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Health Activists Warn Lack Of Lube Hurts HIV Prevention

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Safer-sex messaging on condoms is universal but the generally poor availability of lubricants, and awareness of them, is hindering HIV prevention, health activists warn.

Some personal lubricant – or “lube”- has been shown to lower the risk of HIV transmission by decreasing the risk of condoms breaking.

Despite preliminary proof of lube’s efficacy, far less of the product is procured and distributed than condoms, leading people to use alternative, sometimes harmful, substances during intercourse such as butter or petroleum jelly; oil-based lubricants weaken latex, making the condom more likely to break.

Activists say, however, that a blind spot in research on lubricants as a part of HIV prevention programmes means not enough is known about their impact on HIV risk.

Availability

A 2012 survey by The Global Forum on MSM & HIV (MSMGF), a US-based coalition focused on men who have sex with men (MSM), found that barely a quarter of the 5,000 people from 165 countries surveyed reported easy access to free lubricant. A full 25 percent said free lubricant was completely unavailable. Less than 10 percent of people living in low-income countries reported easy access.

While condoms have been part of family planning and HIV prevention work for decades, safe personal lubricant has only recently emerged as a donor priority. For example, the US government began distributing condoms in the 1970s through its aid and diplomatic missions, but its aid arm, the US Agency for International Development, only began distributing lubricant in 2008.

“Where health systems are less developed, it is critical to help establish and maintain supply chains and distribution systems, as well as support efforts to build and accurately forecast demand [for lube],” explained a representative from the US President’s Emergency Plan for AIDS Relief (PEPFAR):

Acknowledging the importance of using personal lubricants with condoms, especially during anal sex, the UN Population Fund (UNFPA) decided in 2012 to include water-based lubricants in the procurement list of commodities available to governmental and non-governmental clients in low and middle-income countries.

However, outside of community-care settings, the real demand for lubricant remains largely misunderstood.

Research in Burundi found that health care providers sometimes do not provide lube to patients because they consider it to be “promoting homosexual behaviour”, highly-stigmatized there. With lube requests stymied in formal health care settings, NGOs can become the sole method of access.

“Key populations – such as MSM and sex workers – who need the lubricant the most, often get their health-related services from local NGOs, which are not often included in [HIV/AIDS] policies or broader [health] programmes,” explained Bidia Deperthes, a senior HIV adviser with UNFPA’s Comprehensive Condom Programming division in New York.

With these NGOs frequently absent from meetings with donors, lube demand can appear falsely low.

UNFPA, a global leader in the purchase and distribution of contraceptives, spent more than 18 percent of its 2011 budget on male condoms, but less than 0.5 percent on personal lubricants, citing donors’ and decision-makers’ lack of understanding of the true demand for the latter as one reason.

Alternatives

“Before there was lube from the outreach workers, I would use butter,” said Lucky, a transgender sex worker in Kathmandu, Nepal, who said she still uses non-lube products as lubricants when NGOs run out of money to fund free lubricant.

“The condoms would break sometimes, but at least it didn’t hurt as much,” she said.

Silicon and water-based lubricants are “condom compatible” and do not corrode latex. Other types of lubricant, including commercially-produced petroleum-based products like Vaseline, can destroy condoms and put users at risk of HIV and other sexually transmitted diseases.

The World Health Organization (WHO) has published a list of substances commonly used as alternatives to condom-compatible lubricant that may boost the risk of condom failure.

According to an International Rectal Microbicide Advocates (IRMA) 2009 study, most MSM throughout Africa are not using condom-compatible lubricant, a trend also seen in other regions facing a high burden of HIV.

A microbicide is a cream, gel, douche or an enema that may help reduce a person’s risk of HIV infection vaginally or rectally.Medical studies have shown rectal microbicides can offer protection in the absence of condoms and back-up protection if a condom breaks or slips off during anal intercourse.

Distribution and access

The American Foundation for AIDS Research and the US-based Johns Hopkins School of Public Health have identified availability of water-based lubricant and its cost as significant barriers to lubricant access in several countries including Guyana, Ukraine and China.

Lubricant is commercially categorized differently across countries – ranging from a medical device to a cosmetic product – meaning its manufacture, import and export can encounter legal and bureaucratic cross-border delays before reaching users.

Studies have found that even assuming high costs for lubricant production and distribution, “condom-compatible” lube prevention packages that include a condom plus a safe lubricant would only amount to about 1 percent of the global HIV/AIDS budget for 2011 (US$134 million).

Call for more research

Scientists have noted that even in places where lubricant is readily available and widely used,little comprehensive research has been conducted on its safety.

A 2007 global survey revealed more than 100 different types of lubricants are used worldwide during intercourse. WHO has outlined how vaginal and anal intercourse may require different types of lubricant.

“Most importantly, we need to determine the safety of sexual lubricants that are on the market already,” said Jim Pickett, chair of IRMA.

