ARM-ing Africa for Rectal Microbicides

Original content from the Mapping Pathways blog team

These are exciting times in the HIV-prevention landscape.  In an earlier Mapping Pathways post, we covered our colleague, Jim Pickett’s experiences at the Microbicides 2012 (M2012) conference in Sydney in April.  At M2012, advocates discussed a number of important issues, including the importance of adherence in clinical trials. 

A major development at M2012 was a report released by the International Rectal Microbicide Advocates (IRMA), a global network that Jim leads, as a cornerstone of their Project ARM (Africa for Rectal Microbicides). The report, titled “On the Map: Ensuring Africa’s place in Rectal Microbicide Research and Advocacy” outlines priority actions to ensure Africa is involved in rectal microbicide research and advocacy activities.

On The Map is the result of a two-day consultation that took place before the ICASA conference in Addis Ababa in December with African and international stakeholders. Says Pickett, “The central question of the consultation was ‘How can we be more strategic and proactive to make sure Africa is on the map when it comes to rectal microbicide research and advocacy?’”

The Project ARM report lays out seven key action areas specific to rectal microbicide research and advocacy in the African context:

Knowledge, Attitudes and Behaviors (KAB) studies on anal health and anal sex to generate data that can be analyzed across countries and populations

Rectal microbicide acceptability studies

Mapping of sex education curricula to determine what content on anal health is included

Advocacy for lubricant access through the “And Lube” campaign of the Global Lube Advocacy Mobilisation (GLAM)

Documentation of best practices for integrating anal health, anal intercourse and rectal microbicides into sexual health and HIV prevention education

Capacity-building activities for community leaders, advocates, and researchers

Awareness raising and education about anal health, anal intercourse, and rectal microbicides, including development of educational materials and other communications efforts specific to the African context

According to Pickett, members of the Project ARM working group further prioritized the key activities. While the members agreed that all the activities are important, the top three are the KAB studies, awareness raising and education on anal health and anal intercourse, and improving access to condom-compatible lubricants, which are in very short supply across most of Africa.

Pickett explained that the HIV epidemic in Africa is often wrongly considered as solely heterosexual, with sexual transmission driven entirely by unprotected vaginal sex between men and women. “There has been little to no official recognition of the fact that there are gay men and other men who have sex with men in Africa who are enduring high rates of HIV, and that plenty of heterosexuals also have anal sex. Unprotected anal intercourse is 10 to 20 times more likely to result in an HIV infection compared to unprotected vaginal intercourse,” says Pickett.

As mentioned, increasing access to condom-compatible lubricant is a key goal of Project ARM. Access to appropriate lubricants on the continent is quite abysmal. “In the absence of appropriate, safe lubricants, people use things like shampoo, cooking oil, hand lotion, antibiotic creams – even motor oil – that break down the latex in the condom, erasing the protective benefits.. People also use saliva, which dries out quickly – and can cause tears in the condom as well as harm the fragile rectal environment. For safer anal sex, lubrication that is condom-compatible is absolutely necessary,” says Pickett.

 “There is an immediate need for appropriate lubricants for people who have anal intercourse in Africa. If we can’t get lubricant to people now, how will we be able to deliver rectal microbicides to them when they become available? Increasing access to appropriate lube is absolutely critical, and paves the way for access to rectal microbicides down the line. We can’t have campaigns and programs that deliver condoms without also delivering condom-compatible lubes. Period.”

Stay tuned to the blog as we bring you more information on this exciting project. Until then, read a vivid snapshot of advocacy in Africa through the eyes of Brian Kanyemba here. Brian has been very involved with IRMA's Project ARM, and is an integral member of the Project ARM video working group, which is trying to produce an African-focused video on anal health and anal intercourse.

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Mapping Pathways at ICASA: Generating interest, creating buzz

 Original content from our Mapping Pathways blog team

Two Mapping Pathways team members – Molly Morgan Jones from RAND Europe and Jim Pickett from the AIDS Foundation of Chicago – recently presented two project posters at the 16th International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa (ICASA) held in Addis Ababa from December 4-8. This was the first time preliminary project findings from the literature review, online survey, stakeholder interviews, and ExpertLens were officially shared with the wider HIV prevention community on such a large scale. The semi-annual ICASA is Africa’s largest gathering on HIV/AIDS. This year it brought together approximately 7,000 delegates from more than 103 countries. Check out the two Mapping Pathways poster presentations here. The daily poster exhibition showcased posters on research findings, best practices, and innovative strategies in the response to HIV/AIDS in Africa.

“Molly and I had a lot of fun,” says Jim Pickett. “In general, the focus of the conference wasn’t so much about new prevention technologies, so it was important for us to get out there and get the word out. We stood in front of the posters and had some really great discussions – people were  not only interested in the science behind some of these ARV-based prevention strategies, but also understanding the various viewpoints from stakeholders ‘on the ground.’ I think Mapping Pathways generated a real buzz.”

