The GLAM Toolkit: Advocacy to promote lube access in Africa

January 31, 2013

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.