Guest Blogger

The Future of Anal Sex

Filed By Guest Blogger | January 04, 2008 2:00 PM | comments

Filed in: Living
Tags: AIDS prevention, condoms, gay men, gay men's health, gay sex, HIV/AIDS, sex education, STDs

[Editor's Note:] This guest post is by Jim Pickett, director of advocacy for AIDS Foundation Chicago. Jim is also chair of the Chicago Crystal Meth Task Force and chair of the International Rectal Microbicide Advocates.

Jim PickettMost of us use lube when we have butt sex, to get the ass nice and slick. Wouldn't it be nice if the lube also had a special ingredient that offered some protection against HIV and other STDs?

For years gay men have been beaten senseless with “use a condom every time,” “no glove no love” and other proclamations about the joy of latex sex and the horrors that befall those who don’t comply.

And, for good reason. Condoms are still the best method we have of protecting ourselves and our boyfriends/lovers/tricks from HIV and other STDs. But, many of us are frankly sick and tired of using condoms and long for the heat and intimacy of sex without a latex barrier.

Some gay men have stopped using condoms or only use them sometimes when we have anal sex. It doesn’t matter if you call it “barebacking,” “raw sex,” or simply “natural sex” about 50% of us are not using condoms consistently.

Cue the finger pointing, gnashing of teeth, screaming and hollering bemoaning the shameful and reckless behavior of them.

Breathe and compose yourself.

We are 26 years into the AIDS epidemic. Why are we satisfied with only one way to protect ourselves and each other from sexual transmission of HIV? There may be another way.

A rectal microbicide could be that very thing - an agent within a lubricant that could provide protection against HIV and maybe other STDs in the absence of condoms. Or it could provide additional protection with condoms. A rectal microbicide could also be delivered via enema, or rectal douche. Quite a few of us who like to be on the receiving end do some sort of cleansing prior to action, so it would be brilliant to include a rectal microbicide in an enema or rectal douche formulation. This agent may create a barrier in the rectum so HIV cannot enter, it may kill the virus outright, or perhaps it would interfere with HIV’s replication process.

None of this is a pipe dream. There are concerted research and development activities happening now considering each of these options.

In early 2007, UCLA launched the first human trial testing a proposed microbicide for rectal safety – the first effort in rectal microbicide research that went beyond the lab and looked at real, live, human booties. Very exciting stuff. I also chair an international network of over 500 advocates and scientists from 38 countries called the International Rectal Microbicide Advocates (IRMA.) Our mission is to support research and development of safe, effective and acceptable rectal microbicides for the men and women who need them. Yes, women. In terms of overall numbers (just in the US) 7x more women engage in anal sex than gay men.

So, these products are for all of us, regardless of gender or sexual orientation. A lot of people are having anal intercourse, and a lot of it is unprotected. The field needs to hear from people like you, and those you fuck. You can start by getting involved with IRMA.


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I think that that's the force driving barebacking whenever we talk about "false consciousness" and "lack of education" around safer sex - people just like sex without condoms better.

But would these substances be as safe as condoms are?

Gay men just need to grow up. The idea that "many of us are frankly sick and tired of using condoms and long for the heat and intimacy of sex without a latex barrier" simply shows the how little we care about our selves and those who have died before us.

A condom does not inhibit the heat and intimacy of sex unless you allow it to. Barebacking is nothing more than a nice marketing term for unsafe sex.

We need to get some self esteem and stop killing each other. (And for the record, I'm 40 years old, live in San Francisco, and have watched most of my original gay friends die over the years.) Back in the ACT-UP days, at least we remembered what using a condom was about ... trying to save our community from total destruction.

Jim, that's awesome. On the female end of things, it would be nice if spermacides could protect against HIV and other STDs as well as pregnancy to give hetero and bi women extra protection, too.

Jim Pickett | January 4, 2008 3:42 PM

A couple of quick replies:

1. Microbicides will likely never be as effective as condomws. We will continue to promote condom use, and talk about microbicides in the context of providing some protection where there is none. The idea is to expand our options. Not all receptive partners have a choice about protection, after all. So, we need vaginal and rectal microbicides, we need pre-exposure prophylaxis, we need a vaccine - we need all kinds of tools for our prevention toolbox. Condoms aren't enough.

