Sustainable HIV prevention possibilities present choices, challenges

via Science Speaks, by Antigone Barton

When he looks at what biomedical science can do in the next decade to prevent HIV transmission, Jim Turpin of the National Institutes of Health said, he thinks of the lyrics of a Timbuk3 song: “The future’s so bright I gotta wear shades.”

By, which, actually, he means — don’t get blinded by the light; the search for answers will require focus.
“The challenge is not the lack of options,” he said, “but prioritizing the best options.”

Turpin, program officer and branch chief in the Prevention Sciences Program in the Division of AIDS at NIH”s  National Institute of Allergy and Infection Disease spoke this morning in webinar titled “The HIV Prevention Pipeline: A Future of Possibilities.” The webinar was sponsored by the International Rectal Microbicide Advocates (IRMA) and AVAC Global Advocacy for HIV Prevention.

After a series of disappointments in the quest for a vaccine or microbicide to prevent HIV transmission, the last two years offered hope, in strategies using antiretroviral medicine to prevent acquiring HIV, organizers point out. But, with a diversity of prevention needs and challenges among women and men worldwide still demanding answers, is that all there is?

Or, as Turpin put it, “Do we currently have what it takes to create a sustainable prevention pipeline?”

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]

Separating the Smoke from the Fire: Lubricant Use and HIV

Original content from the Mapping Pathways blog team

The January 2012 issue of Sexually Transmitted Diseases – Journal of the American Transmitted Diseases Association has published data from a rectal health and behavior study whose findings “suggest some lubricant products may increase vulnerability to STIs”. The study concludes that “because of wide use of lubricants and their potential as carrier vehicles for microbicides, further research is essential to clarify if lubricant use poses a public health risk”. The paper has fueled a tremendous amount of discussion in HIV treatment and prevention communities around the world because such a link would have massive repercussions. Perhaps the title of the article also helped spark the dialogue: “The Slippery Slope: Lubricant Use and Rectal Sexually Transmitted Infections: A Newly Identified Risk”.

The questions are popping up quickly. What does this mean? Do we begin to alter strategies? Do we wait for conclusive proof? How will the layperson interpret this? Use lubricants or not? Which ones? Water-based? Silicone? Oil-based? Healthcare and advocacy professionals are wondering whether this will impact the messages they communicate to people. One discussion forum grappling with these issues is the membership listserv run by IRMA (International Rectal Microbicide Advocates). The listserv has been the site of a lively conversation among individuals from various countries. And this discussion has been ongoing for a few years. IRMA has a Lube Safety Working Group, and has some great resources on this issue via their blog.

“We need to be clear – there are only associations between lube use for anal intercourse and STDs. There is no proof that lube use causes increased risk. We simply don’t know that. Because we don't know, IRMA has long been advocating for a lube safety research agenda to fill in our gaps in the science and the evidence base,” says Jim Pickett, Director of Prevention Advocacy and Gay Men’s Health at the AIDS Foundation of Chicago, chair of IRMA, and a member of the Mapping Pathways team.

“Our key messages still hold true. 1) More research is urgently needed to explore if there is a link between lube use and acquiring HIV and/or rectal STIs. 2) It is unclear whether any particular type or brand of lube might increase, decrease, or have no effect on acquiring HIV and/or rectal STIs. 3) Using male or female condoms is still considered the best way to prevent acquiring HIV and STIs during anal intercourse. In addition, the use of condom-compatible lubes has been associated with a decreased risk of condoms breaking or slipping. 4) It is not possible at this time to recommend for or against using lubes if having anal intercourse without condoms. Lube use on its own is not a proven method of HIV or STI prevention,” explains Jim.

Read on for an interesting debate on various aspects of the study, prevention options, risk reduction, and risk elimination.

George Victor,  a Project Coordinator and health educator who works with men who have sex with men (MSM) and other minority groups, describes the strategy his team is following: “For now, the data we have indicates that unprotected anal sex carries the highest risk of HIV infection, that latex condoms should always be used correctly with water-based lubrication, and that the rectum has a higher concentration of CD4 cells and a larger surface area than the vagina – which means higher opportunities for infection. Therefore, correct and consistent use of condoms and water-based lubricants, together with quarterly HIV testing and STI screening and treatment is the best bet we have today.”

