The International Rectal Microbicide Advocates (IRMA) recently released a study examining the effect of lubricants on rectal tissue. They ran an internet-based survey in six languages, receiving 8,945 responses highlighting behaviors and attitudes around anal intercourse, condom use, lube use, as well as acceptability of rectal microbicides if they were on the market.
IRMA shares that lubricants, as well as anal sex, enemas, and douching cause some level of inflammation in the rectum, most of which occurs naturally and repairs itself within minutes or hours.
Knowing this, IRMA builds off existing science to better examine levels of inflammation and damage that are a result of AI alone, without lubes, and with lubes.
- Many water-based lubes (such as Astroglide, ID, KY Jelly, and Elbow Grease) are hyperosmolar, meaning they have a higher concentration of soluble components than normal cells in the body, "sucking" away water from inside vaginal/rectal cells, making them shrink in size. A question for IRMA is whether or not this damage is a factor relating to HIV infection risk.
Out of the 41 lubricants examined,
- Most of the lubricants were found to be hyperosmolar.
- KY Jelly, ID Glide, Elbow Grease, and Astroglide are similarly toxic for cells, cell lines, and tissues, with Astroglide being the most toxic.
- PRE and Wet Platinum appear to cause the least damage.
- None of the lubricants have show any significant activity against HIV-1.
- Four Astriglide lubricants actually significantly enhanced HIV-1 replication in vitro.
While water-based lubes don't look great, there are questions of how this translates into real-world use and real-world risk, where factors such as timing, frequency, saliva, accessibility, and condom/lubricant regulation all come into play. There is also the question of IRMA advocating for anal sex without lubricant, which would be painful and unrealistic, so they hope to find out which are the safest.
Bottom line: more research is urgently needed to explore if there is a link between lube use and acquiring HIV and/or rectal STI's.
In the meantime, IRMA reiterates that "using male or female condoms is still considered the best way to prevent acquiring HIV and STIs during AI. In addition, the use of condom-compatible lubes has been associated with a decreased risk of condoms breaking or slipping."
These studies will inevitably inform the development of rectal microbicides, a cream or gel (or potentially a douche or an enema) that could be inserted vaginally or rectally and used to reduce a person's risk of HIV infection. IRMA chair Jim Pickett shared with Bilerico in 2008 that rectal microbicides represent a viable option when condoms fail or when their use cannot be easily negotiated.
For more information on the study, check out IRMA's May 18 presentation. Here is a link to their slides.