2. Not all gay men who have unprotected sex can be categorized as immature or killing each other. If condoms work for you, great. Use them! But we can't expect everyone to want to or be able to use them each and every time. Let's remember, most infections are passed on when the partners don't know their status, or think they are negative. Let's also remember that in long term partnerships, for both gay and straight folks, people are less likely to consistently use a condom each and every time - so providing some other form of protection is a good idea. And not all receptive partners have a choice whether to engage in protected anal intercourse or not - there are a number of factors that can alter the power dynamic and make it difficult or impossible to demand a condom. I believe expanding ways to protect ourselves is exactly a way we can avoid "total destruction."

3. While I focused my post on rectal microbicides for men and women, please be aware that their is a great deal of research and development into safe, effective and acceptable vaginal microbicides. See www.global-campaign.org - the Global Campaign for Microbicides. And there is legislation in the US Congress, led by Senator Barack Obama and Rep Jan Schakowsky, called the Microbicide Development Act which would strengthen our country's efforts in this area.

Jim

Hi all,

I work at The Fenway Insitute in Boston, and would just like to say that I have been a recruiter for various microbicide studies, since I started there 4 years ago. eyebite, women's studies (in the vaginal realm of microbicides) are years ahead of rectal studies, but have recently had some setbacks.

My personal belief is that microbicides should not be seen as the end of condoms. While they may eventually protect against HIV there are plenty of other STDs out there.

I think a mutilpronged approach, using condoms, microbicides, vaccines, and pre-exposure prophylaxis will be the way of the future.

Jim, absolutely anything that might reduce the incidence of infection and seroconversion should be looked at --- and to that extent I commend your efforts. Yet, I believe "eyebite" above has a serious and valid point: Condoms are not about whether we are "having fun" or not, they are about protecting my and my partner's health and life.

A few points:

(1) The GLBT/HIV/AIDS community has done a lousy job at promoting the "female condom" --- a condom that is more loose and, when in position, lies stationary against the rectal interior of the "fuckee" instead of clinging to the skin of the penis of the "fuck-er" --- and thus, the guy doing the fucking experiences sensations almost indistinguishable from no-condom intercourse. I have always thought that the female condom could play a larger role in HIV prevention --- at least the "top" and the "bottom" could take turns sacrificing a small bit of sensation in order to practice protection 100% of the time. The GLBT/HIV/AIDS community needs to do a PR campaign that makes female condoms "fashionable" just as they did early on with regular condoms. (Remember the "Dress for the occasion" poster?)

(2) Any recent dicussion of the "to bareback or not to bareback" issue must include the notion of sero-sorting --- and especially HIV-positives barebacking only with other HIV-positives. Although serosorting is less than ideal (let's face it: even condoms are less than ideal), I do believe that a HIV+ who carefully barebacks only with his HIV+ partners, and wears a condom for his HIV- or HIV-unknown-status partners, is behaving within reasonable guidelines. Clearly the anal anti-virucides and anti-microbicides that this post advocates would be a benefit to HIV+'s who practice serosorting.

(3) In my lexicon, the general term "anal sex" includes rimming, a practice that this post totally ignores. (The term even includes fisting, also ignored.) If one means specifically anal intercourse, then say anal intercourse.

Although rimming does not pose a significant threat of HIV transmission (in the absence of open sores on both parties, such as open mouth lesions getting into contact with open hemorrhoids), it has been labeled by the HIV prevention literature as "unsafe". This deliberate effort at mis-information by HIV prevention groups in the United States, in turn, encourages folks to be confused about the difference between infection vectors for HIV and rectal parasites, which are totally different. The nature of risk in rimming has been totally mis-represented. (Note that HIV literature in Canada and Europe predominantly does not categorize rimming as unsafe vis-a-vis HIV/AIDS.)

(4) One powerful reason that microbicides have not been developed for anal intercourse is this: To invest that sort of corporate effort and resources into anal intercourse would grant social legitimacy to anal intercourse --- and the political right won't stand for that. Unfortunately, many of the political right are also stockholders and investors in the biomedical and pharmaceutical industries, and thus they often have the clout to squash R&D programs that have anything to do specifically with same-gender sexuality and/or anal sexual activity.

(5) There was a period when lubricants such as "WET" included an anti-virucide called nonoxynol-9 (my spelling might not be exact) and for some reason it was discontinued. I believe that some customers complained that the nonoxynol-9 irritated the skin, but I seriously wonder how much that complaint was real and how much was "I don't want to be reminded of HIV while I'm greasing up my tool" mentality. I bring this point up because, if we are dealing with some sort of ostrich mentality here, then any additive that reduces HIV infection will come up against it. Sorry to say that our community is that reality-avoiding and mentally unhealthy, but I am afraid that this phenomenon is large enough that we have to pay attention to it.