Paul Whannel, a communications coordinator with the AIDS Project of Central Iowa, made an interesting point saying, “I question why there’s not a third option: If an MSM is unwilling to use barriers, use silicone lube – it’s at least potentially safer than water-based... A growing segment of MSM will simply ‘check out’ if you're only willing to talk barrier use. Shouldn’t we be talking risk reduction with those guys?”

“Don't forget that many of us gals will simply ‘check out’ as well!” adds Carrie E. Foote, PhD, an Associate Professor of Sociology at Indiana University-Purdue University who has been living with HIV for over 20 years. “I suspect most women and their male partners (especially those who exclusively have sex with women) rarely get any messages at all about anal intercourse. It was nice to see that half the participants in the study were women.”

“Paul, I hear what you are saying and agree with you in principle. I think that for prevention purposes, however, the most effective mechanical methods of prevention would involve some sort of barrier,” responds George. “Having said that, I agree that choice is important. We don’t say to guys that they MUST use a condom and water-based lube. We have a discussion, conduct risk reduction and assessment, and find solutions that are locally available and practical. Our role is to provide information, support, and very importantly options.”

“As rectal microbicide advocates, our whole reason for being is to help serve those for whom condoms don't work (for whatever reason). We are interested in the research and development of safe, effective, acceptable and accessible rectal microbicides for those very people,” points out Jim. “However, I think it gets tricky when we get to making a recommendation regarding lube use as harm reduction (any kind) in the absence of data.”

“What does risk reduction mean anyway?” asks Aditya Bondyopadhyay, an HIV advocate working in India. “Is it not a fact that the only sure method of avoiding risk of infection is to consistently and correctly use a condom in every instance of penetrative anal sex? I feel the emphasis should stay here. Other ways can and should be in addition to this, not stand-alone.”

“The only really ‘sure method of avoiding risk of infection’ is abstinence from anal and oral intercourse – which could be classified as risk elimination,” says Mark Hubbard from Tennessee in the US. “That’s pretty useless for most of the adults we’re trying to reach; everything else, including the consistent use of condoms, is ‘risk reduction.’ The effectiveness of all risk reduction methods varies and is dependent on the user. ALL of these methods (including abstinence and condom use) have advantages and disadvantages that are very real, and vary from person to person.”

Doreen Hardy highlighted the need for a different type of data: “We need better behavioral data – exactly how are people having anal sex? There are so many variables to consider beyond latex and lubes – the degree of sphincter relaxation before penetration, sexual position, concomitant drug use, frequency, etc. Behavioral data could trump the lubricant data. It is such a difficult subject for sexuality educators because it is hard to build rationale with so little evidence. The default educator has become porn and frankly they do a terrible job. Their objective is to edit for arousal value (usually by eroticizing power) not educational value so a lot of people think furtive, hard, and fast anal sex is the norm. Now that it has become a common part of the sexual repertoire of Americans, I think people are willing to talk about it without having it be shrouded in homophobia.  Maybe someone can start with focus groups and move on to larger quantitative studies.”

“One striking thing is that this was mainly a study of people in committed relationships (56% of sex reported was with main partners) and not of casual sex. Casual/one-off sex only featured in less than 5% of encounters or 12% if you add in ‘acquaintances’. Most of the rest (83%) is between main or regular partners or ‘friends’. This makes the ‘the only thing we can say is to use condoms every time’ line even more incomplete as a response: We have to say it, but most research finds that condom use in long-term relationships, even serodiscordant ones, is an exception not a rule,” says a journalist specializing in HIV. “There are way too many uncertainties and confounders in this study to make any pronouncement on its basis … they didn't get into what people might be doing sexually that led them to choose one lube over another, or to use lube at all. I agree with Jim; we cannot make any recommendations about what lube to use on the basis of this study.”

A doctor summed up the overall mood perfectly at the end, “I'm thankful that a lot of the folks on this list are advocating for, conducting, and funding some of the very research we need to be able to answer the questions. I am awaiting the next wave of research with anticipation.”

[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.]

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.]

FDA, Gilead And HIV Prevention-In-A-Pill?

via Pharmalot, by Ed Silverman


The debate over whether the FDA should approve an existing AIDS medication for preventing the spread of HIV has ratcheted up as more than a dozen advocacy groups are urging the agency to accelerate its review process and not wait for data about heterosexuals. The move comes just one month after one prominent advocacy group urged the FDA not to approve Truvada, which is sold by Gilead Sciences, for prevention, or as pre-exposure prophylaxis, for any group.

