IRMA, amfAR and AVAC are delighted to announce that IRMA Nigeria, in partnership with the International Center for Advocacy on the Right to Health, Stop AIDS in Liberia (SAIL), and an organization in Zambia (which requested to remain anonymous), have been awarded Global Lube Access Mobilisation (GLAM) funding to campaign for access to safe, condom-compatible lubricants in their communities.

Throughout the world, and especially in Africa, safe, condom-compatible lubricant (water- and silicone-based) is inaccessible for most people who engage in anal intercourse. It is also inaccessible for women who engage in vaginal intercourse. A number of analyses in various settings indicate that the use of oil-based products is the most common form of lubrication and is known to significantly reduce condom effectiveness. Faced with the lack of condom-compatible lubricants, people often resort to such products as body lotion, soap, cooking oil, spit, pre-cum, antibiotic creams and even motor oil to provide lubrication during anal intercourse. This lack of appropriate lubricant products for people who practice anal and vaginal intercourse is unacceptable when we know that they can keep condoms from breaking and slipping.

In December 2012, IRMA, amfAR, and AVAC launched The GLAM Toolkit – Advocacy to improve access to safe, condom-compatible lubricant in Africa, Version 1.0. The Toolkit offers tools and ideas for civil society and government partners to secure affordable and sustainable condom-compatible lubricant. Tools include a fact sheet, case studies, the results of a review of African National and Strategic Plans on HIV/AIDS and a list of proposed advocacy activities.

After the Toolkit launch, the group released a request for proposals targeted to community advocates and organizations in Africa interested in improving lube access. Eighteen proposals were submitted from 11 African countries. IRMA Nigeria, SAIL and a Zambian organization received the highest scores in a thorough evaluation process and began their lube access advocacy projects this month. These include speaking with sex workers about lube’s importance, working to increase public awareness and reduce stigma, disseminating the GLAM Toolkit and much more.

To learn more about GLAM, click here, and download The GLAM Toolkit here.

The GLAM Toolkit was launched at a side meeting of the AVAC Partners’ Forum. GLAM (Global Lube Access Mobilization) is project of IRMA’s Project ARM (Africa for Rectal Microbicides), and this new resource provides background on the status of lubricant access in Africa and strategies for civil society to secure sustainable supplies of safe, condom-compatible lube.

After introducing the Toolkit, advocates discussed needs, innovative strategies and next steps for the promotion of lubricant as an HIV prevention tool. One challenge faced by advocates for lubricant access is the lack of concrete answers about lube safety. The evidence shows that condom-compatible lube (water- and silicone-based as opposed to petroleum-based) keeps condoms from breaking and slipping, which is important for HIV prevention. It is still unclear, though, which lubes are safe in humans and which might cause inflammation, increased shedding of epithelial cells and rectal bleeding. Such effects could possibly make a person more vulnerable to HIV infection.

Laboratory tests show that particular kinds of lube (iso-osmolar: having the same concentration of dissolvable substances in its cells as normal human cells) have little effect on the structure of rectal cells and the integrity of the rectal membrane. Other lubricants with higher (hyperosmolar) or lower (hypo-osmolar) levels of dissolvable substances are shown to alter cell structure in test tubes. Scientists have found that some hyperosmolar lubricants disrupt rectal epithelial tissue in macaque monkeys. The US Centers for Disease Control and Prevention (CDC) is currently conducting a trial in non-human primates to determine whether an unnamed water-based hyperosmolar lubricant affects SHIV susceptibility and transmission. (SHIV is a non-human primate version of HIV.) The CDC has said that lubricants with different chemical properties will be evaluated at a later date using this model.

Advocates have put the need for more clarity around lube safety front and center. As a result, the PEPFAR Scientific Advisory Board recently formed a lubricant safety working group to produce PEPFAR programmatic recommendations on the use of lubricants.

At the advocates’ meeting, participants agreed that there is an urgent need to clearly articulate what is known and unknown about the science, while working to meet the demand for lube from many different constituencies: gay men, men who have sex with men, and others who have anal sex. Women who have vaginal and/or anal sex also need safe, condom-compatible lubricants as well.

Click here to download The GLAM Toolkit.

At the annual African regional meeting of the Microbicide Trial Network (MTN) in Cape Town, South Africa this past October, AVAC and many of our coalition partners led and contributed to discussions about key emerging issues in microbicides research. 2011 AVAC Fellow Brian Kanyemba led a civil society consultation providing feedback for an upcoming rectal microbicide trial being planned for several countries, including South Africa. Several AVAC Fellows and partners also participated in a full-day joint civil society and MTN Community Working Group meeting, Next Steps for HIV Prevention in Women: Tenofovir Gel and Beyond. In addition AVAC Fellow Grace Kamau and partners Bright Phiri of SAT and Catherine Tomlinson of the Treatment Action Campaign (TAC) joined MTN Community Working Group members on a panel discussing community concerns and perceptions and how to continue to educate and involve communities and local media about the research process. MTN, AVAC Fellows and partners will continue to bring community voices to the table, both in understanding the implications of trial results and planning for new trials.

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