Microbicides and HIV Prevention
Safer sex -- the use of a condom each time people engage in sexual intercourse -- may be the most prudent way to protect oneself from sexually transmitted diseases. But more gay men are tossing caution to the wind in their desire to connect with their partner, skin-to-skin. That's why the information shared and questions raised at a recent panel discussion and forum in Chicago on microbicides is of such great importance. The event was sponsored by the Hearts Foundation, AIDS Foundation of Chicago and Steamworks.
About 40 mostly gay men joined program planner and moderator Jim Pickett (Positively Aware columnist and also of The Faces of AIDS project, among other projects), along with panelists Dr. Eric Christoff (Hearts Foundation), Thomas Dunning (Howard Brown Health Center), Frank Oldham (Horizons) and Grisel Robles (AIDS Foundation Chicago).
"The idea of holding this discussion came to me as I was looking at the strides women have made in the microbicides movement," Pickett said. "I felt it was time we as gay men became involved in the conversation and began using our own creativity and energy. A lot of gay men haven't heard much about it but when they do, they become excited about the possibilities. Microbicides will offer another option for prevention and that's important as so many men are forgoing the regular use of condoms. We need other tools that can be used to protect ourselves and our partners."
A microbicide is a chemical agent that kills a microbe -- any infectious agent such as gonorrhea, syphilis or HIV. And while there are some 60 compounds under investigation for use as possible microbicides, research and development efforts are at this point targeting the product for use by women, for the vagina -- primarily serving as a contraceptive tool. And while that's good news for women, discussion about and research aimed at developing an anal microbicide is much farther away.
"The push for microbicides is not a gay or heterosexual issue -- it's important for all of us," Pickett said. "Anal sex isn't something in which only gay men engage. But we [gay men] need to especially weigh in and say 'we want rectal microbicides.' This forum is the first step. But gay men need a greater consciousness because with microbicides comes the potential for us to have safer sexual lives."
Robles likened the importance of the discussion to the steps taken when a new film is about to be released: "We have to begin now with promotional efforts so when the product is ready for public use, people will know about them and how to use them more effectively. It's all about increasing public awareness and then motivating voters to contact elected officials demanding more dollars for research and development. We want to prepare people for the day when they'll be able to go to the corner store for a few groceries and the microbicide of their choice."
Robles said interest in both vaginal and rectal microbicides has increased as the rate of HIV/AIDS infection, particularly among African-American women, continues to rise.
"We have to be creative in the [microbicide] movement prevention strategies," she said. "Usually the leading pharmaceuticals provide funding for new drug development, but not in this case. Most of the dollars at this point are coming from smaller biotech companies and private donors. Even after first hearing about the potential of microbicides almost eight years ago, we still are only in the first phase of the three required by the federal Food and Drug Administration (FDA)." All new drugs intended for specific therapeutic indications must first undergo three steps: pre-clinical research and development, clinical trials that study the efficacy and safety of the drug in humans and permission to market the drug -- a process that in the three stages can take up to 12 years. And, even after a new drug is released on the market, the FDA continues to monitor the drug for adverse or toxic reactions which may take several years for negative effects to manifest and be discovered. Robles said that Pickett was the real push behind the forum, but now it's time for other gay men to share their views and concerns -- to become vocal and active.
"Microbicides are already being discussed to help women -- now the same message regarding the potential effects and appropriate use for gay men need to take place," Robles said. "The reality is that rectal microbicides will benefit not just the MSM population [men who have sex with men] but heterosexual couples as well. But the process is going too slow. There are only two rectal microbicides in phase one trials -- none in phase two or three."
Dr. Christoff said the failure of nonoxynol-9 (N-9) for rectal use is instructive. "N-9 is all there was and basically still is on the market," he said. "It's been used by women as a spermicide to prevent pregnancy for decades, and some gay men have sought out lubricants containing N-9 in the hope that it might add some protection against HIV. But it was never tested in the rectum. Now subsequent research indicates that N-9 can irritate tissue in the vagina and even increase the risk of contracting HIV. Furthermore, the vaginal and rectal walls are two very different environments -- too different to assume that drugs developed for one may be appropriate for the other." Christoff added that due to the large number of volunteers needed when rectal microbicides reach the clinical trial stage, serious questions of efficacy will certainly arise.
"Not only will we need a huge at-risk population, but some patients will become infected with HIV and other STDs in the testing process," he said.
Oldham expressed his anger at the delay of making microbicides available on the open market, in light of the knowledge that the discussions about these chemical agents first took place in 1994. "We are in a cultural war and it's the oppression of gay men that has prevented the development of not only microbicides but other medications," he said. "It is estimated that a million gay men have already died of AIDS since the first detected cases. How many of those lives could have been saved if microbicides were available as an added measure of prevention? We are all in danger because our lives are not valued. We must demand that this product be moved along in the FDA's established process."
Oldham added that while some view developing rectal microbicides as a stamp of gay sexuality, he said it remains our right -- but one for which we must continue to fight.
"Sexuality for gay men is a culture," he said. "Not only are we fighting to protect our very lives, but we are also fighting for our institutions, like Steamworks [a local bathhouse]. We have the right to follow any lifestyle we desire and to live our lives as we choose. Microbicides are important in that effort."
Dunning agreed with Oldham, saying that homophobia and homo-hatred remain deeply rooted in society and that with the recent shifts in public interests, gay men must make their voices heard. "Hetero-supremacy is just like white supremacy -- both are ideas that say we value one portion of society over another," he said. "But our [gay men's] lives are just as valuable as those who are straight. Our community is not being decimated because of blow jobs -- it's because of HIV/AIDS passed on through anal sex. But people don't want to talk about that. I guess you could say we're lucky here in Chicago because we have access to information and products that help improve the quality of our lives, but what about gay men in rural Nebraska? We know it's still very early in the development of rectal microbicides, but we are only a year or two away from vaginal microbicides. Gay men need to not only give women our support, but we need to demand that research and development be stepped up addressing our specific health needs."
At the conclusion of the forum and panel discussion, sample cards were distributed addressed to [Illinois] U.S. Senators Richard Durbin and Peter Fitzgerald. Participants were urged to write them and other politicians expressing their views.
"We're going to need to be ready for the November elections [for governor] and make sure that the candidate who supports our community's needs is elected," Robles said. "But in terms of rectal microbicides, this is going to be a long battle. And just like women have persevered since '94, men must get active now and be ready for the long haul."
Provided courtesy of Windy City Times, August 28, 2002. Visit www.WindyCityTimes.com.