The document summarizes the Global Advocacy for Microbicides (GLAM) Toolkit, which aims to improve access to lubricants in Africa. The toolkit contains information on lubricant safety research, national strategic plans, case studies on lubricant procurement, and a survey on distribution and access. It also outlines advocacy steps for improving access to safe, condom-compatible lubricants. The document discusses lubricant safety evidence and calls for more research. It announces microgrants and a request for proposals to support lubricant access advocacy projects in Africa utilizing the GLAM Toolkit.

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

2. Today
• Introductions
• Who is IRMA,
what does she do?
• Project ARM,
GLAM background
• GLAM Toolkit
• Lube safety research
• Discussion

3. The arc of the moral universe is long,
but it bends toward justice.

4. 1100+ advocates,
Mission: support
scientists, funders,
development of
policymakers from 6
safe, effective,
acceptable,–and
continents S.
America/Latin
accessible
America and Nigeria
rectal microbicides
for all chapters them
that need
AIDS Foundation of Chicago is the IRMA secretariat 4

5. 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

6. Highly active
moderated
listserv
Focused
projects in Website
Africa, S. • Tons of resources
America
Materials Blog, Facebook,
• Fact sheets, reports Twitter
video
Global teleconferences
• Recorded, materials posted
6

7. @rectalmicro
rectalmicrobicides.org
irma-
rectalmicrobicides. facebook.com/
blogspot.com InternationalRectal
MicrobicideAdvocates
7

8. 8

9. Africa needs a rectal
microbicide research
and advocacy
strategy specific to
the continent 9

10. at ICASA 2011
• Birthing Project ARM
– Working/strategy meeting
before ICASA 2011
– Addis, Ababa, Ethiopia
December 2 – 3, 2011
– 45 individuals:
Africans/allies
10

11. 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
11

12. 12

13. Goals
• Project ARM’s activities will lead to
expanded African rectal microbicide
education and advocacy.
13

14. 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.
14

15. 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.
15

16. 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
16

17. www.rectalmicrobicides.org/ProjectARMreport2012.pdf

18. 18

19. Visit http://tinyurl.com/AndLube

20. Visit http://tinyurl.com/AndLube

21. The GLAM Toolkit
Visit http://tinyurl.com/AndLube 21

22. 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
22

23. 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 (petroleum-
based products) are not safe to use with
condoms.
• Using condom-compatible lube reduces the
risk of condoms breaking or slipping.
23

24. 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.
24

25. • 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 25

26. • 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 26

27. Osmolarity
Many water-based
lubes are
hyperosmolar
27

28. Osmolarity
Osmolarity is a measure of the
concentration of the soluble
components—or solutes—
present in a solution. Can be
iso, hypo, or hyper
28

29. Osmolarity
Iso-osmolar products have
same osmolarity as normal
cells
29

30. Osmolarity
Hypo-osmolar products tend
to make cells swell up with
water, can lead to cells
bursting
30

31. 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
31

32. 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
32

33. 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
33

34. 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
34

35. 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
35

36. IRMA Steering Committee, and Lube Safety Working Group
36

37. Discussion:
How do we
nuance the
issues of
access and
safety?

38. 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
38

39. 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 39

40. Discussion:
Share your
own case
studies

41. GLAM Request for Proposals
• Micro-grants
• 3 to 5 projects
• Lube access advocacy
in Africa utilizing the
Toolkit
• Deadline Tuesday
January 25, 2013
41

42. 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
42

43. 43

44. Thank YOU
44

45. Discussion 45