn't being talked about at all, and this
too needs to be addressed in both the conducting and reporting of
future research. The end goal of all this research is awareness of risk
and behavior change.
We aren't talking about dental hygiene here. We are talking about
activities people engage in for a reason, and sexual pleasure is often
part of that reason. To talk about anal intercourse and lubricant,
particularly to talk about lube as a risk factor, outside of the context of
pleasure makes sense only in the lab, only in theory. It doesn't matter
how good the research is, if you want to affect change in people's
lives, you have to speak to us in a way that we can connect with. If the
only argument you make for behavior change is numeric, it might scare
us for about three minutes, but it's not likely to help us at all.
What's exciting about the IRMA is that they have brought together
such a dynamic group of researchers, academics, activists, educators,
and participants to work together on a problem much more complicated
than any one group of us could ever tackle. They've got all the right
people there. Unfortunately when only one aspect of the work gets the
media spotlight, it's easy to push out the other, more complicated
voices.
I'll give the final paraphrased word to Jim Pickett, IRMA chair,
who in a press conference about the studies cautioned that IRMA doesn't
want people to stop using lubricant, and they aren't suggesting that
educators tell people not to use lubricant. He points out that even if
these results are replicated, it doesn't mean that unprotected anal sex
without lube will be better or safer. At this early research tells us
for certain is, as they have been saying for many years, more research
is needed on lubricants and anal intercourse, and the sooner we get it,
the better equipped will be to make informed decisions about the kinds
of risks we're willing to take and the extent to which we'll go to
protect ourselves from STDs, including HIV.
Male Sex Work More than half of male sex workers in Mombasa, Kenya who
predominantly have male clients may also be having intercourse with women,
according to findings presented at the 17th Conference on Retroviruses and
Opportunistic Infections in San Francisco. Adrian Smith, MSc, of the University of Oxford in the United
Kingdom, said that as many as 59% of men who have sex with men sex workers may
have regular transactional encounters with one or more female partners. “This
fundamentally changes ideas on the directionality of sex work,” he said.
The aim of the study was to determine the nature of
interactions between the HIV epidemics among MSM and heterosexual populations
in Africa.
“We observed a lower HIV prevalence among MSM sex workers
who had sex with women than in those who only had sex with men,” Smith said.
Eighty-three participating MSM sex workers completed
questionnaires and recorded details of 1,014 sexual partners in a diary during
the course of six weeks.
Data on 215 (17%) female partners were recorded.
Among 43 recent female partners, 81% were unmarried and 19%
were married. Three of those women were spouses of MSM sex workers.
The workers received money for sex from 144 women. MSM sex
workers paid the women for sex in 18% of the encounters.
Among single-episode contacts, 99 of 138 were paying female
clients. Payment was given in 45 of 77 recurring sexual relationships.
Penetrative intercourse occurred in 99% of the sexual
encounters between women and MSM sex workers. Those encounters were broken down
as follows: 87% vaginal, 54% anal and 43% for both.
Among the sexual acts, unprotected penetrative vaginal sex
occurred in 38% of encounters, and unprotected anal sex occurred in 46% of
encounters.
“Most unprotected acts overall occurred in partnerships that
were new and being paid for by the female partner,” Smith said. “However, the
chance of an individual encounter being unprotected was highest in a regular
partnership where no money changed hands. Condom use was lowest within
enduring, non-transactional partnerships.”
According to Smith, public misconceptions about the safety
of anal sex vs. vaginal sex may exist. “They may think that anal sex is not as
dangerous,” he said.
“Little is known of the personal risk awareness and
motivations for women seeking sex with MSM sex workers,” Smith said.
“These issues of risk are being overlooked by interventions
targeting risk reduction between MSM alone. Interventions should consider that
MSM sex workers may be having female partners.” — by Rob Volansky
For more information: Smith A. #39. Presented at: 17th Conference on Retroviruses
and Opportunistic Infections; Feb. 16-19, 2010; San Francisco.
http://www.reuters.com/article/idUSTRE62G2DO20100317
In May, 2002, Jerome Mitchell, a 17-year old college freshman from rural
South Carolina, learned he had contracted HIV. The news, of course, was
devastating, but Mitchell believed that he had one thing going for him:
On his own initiative, in anticipation of his first year in college, he
had purchased his own health insurance.