In a letter to the FDA and Gilead, the groups say that approval is needed as soon as possible in order to provide protection to gay and bisexual men and transgender women. And they cited data from a study released last November that found that men and transgender women who have sex with men and received a daily dose of Truvada, along with condoms and safe sex counseling, had an average of 42 percent fewer HIV infections than those who received only condoms and counseling (read here).

In fact, three PrEP trials have shown evidence that using Truvada or Gilead’s Viread, which is a component of Truvada, reduced the risk of infections. The other trials examined use by heterosexual men and women, and a so-called partners trial that looked at couples in which one partner is HIV-negative and the other is HIV-positive.But the advoacy groups complain that before results of the heterosexual study were released, the FDA and Gilead were believed to be ready to proceed with a review of PrEP for men who have sex with men, or MSM. And to them, delay means more infections.

Read the rest.

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

Closure of oral Tenofovir arm in VOICE Pre-Exposure Prophylaxis trial: PrEP as a “niche intervention”?

via Incidence, by Roger J. Tatoud

The Microbicides Trial Network (MTN) September 28th that its VOICE (Vaginal and Oral Interventions to Control the Epidemic, MTN003) HIV Pre-Exposure Prophylaxis (PrEP) prevention study will discontinue the daily oral tenofovir arm of the trial. The decision follows an interim review of the trial’s data by its Data Safety and Monitoring Board (DSMB) which recommended that VOICE stops evaluating the oral tenofovir tablet (TDF, brand name Viread), because it will not be possible for the study to show a difference in effect between the drug and the placebo tablet (futility) for the prevention of HIV infection in the context of that study. Importantly, the DSMB did not found any safety issues associated with the use of TDF in any arm of the trial.

This is the third PrEP trial, after FEM-PrEP and TDF2, for which an interim review of the trial’s data led to a change of course of the study. Because the four other arms of the VOICE trial continue, there are no data available publicly yet to explain why tenofovir would not show effectiveness in this study when three other studies showed a dramatic reduction in the risk of HIV infection with tenofovir alone or in combination with another antiretroviral (see table below). However, Sharon Hillier and Ian McGowan of the Microbicide Trials Network noted that the study’s population – predominately women in their 20’s, could be an important factor.

“If there’s one thing we’ve learned over the years it’s that unmarried women in their 20s are in a very different place in their lives than married women in their 30s. People in different circumstances will make different choices about their use of condoms, their choice of partners and whether or not to use a biomedical prevention product. As we continue the VOICE trial we recognize that there could be many factors that influenced the outcome with oral tenofovir, and even when we have more information available to us, understanding what exactly happened (or not) will not be simple.”

If confirmed (a full analysis of the data will not be available before several months) this would add to the challenge of defining a strategic use for PrEP in the general population or in populations at risk.

Read the rest.


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

Open Letter Urges That PrEP Debate Should be Based on “Facts not Misinformation”

“Ad campaigns that misinform communities at risk for HIV will not help end this epidemic.  We call on everyone to get the facts about PrEP, seek information, and express opinions, but to do so based on real information…”

Earlier this month, a number of US newspapers ran coverage of an open letter, signed by more than 100 “openly HIV-positive gay and bisexual men from across the United States”, calling for an open discussion of the challenges and opportunities presented by pre-exposure prophylaxis (PrEP) for HIV prevention.

The letter was written partly in response to an ongoing paid ad campaign by the AIDS Healthcare Foundation (AHF) that many advocates feel “misrepresents” facts about important PrEP research. Among other things, the campaign expresses concern that PrEP could possibly lead to decreased condom use and an increased risk among gay men because it gives a “false sense of protection”. As a note supporting the open letter posted on IRMA (International Rectal Microbicide Advocates) puts it, “We reject those false assertions and want a full and factual discussion of the pros and cons of PrEP in our community...and make clear our belief that we are entitled to respect, accurate information and new HIV prevention tools.”

“Giving gay men more information about their health only empowers them to make informed decisions. The fear that gay men will take PrEP, forego condoms and become out of control disease spreaders, harkens to the days when men feared women would become crazed nymphomaniacs thanks to the new birth control pill,” says an article about AHF's campaign on FrontiersLA.com, a “breaking gay news” site. You can read more about the AHF campaign on the Mapping Pathways blog post: To PrEP or not to PrEP?

