One of the clear messages from the XIX International AIDS Conference (AIDS 2012) in Washington DC is that HIV prevention research is progressing ahead with thrust to meet needs of most at risk populations such as sex workers, men who have sex with men (MSM), transgender populations, injecting drug users, women and men with high risk behaviours, among others. However a lot more needs to be done in the regional, country and local contexts to bring in unique perspectives of most at risk populations so that their prevention needs can be met. One such initiative that brings in African regional voices of those women, men and transgender women who practice anal sex into main discourses on HIV prevention research and advocacy is Project ARM (Africa for Rectal Microbicides).
"Project ARM was started by the International Rectal Microbicides Advocates (IRMA) two years ago to make sure that as the HIV prevention field moves ahead for research and development of rectal microbicides, these products [when eventually made available] are safe, accessible, and affordable to the people who need them [in African context]. There was a realization that we need to do some specific work in Africa in context that there are many countries where anal sex is illegal, people can be prosecuted and there is lot of [anal sex related] stigma and discrimination too" said Marc-Andre LeBlanc, IRMA Secretary to Citizen News Service (CNS).
Added Marc-Andre LeBlanc: "We were inspired by the work of IRMA Nigeria. IRMA Nigeria was started in 2008. So it was obvious that some specific work could be done around rectal microbicides such as some groups have been looking at MSM issues in African context. Project ARM was born out of the growing need to create a research and advocacy agenda for rectal microbicides in Africa. Project ARM shows us what are the priorities in terms of research, advocacy and community mobilization around rectal microbicides in African context. One of the priorities that came out of Project ARM discussions was lube access. The reason was that people who practice anal sex cannot access lubricants. What makes us think rectal microbicides will be anymore accessible whenever introduced in future?"
Rectal microbicides are products currently under research – that could take the form of gels or lubricants – being developed and tested to reduce a person’s risk of HIV or other sexually transmitted infections from anal sex. The risk of becoming infected with HIV during unprotected anal sex is 10 to 20 times greater than unprotected vaginal sex because the rectal lining is only one-cell thick, the virus can more easily reach immune cells to infect.
IRMA advocates have successfully put spotlight on lube access at AIDS 2012 with "And Lube" campaign. It was great to see 'condomize' campaign gaining focus at AIDS 2012 but was a disappointment to note that people can get condoms and not lubes. There were lube tasting booths at AIDS 2012 though. IRMA raised the issue with "And Lube" campaign and half-way through the conference, lubes were also made available at different booths.
Agreed IRMA advocate from Nigeria - Abimbola Williams: "Project ARM is advocating for the HIV prevention needs of women and men who practice anal sex. The main challenge is funding because money is not enough [for programmes that are required to address HIV prevention needs of women and men practicing anal sex]. Another challenge are laws that criminalize same sex behaviour. Some of these criminalizing laws are being reinforced in some of these countries that criminalize same sex behaviour. This makes it very difficult to talk about rectal microbicides or any related issues."
Nigeria had introduced a new bill which would further threaten the wellbeing of local and visiting LGBT people. The Same Gender Marriage Prohibition Bill was first announced in 2011 seeking to punish those with same-sex behaviour, with 14 years’ imprisonment and has since been amended to include 10 years imprisonment for anyone aiding or witnessing such same sex behaviours. Nigeria needs to follow the example of countries like Rwanda, Kenya or South Africa, which prove that African nations don’t need to persecute the vulnerable in order to strive.
"We have to recognize that it is not just MSM and transgender people who have anal sex but also women in heterosexual relationships. If that route of HIV transmission is not looked at then HIV rates are bound to rise in those practicing anal sex. It is very important to have rectal microbicides because when we know that anal sex can be the driver of HIV in those women and men practicing anal sex, we need HIV prevention options that they can use" said Abimbola.
Citizen News Service (CNS) spoke to a clinical trial participant Rig Rush who now works with Black AIDS Institute. "I believe that Project ARM and studies done on rectal microbicides are important for Africa. I believe that Africa, their people, communities, countries are built around a sense of humanity and when we have a rectal microbicides (these are not yet available and currently under research) then it will not demonize sex. I am talking about destigmatising, educating and empowering people, and informing them that they can enjoy anal sex. Let us do it in a safe, comfortable and holistic approach. I believe that in Africa we can truly promote, motivate, inspire people to make informed decisions about their behaviour. When we have a woman who feels that she has no power or say on what happens to her body, products like rectal microbicides (when found safe, effective and eventually introduced) will be of use for HIV protection. She needs to be in charge of her own life."
Most importantly, Rig Rush gave the carry home message to AIDS 2012 delegates: "Rectal microbicides will be a tool [if found safe, effective and introduced for HIV/ STI prevention]. They don’t replace responsibility and accountability." Food for thought! (CNS)
(The author serves as the Director (Policy and Programmes), Citizen News Service (CNS), and is a World Health Organization (WHO) Director-General’s WNTD Awardee (2008). He writes extensively on health and development through CNS. Email: firstname.lastname@example.org, Website: www.citizen-news.org)