Of campnes and that Alan Carr advert.

In the last few weeks, there have been debate on social media and many blogs on the advert Alan Carr did for PETA  calling for more support for domestic animals in the UK. I completely support this initiative and I think everyone will jump on the wagon as well.

However, the debate around the fairy picture and what that means in the politics of identity is very important and we can not wish it away. The advert sends out one strong message, that the best way to be gay and accepted is to be "camp". 

Alan Carr in the PeTA advert

The case with Alan Carr is a very interesting one. Just like we have been having conversation around sexual racism in the UK, the conversation around camp and dating in the gay community in Europe is a very serious case. Now, I am very prochoice and in that regards I have the believe that people have the right to date who they want to date. So if you dont like dating a black guy, I have no right to call you "racist" for your choice. After all life is always about choices when you can CHOSE. However, like many that have argued against and for, the question is always do you have to make it obvious that "black and asian" need not apply? Well maybe it saves the black the grace of rejection and the white the time he will waste replying.

However, the conversation is deeper than that when it comes to being "camp" for the sake of wanting to be famous and what that means for representation and even identity politics. I will give you an instant. The likes of Carr and his cohort feeds from the fact that they can be camp and what that means is the unintended consequences of stereotyping that comes with labeling all gay people like Carr or those that spend all their time at GAY. If you are not like them then something is not right. 

I will give two examples. Stephen K Amos will never get a show on prime time tv in the UK. It is not because he is not famous, one fact is that he is black and as a black man, he will really have to be extremely good to get a show. Mostly importantly is the fact that, Stephen K Amos is not as camp and so he does not fit the television lazy stereotype of what a gay man should be.

The second unintended consequences is the fact that people that are not as camp will struggle to establish their sexuality. This is very clear in the case of asylum seekers in the UK who do not exhibit any "art" of campness. I remember a judge in the UK challenging the Home Office argument that an appellant is not "gay enough". The judge asked if listening to Kyle and drink pink champagne while wearing a pink tutu is the only way one can be gay.

While I agree in our sense of community, we should not become the victim of what we are trying to fight against... Being camp is cool but we are not all camp and it should not be the basis we should be seen.

Welcome Back from Washington DC

It was a great pleasure to able to attend the XIX International AIDS conference in Washington DC. This event is seen as the "Olympics" of HIV where the race to end the epidemic is one based on unity and not on individual efforts.

This year conference theme was "Turning the tide", a theme that many people will agree with me not only drive the topics and the different activities at the event, but also energized the international community to take a stand and have an "HIV free generation".

We had prominent politicians speaking to the delegates at the event including: President Barack Obama, Secretary General Hilary Clinton and President Francois Hollande (well those are the ones I saw). Even President Hollande making a strong statement about using the transactional tax in France to invest in HIV prevention and treatment.

Don't get me wrong, if I have seen or heard of David Cameron speaking to the delegates I would have written about it. However, since I did not see him I will not make assumption and there I will rest my case about UK government's commitment to investing in HIV prevention and treatment research.

Away from the politics and the politicians point scoring, there were many interesting as well as promising data, results and innovation coming out of the conference. As part of my IAS blogging, I will be highlighting this key "expectations" from Treatment as Prevention (TasP), Microbicides, Vaccines, Medical Male Circumcision (MMCV), HIV testing and the most amazing of them all, the Lancet report on HIV and Men who have sex with men and Gay men all over the world.

My commitment is to give you an insight into each topic twice a week starting from this week and all you have to do is just watch out and share your views.

Let’s do the black talk – HIV and black gay men in Europe

Just as I return from Stockholm where I attended the first European conference “The Future of Prevention for MSM in Europe” (FEMP) specifically addressing prevention issues affecting men who have sex with other men (MSM), I am surprised, as much as you should be, that this was the first European conference of its kind since the outbreak of the epidemic 30 years ago.

The US and South Africa have been exemplary in leading the way with innovative approaches to HIV prevention, treatment and advocacy.

As a black gay man of African origin living in the United Kingdom, the challenges I face in my everyday life are in no way different from those faced by black gay, bisexual and other MSM in America.

However, whilst there is a history of over 200 years of black civil rights movement in America, there is little that can be said about similar black organisations in Europe.

But the problem has deeper roots. Most amazingly, the results of the recent HIV prevalence survey conducted by the European Centre for Disease Control (ECDC) do not differentiate the HIV epidemic in Europe according to ethnic origin mostly because the French and the Germans do not allow for identifying and recording racial background.

The hypocrisy of the French “equality” motto is that by denying the existence of epidemiologic differences related to racial background it further oppresses ethnic minorities, mostly black, by denying them the rights to tailored healthcare.

In the UK the Health Protection Agency (HPA) estimates that 86,500 people are living with HIV in 2010.

An estimated 4% of Black Africans living in England have been diagnosed with HIV, compared with 0.1% of the white population. The disease disproportionately affects MSM who represents nearly half of those newly infected with a consistently higher proportion of black MSM.

The latest HIV diagnosis data for 2001-10 from the HPA shows a steady increase in the number of new diagnosis in the black MSM population (Black Caribbean, Black African and Black other) from 100 in 2000 to 112 in 2010.

If these data can be translated to the European scale, the choice of the French and German government to ignore race is raising serious questions about the real HIV prevalence in the black/African community in Europe.