At this year’s ICASA, concerns about funding took center stage. According to a conference write-up, “Underlying the encouraging atmosphere, participants, presenters and conference organizers shared concerns about recent announcements regarding cuts in much needed life-saving funding for HIV, AIDS, tuberculosis and malaria. The financial blow of the Global Fund, which suspended normal disbursements until 2014, comes at the worst moment – when the use of antiretroviral drugs for treatment and prevention has dramatically reduced mortality from the virus and reduce transmission of AIDS.” Read the rest of this synopsis on the conference here: ICASA 2011 Closes with a Call for a Sustainable HIV Response

Apart from discussions on funding, other conference presentations included promoting gender equality (a high-level task force “Women, Girls, Gender Equality and HIV for Eastern and Southern Africa” was launched); strengthening health systems and showcasing the additional benefits the AIDS response has had for the broader health and development; and committing to the elimination of new HIV infections in young children. Pickett co-chaired a session on HIV and LGBT issues in the African context as well, which was standing room only.

On the last day of the conference, delegates gathered together to discuss how to deliver on the 2011 United Nations Political Declaration on HIV/AIDS for Africa, which was unanimously adopted this June. The declaration calls for universal access by 2015. Read more here.

Check out the Mapping Pathways posters here. And let us know what you think. You may leave a comment here, or send us an email at: mappingpathways@gmail.com

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Update on IRMA’s Project ARM – Africa for Rectal Microbicides Strategy Meeting in Addis: Dedication and passion are paving the way forward

  Original content from our Mapping Pathways blog team

“It was an amazing group, and one that moved me to near tears on a number of occasions”

Our colleague Jim Pickett from the AIDS Foundation of Chicago, a Mapping Pathways partner organization, just returned from an inspiring week in Addis Ababa, Ethiopia, where he led a strategy meeting for the International Rectal Microbicide Advocates (IRMA) and then attended the ICASA 2011 conference (read more about both here and here). We checked in with Jim for an update on IRMA's Project ARM (Africa for Rectal Microbicides) strategy meeting, which was held in Dec 2 and 3 (click here for a fact sheet on Project ARM).

The meeting, which was the result of 18 months of planning and coordination, convened about 40 individuals - both invited speakers and guests, including 16 individuals who secured scholarships to attend (out of 145 applicants.) The meeting participants represented countries including Ethiopia, Rwanda, Cameroon, Kenya, Nigeria, Zambia, Malawi, Zimbabwe, South Africa, Uganda, Canada, United Kingdom, and the United States  -researchers, advocates, LGBT people, heterosexual people, and those representing sex workers, prison populations and more.

“It was an amazing group, and one that moved me to near tears on a number of occasions,” says Pickett, who explained that the aim of this meeting was for people to come together and create a strategy, a road map, around rectal microbicide research and advocacy specific to the African context. “I've been to many, many meetings – too many –  in my day and I think the Project ARM meeting was, by far, one of the most productive, inspiring, exciting, energizing, and emotionally moving ones I've ever had the privilege to attend. Yes, I am obviously biased - but it isn't often that events like these make me misty-eyed and put a lump in my throat – repeatedly.”

The journey to getting all these people together for this meeting was not easy, as many faced multiple challenges securing the required visas for travel to Ethiopia. Says Pickett, “There was this incredible energy in the room. We’d been planning this meeting for the past 18 months, and it has been a long journey for all of us to make this happen. A number of the people attending went to extraordinary lengths to get to Addis Ababa. They had to make so many trips to embassies and consulates for visas, so many obstacles were placed in their way to dissuade them from attending, but none of them took no for an answer. The incredible perseverance they exhibited simply to show up was extremely moving.”

The participants spent the two days together getting informed – including sharing the latest updates on rectal microbicide science, rectal microbicide advocacy, issues around LGBT crimininalization, anal sex prevalence, the gay/MSM epidemic, and more. “But we didn't just passively listen to others speak - we broke out into small groups a number of times to unpack what we learned and to come up with priorities and plans for moving forward,” says Pickett.

Four advocacy-focused items and four research-focused items were prioritized, and action steps were developed for each. These included expanded rectal microbicide scientific research activities in Africa, expanded research into anal sex behaviors among African straight and gay/MSM populations, communication/education efforts, and the birth of  the Global Lube Access Mobilization (GLAM) campaign called "And Lube" to support increased access and availability of condom-compatible lubes throughout Africa. Current lubricant access across the continent is absolutely abysmal.

What especially surprised and moved Pickett was the level of enthusiasm and positivity in the room. “A lot of these people come from countries that have seriously troubling environments and where advancing HIV prevention and advocacy is met with extreme homophobia. So I thought that a lot of the discussion would be on the challenges and obstacles-- I mean, so many of the countries we were focusing on are settings where you can’t even think of doing a microbicide trial, let alone discussing sexuality openly without worrying for your safety – yet the participants didn’t get stuck on these negatives. These are men and women who are brave and strong and are committed to fighting for better health and civil rights for the people in their country. It was extraordinarily fulfilling to witness their passion and energy first hand; to see them standing up and doing this work despite the numerous challenges and obstacles in their way.”

