International Rectal Microbicide Advocates tries to clear the air on Microbicides studies

There has been a TON of press in the last few days stemming from the Microbicides 2010 conference regarding two new studies on the safety of lubricants used for anal sex.

Below is an excellent, non-hyperbolic story from Gus Cairns over at AIDSmap, and below that, IRMA’s press release plus the audio recording of the press conference where this information was presented to the media.

Following that is a note from Marc-André LeBlanc:
IRMA Steering Committee Member and Chief Lubricant Safety Expert

Next is a synopsis from our new report regarding IRMA priorities and activities regarding lube safety, and finally, a selection of the media coverage on this topic.

Researchers Charlene Dezzutti and Pamina Gorbach at M2010 the press conference

Rectal lubricants may enhance the risk of STIs – Aidsmap

IRMA Press Release – Research on lubricant safety very past due

M2010 press conference on lubricants and rectal sex – audio recording courtesy of Bobby Ramakant

JUST ADDED 4:21 Central Time 5/27: Some Sexual Lubricants Linked to Increased Risk for Chlamydia, Gonorrhea, by Bob Roehr on Medscape – another good article

Dear IRMA members,

Imagine our excitement to see such an explosion of interest in lube safety!

As many of you know, this has been a core objective of IRMA’s work for 5 years, and one of the reasons we formed at all. The whole idea behind the huge survey we launched in 2007 was to obtain data that would allow the field of lube safety research to move forward. We published the results of the survey — to our knowledge the world’s largest survey on anal sex and lubes with nearly 9,000 partiicpants in over 100 countries — in our 2008 report Less Silence, More Science. And we are thrilled to report that the results have just been accepted for publication in a peer reviewed journal and should be available very soon. Watch this space!

We will send out a notice for an IRMA call very soon, where we will provide an overview of the studies announced at M2010 this week, provide background on research done so far, and discuss plan for future research. This will also provide all of us with an opportunity to discuss messaging in relation to rectal safety of lubes.

In the meantime, we will continue to share information as it becomes available. For instance, you can check IRMA’s lovely new report From Promise to Product for some background information — including section 2.11 for some background information on testing of lubes, and section 4.4 for a description of IRMA’s work in this area. The two sections are copied below for your reference.

It is truly wonderful to be poised for true progress on this critical issue and we welcome everyone’s thoughts and efforts!

Sincerely,

Marc-André LeBlanc
IRMA Steering Committee Member and Chief Lubricant Safety Expert

 
Excerpts from report

What do we know about the rectal safety of sexual lubricants?

In addition to the studies released at M2010, a few others have assessed the relative safety of sexual lubricants, though not always looking at rectal safety specifically. These studies looked at:

    * Using in vitro and mouse assays to determine cellular toxicity, increased risk of HSV-2 infection, and epithelial sloughing caused by lubricants
    * Testing the osmolarity of lubricants
    * Using slug mucosal irritation assays to evaluate mucosal irritation caused by lubricants

The question remains: what do all of these studies tell us? We’re not sure. We still don’t know what assays should be used to determine the rectal safety of lubricants. Furthermore, even when studies find a wide range of values for their safety markers, we still don’t know to what extent—if any—some of these markers might indicate a higher risk of HIV transmission.

Relatively high levels of cellular toxicity, mucosal irritation, cell damage caused by hyperosmolar or hypo-osmolar products, inflammation, or epithelial sloughing could in theory increase the risk of HIV infection. However, this remains to be proven. 

It is important to keep in mind that:

    * Some level of inflammation and irritation occurs naturally in rectal mucosa, even among healthy individuals;
    * Anal intercourse itself, as well as enemas and douching, causes some transient damage; and
    * Rectal epithelium regenerates quickly after minor damage or sloughing.

We must be able to compare normal levels of inflammation, irritation, cell damage and epithelial sloughing that occur among healthy individuals and those that are a result of AI. The question then becomes: does AI with lubes cause increased levels, similar levels, or lower levels of these markers compared to AI without lubes? Even if we were to find that some lubes cause higher levels of disruption, we would still need to investigate whether this translates into a higher risk for HIV transmission.