With an incomplete picture and missing data, how can we advocate for black gay, bi and MSM driven and led HIV prevention and treatment?

Unlike the French and the German agencies, the UK Health Protection Agency has one of the most comprehensive datasets on HIV prevalence, taking into account race and ethnicity in the whole of Europe.

This may explain why many UK black gay advocates attended FEMP and why they have been at the forefront of the battle for similar data collecting system in other European countries.

However, these data should not hide structural and cultural issues affecting Black MSM and suggesting that number of infection remains underestimated.

The impact of institutional racism and community discrimination on the self-confidence of young black gay/bisexual men and MSM to access healthcare in the UK was investigated by the Monya project, funded by Newham Primary care trust in London and carried out by Naz Project London.

Surveys showed that more than 60% of MSM of African origin agreed that they did not fit into the mainstream, predominantly white, gay setting.

As many as 45% criticised the healthcare professionals for being heteronormative and almost 70% said the counselling they received at the sexual health clinics did not meet their needs for full sexual happiness and fulfilment.

Whilst the ECDC agreed that there is a need for concrete intervention for HIV prevention for heterosexual migrants from high epidemic countries, there was nothing said about the need for tailored HIV prevalence for MSM from the same region.

We cannot blame the ECDC for being limited by red tape and national policies, but I was shocked that despite 5 plenary and more than 15 breakout sessions, there was not one single session talking about black gay, bisexual men and MSM at the FEMP conference.

The one session on migration was flawed by an ambiguous EMIS definition of migration and data collected on migration that do not distinguish between internal and external migration. Further, the panel consisting of two Spanish researchers could not provide convincing answers about the epidemic of black gay/bi sexual and MSM from high epidemic areas like Africa.

While I strongly believe that there is a need for a European MSM conference, I think that this conference failed in acknowledging and accepting that there is a need to put black and African MSM men on the agenda.

Even the number of black and African gay men at the event was nothing to be proud of, with fewer than 10
of them amongst 200 participants. The HIV Epidemic in the community is a time bomb waiting to explode and we are turning our back to it.

I went to this meeting to assess and investigate the need to establish a European-wide MSM HIV prevention and treatment advocacy, but whilst the conference raised good points, I returned to London having failed to achieve my aim, as there was no platform for black gay men to meet and discuss the issues that matters to
them.

As we plan for the next FEMP conference, it is important we start talking about the hidden and mostly ignored HIV epidemic in the black MSM community and what roles social factors like religion, culture, self confidence and racism are playing in the increasing epidemic in the black community in Europe.

We, the black MSM community in Europe, should be demanding for research-driven prevention policies from health care authorities and our governments. We have a lot to learn from our brothers from America and we need them to help us in organizing and lobbying. We do not want to wait for another five years and then to become the agenda of the “HIV do-gooders” trying to save the endangered species.

Representation: The undefined Job Description

Since the discussion around Pre- Exposure Prophylaxis-PrEP, (the anti HIV drugs to be taken by HIV negative people to prevent them from getting HIV even if they come in contact with virus). I have listened, spoke, argued and even made cases for the cautious implement of the policy so that the people that will be taking the pills know what really they are getting themselves into and be able to make an informed choice about their life, their health and their future.

However, there is been a particular group of people that have been missing in this very important discussion, the people that will be taking the drug. The issue of representation in this case has been taken over by the HIV positive old horses that think that they can speak for everyone. Just like the pope and the Catholics criticizing condoms and contraceptives for women when they are not one that will use it.

This scenario of self appointed speaker/ representative is not limited to the HIV field. I have seen many people speaking on behalf of other people with such authority (mind you I am not excluding myself) and with the use of the word "Community" that you asked yourself when was the election conducted? Who are the opposition party? On which political platform that person stood? These questions brought about the argument of the notable academia Anne-Marie Slaughter when she talked about "Representation and Democratic deficit". 

Just recently I was drag into a twitter argument over racism and representation again. When on BBC Sunday Morning live, a panel discussing racism has no black person on it. The argument was in 21st century, do we really need to have a black person talk about black issues? Do we only need a gay person to voice the concerns of gay people? And since we have no HIV negative community, do we really then have to look for someone to speak for them?

Do we really need to desperately look for someone to speak for a group of people? As an African Gay man living with HIV living in London, I constantly find myself having to speak or represent that community and on many occasion I have asked myself that do I really know what deep down the issues are? Does having those boxes to tick makes me the best person to speak for this group of people?

As much as I asked myself these questions, I have never been able to find an answer to it nor will I ever be able to find an answer to it. However, what makes my case different is that I have to certain degree the support of the group of people I represent. This is clearly different from White people representing Black issues, or an HIV positive man talking about what is best for HIV negative man with such authority.

We all know that there is a difference between taking a pill to stay alive and taking a pill because it is an option not to catch something. Both are different and the level of tolerating the risk differs as well.

I wish we can take the PrEP conversation away from the ball room of HIV positive people to the dinner room of HIV negative people and allow them to take centre stage on the discussion as much as taking the conversation of racism away from the sympathetic white middle class to the reality of black people on the street of the UK.

Dont call me "Non-White" its just racism

Human beings with any sense of intellectual prowess are known to be full of rhetorics. These rhetorics are most times their ways of either exercising their wealth of intelligence or simply showing how they can be more stupid than the rest of of us. And if it is the latter, then they find themselves in a situation where they are boxed to the corner and fighting for survival.

