The Anal Dialogues

Published: July 1, 2011

Rectal microbicides-topical gels, ointments and lubricants laced with ?drugs to block HIV-could help stop the spread of the virus. So why is it taking so long to develop them? For one thing, an unwillingness to talk about sex-especially anal sex. Given the potential of microbicides’ protective power, it’s time we loosen our tongues in order to start saving lives.

In 1992, at a meeting of the Delaware Valley Women and AIDS Network, Anna Forbes first heard about experimental compounds called vaginal microbicides. It sparked an “A-ha!” moment for the longtime advocate for women’s health. Forbes saw right away how a microbicide—a gel, cream, lubricant or other topical agent that could be applied to the vagina  to inhibit sexual transmission of HIV—would offer a much-needed method of protection to women, especially those who couldn’t get their partners to use condoms. And as an advocate for gay men’s health, Forbes also imagined how a rectal microbicide could offer a valuable prevention tool for anal sex for both men and women.

Women and gay men share the common concern of having their health needs respected and addressed, Forbes says. “A receptive partner is a receptive partner.” Effective microbicides would arm both male and female receptive partners with prevention tools that could save their lives.

But when she started talking about the notion of vaginal and rectal microbicides, Forbes found that even people on the cutting edge of women’s and gay men’s health advocacy were uncomfortable talking so specifically about sex, especially anal sex. It showed, according to Forbes, “this weird way that homophobia and sexism intersected.” And it pointed out “the well-kept secret that women have anal sex too.”

Undaunted by the reluctance of many of her peers, and inspired by the potential lifesaving power of microbicides, Forbes set out to convince the world to think similarly, working for a decade at the Global Campaign for Microbicides (she ?recently moved into consulting). The topic continued to be a hard sell. “The trouble with microbicides in comparison to pills and injections,” Forbes says, “is that they are applied ‘down there.’ You can’t talk about microbicides without talking about sex.”

Thanks in part to the unflagging efforts of Forbes and other visionary leaders (along with increasingly promising research data), the scientific and advocacy communities began rallying around vaginal microbicide research. Yet, very few people supported the notion of a rectal version. Forbes recalls the first time she saw the topic discussed in the print media, in a 1999 POZ article, “Beyond Condoms: Life After Latex,” in which journalist Michael Scarce presciently wrote: “The astonishing thing is, gay men raise no voice to advocate for a form of HIV prevention that maximizes pleasure and safety.” In Colorado the next year, at the second LGBTI Health Summit (the initials embrace lesbian, gay, bisexual, trans and intersex people), Forbes gave a presentation on the need for rectal microbicides. Only about five people showed up. Clearly, interest in the subject was lacking—even among the most likely benefactors, gay men.

Then, another A-ha! moment: The messenger, Forbes realized, needed to double as the message. A straight woman couldn’t draw the same attention in the gay community as a gay man could. “We needed a gay male face, somebody with a track record in the [prevention] field,” she says. She envisioned an organized group led by a gay man working to promote rectal microbicides and in the process tackling the taboos associated with anal sex. In 2005, Forbes approached some likely advocates: Marc-André LeBlanc from the Canadian AIDS Society, Julie Davids from CHAMP (Community HIV/AIDS Mobilization Project) and Jim Pickett of the AIDS Foundation of Chicago. Although all were overextended, they agreed on the need to fight for a new form of prevention. Thus, the International Rectal Microbicide Advocates (IRMA) group was formed.

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