These questions remain to be answered, and we are still left with little data that can be translated into useful information that the public can use to make choices about lubricants. One thing to consider: if lubricants increase the use of condoms, that is probably a more important factor in preventing HIV transmission than any potential risk from lubes. For the moment, the use of lubes compatible with condoms is still considered to be an important risk-reduction tool for rectal transmission of HIV, and is likely to remain so. One day we may have valuable information on the relative safety of different lubricants, allowing users to make better informed decisions about which products they use.

IRMA’s advocacy on the safety of lubricants used for anal sex

Many men and women use sexual lubricants during AI, yet we know very little about the relative safety of these lubes. Obtaining safety data on products used as sexual lubricants for anal sex would be valuable for public health reasons.

Accordingly, IRMA prioritises advocacy for data collection on the rectal safety of lubricants. Wholly absent in current HIV prevention activities, a translation of this type of data into useful information for users, funders, programme directors, and policy makers would be of significant benefit to the field. Lessons learned in this undertaking will also provide valuable insights into message development on the safety and efficacy of vaginal and rectal microbicides, when these products become available.

Due to the paucity of this type of information, IRMA launched a global web-based survey in 2007 (see an overview of the results from this survey in IRMA’s previous report: Less Silence, More Science: Advocacy to Make Rectal Microbicides a Reality). The survey provided valuable information on lube use, preferences, and acceptability among nearly 9,000 men and women from over 100 countries, establishing a prioritised list of the most widely-used lubes to test for rectal safety.

A working group comprised of advocates and researchers was convened by IRMA to discuss the feasibility of testing sexual lubricants for rectal safety. While the working group identified significant scientific challenges that remain unaddressed to this day, there has been some progress.

IRMA’s action on lubricant safety includes the following activities:

    * Encouraging researchers to test lubes for rectal safety and to share their findings;
    * Facilitating dialogue among leading researchers and advocates within the working group on rectal safety of lubricants;
    * Compiling articles and studies related to lube safety, particularly for rectal use, and maintaining an updated background document on this issue;
    * Making IRMA’s list of most widely-used lubes available to anyone interested in testing lubes; and
    * Keeping IRMA membership updated on developments in this area.

Here is just a SAMPLE of some of the news stories 
generated on this issue in the last day.

 

  1. Use of lubricants with anal sex could increase risk of HIV – Physorg.com
  2. Lubricant Use May Raise HIV Infection Risk During Anal Sex – MSN
  3. Risk of sexually transmitted disease three times higher when lubricant used with anal sex – Times LIVe Blog (South Africa)
  4. Use of lubricants with anal sex could increase risk of HIV – Armenian Medical Network
  5. Use of lubricants with anal sex could increase risk of HIV – Science Blog
  6. Unprotected anal sex ups HIV risk 20-fold – Thaindian News
  7. So Now Anal Lube Increases Your Risk of Getting HIV? – Queerty
  8. Lubricants for Anal Sex May Increase Risk of HIV, STIs – POZ
  9. Lubricant Use May Raise HIV Infection Risk During Anal Sex – U.s. News and World Report
  10. Lubricant Use May Raise HIV Infection Risk During Anal Sex – Bloomberg Business Week
  11. Unprotected anal sex ups HIV risk 20-fold – Sify News
  12. Currently Available Lubricants Used For Anal Sex May Actually Make It Easier For HIV To Be Transmitted – Medical News Today
  13. Lubricants may increase disease risk of anal sex, studies show – Los Angeles Times
  14. Lube May Make Anal Sex More Risky – Gawker
  15. Use of lubricants with anal sex could increase risk of HIV – HIV Atlas
  16. Use of Lubricants With Anal Sex Could Increase Risk of HIV – Science Daily
  17. IRMA: Research on lubricant safety very past due – Physorg.com
  18. Lubricant Use May Raise HIV Infection Risk During Anal Sex – Yahoo News
  19. Use of lubricants with anal sex could increase risk of HIV – e!Science News
  20. Lubricant Use May Raise HIV Infection Risk During Anal Sex – MedicineNet.com
  21. Why it is important to give that lubricant a second look – Africa Science News Service
  22. Anal sex studies from Microbicides conference show increased HIV transmission risk with some lubes  – Examiner.com
  23. Lubricant use with anal sex may raise HIV risk – DNA India
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Portugal’s president reluctantly approves gay marriage law

Portugal is the sixth country in Europe to legalise gay marriage after its president approved legislation.

