November 2009

Reporting live from the hallowed halls of the University of Oxford was never more exciting than last week, when Jerry Galea of the UCLA Programme in Global Health and the International Rectal Microbicide Advocates (IRMA) talked about the frontiers (or should that be ‘rear-iers’) of HIV prevention: the search for an effective rectal microbicide.

His visit was hosted by Oxford’s Centre for Evidence-Based Intervention (CEBI) in the Department of Social Policy and Social Work, and featured the facts about who’s having anal sex around the world (news flash: not just gay men), and the slippery subject of how to have your anal play and stay safe, too.

What are microbicides, and why would I put them up my *&%$?
Microbicides are a new type of product being developed which can be inserted into the vagina or rectum to reduce a person’s risk of HIV infection and possibly other sexually transmitted infections. Research to develop and test an effective vaginal microbicide has been ongoing for a number of years and, while there is no currently approved, effective product, there are a number of strong candidates. Yet research into rectal microbicides is in its infancy, despite the widespread practice of anal sex and the comparably high risk of transmission compared to most other forms of unprotected sex.

According to Galea, recent research shows that among heterosexuals in the UK the practice of anal intercourse is increasing. In the US 30–45% of heterosexual men and women reported experiencing anal sex, and the rate in Brazil was similar: around 40%. About 43% of female sex workers in South Africa report having engaged in anal intercourse.

If an effective vaginal microbicide is found, it will be crucially important to determine its effect on the anus because, explained Galea, before too long, someone will undoubtedly stick it up their arse. The vagina is relatively “durable” compared to the rectum – the latter being far more susceptible to irritation, tears and other damage – which is why unprotected anal intercourse poses a higher risk of HIV transmission than, for example, unprotected vaginal intercourse. Thus, finding and testing a rectal microbicide is a priority.

Enema anyone?
While there are many unanswered questions about rectal microbicides at this stage, one of the most interesting (at least for some of us) is about insertion and quantity. While we can simply lube up a penis or dildo with ordinary lubricant to make sex slippery (and reduce the chance of condom breakage or rectal damage), the same approach is unlikely to do the job when it comes to rectal microbicides. To be effective, microbicides may need to be applied in large quantities (a few tablespoons? a couple of cups? no one knows…). How’re we going to get all that up there and keep it there (enema anyone?)? And what happens when you stand up? (This fun Japanese ‘enema toilet’ may be the answer!)

Pleasure potential
This is a fascinating area of research and one that is long overdue for funding and support (both of which, unfortunately, are not sufficient at current levels). It’s also relevant from a pleasure perspective: if an effective rectal microbicide is developed, can it be marketed as a pleasure enhancement tool, rather than a clinical or pharmaceutical product? Will it be called ‘Recto-prevent’ … or Backdoor Butter? Will it be stigmatized, or celebrated as a way to have great sex while lowering the risk of infection?

Learn more and support the research and advocacy for rectal microbicides at the IRMA website.