Lubricants' use may put individuals at higher risk of HIV

Bobby Ramakant *

"Use of lubricants may put individuals at higher risk" said Professor (Dr) Ian McGowan, co-chair of the International Microbicides Conference (M2010) in Pittsburgh, USA at a press conference. "One of the M2010 themes is the growing realization that there is a significant issue of HIV acquisition through rectal sex not only for men who have sex with men (MSM) who are clearly very visible HIV high risk group but increasingly for women who may be exposed to the virus rectally which is relatively new observation although may be going on for quite some time" added Prof Ian McGowan.

"What we have seen at this conference is that there are MSM in sub-saharan Africa and HIV rates are alarmingly high in this population" said Prof Ian McGowan. As per published data, there is a number of women who were reported to have anal sex.

"We were testing some over-the-counter (OTC) lubricants that HIV prevention advocates have identified or some which are commonly used by those who engage in rectal sex. These were some of the basic formulations of lubricants that one can buy OTC or through internet. And what we were seeing is that those lubricants that had higher concentration of salts were actually damaging the epithelial of the rectal tissue" said Dr Charlene S Dezzutti, Associate Professor, University of Pittsburgh. Damage to rectal epithelial is supposed to up the risk of contracting HIV.

"Silicon based lubricants and the lubricants that didn't had too many salts in it didn't show any damage to the rectal epithelial" said Dr Charlene Dezzutti. Noted HIV prevention activist and journalist Anna Forbes commented "Lubricants are not evaluated by the Federation Drug Authority (FDA) in the same way as the drugs are, nevertheless some human data is showing there is some real potential health risk."

"None of our models are validated so we don't know how predictive they are of health outcomes and these indications are based on some of the very first studies that need further evaluation" said Dr Charlene Dezzutti. "We did a study in Baltimore and Los Angeles (LA) in 2006 and 2009, and men and women who reported that they had receptive anal intercourse, and half the survey sample was HIV positive and half wasn't, we found that more people who used rectal lubricants had sexually transmitted diseases (STDs)" said Dr Pamina Gorbach, Associate Professor, University of California Los Angeles (UCLA).

"There are so many types of lubes in the market and changes every day! And most men remember only the brand name, it is difficult for study participants to remember what they used especially if you go overtime. Also at times, people used different types of lubes - mixed different kinds of lubes" said Dr Pamina Gorbach. "20% of men who used lubes used more than one type of lube" further added Dr Pamina Gorbach.

Boston study on MSM was conducted in the largest health centre for sexual minorities which takes care of about 15,000 people and out of these, 9000 are MSM, 1300 are HIV positive. "Rationale of the study was that we are in a situation in US where MSM are the largest group of people who get new HIV infections in the country and there have been guidelines for example on use of antiretroviral drugs, use of post-exposure prophylaxis for more than 15 years, but our experience tells us that they are not really utilized" said Professor (Dr) Kenneth Mayer from Brown University.

"We recruited a group of men who had a substantial risk of becoming HIV infected and of what they knew and what their attitudes were towards these different prevention modalities. So the study sample consisted of 105 men who were initially recruited for looking at the acceptability of rectal products like lubricants and other approaches to rectal prevention of HIV. Mean age was 41 years of age and majority had completed high school. Three quarters were Caucasians, and 15-20% were African American" said Prof Kenneth Mayer.

"Men to be in the study were supposed to have at least 1 episode of anal sex in two weeks in the preceding year, so about 25 anal sex episodes to get in the study. Prior to coming to the study men have had 9 episodes of anal sex with a mean number of 4 partners and over half of these episodes were unprotected. What we found out on post-exposure prophylaxis where there are guidelines already, that about 7% of men had used post-exposure prophylaxis, less than half of men had ever heard of post exposure prophylaxis.

When we explained the benefits of post exposure prophylaxis, close to 60% of men said they would consider using post-exposure prophylaxis. 40% of men said they would consider using pre-exposure prophylaxis. When we asked them about rectal microbicides, nearly half of the men said they would consider using rectal microbicides. There is substantial lack of information on existing prevention modalities in the communities like post-exposure prophylaxis" said Prof Kenneth Mayer.

On a question from a journalist attending the press conference, "how much of anal sex is among MSM and how much is among heterosexual people", the panellists responded "there are many more women who have had heterosexual anal intercourse ever or in the last year clearly - than MSM. MSM probably represent a relatively small number of population in the world, so in terms of numbers of individuals they are less, however there may be more incidence of anal sex per se."

"Over a third of women in US had anal intercourse - no data exists on how often they had it" added Dr Pamina. "Some of the lubricants aren't condom friendly, silicon based lubricants are condom friendly and don't harm or break the condom" added the panellists.

Users of lubricants have been advised to double check on the package for content that make up the product they buy as this could expose them to risks of infection with sexually transmitted diseases and HIV. A laboratory study that compared over-the-counter and mail-order lubricants commonly used with receptive anal intercourse found many of the products contain higher amounts of dissolved salts and sugars compared to what's normally found in a cell. As a result, the products had toxic effects on the cells and rectal tissue studied. None of the lubricants had measurable anti-HIV activity.