Dr. Ian McGowan, co-principal investigator of the Microbicide Trials Network (MTN) attended the meeting, presenting the latest in rectal microbicide science. He also addressed some of the questions regarding the recent closure of the VOICE trial’s study arm testing tenofovir gel. The decision was made due to futility – while tenofovir gel was found to be safe, the trial was not able to prove the gel worked to prevent HIV. See the statement from the MTN for more information. Previously the trial had to drop its tenofovir tablet arm due to futility as well. The Truvada tablet arm in the trial is continuing. “There was a lot of speculation in the room about why it was closed,” said Pickett. Many of the people present speculated that a lack of adherence might have been a factor, said Pickett. “But of course, it’s all speculation at this point, we don’t know what happened, and we won’t till the end of next year likely.” He added that McGowan confirmed that it is still important to move forward on both vaginal and rectal microbicide research and to keep exploring ways to create a more diversified microbicide pipeline (learn more about the microbicide pipeline here and here).

For Pickett, another big highlight was McGowan’s strong validation for Project ARM’s objectives. McGowan, a highly respected veteran in microbicides research, publicly offered MTN support for future Project ARM activities and commended the participants for their collective intellect and passion. Said Pickett, “Ian participated in many of the small break-out groups, and I think he was impressed by the high quality of thought, curiosity, and energy in the room. And to have that kind of validation from someone who is one of the key rectal microbicide researchers on the planet… it was a really big moment for us. There isn’t a doubt in my mind now that Africa is squarely on the rectal microbicide map.”

Pickett also felt that an interesting backdrop to the IRMA meeting was Hillary Clinton’s speech that formalized the Obama administration’s prioritization of LGBT rights globally, helping to bolster rights’ groups on the ground in their fight against discrimination. “At the end of the day,” said Pickett, “if people aren’t free to be who they are, wherever they are, they won’t be able to make use of any prevention technology, let alone rectal microbicides. There’s no point in having a really great microbicide on the shelf if people are not safe, and therefore unable, to access it.”

Jim Pickett is the Director of Prevention Advocacy and Gay Men's Health at the AIDS Foundation of Chicago. He is chair of IRMA (International Rectal Microbicide Advocates), and a member of the Mapping Pathways team. A full report from the Project ARM meeting in Addis, laying out a rectal microbicide research and advocacy strategy for Africa will be released at the Microbicides 2012 conference in Sydney in April 2012. Until then, find updates here.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Mapping Pathways presents two posters at ICASA 2011 in Addis Ababa

Original content from our Mapping Pathways blog team

On December 5 Molly Morgan Jones and Jim Pickett from the Mapping Pathways project (left, top picture) presented two posters on our findings at the ICASA 2011 conference taking place now (through December 8) in Addis Ababa, Ethiopia.

The world has made great progress in fighting HIV/AIDS since the late 1990s. While incidence rates in sub-Saharan Africa have fallen, most of the world's new infections still occur there. A portfolio of approaches – or 'pathways' – to prevention is needed. Recent trial data shows great promise in four antiretroviral (ARV) prevention strategies.

The Mapping Pathways project used four separate methodologies to access diverse stakeholder perspectives and assess the evidence base, looking specifically at South Africa, India and the USA. 

We employ an adaptive approach to policy development around ARV-based prevention strategies. The project has engaged various stakeholders from India, South Africa and the United States in surveys, interviews and iterative exchanges to understand local perspectives and the empirical evidence needed to develop appropriate policy pathways for different contexts.

What will these pathways look like, how do we navigate them and where will they lead?

Please check out our posters - below - to learn more. And let us know what you think. You may leave a comment here, or send us an email at mappingpathways@gmail.com.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Rectal Microbicides & Africa: A Leap Forward

Original content from our Mapping Pathways blog team

Rectal microbicide advocacy has taken a huge leap forward this year, particularly in Africa. An excellent example of this progress is the International Rectal Microbicide Advocates (IRMA)-hosted Project ARM – Africa for Rectal Microbicides  meeting underway now  in Addis Ababa, Ethiopia in advance of the ICASA 2011 conference. “I am so proud of the fact that we’re at a point where we can hold a two-day strategy meeting in Africa, focusing on rectal microbicides research and advocacy in Africa. That’s just huge. A few years ago this would have been impossible – people would have laughed at you for suggesting it,” says Jim Pickett, chair of IRMA, a Director at the AIDS Foundation of Chicago, and member of the Mapping Pathways team.

The rectal microbicides field itself is also expanding, as researchers continue to push boundaries. Until now, there have only been small-scale Phase I trials for rectal microbicides. This year the first Phase II trial was announced – an expanded safety study that will begin in 2012. “The trial will involve 200 individuals, which is almost double the total number of human beings who’ve been in rectal microbicides trials so far,” Jim points out. The study is going to be multinational, taking the research outside the US to countries like Thailand, Peru, and even South Africa.

“Not too long ago, saying rectal microbicides clinical research and Africa in the same sentence would have gotten a huge eye-roll. Now it’s real, it’s happening,” says Jim. “I think that says a lot about how advocacy and science together have elevated the field, creating a great deal of understanding and support for it.”

Stay tuned to the Mapping Pathways blog for news and updates from the IRMA meeting and ICASA conference in Addis Ababa.

Please note: Registration for the AIDS 2012 conference in Washington, D.C. opened yesterday. Get the details here.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]