Shortly after his diagnosis, however, his insurance company, Fortis,
revoked his policy. Mitchell was told that without further treatment his
HIV would become full-blown AIDS within a year or two and he would most
likely die within two years after that.
So he hired an attorney -- not because he wanted to sue anyone; on the
contrary, the shy African-American teenager expected his insurance was
canceled by mistake and would be reinstated once he set the company
straight.
But Fortis, now known as Assurant Health, ignored his attorney's
letters, as they had earlier inquiries from a case worker at a local
clinic who was helping him. So Mitchell sued.
In 2004, a jury in Florence County, South Carolina, ordered Assurant
Health, part of Assurant Inc, to pay Mitchell $15 million for wrongly
revoking his heath insurance policy.
In September 2009, the South Carolina Supreme Court upheld the lower
court's verdict, although the court reduced the amount to be paid him to
$10 million.
By winning the verdict against Fortis, Mitchell not only obtained a
measure of justice for himself; he also helped expose wrongdoing on the
part of Fortis that could have repercussions for the entire health
insurance industry.
Read the rest.
http://www.reuters.com/article/idUSTRE62G2DO20100317
HIV counselling doesn’t adequately address
mental health issues“The drop-in centres and other AIDS-related healthcare
service centres are providing counselling for HIV to MSM and
transgender
people, but counselling for mental health issues is not being looked
upon
adequately” said Aniruddh Vasudevan, Director of The Shakti Centre in Chennai.
Aniruddh was speaking at the plenary of the State Consultation for MSM
and
Transgender on “Confronting Crises: The Situation Today.” Read more
“Many transgender people in Tamil Nadu are school
drop-outs.
Many transgender activists who went for sex reassignment surgeries in Tamil
Nadu broke down, cried, due to the trauma and insult they had to
face while
going through the psychiatric counselling process” said Aniruddh
Vasudevan.
However a Kolkata-based psychological counsellor
has another
opinion. In AIDS related clinics, by integrating mental health in
general
healthcare has not only reduced stigma-related to mental health but also
increased access to mental and general health services for the
men-who-have- sex-with- men (MSM) and transgender communities. “Clubbing
medical
practitioner and counsellor together in the drop-in centre and other
clinics
has put off the mental-health related stigma” said Mou Bhattacharyya,
Psychological Counsellor
with PLUS (partner of MANAS Bangla).
There is no denying to the fact that mental health
issues
are unique to transgender and MSM people, and are not adequately being
addressed.
“Mental
health needs are huge for transgender as they are
neglected and maltreated by the society, and their own family friends or
family
in some cases who are source of trauma” said Mou Bhattacharyya. “Earlier
experience of trauma comes from your own family and friends.
Maltreatment
includes teasing, humiliation coming from very closed ones, not even
given the
minimum respect or importance of what you expect from your family
members” adds
Mou.
“From the very inception of MANAS Bangla, Mental health
issues are very much integrated. In each of the drop-in centres,
the main
agenda is to let people come in and talk and share things with each
other.
Every drop-in centre, has one doctor and one counsellor along with other
team
members like peer counsellors” shares Mou Bhattacharyya.
Are MSM and transgender people who come to these
clinics
willing to access counselling services? “People who come to these
drop-in
centres are more than keen to access these services. Every day they are
going
through several traumatic experiences, when they travel for work or
travel for
other reasons, or at home or from their partners with whom they may
interact
sexually or otherwise. Mainly the ongoing problems are with their male
partners, family members and other closed relatives and their own
confusion and
frustration regarding their identity, sexual preferences and other
issues” says
Mou Bhattacharyya.
“People who have opened up regarding their sexual
identities
are coming to these drop-in centres. There are lot of people who are not
yet
open regarding their sexual identity and are difficult to reach. With
rising
HIV awareness, people are more keen to come in for services” says Mou
Bhattacharyya.
Counselling is the main coping strategy counsellors
at these
clinics resort to. “If the person needs mental health medicines we refer to the
doctors. Doctor who comes to drop-in centre is not a psychiatrist, so if
we
need psychiatric help, we need to refer to psychiatrists. We have a pool
of
psychiatrists who are sensitive to issues and people can access services
with
care without any stigma or discrimination at these healthcare settings”
says
Mou Bhattacharyya. |
