Transcript Improve Lube Access in Africa with the New GLAM Toolkit AVAC Partner’s Forum – Johannesburg – 6 Dec ‘12

Improve Lube Access in Africa
with the New GLAM Toolkit
AVAC Partner’s Forum – Johannesburg – 6 Dec ‘12
Today
• Introductions
• Who is IRMA,
what does she do?
• Project ARM,
GLAM background
• GLAM Toolkit
• Lube safety research
• Discussion
The arc of the moral universe is long,
but it bends toward justice.
1100+
advocates,
Mission:
support
scientists,
funders,
development
of
policymakers
from 6
safe, effective,
continents –and
S.
acceptable,
America/Latin
accessible
America
and Nigeria
rectal microbicides
for all chapters
that need them
AIDS Foundation of Chicago is the IRMA secretariat
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Advocacy priorities
o Increase and diversify funding
o Increase research activities
o RM research, expand pipeline
o Lubricant safety, lubricant access
o Increase knowledge
o Heterosexual anal sex
o Anal sex behaviours
and practices in general
Highly active
moderated
listserv
Focused
projects in
Africa, S.
America
Website
• Tons of resources
Materials
Blog, Facebook,
Twitter
• Fact sheets, reports
video
Global teleconferences
• Recorded, materials posted
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@rectalmicro
rectalmicrobicides.org
irmarectalmicrobicides.
blogspot.com
facebook.com/
InternationalRectal
MicrobicideAdvocates
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Africa needs a rectal
microbicide research
and advocacy
strategy specific to
the continent
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at ICASA 2011
• Birthing Project ARM
– Working/strategy meeting
before ICASA 2011
– Addis, Ababa, Ethiopia
December 2 – 3, 2011
– 45 individuals:
Africans/allies
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at ICASA 2011
45 individuals
Invited and scholarship recipients
– Cameroon, Canada, Ethiopia, Kenya, Malawi,
Nigeria, RSA, Rwanda, Uganda, UK, USA, Zambia
– Competitive scholarship program supported
additional 16 Africans to attend
• 145 Africans submitted scholarship applications
• Represented: gay/MSM, female, trans, openly
HIV+, researchers, advocates, NGOs
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Goals
• Project ARM’s activities will lead to
expanded African rectal microbicide
education and advocacy.
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Goals
• Project ARM’s activities will support
the planning and implementation of
rectal microbicide clinical trials in
Africa in an environment that are as
safe as possible.
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Goals
• Project ARM’s activities will support
the eventual rollout of safe, effective,
acceptable and accessible rectal
microbicides for African men, women,
and transgender individuals.
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7 Research and Advocacy priority actions
1. GLAM – “And Lube!”
2. KAB – AI, anal health
perspectives and practices
3. Communication education materials
4. Acceptability study, studies
5. Mapping sex education
6. Document best practices in anal health,
RM advocacy
7. Awareness raising and education
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www.rectalmicrobicides.org/ProjectARMreport2012.pdf
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Visit http://tinyurl.com/AndLube
Visit http://tinyurl.com/AndLube
The GLAM Toolkit
Visit http://tinyurl.com/AndLube
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What is in the GLAM Toolkit?
• Facts on Lube Access and Safety
• Review of African
National Strategic Plans
• Lube Procurement
National Case Studies
• Findings from Survey on Lube
Distribution and Access
• Advocacy Steps for Improving Access to
Safe, Condom-Compatible Lubricant
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What is in the GLAM Toolkit?
Lube Access and Safety Info
• Many people use some type of lubricant during
anal and vaginal intercourse.
• Some lubricants (water- and silicone-based) are
safe to use with condoms; others (petroleumbased products) are not safe to use with
condoms.
• Using condom-compatible lube reduces the
risk of condoms breaking or slipping.
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What is in the GLAM Toolkit?
Lube Access and Safety Info
• Condom-compatible lubes are inaccessible to
most people around the world, esp. Africa.
• Promotion and distribution of condoms and
safe condom-compatible lube should go hand
in hand.
• However, more research is needed on the
safety of lubricants to determine which
products are safest.
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• Some studies tested lubes in a lab to see if they
killed HIV in vitro or enhanced HIV-1 replication
in vitro.
• Some tested lubes on rectal tissue in mice to
see if toxic, irritating, caused damage.
• Some used human tissue (vaginal or rectal) and
tested lubes in vitro to see if toxic, irritating or
caused damage to the tissue.
Lube Studies
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• Only one study has tested the effect of
lubes on rectal tissue in humans.
• Another study looked at the link between
self-reported lube use during anal
intercourse and testing positive for some
rectal STIs.
Lube Studies
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Osmolarity
Many water-based
lubes are
hyperosmolar
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Osmolarity
Osmolarity is a measure of the
concentration of the soluble
components—or solutes—
present in a solution. Can be
iso, hypo, or hyper
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Osmolarity
Iso-osmolar products have
same osmolarity as normal
cells
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Osmolarity
Hypo-osmolar products tend
to make cells swell up with
water, can lead to cells
bursting
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Osmolarity
***Hyperosmolar products
have a higher concentration of
solutes than normal human
cells. When in contact with
rectal/vaginal cells, “suck”
away water from inside cells,
making them shrink in size
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BASED ON CURRENT EVIDENCE:
•Unclear whether any particular type or
brand of lube might increase, decrease,
have no effect on acquiring HIV and/or
rectal STIs
•Using male or female condoms
consistently and correctly still considered
best way to prevent acquiring HIV and STIs
during anal and vaginal intercourse
IRMA Steering Committee, and Lube Safety Working Group
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BASED ON CURRENT EVIDENCE:
•Condom-compatible lubes associated
with decreased risk of condoms
breaking, slipping
•Not possible at this time to
recommend for/against using lubes if
having AI without condoms
•Lube use on its own not proven
method of HIV or STI prevention
IRMA Steering Committee, and Lube Safety Working Group
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Lube Fact Sheet, Lube QA
oSafety of lubricants for rectal use:
A fact sheet for HIV educators and
advocates
oSafety of lubricants for rectal use:
Questions & Answers for HIV educators
and advocates
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ACTION ON LUBE ACCESS /SAFETY:
•IRMA Lube Safety Working Group
•CDC Lube Safety Working Group
•WHO/UNFPA/FHI360 Guidance
(draft, process began April ‘11)
•Population Services International
•Manufacturers
•U.S. Food and Drug Admin (FDA)
•PEPFAR Lube Safety Working Group
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IRMA Steering Committee, and Lube Safety Working Group
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Discussion:
How do we
nuance the
issues of
access and
safety?
What is in the GLAM Toolkit?
Review of African
National Strategic Plans
• 43 countries reviewed, 7
incorporated lube
• Burundi, Djibouti, Gabon
Namibia, Nigeria, Rwanda,
RSA
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What is in the GLAM Toolkit?
Lube Procurement Case Studies
• Collected at AIDS 2012, MSM Zone
• Zimbabwe, Burundi, Uganda, Kenya
• Challenges and successes of lube procurement
and distribution for GMT (gay men, MSM,
trans) in African contexts
• Highlight creative efforts
• Issues related to lube related stigma, customs,
taxes, sustainability
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Discussion:
Share your
own case
studies
GLAM Request for Proposals
• Micro-grants
• 3 to 5 projects
• Lube access advocacy
in Africa utilizing the
Toolkit
• Deadline Tuesday
January 25, 2013
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GLAM Request for Proposals
• Funding recs to be
announced in Feb ‘13
• Projects begin March
• Approx. 6 months
• Open to AVAC/amfAR
partners, Project ARM
members
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Thank YOU
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Discussion
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