The Catholic country’s parliament passed a bill allowing gay couples to wed in January and it was ratified by President Anibal Cavaco Silva yesterday.

The law was passed just three days after Pope Benedict XVI finished a visit to Portugal. He had warned his followers that allowing gay marriage was a “dangerous threat to the common good”.

The new legislation removes any references to gender in the country’s marriage laws. However, it does not allow gay couples to adopt children.

Although centre-right parties opposed the change, all left-wing parties supported it.

Mr Silva said in a televised address he regretted the fact that political parties had been unable to reach a compromise on the issue.

He said he did not veto the law, as the country has other pressing issue such as unemployment and debt to deal with and parliament has the power to override him.

He said: “I feel I should not contribute to a pointless extension of this debate, which would only serve to deepen the divisions between the Portuguese and divert the attention of politicians away from the grave problems affecting us.”

Mr Silva would not answer questions on his own views but added he was setting aside his “personal convictions”.

Five other European countries allow gay marriage: Spain, Belgium, the Netherlands, Norway and Sweden.

Some others allow civil partnerships. In the UK, these grant all the rights of marriage although some argue that “separate but equal” is not good enough. Straight couples cannot have a civil partnership.

France has PACS, or pacte civil de solidarité, which are open to both straight and gay couples

UNAIDS sponsored IDAHO activity scenes from New Kingston

Emancipation Park today International Day Against Homophobia and Transphobia was the scene of the above captured scenes to mark the day. The participants mostly Jamaicans on the face of it had several foreigners as well as indicated in the press release from JFLAG seen below.

Many of the ordinary Gay Jamaicans never even knew of this planned action and would have wanted to attend, this is symptomatic of the kind of classist internally bigotted way of advocacy a constant complaint echoed over and over again by folks who want to participate. This doesn’t auger well for trust in them.
Just a select few excluding the voices of others and then asking the public to be tolerant of homosexuality is at best hypocritical to those who have some inside knowledge. We do hope that the JFLAG website will reflect the images and the new press release as the old one still stands on their page.
Anyway Happy IDAHO DAY!!!!
Celebrate yourselves
Peace and tolerance
H

Exposure to HIV-1 Directly Impairs Mucosal Epithelial Barrier Integrity Allowing Microbial Translocation

Introduction Top

The mucosa presents a primary barrier against a multitude of micro-organisms present on the mucosal surfaces of the human body [1]. The intestinal and upper reproductive tract are lined by a continuous monolayer of columnar epithelial cells that is responsible for maintaining the physical and functional barrier to harmful microorganisms, such as bacteria and their products, including bacterial toxins as well as commensal organisms [2][4]. The preservation of the barrier function is dependent on the intactness of apical plasma membrane on the epithelial cells as well as the intercellular tight junctions. The disruption of the tight junctions can cause increased permeability, leading to “leakiness” such that normally excluded molecules can cross the mucosal epithelium by paracellular permeation, and could lead to inflammatory conditions in the mucosa.

Various pathogenic organisms have developed strategies to either infect or traverse through the epithelial cells at mucosal surfaces, as part of the strategy to establish infection in the host. In fact, mucosal transmission account for majority of infections in humans [5]. Viruses such as rotavirus and astrovirus as well as bacteria such as enteropathogenic E. Coli and C. difficile are known to increase intestinal permeability by disrupting tight junctions, as part of their pathogenesis [6][9]. Increased permeability is also related to a number of other disease conditions that may or may not be related to infection by a pathogen. Crohn’s disease, a chronic inflammatory condition of the intestines is characterized by defective tight junction barrier functions, manifested by increased intestinal permeability, although the etiology of the disease is not clearly understood [10].