David Starkey on Newsnight.

One of such is Prof David Starkey the notable Historian (well many will question my use of "notable" for this honourable gentleman, but you will have to forgive me for that) behaviour during the London riot when he in his almighty stupidity argued on BBC newsnight (you can watch the video here)  that "white has become black" and that is the reason for white kids involvement in the right. 

The fury that followed was one that hell could not contain and this Professor will end up covering his head in shame. Not that it really matters when it comes to David Starkey, he was the same man that made controversial statement about gay people on BBC question time. And for clarification purpose, David himself is gay.

Now this blog is not about David in anyway and I am not sure I want to write about David. This blog is about two presentations at the just conclude British HIV Association (BHIVA) conference held in Birmingham United Kingdom. The two controversial presentations where those from Dr Anthony Mills from Los Angeles and Dr Chloe Orkin from Bart and the London NHS. 

It will be important to note that it was not the content of the presentation that made some people uncomfortable and that includes me but the ethic classification in the presentation. During his presentation on the "non- inferior efficacy and favourable safety of Quad compared to efavirenz/emtricitabine/tenofovir DF in treatment naive HIV-1 infected subjects" He classify the race as "white and non-white". I almost jumped on my seat. My immediate reaction is what really is racially non white? Black, Indians, Chinese, Hispanic or any other race that is not white? 

Also in considering metabolic assumption of HIV drugs in HIV positive people, racial classification is very important because of genetic make up. Saying white and non- white gives no explanation to what is happening to "African American" as they account for the emerging epidemic in America and likely to be on treatment and possibly react to the drugs in a different way compared to their white counterpart.

As if that was not enough insult for one day, Dr Chloe came on and made a presentation on "Efficacy, safety and pharmacokinetic results of an ongoing international phase 3 study comparing Quad with ritonavir-boosted atazanavir plus emtricitabine/tenofovir DF in treatment naive HIV-1 infected subjects at 48 weeks". In the same fashion talked about white and non white.

Angered by this blatantly act of intentional or unintentional racism, I went on twitter and vent my anger about the attitude of clinicians/researchers on not just race classification but recruitment of Black and Hispanic people into HIV trials. The reactions on twitter was nothing but that of anger and disgust. However, I did not stop there, I stood up and went to the microphone to challenged the notion of the concept of "White and non-white". 

I was not doing this to be a hero or become controversial, but to put the record straight that knowing how people are doing differently will help in designing and development of care and support service for HIV positive people from different ethnic background.

To my utter dismay, I was shocked at the way my concern was ignored not just by the researchers but by the chair of the session.

As if ignoring my concerns was not enough, afterwards, I was challenged by many clinician and researchers accusing me of raising a non issue to distract many people from the main issue of the conference.

I left Birmingham not angry, but determined to put this right once and for all. As an African living in the UK already given the Black identity I did not asked for, being tagged "non-white" in 2012 is nothing but blatant act of racism and bigoted insult.

Growing older with HIV: What do we know?

Its been over 30 years into the HIV epidemic, when the world came to the realisation of what would end up to be a global challenge. However with more advanced drugs to treat the virus, there are evidence of HIV positive people growing older.

This sounds as great news for many people infected and affected by HIV. However, the downside of this is the increasing challenges of co-morbidity, HIV drugs toxicity, and aging. As we grow older, our body will go through a process of breakdown that will require more medical attention. We have to deal with the issue of Alzheimer, Cancer, Diabetes and ever increasing difficulties of care.

Dr Graeme Moyle of Chelsea and Westminster, in a presentation at one of British HIV Association Conference in London, quoting the SMART study concluded that HIV viral load can also be contributing risk to Cardiovascular disease in people over 50 years. This is further compounded with the challenge of late presentation of HIV.

Dr. Graeme Moyle

Increasing the challenges for older HIV positive people is the type of drugs prescribed for the treatment of the virus. Certain protease inhibitors  like Lopinavir and Idinavir have shown an increase in fat accumulation called Lipid in older people living with HIV. This means that these drugs will increase the risk of other diseases like hypertension, Diabetes and other diseases like renal dysfucntion, reduce bone mineral density, fraility, non-AIDS defining cancer and neurocongnitive dysfunction.

 Another factor increasing the risk for older HIV positive people is the CD4 nadir at the time of diagnosis. The lower the CD4 cell counts the more possibility of aggravated old age diseases as listed above.

As HIV positive people grow older and more people get diagnosed late, the challenges to manage the disease in line with other old age diseases will come with more community advocacy around lifestyle changes.

Prof. Peter Kroker of Chelsea and Westminster Hospital London suggested that we should start addressing factors that will increase co-morbidity at old age, these include: Smoking, alcohol, diet, and inactivity. Coupled with this should be the regular assessment of risk factors like: blood pressure, lipids, cardiovascular fitness, vitamin status and renal functions.

Prof. Peter Kroker

He stated that the important thing to know is that living with HIV is a life time challenge on its own, this challenge gets complicated with aging, and old age defining diseases. Supporting older people living with HIV and other diseases should be a priority not just for the community but for the health care providers and the government.

