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Evidence for the need for rectal microbicides

Evidence for the need for rectal microbicides. Arif Jafar Naz Foundation International Rectal Microbicides Meeting November 29, 2006. Data Needs. A vaginal microbicide trial costs 80 million dollars Could prevent 2.5 million infections in three years

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Evidence for the need for rectal microbicides

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  1. Evidence for the need for rectal microbicides Arif Jafar Naz Foundation International Rectal Microbicides Meeting November 29, 2006

  2. Data Needs • A vaginal microbicide trial costs 80 million dollars • Could prevent 2.5 million infections in three years • Would provide 2.7 billion savings in health care • Would have a target population of 10 million women • A successful rectal microbicide trial would cost? • Would prevent how many infections in three years? • Would provide what level of savings? • Would have a target population of?

  3. Anal Intercourse (AI) • HIV transmission 10- to 100-fold more efficient through anal than vaginal intercourse • Investments in rectal microbicides have been scant for several reasons, including the field’s perceived relevance only to MSM • But, more women have receptive anal sex than men Estimated that the total volume of heterosexual unprotected AI is up to fivefold that of males who have sex with males

  4. Heterosexual AI • Studies show that up to 30% of the heterosexual population in many cultures engage in anal intercourse (32% as reported by India Today, among Indian women – Nov, 2005) • New data UK: 48.8% UAI in the past year; US: 30% UAI (HIV – men in past year). • STD rates confirm UAI prevalence • In one US study, 32% of high-risk women participants reported anal sex in past six months (Gross et al 2000) • In a Chinese study of 1300 people from 41 cities, nearly 70% of men and women reported engaging in anal intercourse (Burton 1990)

  5. Heterosexual AI • Female AI greater in societies where contraception is unavailable and virginity is prized, but little data – taboos and legal restrictions (e.g., Section 377 of the IPC) make research challenging • Studies show that women engaging in AI seldom succeed in having their male partners use condoms. • Recent South African study shows that among heterosexual men, anal sex was associated with being HIV-positive; those who engage in the behavior are nearly twice as likely to be infected as their male counterparts reporting only vaginal sex.

  6. AI amongst MSM • Findings from a Gay Men’s Sex Survey in 2002 in the U.K. showed that 48.8% of all men who had sex with men had had unprotected anal intercourse in the past year. 14.6% of HIV negative (at last test) or untested men said they definitely, or probably, had unprotected anal sex with a man they thought was HIV-positive in the past year. • 70% of kothi identified men among males who have sex with males in 4 Indian cities engage in anal sex (N = 800), Condom usage only 36% • 62% boys living on the street in Bangalore reported having unprotected AI regularly with one another

  7. Finally…. Is this sufficient to make a case for rectal microbicides? What anecdotal evidence do we have?

  8. Thank you

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