Anal health is not just a gay issue: Women need rectal microbicides too. By BOBBY RAMAKANT


"It is high time that anal health and hygiene comes out of the closet" said Dr Ross Cranston from University of Pittsburgh, USA. Dr Cranston was referring to the multitude of anal health complications people practicing receptive anal sex are likely to be dealing with in their lives and very little quality care and products that exist to relieve them. The awareness level in people (women, men, transgender women) who reported to practice receptive anal sex was abysmally low. Zero per cent of such respondents had knowledge related to their anal cancer risk, and just half of them knew about Herpes Simplex Virus (HSV - the virus that causes genital herpes). Awareness certainly needs to be upped in people practicing receptive anal sex.
Carol Odada, HIV prevention advocate from Kenya said to Citizen News Service (CNS) at the recently concluded XIX International AIDS Conference (AIDS 2012): "Women face the brunt of health problems, be it communicable or non-communicable diseases. Anal sex happens everywhere. Even young people who are learning about sex might want to know how it feels. We should encourage as many HIV prevention options as possible. We should try to meet HIV prevention needs of every person. Anal sex is not just happening between men who have sex with men (MSM) or transgender people but many men and women too have anal sex. That is why there is a pressing need for more options for these people to protect them from a range of sexually transmitted infections (STIs) including HIV. At times women in sex work are offered more money for unprotected anal sex. They too need prevention options to protect them from STIs including HIV during vaginal, oral or anal sex. We all must remember that what works for me may not work for you. There are effective HIV prevention strategies but not everybody can use them, for example, male condoms, or voluntary medical male circumcision (VMMC). Beyond individual preferences and realities there are certain medical conditions such as haemophilia in which people cannot be circumcised. For me, all HIV prevention strategies work and we all need them, and there is no priority in this."
There are major efforts taking shape to boost communication strategies around rectal microbicides. Rectal microbicides are products that could take the form of gels or lubricants – being developed to reduce a person’s risk of HIV or other sexually transmitted infections (STIs) through anal receptive sex. A animated video to communicate the science of rectal microbicides research was earlier screened at the 2012 International Microbicides Conference in Sydney. A revised version of this video was also screened at the AIDS 2012. This video is a creative effort to simplify science and help research participants and affected communities understand what rectal microbicides research is, why it is so important and also help clear questions they or their fellow people might have about the research.
Though this video on clinical trials of rectal microbicides is still not finalized, there is a felt need to develop another video to communicate with the broader audience on the high risk anal behaviour and related issues. Barbara Friedland from Population Council said to CNS: "The earlier video on clinical trials is being made shorter. There is a need of rectal microbicides for everyone and ideally we should have same product to be used vaginally and rectally because women who have anal sex should be able to use the same product vaginally. The other video will be for broader audience and will be an advocacy piece not about clinical trials but about the need of awareness about how anal sex is a high risk behaviour and related issues. There is evidence to show that people in Africa don’t realize that, as all messages are about peno-vaginal sex, hopefully this video will help address some of these issues and advocate that prevention options like rectal microbicides are needed for everybody who practice anal intercourse."
Project ARM (Africa for Rectal Microbicides) is another inspiring initiative of International Rectal Microbicides Advocates (IRMA). "Project ARM was started by IRMA two years ago to make sure that as the HIV prevention field moves ahead for research and development of rectal microbicides, these products [when eventually made available] are safe, accessible, and affordable to the people who need them [in African context]. There was a realization that we need to do some specific work in Africa in context that there are many countries where anal sex is illegal, people can be prosecuted and there is lot of [anal sex related] stigma and discrimination too" said Marc-Andre LeBlanc, IRMA Secretary.
Agreed Carol Odada: "Project ARM is the best thing to happen to us. It is a dream come true! It took a little bit too long. We are thinking of advocating on issues that Africa has never thought of. When I was making my banner ‘Rectal Microbicides for women’, one of our fellow HIV advocates in Africa said that this is not correct and it should rather read ‘African women need microbicides’. I insisted that ‘women need rectal microbicides too’. Even amongst our HIV advocates we have to push this issue as it (prevention options for anal sex) is a no go issue. It is not going to be easy but I believe that if there are going to be products, women and men are going to use it if they need it and if these products are cheap and accessible."
There is a pressing need to raise awareness about anal health and hygiene among all people practicing anal sex, and develop safe and effective products that can serve their unique needs in their local contexts too.
(The author serves as the Director (Policy and Programmes), Citizen News Service (CNS) and is a World Health Organization (WHO) Director-General’s WNTD Awardee 2008. He writes extensively on health and development through CNS. Email:, website:

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