Experts see the lack of research as a disappointment 30 years into the AIDS epidemic, and as a mandate for more studies on lubricant.

 

A version of this article first appeared at IRIN Plus News, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs, and is used by permission.

Image: Natalie Bailey/IRIN

Kyle Knight is a Fulbright Scholar in Nepal where his research focuses on the LGBTI rights movement. He previously worked at Human Rights Watch, where he focused on children’s rights issue. For three years, he worked as a suicide prevention counselor for LGBTQ youth at the Trevor Project in New York City. He currently sits on the Trevor Project’s Advocacy and Public Policy Committee, is the president of the Duke University LGBT Network, and a is lecturer in Gender Studies at Tribhuvan University, Nepal’s state-run university in Kathmandu. You can follow him on Twitter @knightktm.

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News

CNN Smacks Down Trump Rant Courthouse So ‘Heavily Guarded’ MAGA Cannot Attend His Trial

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Donald Trump’s Friday morning claim Manhattan’s Criminal Courts Building is “heavily guarded” so his supporters cannot attend his trial was torched by a top CNN anchor. The ex-president, facing 34 felony charges in New York, had been urging his followers to show up and protest on the courthouse steps, but few have.

“I’m at the heavily guarded Courthouse. Security is that of Fort Knox, all so that MAGA will not be able to attend this trial, presided over by a highly conflicted pawn of the Democrat Party. It is a sight to behold! Getting ready to do my Courthouse presser. Two minutes!” Trump wrote Friday morning on his Truth Social account.

CNN’s Kaitlan Collins supplied a different view.

“Again, the courthouse is open the public. The park outside, where a handful of his supporters have gathered on trials days, is easily accessible,” she wrote minutes after his post.

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Trump has tried to rile up his followers to come out and make a strong showing.

On Monday Trump urged his supporters to “rally behind MAGA” and “go out and peacefully protest” at courthouses across the country, while complaining that “people who truly LOVE our Country, and want to MAKE AMERICA GREAT AGAIN, are not allowed to ‘Peacefully Protest,’ and are rudely and systematically shut down and ushered off to far away ‘holding areas,’ essentially denying them their Constitutional Rights.”

On Wednesday Trump claimed, “The Courthouse area in Lower Manhattan is in a COMPLETE LOCKDOWN mode, not for reasons of safety, but because they don’t want any of the thousands of MAGA supporters to be present. If they did the same thing at Columbia, and other locations, there would be no problem with the protesters!”

After detailing several of his false claims about security measures prohibiting his followers from being able to show their support and protest, CNN published a fact-check on Wednesday:

“Trump’s claims are all false. The police have not turned away ‘thousands of people’ from the courthouse during his trial; only a handful of Trump supporters have shown up to demonstrate near the building,” CNN reported.

“And while there are various security measures in place in the area, including some street closures enforced by police officers and barricades, it’s not true that ‘for blocks you can’t get near this courthouse.’ In reality, the designated protest zone for the trial is at a park directly across the street from the courthouse – and, in addition, people are permitted to drive right up to the front of the courthouse and walk into the building, which remains open to the public. If people show up early enough in the morning, they can even get into the trial courtroom itself or the overflow room that shows near-live video of the proceedings.”

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‘Assassination of Political Rivals as an Official Act’: AOC Warns Take Trump ‘Seriously’

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17 hours ago

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April 25, 2024

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Democratic U.S. Rep. Alexandria Ocasio-Cortez is responding to Thursday’s U.S. Supreme Court hearing on Donald Trump’s claim he has “absolute immunity” from criminal prosecution because he was a U.S. president, and she delivered a strong warning in response.

Trump’s attorney argued before the nation’s highest court that the ex-president could have ordered the assassination of a political rival and not face criminal prosecution unless he was first impeached by the House of Representatives and then convicted by the Senate.

But even then, Trump attorney John Sauer argued, if assassinating his political rival were done as an “official act,” he would be automatically immune from all prosecution.

Justice Sonia Sotomayor, presenting the hypothetical, expressed, “there are some things that are so fundamentally evil that they have to be protected against.”

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“If the president decides that his rival is a corrupt person, and he orders the military, or orders someone to assassinate him, is that within his official acts for which he can get immunity?” she asked.

“It would depend on the hypothetical, but we can see that could well be an official act,” Trump attorney Sauer quickly replied.

Sauer later claimed that if a president ordered the U.S. military to wage a coup, he could also be immune from prosecution, again, if it were an “official act.”

The Atlantic’s Tom Nichols, a retired U.S. Naval War College professor and an expert on Russia, nuclear weapons, and national security affairs, was quick to poke a large hole in that hypothetical.

“If the president suspends the Senate, you can’t prosecute him because it’s not an official act until the Senate impeaches …. Uh oh,” he declared.

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U.S. Rep. Alexandria Ocasio-Cortez blasted the Trump team.

“The assassination of political rivals as an official act,” the New York Democrat wrote.