There should also be more community led advocacy and training on HIV and aging. This is because according to the words of Prof Kroker " In 1996, I would never have thought I will stand here today, 30 years after the epidemic to be talking about HIV and aging? Back then we thought living over 5 years               will be more to luck than reality but here we are today"

Mandatory HIV testing: Public health vs Human rights

At the ongoing British HIV Association conference (BHIVA) taking place in Birmingham UK, a session on Late presenting of HIV highlights the characteristics of the epidemic in the UK raising the need for more community awareness amongst Men who have sex with Men (MSM) and people of African origin

Dr Valerie Delpech of the HPA in her presentation stated that as at the end of 2011, there are almost 120,000 people living with HIV in the UK, and that since the breakout of the epidemic 30 years ago, the UK has seen 20,000 AIDS related death and of the people living with HIV as at 2012, 25% of them are unaware that they have the virus. And these are mainly the population driving the epidemic. Furthermore, she started the epidemic is concentrated between MSM and African communities in the UK.

However, there is something that sets the African community aside from the MSM, and this is CD4 cell counts at the time of diagnosis. In the UK, African communities account for the highest number of late diagnosis of HIV. In this article, late diagnosis of HIV will be diagnosis of HIV at a CD4 cell count less than 350. This is because at this stage, the immune system (the cells that protect the body from disease attacks and they are the cell the virus needs to reproduce in the body) has weakened and do not have the power to fight the virus anymore.

Dr Valerie Delpech

At this stage of low CD4 cell counts, a person will start developing what is known as opportunistic infections and this will eventually leads to AIDS if not treated on time. The only treatment for HIV still remains Anti-HIV drugs.

In the UK we are seeing the rate of late diagnosis to be as high as 50%, however while more MSM are testing on time for HIV (Prompt testing), we are seeing an increase in late diagnosis amongst Heterosexual men from Africa. Of the 50% of people that presented late for HIV testing last year, 63% of them are heterosexual men of African origin. This data from HPA reaffirms the challenges African HIV charities are facing in the UK.

Age has also been identified as one of the key areas where there is an increasing rate of late diagnosis with 62% of people over 50 years diagnosed so far are diagnosed late.

Dr Marthin Fisher from the Royal Sussex Hospital Brighton raised the challenges of late diagnosis in relations to treatment adherence and effectiveness. He argued the later someone present for HIV the more difficult it is for the person to have better Quality of Care (QoC) and this will further reduce the chances of the individual to respond to treatment and even reduce their options for further treatment with new drugs.

Therefore the question is, should we offer mandatory HIV testing for everyone from high risk population? (When I say high risk, I am talking about the people that belong to the population with high rate of HIV epidemic MSM and Africans). If the answer to this question is yes, then how do we deal with the issue of fundamental human rights of an individual to say NO to HIV testing?

How do we make HIV testing attractive and easy to take up for people and most importantly for African heterosexual men? With the advent of better treatments that are prolonging life span of HIV positive people, it is not then a good public health issue to test people early and put them on treatment as soon as possible?

Dr Marthin Fisher

The other positive outlook to treating HIV early is that as we put people on treatment we reduce the transmission risk of HIV as seen in a study called HPTN 052. And this can only be possible if we test more people and put as many people in treatment as possible.

This is indeed an advocacy need of African communities in the UK but most importantly the need for African men to take the mantle of leadership in the fight against HIV and late diagnosis in the UK.

Though there will continue to be controversy over mandatory testing of HIV and fundamental human rights, but there is always a way out and one of it will be that everyone be offer routine HIV testing irrespective of race, gender or sexual orientation. Another important solution will be looking at the option of non conventional testing centers like community testing.

Finally we need to talk more about the advantages of testing for HIV and confront stigma and discrimination attached to HIV most especially within the African communities in the UK.

Funmi Iyanda: A Hero or A Villain

                                                  

Funmi Iyanda

This lady has created an image for herself, one many people that grew up with her New Dawn with Funmi Iyanda will basically call "amazon". However to many who have loved to loathe her, she is nothing but a thorn in the flesh and one that they will be very happy to get rid off.

 Funmi has an imagine of a non nonsense woman, a social critics and one you will not expect from a social corrupt setting like Nigeria. She reminds one of the "The Man" in Ayi Kwei Armah "The Beautyfuls Are Not Yet Born". And more important many will attribute the personality of a fearless feminist, one who will crush every obstacle on her path.

 Her breakfast show that ran for over 10 years in Nigeria (New Dawn with Funmi Iyanda) was the talking point of social discourse in the 90s, she treats her issues with passion while at the same time tries to remove herself from her passion. During her time on TV, she quizzed many people from high flying politicians to celebrities and to ordinary citizens who are trying to salvage their country. No wonder she got the title "Oprah Winfrey" of Nigeria, one title she does not take lightly to as she believes she is an enigma on her own.

 The major issue in Funmi television history came on the morning of 6th October 2004 when innocently (Yes! innocently)she interviewed Bisi Alimi, the controversial Nigerian gay rights activist. This simple interview sent a shocking waves round Nigeria, and the aftermath left Funmi coming to the reality of the country she so loved.

 So it was not surprising recently when on twitter she started a conversation about a newspaper report of the sexuality of Nigeria female singer Asa.  The backlash was overwhlming. The hate tweet that followed was beyond believe and it was interesting to see her losing many of her followers that day for saying as a matter of principles that she is open to discuss on LGBTI issues in Nigeria, and that she will not in any way discriminate against anyone based on their sexual orientation or gender identity.