AJ ---

Regarding nonoxynol 9 - it was discontinued in lubricants because it was shown to be absolutely unsafe and to exacerbate HIV infection. It was, and is, especially toxic in the rectum - stripping sheets of epithelial cells right off. So, no denial there. Unfortunately, two big condom makers - Trojan and Lifestyles, still insist on putting this ingredient on some of their condoms as a form of pregnancy protection. Absolutely unnecessary and potentially harmful. See this post on our gay men's health blog on N-9 from just a few days ago http://lifelube.blogspot.com/2007/12/n-9-contraceptives-must-carry-warning.html

N-9 should be avoided at all costs. Use condoms by Durex or Johnson and Johnson - which have voluntarily removed N-9 from all their condoms.

As for pharma being interested in microbicide development - not at all. The lion's share of r&d dollars come from the US govt --- about 97% of rectal microbicide comes from the US, most of it at the NIH.

IRMA is releasing a report at the Microbicides 2008 conference in Delhi this February which examines the political, sociocultural, and biological challenges to developing a safe, effective, acceptable rectal microbicide. It also looks closely at scientific activities underway and planned. It will be widely available the end of February online.

Thanks for the notes on language - being clear is a must and I agree.

Jim

A condom does not inhibit the heat and intimacy of sex unless you allow it to. Barebacking is nothing more than a nice marketing term for unsafe sex.

I completely disagree with the 1st sentence, but just as heartily agree with the second.

I wondered what happened to Nonoxynol-9. I remember when it was introduced in the early 90s to great fan fare. Wasn't it basically the same idea?

beergoggles | January 4, 2008 7:01 PM

I remember the old days of N-9 too (when I was still having sex with girls) - it would make my penis break out all red and splotchy with those areas swelling (well in addition to the normal kind of penile swelling). It wasn't a pleasant experience at all.

So glad they have condoms without it now.

Michael Crawford Michael Crawford | January 5, 2008 1:23 AM

Jim,

Thanks so much for writing this great post and helping to spread the word about research into rectal microbicides. It is critical that we give people as many options as possible to reduce their risk of HIV infection. Please keep us up to date on new developments.

From post 6, point 2: " I do believe that a HIV+ who carefully barebacks only with his HIV+ partners, and wears a condom for his HIV- or HIV-unknown-status partners, is behaving within reasonable guidelines. "

It is my understanding that this is unsafe behavior, due to the mutating properties of HIV. Two partners with the same virus can, over time, develop different strains. It is dangerous to suggest that they can have safe sex without condoms.

It is my understanding that this is unsafe behavior, due to the mutating properties of HIV. Two partners with the same virus can, over time, develop different strains. It is dangerous to suggest that they can have safe sex without condoms.

I understand the argument --- but even some doctors agree that it is merely speculative, and that there is no reliable scientific evidence to support it.

I'm not saying this theory is wrong --- I'm merely saying it is theoretical and unproven. You certainly have a right to your viewpoint.

Finally, if both HIV+ partners are on anti-HIV med cocktails, then the viral replication rate might be extrememly low or undetectable --- making mutation issues even less likely.

I agree that it is dangerous to advocate as established fact that they can bareback safely --- the other side of the coin is equally unproven and should be equally pointed out --- but to ban that it even be suggested rules out a scientific discussion that merits our attention.

P.S. Thank you, Jim, for supplying the whole story on nonoxynol-9 ... apparently I wasn't the only one who missed the final chapter in that saga.

I'm certain you'll delete this comment since people like you are pretty much unwilling to hear from the other side in your desparate search to pleasure yourselves and find excuses for your behavior. Your practices of unsafe sex threaten all Americans, not only with vile diseases but with skyrocketing health insurance costs.

I write more about it here: http://incogman.wordpress.com/

Let's see you put up this comment. I won't hold my breath. America is waking up and you'd better start thinking about it.

Hey IM,

Speaking as the editor who approved your comment, let me say that you're obviously wrong...again.

To the point of whether different strains of HIV can be transmitted between POZ people - yes, we don't have much evidence to this, and most of what we know is theoretical. I think the bigger issue here is an individual's level of comfort with risk. It is odd to me that many of us rhetorically do not accept risk when it comes to sexual behaviors, yet take all kinds of risks in the rest of our lives. How about driving? Pretty dangerous stuff. Yet no matter how many people get maimed and killed due to the fact they were driving a car, I have yet to hear a call for abstinence. We all need to inform ourselves, avoid substances that cloud our judgment, and make decisions based on what we know and what we are comfortable with. My comfort level may be different than yours - but I would hope we both make our decisions with good, sound information, that we are not inebriated and unable to use that sound information wisely, and that we are all able to stand by each other's decisions made in such a context- whether we agree with them or not.
Jim

More on resistance - this is a link to an article published in AIDS today...

http://lifelube.blogspot.com/2008/01/dutch-find-no-evidence-of.html

Hey IM,

Speaking as the editor who approved your comment, let me say that you're obviously wrong...again.