In response to the campaign by the AHF, the open letter states: “PrEP raises many important questions that should be discussed and debated. We are disappointed, however, that an organization that runs HIV clinics, the AIDS Healthcare Foundation (AHF), has chosen to spend tens of thousands of dollars on ads that use simplistic and often misleading arguments to condemn PrEP before the FDA and the HIV community have had a chance to fully review and debate the study data.”

The letter then goes on to urge the AHF to put a stop to its campaign: “Ad campaigns that misinform communities at risk for HIV will not help end this epidemic.  We call on everyone to get the facts about PrEP, seek information, and express opinions, but to do so based on real information, not fear of the scientific process or prejudice against gay/bi men. To that end, we call on AHF to end their expensive and misleading ad campaign, and to work together with us to promote an informed public discussion of HIV prevention that can help reduce HIV risk and save lives.”

One signee who was quoted in an article published in the Sacramento Bee explained his reasons for signing the letter, “As an HIV positive gay man I signed this letter because I learned from experience we need all credible options to stop this epidemic. I owe my life to the fact that advocates and activists have pushed hard for decades to make effective AIDS drugs available to HIV-positive people," said Kali Lindsey.  "Now we know that AIDS drugs can also play an important role in the health and well-being of HIV-negative gay men, how could we not move forward to reap the benefits of this research. It is not an option to ignore these findings."


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

First Official Mapping Pathways Presentation a Success: Canada keen to adapt project

“It’s not about telling people to go down any one pathway; it’s about providing an array of pathways that are illuminated with a little more analysis with which to shape informed policies and programs.”

Earlier this year, Jim Pickett of the AIDS Foundation of Chicago, a Mapping Pathways partner organization, was asked how he and his colleagues would measure success for this initiative. His response was prompt, explaining that the project would be successful if the knowledge and wisdom it brings together is able to provide tools that are usable for the various stakeholders. “So, for example, if here in Chicago I can take these findings to the Chicago Department of Public Health and it can help inform their community planning process around the prioritization of prevention and care dollars. Or, in India you could take the results of our outputs to the Minister of Health in Delhi and say, ‘Here is something to help us help you think about and plan how you’re going to allocate resources or roll out potential programs…or not.’ Maybe a jurisdiction will decide it will not focus on PrEP, and instead will focus on getting more people tested and treated and on doing a better job on getting people condoms. Basically, we want to help create a package of tools that people can then use to actually influence policy and do good programming in their particular context. At the end of the day, and this is the big picture, we want to avert HIV infections. We want less people to become infected and we want more people who are infected to be linked to appropriate care and treatment. And if our project can, in some small way, help create policies and programs that prevent more infections and get more people into care and treatments that are sustainable and appropriate, then I think we are successful.” (Read more of Jim’s wonderful conversation at the Mapping Pathways blog post “Success! Now What?”)

Recently, at a national stakeholder consultation in Ottawa Canada (see footnote), part of this vision for the Mapping Pathways project came true. Pickett was invited to introduce the project and share some preliminary data to a group of 30-40 key stakeholders from the Canadian government, AIDS service organizations, and others interested in new prevention technologies. This was the first official Mapping Pathways presentation since the project began earlier this year. The consultation was designed to get Canada to think how the country will deal with and incorporate the increasing number of prevention tools and strategies that are already available or will become available soon – PrEP, TLC+, and microbicides (read more about these strategies here and the various prevention trials here).

 “Canada has been following new prevention technologies for a long time,” said Pickett. “So now they are watching the science (and what at incredible year of science it’s been!), and there are things that are actionable; expanding treatment is actionable now. PrEP could be considered actionable now. So at this consultation, these folks were asking, ‘What should we do?’, ‘How do we figure this out?’, ‘What tools will we need?’, ‘How is it going to look?’, ‘How do national bodies fit into this strategy?’”

“Just asking these questions is so challenging,” said Pickett. “And Mapping Pathways is in no way saying any country should do something or not. We’re just asking questions, looking at the data, and then presenting what we find in a useful and usable way.” As Pickett put it at the beginning of this project, “It’s not about telling people to go down any one pathway; it’s about providing an array of pathways that are illuminated with a little more analysis with which to shape informed policies and programs.”