 Her religious conservative followers threw tantarum, they called her names and stated in clear terms what a disgrace she is. Many even accused her of being a Lesbian. However, while these group of people were busying themselves slagging her off, there was another group of progressive Nigerians who got drawn into the debate and the interesting thing was, for every one religious conservative she lost, she got 3 progressive followers.

 This shows that even in Nigeria, the war of homosexuality is fought on both sides, and Funmi with her controversial views on the issues and many other issues ranging from Women's rights, abortion and single parenthood is found right in the middle of it. No matter what you think of these fearless woman, whether you see her as someone to love or loathe: Funmi has come to stay as Nigeria mermite.

In Africa, anal sex goes Hetero

While I was in secondary school, I have always been told that rectal sex is something between two men. Even many anti gay activists have used this sexual practice as a means of attacking the gay movement. It is the core of the sodomy law in Africa and the buggery law in other part of the world.

However, the recent study in Africa has shown an increasing number of straight people and mostly young heterosexual people practising anal sex on a daily basis.

While the notion of sex in itself is a very difficult topic to tackle in the African setting, the mere fact that more and more straight couples in Africa are embarking on a rectal sexual journey for pleasure gives a call for concern – because most of this is unprotected by condoms.

An act of unprotected anal intercourse is 10 to 20 times more likely to result in HIV transmission compared to an act of unprotected vaginal intercourse, due to the different biological characteristics of the rectum which make it much more susceptible to infection.

What do we know?

According to Morenike Ukpong, a Nigerian Microbicide activist ; over 12% of young people in Nigeria are practising anal intercourse. In different studies done across Africa, the following were found as anal sexual practices among heterosexuals.

An anonymous survey of 2593 men and 1818 women in Cape Town according to Kalichman et al (2009), they found out 14% of Men and 10% of Women have engaged in anal sex in the last 3 months, of this only 67% of the men use condoms compared to just 50% of the woman.

Even there is a significant drop of condom use among truck drivers (N=320) in South Africa Ramjee et al (2002) and sex workers (N=147) in Kenya. Schwandt et al (2006). The two studies find 42% of truck drivers having anal sex with female sex workers, while it was 40% among female sex worker who said they have ever practised anal sex.

This is not the end of the surprising data. In Lane et al (2006) findings, it showed that young people between the ages of 15-24 years in South Africa engage in anal sexual behaviour. There is no difference between the sexes, while young male engage at rate of 5.5%, young female are at 5.3%.

More interesting is Matasha (1998) findings that among primary school pupils in Tanzania, 9% had anal sex as their first sexual experience.

Taken together, these studies show that there is a previously unknown anal sexual behaviour among heterosexuals but the focus on anal sex and health for many years has been the limited to gay/MSM communities.

What we are getting wrong

The focus of HIV prevention in Africa has always been primarily targeted at vaginal sex, and thereby prevention messages have always been use condoms. But we are now finding out that as straight people engage in anal sex, the likelihood of using condoms diminishes. For many, anal intercourse may be a form of virginity protection, or contraception, and there is a common belief that anal intercourse carries no risk for HIV infection.

Dr. Karim of the famous CAPRISA 004 argued that this sexual behaviour – when unprotected - could be driving a sizable amount of new HIV infections in Africa. In agreeing with him, I asked the question “is it time for us to broaden our scope of what HIV transmission looks like in Africa?”

If we still argue that HIV transmission in Africa is mainly heterosexual, are we assuming that the risk is only from unprotected vaginal intercourse? Or are we going to acknowledge the prevalence of unprotected anal intercourse among heterosexuals and address heterosexual transmission more broadly, and honestly?

Not only are we overlooking the reality and the prevalence of this sexual behaviour among the general heterosexual population (Note that these are small studies, which means that if we were to conduct bigger and broader survey we will find more), we are also losing the need to do a reassessment of our prevention strategy that will provide safer anal intercourse irrespective of gender or sexual orientation.

Coupled with the myth around anal sex is the lack of using the right lube. In a presentation at the strategic meeting by Dr. Brian Kanyemba from the Desmond Tutu foundation, he said people were using all kinds of things for lubricant: olive oil, Vaseline, Vicks and even mayonnaise - none of which are condom-compatible.

Gay and straight couples need to know the facts about anal intercourse, and need condoms and condom-compatible lubricants to engage in this behaviour in a safer way.

The hope. The future

Anal sex is a pleasurable sexual activities and it can be safe if and when certain conditions are met. These conditions include; using condoms with condom-compatible lubrication.

Another answer to safer anal sex is rectal Microbicides - which would be a lube or a gel with anti-HIV properties.

A safe and effective rectal Microbicides could help everyone engaging in anal sex have a pleasurable and safer sexual experience.

It is important to know however that it is not a replacement for condom use, but it is to be used as an additional option for protection, Ideally, one day we will have rectal Microbicides that not only protect against HIV, but other STDs as well.

As we drive towards zero HIV infection, it is also important we started looking at other prevention technologies that will be very easy for people to use without actually affecting their sexual behaviour.

As IRMA’s rectal Microbicides advocates sat down to work at the Project ARM meeting in Addis in 2010, one of the interesting things that came out was the need to intensify advocacy for rectal Microbicides in many ways and that includes engaging with our community to let people know that anal sex is a human behaviour, both homosexual and heterosexual.

