1. National Working Group on Microbicides Rectal microbicides: The political landscape Ananthy Thambinayagam, MPH Global Campaign for Microbicides Rectal Microbicides Meeting November 29, 2006

2. National Working Group on Microbicides Rectal microbicides Anal intercourse practiced by heterosexual men and women and gay men Interest in rectal microbicides is growing Rectal microbicide science and testing is much farther behind than on vaginal microbicides Developing a safe and effective rectal microbicide is scientifically more difficult than developing a vaginal microbicide

3. National Working Group on Microbicides Predicted required studies for regulatory approval of rectal microbicides $69,450,000 over 10-15 years

4. National Working Group on Microbicides Funding for rectal microbicides research Total investment for 2000-2006: $34 million US public sector is primary source of funds (2000-2006) –$33.1 million (97.4% of global R&D funds) –NIH: $30.8 million & CDC:$2.3 million –$0.12 per capita EU, multilaterals & others: below detectable levels Compare other NIH funding just in 2005 –Bioterrorism: $1.7 billion –Avian flu vaccine & drug research: $3.3 billion

5. National Working Group on Microbicides Rectal microbicides expenditures: 2000-2006

6. National Working Group on Microbicides Political realities & challenges Homophobia and discomfort around anal sex has slowed investigation into this topic Religious right-wing/current administration in US extremely squeamish about research into rectal microbicides Gay men have at least one method of HIV prevention within their control for self-protection Cost effectiveness of rectal microbicides not yet established Will the Section 377 of the Indian Penal Code pose a barrier to research?

7. National Working Group on Microbicides Rectal microbicide advocacy: challenges May make it more difficult to gain mainstream support for vaginal microbicide research Could create backlash and compromise vaginal research funding (public US$ fund 74% of global vaginal microbicide research) Given state of the science, could promote overly optimistic expectations Fault lines forming regarding licensing of future vaginal microbicides without definite data on rectal safety

8. National Working Group on Microbicides Rectal microbicides advocacy: Global Campaign for Microbicides Led campaign to get N-9 removed from condoms and sexual lubricants Helped found International Rectal Microbicides Working Group with funding and technical support Advocated for safety testing of existing lubricants Pushed for more rectal safety evaluation and possible labeling of vaginal microbicides Supported rectal microbicide publications, advocacy and research reports

9. National Working Group on Microbicides New strategy to raise awareness and demand among gay men Three components: –Internet – http://lifelube.org –Public presence in forums & conferences –Media – print, electronic, guerilla! Rectal microbicides advocacy: LifeLube

10. National Working Group on Microbicides International Rectal Microbicides Working Group (IRMWG) Convened by Chicago AIDS Foundation and CHAMP Global listserv (currently 300 members) Bi-monthly conference calls New 22 member steering group Developed an advocacy agenda To join, contact Jim Pickett, jpickett@aidschicago.org Presence at conferences: –Microbicides 2006 conference –Gay Men’s Health Conferences –Gay and Lesbian Medical Association annual meeting

11. National Working Group on Microbicides GCM and LifeLube encourage people to: Visit www.global-campaign.org or www.lifelube.org Join the International Rectal Microbicide Working Group calls and listserv Sign up for the Global Campaign’s newsletter Host a talk on microbicides – this and other presentations available for download

12. National Working Group on Microbicides “Technology should be the friend of all people, not solely a tool for the dominant group. We must demand that the full resources of our nations be committed to the development of new prevention technologies such as rectal microbicides that will allow us another way to care for each other and keep each other healthy.” Eric Rofes, professor, author, and advocate for men’s health

13. National Working Group on Microbicides Opportunities for action 1.Campaigns to remove N-9 from condoms or lubricants 2.Safety evaluation of existing lubricants 3.More research into the incidence of anal intercourse 4.Pressure for more funding 5.Advocacy for eventual rectal effectiveness studies 6.More research on how to limit behavioral disinhibition 7.Others – more India specific?

14. National Working Group on Microbicides Thank you