First Person

Microbicides and their promise of expanding our HIV prevention armamentarium stole the headlines resulting from the 15th International AIDS Conference, held in July. With six vaginal microbicide candidates in or entering Phase III clinical trials in late 2004, researchers and advocates around the world had plenty to celebrate. We've come a long way, babies. But we have a long way to go. While we might reasonably expect vaginal microbicides on the market by 2010, rectal microbicides are decidedly behind the curve. They are not even on a projected time line yet. And it is time we change this dynamic. Gay men like me are suffering crisis, fear, and condom fatigue. Lots of us are not rolling one on before getting it on, for a host of reasons. Frankly, some of us just want to enjoy natural sex again, even amid shrieks of 'Bareback!' and the attendant clutching of pearls. But let us not rush to judgment. The behavioral changes that worked well here during the earlier years of the AIDS epidemic no longer have the same currency in the years since the highly active antiretroviral therapy era began. We must demand new solutions from the same marketplace that gives us 100 different ways to have a cup of coffee. We need rectal microbicides. This does not have to be a fairy tale. Preclinical research has already begun. We know it is going to be a lot harder to protect the hole-y trinity of anus, rectum, and colon compared to protecting the vagina. The rectum is much more delicate, and there is a great deal more surface area to consider--about two feet up the colon to the spleen. Ejaculate can travel that far. More research on the mechanics of anal intercourse and HIV transmission'and the sociocultural stew in which it takes place'must happen. Our community must engage in the search for products (lubricants, douches, enemas) that might be formulated into rectal microbicides and give us options beyond the 'ABC' HIV prevention method: Abstain and be faithful to a partner or spouse, or beyond that, use condoms. Women must engage as well, since plenty of American women have anal sex'usually without a condom'in the hope of avoiding pregnancy. We all need to love, cherish, and protect our booties. The time line starts today. Pickett is a Chicago-based gay men's health activist. He is collaborating with the Global Campaign for Microbicides and the AIDS Foundation of Chicago on a new initiative called LifeLube, designed to engage gay men in rectal microbicide advocacy.