HIV-1 infection is initiated primarily on mucosal surfaces, through heterosexual or homosexual transmission [1],[11]. In fact, mucosal transmission accounts for greater than 90% of HIV infection [12],[13]. A number of clinical studies have reported intestinal barrier dysfunction, especially during chronic stage of HIV infection [14][19]. However, the pathophysiologic mechanism associated with compromised barrier function and whether HIV-1 plays a direct role in this is still unclear. Currently, epithelial barrier defect during HIV-1 infection is thought to be a consequence of mucosal T cell activation following infection, which could lead to increased production of inflammatory cytokines [19],[20]. The intestinal barrier dysfunction has also been implicated as the cause of systemic immune activation during chronic phase of HIV infection, although a recent study has raised the possibility that this may not be universal phenomenon [20],[21]. Studies that have demonstrated immune activation propose this to be the main driving force for progressive immune failure leading to the immunodeficiency stage [22][24]. In these studies, HIV disease progression was shown to correlate with increased circulating level of LPS, considered an indicator of microbial translocation, in chronic HIV-infected individuals [25]. Interestingly, immune activation was observed in both the chronic as well as acute phase of HIV infection [25]. The source of or mechanism whereby microbial products could cross the epithelial barrier leading to immune activation have not been elucidated thus far.

In the present study, we investigated the direct effects of HIV-1 exposure on intestinal and genital mucosal epithelia, where primary HIV-1 infection is frequently initiated. We show that in fact the impairment of epithelial barrier function can be a direct result of exposure to HIV-1. Using ex-vivo cultures of pure primary genital epithelium as well as an intestinal epithelial cell line, we show significantly decreased barrier functions and enhanced permeability that is not unique to the intestinal epithelium; similar increase in permeability was seen in the genital epithelium as well. Small amounts of both bacterial and viral translocation were seen following HIV-1 exposure. The mechanism appears to be mediated by increased production of inflammatory cytokines directly from the epithelial cells following exposure to HIV-1, including TNF-alpha, known to disrupt barrier functions. Further, we show that HIV-1 envelope protein gp120 was able to impair barrier functions in epithelial cells on its own. Neutralization of gp120 or exposure to HIV-1 lacking gp160 surface envelope glycoprotein did not have any effect on epithelial cells. These results provide strong evidence that exposure to HIV-1 may lead to impairment in barrier function of mucosal epithelium which could result both in translocation of HIV-1 and/or luminal bacteria that could serve as the source of immune activation during HIV-1 infection.

REST OF THE STUDY HERE

Guard against the tyranny of the majority

The Editor, Sir:

At a recent Jamaicans for Justice (JFJ) public forum on the proposed Charter of Rights and Freedoms, David Wong Ken, attorney-at-law, reminded the audience that human rights were not gifts of the State but were the birthright of every individual.

The State should, therefore, only seek to limit these rights if there is an overwhelming state interest, as this protects minority groups from the ‘tyranny of the majority’. These rights and freedoms of course include privacy, freedom of speech and respect for bodily integrity.

In most democratic societies, it is the courts which determine the validity of laws limiting human rights. This is the basis of the doctrine of separation of powers.

Yet, in response to why sexual orientation was excluded from the grounds of non-discrimination in the charter, Senator Dorothy Lightbourne, minister of justice and attorney general, emphasised views expressed on radio talk-show programmes and submissions by the powerful lobby Lawyers Christian Fellowship. By the same token, all laws regarding sexual offences, ‘obscene publications’ and abortion have been permanently saved from judicial review under the new charter.

LACK OF LEADERSHIP

This action by the Government betrays a glaring lack of leadership on the matter of human rights, despite our international obligations, as found in OAS Resolutions 2435 and 2504 on Human Rights, Sexual Orientation and Gender Identity. There is also clear contempt for our courts, a complete disregard for the doctrine of separation of powers, and the supreme arrogance of the Lawyers Christian Fellowship that they will always know better than judges regarding what is best for Jamaican society, even in an evolving democracy when they are long dead and gone.

The charter presents a unique opportunity for Jamaica to forge a new path of human-rights recognition for all its citizens, as well as a new sense of respect for the rule of law. Instead, this wonderful experiment has been hijacked by a narrow-minded set of persons who have a perverse preoccupation with what consenting adults do in the privacy of their bedrooms.

I am, etc.,

MAURICE TOMLINSON

maurice_tomlinson@yahoo.com

Montego Bay PO #2

St James