November 26, 2004

GAY PEOPLE'S CHRONICLE 15

Can anal sex be made less risky? Is there another way?

by Julie Patterson

Much of the dialogue about developing new topical creams to prevent HIV transmission has focused on vaginal sex, but the virus is more easily transmitted to a receptive partner during anal sex than during vaginal sex. What new developments might show promise for reducing HIV transmission during anal intercourse?

Latex and polyurethane condoms provide an effective barrier against HIV transmission when used correctly and consistently, but many receptive anal sex partners find it difficult to use condoms every time they have sex. A new product, called a "rectal microbicide," may be able to offer some protection in the absence of condoms, or as a back-up form of protection in case of condom failure.

Rectal microbicides are part of a broad category of topical products that act to prevent HIV and other sexually transmitted disease infection in the rectum.

Effective microbicides prevent infection by working to interrupt various stages of the

Nonoxynol-9 is not a good microbicide. It can irritate tissues and make it easier fir HIV to enter the body.

infection process: killing or inactivating pathogens; creating a physical barrier between the pathogen and vulnerable cells; strengthening the body's natural defenses; or inhibiting viral entry or replication. The best of these agents will probably combine one or more of these approaches, in much the same way that HIV anti-retroviral medications work best in combination.

(By the way, some of the most important research on microbicides is being carried out right here in Cleveland, at the Case Western

Reserve University/University Hospitals Center for AIDS Research, where Dr. Michael Lederman has worked with a team of researchers from around the world to develop compounds that show significant potential.)

Remember, nonoxynol-9 is not an effective rectal or vaginal microbicide. Condom and lubricant manufacturers did, at one point, recommend the use of N-9, but it can irritate tissues and actually make it easier for HIV to enter the body. The message is now clear: Do not use condoms or lubricants that have N-9 as a form of HIV prevention.

Most microbicide research has focused on vaginal use, but several rectal studies are currently under way, including lab studies that have made it to human clinical trials. The lab studies are focusing on the effects of the new agents on the rectal flora, or natural environment in the rectum. Human clinical trials are measuring levels of inflammation in the rectum that occur

during typical anal intercourse as baseline. This way, future trials will be able to determine if a microbicide is causing unusual irritation or inflammation.

Other human trials are studying the potential of microbicides to irritate the penis or urethra of the insertive partner. Clearly, both partners will need to be willing and able to use rectal microbicides if they are to be successful.

Overall, research is beginning to fill our gaps in knowledge about how anal sex plays a part in HIV transmission, and options for how transmission can be prevented. This kind of research is necessary and timely as we see rising infection rates from unprotected anal sex. Having only one prevention toolcondoms is not enough. We need additional tools and they may be on the way soon.

Julie Patterson, MPH, is the community capacity building manager for the AIDS Taskforce of Greater Cleveland.

AIDS clinical trials units are working for the cure

by Bob Bucklew

In 1986, as HIV continued its deadly spread throughout the United States, the federal government established several AIDS treatment and evaluation units to conduct studies and do research on how to medically confront the burgeoning epidemic.

From this beginning, the Adult AIDS Clinical Trials Group was formed. It has grown to comprise over 40 AIDS clinical trials units across the country, often centered in large population areas and associated with research universities. Ohio has three units: Case Western Reserve University and the University Hospitals of Cleveland, Ohio State University, and the University of Cincinnati.

Throughout the years of the epidemic, AIDS clinical trials units have played a major role in setting the standards of care for HIV infection, both domestically and abroad. The units were very important in first studying the life-saving anti-HIV drugs (called HAART, drug cocktail or triple combination therapy) which became available in the mid 1990s. The units have been equally as important in developing treatments for many of the opportunistic infections that can befall people with HIV. While medical discoveries have greatly improved the life expectancy and the quality of life for many HIV-positive people, there is so much more work to do. New anti-HIV drugs must be developed for people who have become resistant to the current drugs. Many of the medications taken by people with HIV cause side effects which need to be better understood, and ways found to decrease or eliminate them. And of course, there is a constant search for major breakthroughs in the treatment of HIV and AIDS such as a therapeutic vaccine, which could radically change the way HIV is treated.

Throughout their existence, the AIDS clinical trials units have been successful only as far as they have formed close partnerships with the HIV-positive people who volunteer for the trials. Open and full disclosure of all aspects of trials, and a willingness to go the extra mile in answering any and all questions a volunteer may have, has made these partnerships work.

For more information about AIDS clinical trials, contact the nearest AIDS clinical trials unit: Case Western Reserve University/University Hospitals of Cleveland at 216-368-2437 (368-AIDS) or the MetroHealth Medical Center subunit at 216778-5489; Ohio State University at 614-293-8112 or the University of Cincinnati, 513-584-8373.

Bob Bucklewis the outreach coordinator for the AIDS Clinical Trials Unit of Case Western Reserve University.

Más Vida to make Taskforce more Spanish accessible

by Earl Pike

Cleveland-The AIDS Taskforce of Greater Cleveland is pleased to announce the hiring of Marilyn Rodriguez as program coordinator for the Más Vida project, a three-year initiative funded by the federal Office of Minority Health that will make the organization more accessible to its Spanish-speaking clients.

All client information and forms as well as building signage will be translated into Spanish.

Rodriguez, a speaker for Kemp Heartland and the Elizabeth Glaser Pediatric AIDS Foundation, has traveled nationally to speak about HIV and its impact. Her work in this field is personal since both her parents died of AIDS and her younger sister is ill with the disease.

She looks forward to this "opportunity for the clients and staff of the AIDS Taskforce to take the organization to the next level."

For more information about the Más Vida initiative, contract Earl Pike at 216-621-0766, ext. 262.

Rodriguez, formerly a prevention educator with Proyecto Luz, will be responsible for a program that includes a Spanish-speaking case manager, Spanish language and cultural awareness classes for staff and a pool of Spanish-English/English-Spanish translators available at the Taskforce and other area nonprofits where people living with AIDS and their families go to obtain services.hgt

Earl Pike is the executive director of the AIDS Taskforce of Greater Cleveland.

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