No, I'm right. You just put up my comment. Now, we have ASA300 coming out of the Gay community of Castro street.

Thank you Gays!

www.incogman.wordpress.com

Damn, you're consistent, if nothing else. Not only am I not from Castro St., I've never even been to San Francisco. I live in New Jersey. In fact, as far as I know, none of the current editorial staff lives there.

Wrong again, care to go for the big prize?

Damn, you're consistent, if nothing else. Not only am I not from Castro St., I've never even been to San Francisco. I live in New Jersey. In fact, as far as I know, none of the current editorial staff lives there.

Wrong again, care to go for the big prize?

Oh yeah, I'm consistent and, like many Americans, mighty disgusted with the behavior celebrated here. This MRSA 300 coming out of San Fran, results in some pretty nasty tissue destruction. And you folks seem more concerned with your pleasuring yourselves than any concerns of the rest of America. Asstounding!

So what's the BIG prize? A "fisting" dildo or a blind date with one of your lovely readers? No, thanks, I'd rather not.

You'll never put this comment up -- since you know my gripes are legit.
http://incogman.wordpress.com/

Now, a new variant of that strain, resistant to six major kinds of antibiotics, is spreading among gay men in San Francisco, Boston, New York and Los Angeles.

City doctors first spotted the original USA300 during tests for patients treated at a walk-in clinic for skin infections in 2001. Since then, they have watched it morph from laboratory curiosity into the dominant form of staph infection in much of the United States.
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/01/15/MNUKUDB6D.DTL


Think you'll find a "miricle lotion" to protect against this? Think again. This information is now starting to be discussed among Heteros out among the "fly-over" people. Americans are sick of this and no longer will Gays be so fashionable. Tough to hear that one!

http://incogman.wordpress.com/

From LifeLube's post on MRSA, via the folks at aidsmap:

But gay men and people with HIV aren’t the only groups affected by community-acquired MRSA.

Heterosexual transmission has been reported.

What’s more, there’s good evidence that the infection occurs more frequently in groups the media often likes to praise – such as athletes and military personnel.

And a lot of what was said about the new strain of MRSA was misleading or inaccurate.

It isn’t the “new HIV.”

MRSA (Methicillin-resistant Staphylococcus aureus) can cause very unpleasant symptoms, such as skin boils, and can in extreme cases cause a fatal form of pneumonia, but there are, in fact, antibiotics that can cure it.

Simple washing with soap and water after close physical contact (even after sex between men!) is enough to prevent infection in most cases.

And although the infection occurred more frequently in gay men in an area of San Francisco, it occurs in the general population.

It is important that people are told about potential health concerns. But the information provided needs to be accurate and measured. Much of the reporting in this case was alarmist and homophobic. And the wording of the press release that went out to the media wasn’t helpful, a reminder to investigators and publicity departments of the importance of sticking to the facts and avoiding sensation when presenting findings to the media and public.

More on this, including fact sheets from the NY State Dept of Health and the CDC, are here

http://lifelube.blogspot.com/2008/01/shock-horror-superbug-fears-greatly.html


Wolfgang E. B. | May 22, 2008 5:31 PM

How about reducing promiscuity and increasing STD testing? When two guys who are both STD-free have sex, they can do so safely without a condom, no?

Call me conservative if you want, but it seems to me that encouraging monogamous relationships and discouraging promiscuity throughout the GLBT community would go a long way toward reducing AIDS and other STD transmission, as well as improving our political standing.

First of all - we need new tools for prevention. Monongamy and regular testing are certainly strategies - however, monogamy tends to have a higher failure rate than condoms. Among women around the world, the top risk factor for acquiring HIV is, in fact, marriage.

Also, the notion that "promiscuity" is what is causing the spread of HIV is faulty. We know from the research of the CDC's Greg Millet that risk behaviors among gay black men are actually lower than those of gay men of other races - yet they have the highest HIV prevalence - as much as 50% of gay black men in the US are HIV+. So, reducing "promiscuity" will not fix the problem - much of which is about lack of access to healthcare.

We need prevention based on science - not ideology. So, we need all kinds of tools like microbicides, vaccines, oral prevention, and other methods such as condoms, regular STD testing and treatment.