There is increasing need for information on anal sex, anal  health and active involvement of NGOs in Africa. This campaign should also include NGOs working with African communities all over the world. Also we should start the discussion with women; both young and old that there is a need for more discussion on anal sex

Rectal Microbicides are looking like the future of HIV prevention, but for the dream to be achieved, there is the need for everyone to be involved in the process – on both the research and advocacy fronts.

From civil societies to clinicians, doctors to government officials, international organizations and funders the world over.

But while we await the rectal Microbicides reality, we should not forget that when we talk anal sex, we should also scream……… AND LUBE.

As without the right use of the right lube, anal sex will not only be painful and unpleasant, but also puts the receptive partner at the danger of sexually transmitted infections including HIV.

Anal sex is great, condom use is pleasure, but don’t forget AND LUBE.

Reference:

http://tribune.com.ng/index.php/news/32479-12-nigerian-secondary-school-students-practise-anal-sex

http://journals.lww.com/aidsonline/Abstract/2006/01020/Heterosexual_anal_intercourse_increases_risk_of.19.aspx

Matasha et al (1998) Sexual and reproductive health among primary and secondary school pupils in Mwanza, Tanzania: need for intervention.

'A non-discriminatory programme for gay men will reduce HIV infection in Nigeria'

Bisi Alimi;a case for non discriminatory HIV prevention for Nigerian gay men

In 2004,Adebisi Alimi was on the Funmi Iyanda Show told Nigerian he was gay thus becoming the first openly gay man in Nigeria.That bold move made headlines.Expectedly, the backlash was overwhelming sending Bisi back to the closet and constantly watching his back during public outings.He was granted asylum by the UK government in 2008 and currently studying for a Masters degree in Global Governance and Public Policy at the University of London.Bisi studied drama at the University of Lagos and before leaving for the UK had become a strong advocate for non-discriminatory programming for men who have sex(MSM) in Nigeria earning the membership of groups such as UNAIDS Intervention Team for MSM in Nigeria and amFAR MSM/HIV review panel for Africa 2008.He spoke with NIGERIAN HEALTH JOURNAL on his current efforts and the future of HIV prevention for MSM in Nigeria.

How would you appraise Nigeria’s HIV/AIDS programming especially as it relates to an all-inclusive programming for most at risk groups?

I left Nigeria about 4 years ago, and the impression I get each time I meet Nigerian HIV advocates at International conferences is that things are changing, and I can see that too. At the Microbicides Conference in Pittsburgh in 2010, the Nigerian delegation were discussing Rectal Microbicides. At the Int’l AIDS Conference in Vienna, I attend the session on HIV funding, and the Nigerian government representative spoke about investing in vulnerable and high-risk communities. Whether this is the case in reality I am not sure but the mere fact that we have moved away from the culture of ‘do not talk about it’, to that of developing policies that seem to be inclusive is very interesting. I have seen an increasing number of MSM community-based organisations(CBOs) working on Men who have Sex with Men(MSM) issues responding to the crisis within the community, and I am really happy about the stage we are now.

Programming for sexual minorities like MSM might remain a hard nut to crack in Nigeria. Does this reflect a lack of capacity to programme for MSM aside the issue of intolerance?

There are a lot of issues to this.The MSM or what you may want to call the “Gay community’ in Nigeria needs to do more in the area of creating proactive visibility. Visibility was what *Dare Odumuye and I did in the 90s and early 2000. We didn’t just sit around waiting for miracle to happen; we took our cases to those that matter. Now the MSM community is characterised by bickering and struggle for funding instead of coming up with very creative approach to involvement. Living in the UK has opened my eyes to community involvement and engagement and I feel there is need for more of that approach from CBOs in Nigeria. There is also the hypocrisy around human sexuality and religion, which we have been deceived to consider as our culture. Nigeria’s cultural identity is not built around Islam or Christianity. Let me add that government has not created an enabling environment for most of these organizations to prosper or take shape and when they struggle to exist, there is not enough protection for them. The anti-gay scenario in Nigeria is not encouraging either.So,for there to be an active HIV intervention and proactive service delivery to reduce the impact on HIV within the gay community,everyone has a role and our approach and attitude towards alternative sexuality and lifestyle needs to change.

What does it take to bring MSM issues to the front burner of our AIDS given the fact that religion keeps popping up even in addressing public health challenges?

It will not be easy, and I quite agree with you that religion is one of the key barrels to providing adequate and all inclusive sexual health services .Mind you, this is not just an MSM issue, even women HIV response in Nigeria is still behind the desire for the MDGs. Nigeria still does not have a clear cut policy and working framework for prevention, and access to treatment in Nigeria is still below the target for universal access. So, the agenda of inclusiveness will be key in bringing the issues of MSM and HIV to the table. The MSM activists should know that it is very important they work in a very inclusive environment, where they collaborate with other activists to have a comprehensive approach.When this is done, it will break the barrel of religion. Unless this is done, and the approach of ‘we and them’ is ditched, the desire for inclusion will continue to stay in the dreamland.


Can you articulate what Nigeria stands to benefits from a comprehensive programme for MSM and related groups?

