The need to discuss a rectal microbicide agenda for Nigeria
I am in Ethiopia and I sat down through a 2 days session listening to data presentation about the HIV context and situation in Africa. As usual, I was all out to hear and listen about what the data was saying about Nigeria.
One key issue was the place and role of anal sex in driving the HIV epidemic in Nigeria. This can no longer be ignored. As per statistics, yes there are Statistics from Nigeria that shows that anal sex is practiced by 12% of public secondary schools students. There was another presentation that showed that 12.1% of university students and 15.2% in-school adolescents in Northern Nigeria practice anal sex.
What does this evidence mean? Anal sex is known to be the highest risk form of sexual transmission of HIV infection with approximately 14 (10-20) times higher risk of HIV transmission when compared to penile-vagina sex. The probability of HIV infection transmission in penetrative anal sex is about 1.4% per sex act both in heterosexual and homosexual relationships.
There are evidence to show that about 10% of women and 14% of men in the general population practice anal sex with condom use being low during this sexual practice as a result of multiple erroneous beliefs including beliefs that anal sex is safer than vaginal sex. Request for anal sex by clients of FSW is high (not a negligible proportion) with men paying higher to have anal sex with sex workers (male and female) for many reasons (more pleasurable, tighter, gets to ejaculate faster and for prevention of STIs, and it is cleaner as fewer people engage with this “‘hole”).
And you know what? For women the risk is highest as they will always be the receptor in either vagina or anal sex. May this be an unidentified driver of the HIV epidemic amongst females. Studies do show that many women engage in anal sex during pregnancy, menstruation, for pleasure and a whole host of other reasons. Yet evidence shows that as receptors of sex (anal or vaginal) their risks are increased.
What do we need to do? I personally think there is the need to discuss more openly about the risk of anal sex. Many times we discuss sex during our sex, sexuality and HIV education in a way that unconsciously limit our verbal and non verbal communication about sex to vaginal sex. Our discussion around sex must become broader to encourage public understanding of the multiple forms of sexual practices (vaginal, oral, anal) and the risk of HIV infection associated with all the forms of sex. I had personally been engaged in a public discussion with university students where a major player in the HIV field actually noted in her discussion that anal sex was safe. Anal sex is associated with high risk and we need to get the public to understand this. Our family life education series need to identify this and share this information in schools in view of the statistics that show that despite under-reporting 12% -15% of adolescents practice anal sex.
Do we discourage anal sex? People have choices. We need to promote safe practices. Anal sex and howbeit all sexual practices need to be made safe using dental dams for oral sex, condom for vaginal sex, and condom + lubricants for anal sex and vaginal sex when the vagina is dry. These are existing tools and they are effective. We need to advocate for increased distribution and access to lubricants in the same spaces as condoms can be accessed. And for the future, there are rectal microbicides.
What is rectal microbicide?
When developed, it will be available as a lubricant, gel, douche or an enema that can be used by women and men to reduce the risk of HIV transmission during anal sex. It would be able to offer some level of protection from HIV infection even in the absence of a condom. It would also serve as a backup protection if a condom breaks or slips off during anal intercourse. For more information, visit www.rectalmicrobicides.org
Some Nigerian researchers are very much interested in conducting rectal microbicides research. Let’s support this process. Let’s speak up for rectal microbicides in Nigeria. Let’s discuss about this during out World AIDS day activities as we ensure a AIDS free generation.