Transcript Hyperosmolar Lubricant Study in Cape Town Kevin Rebe Anova Health Institute Cape Town, South Africa.

Hyperosmolar Lubricant Study in Cape Town
Kevin Rebe
Anova Health Institute
Cape Town, South Africa
HIV Prevention for MSM
Lubricant is part of the HIV prevention toolkit but:
Lubricant safety not adequately studied
Without evidence, safety cannot be assessed by suppliers or end
users of lubricant products
Condoms… and Lube! in South Africa
• The (no-) Choice condom
• Lubricants were not part of state
program but now have been included in
comprehensive HIV prevention for key
populations
• Public health recommendations are
being made regarding lubricant in the
absence of complete safety information
and regulation
• Heteronormative messaging persists
Heteronormative: Regarding heterosexual sex as
normal and all other sexual activity as “abnormal”
Heteronormative Messaging
Non-heteronormative: Regard all consensual sex
as normal without moral judgment
Why do a lube study in Cape Town
• No regional data!
• Little or no regional awareness of lubricant
safety issues
• More NGO’s are active now in MSM health
care provision including condom and lube
provision  Creating demand
• No general health provider knowledge of
types of lube and clinical issues
Why do a lube study in Cape Town?
• Want accessible information in a highly-read
locally accessible (free) journal which most
junior health providers in state health centers
will read!
• Need to raise osmolality issue for:
– NGO tenders
– DOH tenders
– End users
Osmolality not required
Rectal toxicity results not required
What Did We Do?
• Lube procured from Adult World
– Largest sex shop franchise in South Africa
– City-based store
– High MSM traffic, including on-site video booths
– Sex-on-site cubicles
– Best selling brands of lube
Attempted to ensure we assayed
lubricants most commonly purchased by
MSM rather than heterosexual clients
What Did We Do?
University of Cape Town
Division of Chemical Pathology
Screened for Osmolality and
Glycerol
What Did We Do?
Analyzed common food-based lubricant substitutes:
What is Osmolality?
Hyper-osmolar – Draws water in and
dehydrates the surroundings
Hypo-osmolar – Water is drawn out and
swells the surroundings
Lube Study Results
Sexual Lube Product
Osmolality
(mosmol/l)
Glycerol (mmol/l)
JO H2O Water Based™
New H2O Tangerine Dream™
Wet Stuff Vitamin E™
Lube Original Personal Lubricant™
Assegai™
K-Y Jelly™
Health4men™
Leather Personal Lubricant™
Plain low fat yoghurt
Egg white
9440
9340
7100
5270
4630
2430
1480
270
428
276
8500
8050
4025
2435
3450
1270
1265
30
36*
0.1
Semen
340
0
* Triglyceride rather than glycerol
Plasma osmolality = 280 mosmol/l
S Afr Med J. 2013 Oct 11;104(1):49-51. doi: 10.7196/samj.7002.
http://www.samj.org.za/index.php/samj/article/view/7002
Study Conclusions
• Most (88%) assayed lubricants are hyperosmolar
• Some lubricants were better than others
• None of the lubricants assayed include osmolality on packaging
• Food products have low osmolality and could potentially be used
as lubricant substitutes
Lube Study Recommendations
• Local awareness needs to be raised
regarding lubricant safety for anal use
• Correct MSM-targeted IEC materials need
to be created and distributed
• Lubricants should be used together with
condoms
• Choose a low osmolality lubricant if have
the choice (especially if using lubricant in
the absence of condoms)
That’s nice but so what?
• Did not “prove” that hyperosmolar lubricants
are toxic if used anally or that they  HIV
• Osmolality is now included in lubricant tender
specifications by:
– Department of Health
– NGOs targeting MSM healthcare
• Exposure!!
Thank You