It is a fact that in countries where there are inclusive HIV prevention and treatment approach, the rate of infection will go down and there is an increased awareness. Also,we know from social scientists that sexual behaviour rather than sexual identity are the drivers for increase rate of HIV infections, also in countries where people are given the freedom to make informed choices based on non-discriminatory HIV information,a low rate of infection means a healthier country, and a very productive one. Prevention has been seen to be very cost effective if it is inclusive. A well-formed intervention means that there will be less tendency for risk behaviours and that means people will do what will make them healthy. There will be an increase in sexual satisfaction and that also means people having the sex they desire with enough information on safer sex. A non-discriminatory comprehensive programme for MSM will mean less infection rate and a healthy nation for all of us.


Is it true that the major source of risk from the MSM community to the general population are the bisexuals. Could you please clarify or put this in the right perspective?

I distaste stereotyping and scapegoating. I strongly believe people should be able to enjoy sex through the expression of their sexuality. What is missing is necessary and needful information for people to have informed choices about the kind of sex they have. Like I said, HIV is not an issue of sexual identity or sexuality, it is more of sexual behaviour and that is what we have to look into. There are evidence now that there are increasing heterosexual anal sex and this is a new revelation in Africa, so we need to be very careful when we talk about these things.

Do you subscribe to the proposal that programming for MSM should be addressed under the general purview of men’s health so as to navigate the stigma and discrimination.

No,I strongly oppose that. There are differences in issues affecting these populations and it will be unfair for us to merge the two issues together. Heterosexual men have little or no concern about anal cancer, and many other sexually transmitted infections( STIs) that are common in the gay community. Also the issue of understanding sex and sexuality differs from the two groups, just as much as issues affecting men differs from race, to ethnicity, so it will be one of the biggest mistakes of prevention to confuse the two.

Advocacy for MSM in Nigeria dimmed with the demise of Dare Odumuye in 2007.What would you attribute this to?

Dare had a vision to start an advocacy that will open the door for prevention that is inclusive. Now,what we have are career advocates.Dare and I had a passion and it was that passion that dictated what we did. We were not paid, we had no means of making money from the advocacy,and even our aim was not to travel out of the country. But now, advocacy is tied around money and overseas trips.Also Dare knew what needed to be done; he knew who has the power to get it done. He was more local than global and it worked, he was able to open doors, network and get result locally and that is what is missing. I want to see more passionate advocates;those that will not aim to be super heroes of the community, but spokespersons for the community-speaking not what they think but what reflects the desire and need of the community.

Is there a leadership gap to be filled at the moment and who is playing that role?

There is a leadership role to be filled indeed, and there is no one I can single out is playing that role. The community is seriously fragmented and the increasing competition for funding is creating a divided community where there is no cohesion and no clear-cut agenda for advocacy and this is a big shame. When Dare was alive, we all look up to him to lead the way, but now, it is a different story.

Your absence also has created some gaps. What have you been up to lately?

Really? I will take that as a compliment. I moved to the UK in 2007 after my coming out on Funmi Iyanda’s show. I know many people are saying that I used the show as a means to run away. I think I will be happy to make it clear here that it was never my wish to leave Nigeria. I miss Nigeria a lot and wish I could go back home and share my experience. I really wish to get back in the struggle and tackle some of the issues you raised in your questions. I am not boasting, but I think I still command respect within the community and I can help in coordinating an agenda. As for what I am doing; well I am doing my Masters at the University of London at the moment, and that will finish in the summer. I am studying politics but with special interest in International development and Aids. Im looking at how the systematic global north funding has either helped or undermine development in Africa, but I will also look at HIV and Poverty within minority groups. Finally, possibly come back home one day and get involved in politics.

Do you see a change soon in attitude towards MSM in Nigeria especially as we continue to seek for innovative ideas and ways to control this epidemic?

Yes I really do see a change; I am more optimistic now than I was 4 years ago. I have seen loads of changes, there are increasing room for discourse around human sexuality now, though most times in negative ways, but I know that even negative publicity is sometimes a good step in the right direction. All that we need is a very strong and cohesive community of MSM, which is driven by passion and ready to effect a change without discord.

What Biology did not teach me about Human Sexual Make up.

I am sure I am not the first person writing on the curriculum of Biology in secondary schools, but since I have a personal experience growing up in Africa, there are certain things that Biology has taught me that are not true, and many things biology has failed to teach me.

As I grow older, I discover many things in life that I never learnt in class, and those things I was taught, that either never existed, or existed but was taught wrongly. This distorted information helped in shaping my ideology as a young man, and formed many erroneous view I had, it became the standard for my believe and relationship with people and things around me. So to finally discover that almost all the things I spent 6 years of my life learning was either false, or half true and that I have to start unlearning them, was a big task for me.

I am very sure many of you can see yourself in this picture, and have to go back to the classroom of life and social interaction to unlearn many things and start learning many things, most often than not, it is always after making a big mistake or taken a big wrong step.

For instance, on the issue of human sexuality, I was taught in my youth that the world is made of "Man" and "Woman", and that man and woman will meet and have sex and have babies, and that anyone who does not conform to the ideal of man and woman is biological deformed and needs help, and that includes people that self identifies as either Gay, Lesbian, Transgender or Inter-sex.