While data from the Mapping Pathways project is still being collected and synthesized, Pickett was able to present snapshots from South Africa, the US, and India; including interesting quotes from stakeholders; and general, country-specific perceptions and trends emerging from the surveys and in-depth stakeholder interviews. 

Much to Pickett’s delight, the presentation was enthusiastically received, with the Canadian stakeholders keen to go ahead and create a Canadian version of the Mapping Pathways project. “We haven’t even synthesized the data completely as yet and people are already interested in it and how they can make the project their own!”

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.

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[1]  Canada Institute of Health Research Meeting, September 16, 2011

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

2012 International Microbicides Conference Scholarship and Abstract Opportunity!

via International Microbicides Conference Secretariat

Do you need funding to attend M2012?

The M2012 organisers are pleased to announce that scholarships are available to attend the conference in Sydney, Australia. Scholarships will be offered in four categories that each have distinct criteria:

1. Research

2. Community

3. Government Official/ Public Health Policy

4. Media

Click here to find out how to apply for the scholarship.  

For more information please visit the conference website: http://www.microbicides2012.org/.

Do you want to submit an Abstract to the Conference?
The 2012 International Microbicides Conference (M2012) invites papers of high quality in the areas of HIV prevention, with a particular focus on microbicides, oral chemoprophylaxis, and their interface with other prevention strategies. The conference is interdisciplinary, and encourages the full involvement of communities and individuals affected by HIV. Abstract submissions will be reviewed by the Scientific Program Committee for content, presentation, timeliness, and current interest of the topic to M2012 participants. Abstracts are welcomed from researchers, program implementers, policy makers, advocates, and community members, and will be considered for inclusion provided they meet the guidelines below.

Please click here to view the abstract submission guidelines. See below to upload your submission.

DEADLINE FOR ABSTRACT SUBMISSION
Authors should submit abstracts no later than 5pm AEST time on Thursday 17 November 2011.

GUIDELINES FOR SUBMISSION
Abstracts should be submitted via the online submission form. You should first log into your account on the M2012 Delegate Portal to submit an abstract. The delegate portal will be available this week.

If you are a new user please click the 'CREATE A NEW ACCOUNT LINK' at the bottom of the log in page.
If you previously created an account, but forgot your user ID and / or password, please select the link 'FORGOT PASSWORD' on the log in page.

Applicants should complete name, address and other details on the online form, and then upload the abstract as a WORD document. You can exit at any time and log back in to edit your submission prior to the deadline. Please carefully review the abstract prior to its submission. Please do not enter multiple submissions of the same abstract with incremental changes.
Step-by-step instructions are incorporated into the online abstract submission form; however, if you require assistance, or have any questions or concerns about the abstract program or submission process, please contact us. Please send an e-mail to the conference organisers at info@microbicides2012.org

Please click here to upload your abtsract through the delegate portal.

NOTIFICATION AND CORRESPONDENCE
Upon submission of your abstract via the online form, you will receive an acknowledgement within approximately 5 working days at the e-mail address you provide. Please retain this information for your records as verification of receipt. If you do not receive an acknowledgement within approximately 5 working days after submission of your abstract, please contact us. Please send an e-mail to the conference organisers at info@microbicides2012.org
Abstract dispositions will be e-mailed to the submitter of the abstract after 16 January 2012.  It is the responsibility of the primary author to inform co-authors about an abstract's disposition.

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

On the Ground with Brian Kanyemba: A snapshot of advocacy in Africa

It’s one thing to read about HIV advocacy and prevention and another to experience it first-hand, on the ground, day to day. That’s how Brian Kanyemba experiences it. He is the research assistant at the Desmond Tutu HIV Foundation, a Mapping Pathways partner organization. A core part of Brian’s job involves traveling through South Africa’s villages and cities, talking to people about issues surrounding men who have sex with men (MSM), and what the prevalence of HIV means within this group of people. Of late, his focus has been on putting forward the “meaningfulness of Pre-Exposure Prophylaxis (PrEP)” within the South African context, especially for the MSM community. This is no easy task.

