1. Rectal microbicides Bridget Haire International Rectal Microbicides Advocates (IRMA)

2. Overview Women and men have anal sex Vaginal microbicides will be used ano/rectally Rectal safety evaluation microbicide products is ongoing Rectal microbicide advocacy

3. Receptive anal sex Highest risk sexual activity Frequently invisible in research on heterosexuals – tendency toward making assumptions about the nature of male/female sexual practice Women who have receptive vaginal and anal sex are likely to use the same product in both places

4. Is a rectal microbicide possible? Against Hard enough in the vagina Surface area too big, mucosa too delicate For If PrEP is plausible, then the rectum is a site for topical PrEP Ian McGowan and Peter Anton think so.

5. Heterosexual anal sex US Ian McGowan

6. Outside the US Ian McGowan

7. Anal sex and risk Information is relatively poor – reflects lifetime practice rather than giving an idea about frequency Risk of HIV is 5-80 times greater in unprotected anal than unprotected vaginal sex Some new data shows a confluence of HIV risk factors in hetro anal sex in young adults at US STI clinics (Gorbach 2008)

8. The lesson.. Advocacy focused on getting better information about sexual practice is critical to get researchers to ask the right questions and understand the answers – “heterosexual transmission” is not the most useful category.

9. Safety studies Ian McGowan

10. IRMA

11. IRMA mission Accelerate research Rectal safety studies on viable vaginal microbicides Provide a central forum for exchange and debate on RM and NPT Convene diverse perspectives and scientific disciplines

12. Advocacy achievements Consensus statement on rectal safety of vaginal products Watch dog on unproven products making claims of efficacy (Kirklees Medical Ltd) Survey on lubricants used for anal sex had 8,945 responses from 107 countries in 6 languages Two publications: Investments and Advocacy and Less Silence, More Science Fundraising with AmFAR dedicated to research on rectal transmission

13. Goals Increase funding Diversify funding sources Recruit new researchers Advocate for more international research into anal sex and rectal HIV transmission Encourage safety testing of more commercial lubricants Develop a global RM development plan

14. Thanks