GMHC Presents The Bottom Line on Rectal Microbicide Research

More than 50 community members braved the winter chill rushing up from the Hudson River to trek to GMHC's new headquarters on 33rd Street near Tenth Avenue for "The Bottom Line on Rectal Microbicide Research," a discussion and video presentation by Jim Pickett, chair of the International Rectal Microbicide Advocates and director of Prevention Advocacy and Gay Men's Health at the AIDS Foundation of Chicago. His combination of knowledge and humor made for an enjoyable and informative presentation about a topic that few feel comfortable discussing.

"I love talking about the things that make people clutch their pearls: sex, drugs and rock and roll. I like to be edgy; it's in my nature," said Pickett, who has made landed on POZ Magazine's Top 100 list for the past three years.

As a gay man living with HIV since 1995, Pre-Exposure Phrophylaxis (PrEP) and microbicides are not something that are in Pickett's future as a personal method of prevention. But he still has a passion for prevention, and travels extensively to spread his message; he admits to having journeyed 100,000 miles between January and June of last year.

"I'm motivated by the fact that people don't need to become HIV-positive," said Pickett. "And you can't just tell people 'Don't do it,' you need options and choices. I want to help people stay healthy, and not live my experience, and have fun options that they actually like."

To that end, IRMA is working to promote funding in the field of rectal microbicides, to increase research activities, to improve safety and access and to increase the knowledge around anal sex. Having resources besides condoms and lube gives people more prevention methods in their toolbox.

Although there is currently no working microbicide on the market, human trials on vaginal microbicides are currently being done in Africa, to stop the virus from replicating, prevent STDs, and maintain the natural normal microflora. But rectal microbicides must protect a much more sensitive area: the booty, as Pickett likes to call it.

"The act of anal sex is ten to twenty times more likely to result in HIV transmission than vaginal sex," said Pickett. "Your anus is a fragile rosebud. There is one cell layer, verses 40 cell layers in the vagina. And right on the other side are the CD4 cells, which HIV latches on to like a welcome wagon."

Project Gel is a current trial underway in the U.S. and Puerto Rico to test a Tenofovir-based gel that subjects insert in their rectum every day for eight weeks, in tandem with oral Truvada. They will test safety and absorption, and discover whether this is a product that men enjoy using.

"For a product to be used, it has to be fabulous," noted Pickett, recalling the dismal response to a Tenofovir-based cream that made subjects feel as though they needed to have a bowel movement.

The education also needs to go hand in hand with product development. Pickett showed the video "Safe Sex in the City," featuring cartoon character Mr. Condom, who worried about his shrinking role in the face of microbicide development.

The film took the mystery out of safe sex, underscoring the fact that condoms are 99 percent effective as a barrier protection, regardless of what future microbicide innovations may yield. For now, said Pickett, the most important thing to do is to raise education efforts.

"We need to talk about it, to demystify anal health," said Pickett. "We need to make knowledge more fun."

Rectal Health Part of GMHC’s Longtime Mission

Back in the '90s, GMHC offered a course on rectal health called "Bootylicious: The Tunnel of Love." Pickett admitted to borrowing the name for an event he held in Chicago. Longtime GMHC employee Mark Kornegay said that the workshop had a prerequisite that members take STIs 101 and HIV 101 first, and that it was catered to receptive partners of anal sex.

"We were talking about how men take care of their anus. And we developed a curriculum for this workshop that became wildly and hugely successful," he said.

The workshop discussed sundry aspects of anal sex, including sensitivity, douching, enemas, Kegel exercises, diet and hygiene, in a series of eight sessions.

"We ran it for several years, and then it just ended up sitting on the shelf for a few years," he said. "I think it needs to be dusted off. I really would be interested in doing it again. It gave tools for men to keep themselves safe."