Let’s talk about sex
“South Africa is a really interesting and dynamic place,” says Brian. “We might have gay rights and rights access of services across all sexual orientations, but when you start to talk about MSM, or about PrEP as an intervention among MSM, this is faced by a huge mental wall.” This wall extends to talking about rectal microbocides as well, mostly due to the taboo against anal sex. Currently in development, rectal microbocides, or “topical PrEP”, are ARV-based products that might reduce the risk of HIV infection when used topically in the rectum during anal intercourse. These are in phase II, with an expected phase III to be carried out in Africa and possibly Cape Town (to learn more about rectal microbocides and PrEP click here and here). “No one will come forward to talk about this openly,” says Brian, “because in Africa, anal sex is associated with homosexuality, and homosexuality in Africa is not okay.”

One way Brian goes around this taboo is by using a simple game about sexual pleasure called “Mapping the Body”. While talking to people, he introduces the discussion on rectal microbicides by drawing three images on the board: a simple figure of a man, a woman, and another man. “I say, ‘Guys let’s put stars on areas where one can be sexually stimulated’,” says Brian. “You get amazing ideas from the group. And some people will say to put a star on the anal area, and then from there it is easier to link to PrEP and to introduce rectal microbocides.” By conducting a matter-of-fact discussion focused on pleasure and the body, Brian finds the group is much better able to accept the idea of rectal microbocides as a form of protection.

“Heck no… I am not interested.”
Despite his innovative methods, Brian has run into some pretty big walls where the topic of MSM and PrEP is concerned, especially within the healthcare sector and even the government. At a meeting with a parliament member who represents HIV issues, Brian recalls that when he brought up the topic of MSM and PrEP, she said, “’Oh no, can you please stop there because that doesn’t exist in my frame of mind.’” Says Brian, “This was a woman in the parliament whose job was to discuss issues of HIV. So, I’m talking to her about MSM being a group of people who have a high prevalence of HIV infection and she just says, ‘Heck no, we’re not going to talk about that topic now. I am not interested.’”

Brian clearly remembers his most unexpected encounter with homonegativity – it was at a focus-group PrEP presentation that he conducted in Durban, the third-largest city in South Africa. Recalls Brian, “I put the word MSM on the board, and do you know what one woman participant said? She said, ‘By MSM do you mean men who have sex with men? Yes, they must die; and if not, they must be killed!’” The woman participant who said this was on the community advisory board for one of the major HIV trials in South Africa, which made the statement all the more startling for Brian. “I was so taken aback. I thought, ‘Oh my God, this is where the advocacy has to start from.’”

A personal quest and mission
For Brian, the advocacy began many years ago in Zimbabwe, when he was just 19 and right out of college. He says, “As I was growing up, it was just accepted that being gay is bad. That is one of the reasons I left Zimbabwe, because of the way gay people are treated, are not spoken about.” He vividly remembers the moment that he began on his path as an HIV advocate, “A very close friend of mine was diagnosed with HIV and he was gay and, at the end of the day, he committed suicide. He didn’t understand HIV, he didn’t understand that it’s not a death penalty, he didn’t know that you can access treatment, he didn’t know that ARV treatment and care is available… and so advocacy become a passion, it was so personal to me.”

Despite the intense societal taboo, Brian worked in Zimbabwe on HIV and gay rights issues for almost a decade. His first job was with the National Army, working at the provisional hospitals on HIV and AIDS issues, ARV rollout, and providing counseling services for homosexuals. Says Brian, “I was working in the psychiatric department of the hospital… they realized I was gay, so they sent me to the lunatic asylum!”

Brian’s journey hasn’t been easy, and yet he continues with dedication, enthusiasm and hope. Why? Why not choose an easier job, an easier path? Brian’s response is prompt, “They say in my culture that when a funeral happens next door, you say ‘Ah ok, there is a funeral.’ But when a funeral happens in your house, it becomes a personal issue. When my friend passed away, I thought, ‘Ok, I need to put on my armour and start fighting this war now. I am going to stop this. I am going to stop thinking like a young person, and I am going to fight and go forward fighting for all my friends and for my community.’ It was very early in my life that I decided this, and I am not going to stop.”

Brian is a research assistant with the Desmond Tutu HIV Foundation, a Mapping Pathways partner organization. He is also an advocate fellow with the AIDS Vaccine Advocacy Coalition (AVAC), and is an active member of the International Rectal Microbicide Advocates (IRMA). He has been very involved with IRMA's Project ARM - Africa for Rectal Microbicides, and is an integral member of the Project ARM video working group, which is producing an African-focused video on anal sex and rectal microbicides.

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