“Understand what the Trump team is arguing for here. Take it seriously and at face value,” she said, issuing a warning: “This is not a game.”

Marc Elias, who has been an attorney to top Democrats and the Democratic National Committee, remarked, “I am in shock that a lawyer stood in the U.S Supreme Court and said that a president could assassinate his political opponent and it would be immune as ‘an official act.’ I am in despair that several Justices seemed to think this answer made perfect sense.”

CNN legal analyst Norm Eisen, a former U.S. Ambassador and White House Special Counsel for Ethics and Government Reform under President Barack Obama, boiled it down: “Trump is seeking dictatorial powers.”

Watch the video above or at this link.

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Justices’ Views on Trump Immunity Stun Experts: ‘Watching the Constitution Be Rewritten’

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April 25, 2024

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Legal experts appeared somewhat pleased during the first half of the Supreme Court’s historic hearing on Donald Trump’s claim he has “absolute immunity” from criminal prosecution because he was the President of the United States, as the justice appeared unwilling to accept that claim, but were stunned later when the right-wing justices questioned the U.S. Dept. of Justice’s attorney. Many experts are suggesting the ex-president may have won at least a part of the day, and some are expressing concern about the future of American democracy.

“Former President Trump seems likely to win at least a partial victory from the Supreme Court in his effort to avoid prosecution for his role in Jan. 6,” Axios reports. “A definitive ruling against Trump — a clear rejection of his theory of immunity that would allow his Jan. 6 trial to promptly resume — seemed to be the least likely outcome.”

The most likely outcome “might be for the high court to punt, perhaps kicking the case back to lower courts for more nuanced hearings. That would still be a victory for Trump, who has sought first and foremost to delay a trial in the Jan. 6 case until after Inauguration Day in 2025.”

Slate’s Mark Joseph Stern, who covers the courts and the law, noted: “This did NOT go very well [for Special Counsel] Jack Smith’s team. Thomas, Alito, and Kavanaugh think Trump’s Jan. 6 prosecution is unconstitutional. Maybe Gorsuch too. Roberts is skeptical of the charges. Barrett is more amenable to Smith but still wants some immunity.”

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Civil rights attorney and Tufts University professor Matthew Segal, responding to Stern’s remarks, commented: “If this is true, and if Trump becomes president again, there is likely no limit to the harm he’d be willing to cause — to the country, and to specific individuals — under the aegis of this immunity.”

Noted foreign policy, national security and political affairs analyst and commentator David Rothkopf observed: “Feels like the court is leaning toward creating new immunity protections for a president. It’s amazing. We’re watching the Constitution be rewritten in front of our eyes in real time.”

“Frog in boiling water alert,” warned Ian Bassin, a former Associate White House Counsel under President Barack Obama. “Who could have imagined 8 years ago that in the Trump era the Supreme Court would be considering whether a president should be above the law for assassinating opponents or ordering a military coup and that *at least* four justices might agree.”

NYU professor of law Melissa Murray responded to Bassin: “We are normalizing authoritarianism.”

Trump’s attorney, John Sauer, argued before the Supreme Court justices that if Trump had a political rival assassinated, he could only be prosecuted if he had first been impeach by the U.S. House of Representatives then convicted by the U.S. Senate.

During oral arguments Thursday, MSNBC host Chris Hayes commented on social media, “Something that drives me a little insane, I’ll admit, is that Trump’s OWN LAWYERS at his impeachment told the Senators to vote not to convict him BECAUSE he could be prosecuted if it came to that. Now they’re arguing that the only way he could be prosecuted is if they convicted.”

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Attorney and former FBI agent Asha Rangappa warned, “It’s worth highlighting that Trump’s lawyers are setting up another argument for a second Trump presidency: Criminal laws don’t apply to the President unless they specifically say so…this lays the groundwork for saying (in the future) he can’t be impeached for conduct he can’t be prosecuted for.”

But NYU and Harvard professor of law Ryan Goodman shared a different perspective.

“Due to Trump attorney’s concessions in Supreme Court oral argument, there’s now a very clear path for DOJ’s case to go forward. It’d be a travesty for Justices to delay matters further. Justice Amy Coney Barrett got Trump attorney to concede core allegations are private acts.”

NYU professor of history Ruth Ben-Ghiat, an expert scholar on authoritarians, fascism, and democracy concluded, “Folks, whatever the Court does, having this case heard and the idea of having immunity for a military coup taken seriously by being debated is a big victory in the information war that MAGA and allies wage alongside legal battles. Authoritarians specialize in normalizing extreme ideas and and involves giving them a respected platform.”

The Nation’s justice correspondent Elie Mystal offered up a prediction: “Court doesn’t come back till May 9th which will be a decision day. But I think they won’t decide *this* case until July 3rd for max delay. And that decision will be 5-4 to remand the case back to DC, for additional delay.”

Watch the video above or at this link.

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