Another is the issue of "Hermaphrodite" in contrast to "Inter-sex". As a teenager growing up, I was taught that people with both sexes are biologically deformed, needs help and most times they do not live long into old age. Also biology taught me that it is a serious medical condition that needs instant intervention. Biology taught me that the make up of the body of a girl is different from that of a boy, and that is it not possible for a boy to have biological make up of a girl, and for this reason the whole concept of "Trangenderism" is an ideology that violates the order of nature and so should not be encourage.

But as I grow older and discover things for myself, I realise that most of this things is either false or half true, and that this has formed the basis for hatred, violence and discriminations, and not necessarily religion, as many has suggested (mind you I am one of the most antagonist of religious institutions)

On of the issue of Trans, I was fortunate enough to attend the first International congress on Gender Identity and Human rights in Barcelona in June 2010. In as much as it sounded that I was invading other people's safe space, I was exposed to a world I have never been before. I saw things and heard things I would never have seen or heard in my life.

Prior to my trip to Barcelona, I have many friends who are Trans and in the private of my room, I have asked myself questions about Trans people and the desire behind transiting, but I have never been bold enough to call on my friends to explain certain things to me. Not because I do not want to ask, but I was wondering, how can a man want to turn to a woman, why will someone want to go through such pain to do that, or why would a woman wants to transit.

As a gay man, I have enough troubles being gay, black and African, and these further complicate the views I have about Trans people. But being in the audience in Barcelona, listening to Trans people talking, and sharing their journey through life, I felt ashamed of my ignorance, this ignorance was not based on my inability to learn, but on what I was taught in Biology class.

I heard about Hormones, pathology, electric shock, correctional counselling. I heard the story of survival, sex works and the pain of living in a body that is not yours, looking at gentiles that do not represent you, and the burden of having to live your life in falsehood. I started to question biology teachings of man and woman, and specific human make up based on gender at birth, and the actual gender of the person.

There is also the issue gender binary of man and woman, and the exclusion of people who do not self identifies as one, either a man or a woman. There is also the discrimination on the basis that you have to be either LGB, or Straight, and then even within the LGB, the issues affect the T and I are left for the dogs.

I also had the opportunity to attend the session on Inter-sex, where for the first time in my life, I came face to face with people who are inter-sex and listened to their horrible childhood experience. I heard about the killing of inter-sex people in Africa, and the discrimination they faced in the LGB movement, I listen to advocates sharing their journey through life and the pains of denial of full sexual empowerment based on fear and hatred.

The painful thing is, it has taken me 35 years to understand the diversity in Human sexual make up, and finally when I learnt about it, it was a shock that will have to stay with me for a long time. If only when I was young and innocent, Biology has taught me all this, and not only me, but many other young people like me, maybe then, there wont be so much hatred in the world, religion will not have the power to manipulate us, and maybe, just maybe, many people that have committed suicides and gone into drug use as a reprival would have had a different life now.

Maybe there wont have been that debate for a "Gender Neutral Toilet", maybe everyone that wants to transit can do so with enough empowerment, maybe Inter-sex people can have the power to decide what is best for them.

Maybe, just Maybe.............

Today, I challenge the Human Sexual make up as proposed by Biology, I expand my knowledge of Human and Humanity and though I have to break my bank to be able to be in Barcelona, it was a trip worth taking.

HIV prevention and the Immigrant African MSM in London

As the political climate in the UK hots up, there are many expectations from many people and the three political parties are trying their best to make as many promised as possible, from Conservatives "giving power to the people", to Labour promise of "better future for all" and the Liberal Democrats saying "Better and Fairer Tax for all"

One thing that is of big concern to me is the issue of politicians commitment to "Sexual Health", and when I talk about sexual health, as a concerned sexual health advocate, I am talking about promise from politician on investment in Research and investing in treatment option. More money into prevention work for high risk groups, and the decriminalization of HIV transmission.

In the 80’s HIV was more of a winning gimmick for politicians. They made promises to tackle the epidemic, but 25 years on, with increasing number of people getting infected every minute, that issue is no more a political priority. As even more importantly is the issue of Immigrants and HIV transmission in Europe and mostly in the UK.

In 2007, I had the opportunity to kick start a project funded by the Newham PCT. The concept behind which was to provide prevention services for African MSM living in London, so that there can be an uptake of HIV testing and thereby reduce late diagnosis.

In 3 years, the project saw a huge interest in testing, and more men have been placed on treatment, they have been trained to be community champions, and this has seen more of this men coming to term with their sexuality.

But just when the excitement was high, and we are seeing an improvement in the sexual health of Immigrant African MSM, the funder are not sure this is a viable project, they are faced with the need to cut back on public funding and to prioritize spending within the Health system, and the first victim will be those projects that are not considered as point scoring.

With a service user base of over 50, this project, being the only in the whole of UK, providing such service for Immigrant African MSM will come an end, and the men will have to look elsewhere for their sexual health needs, and the funny thing is this might take another five years before another primary care trust sees the reason to fund such a project.

So, in 2010, HIV treatment, research, and prevention investment is not a political point scoring, but it gulps more money than even the banks.

So as I pack my bags and leave a dream behind, I think of many African MSM that will be arriving the UK with dire need for sexual health, one that is design to understand the dynamics of their identity and social constructs.

Just really wish someone can see beyond their nose.

The Search for a leading Black LGBT role Model

At the last NUS LGBT conference, the Black LGBT students caucus had a training session where they were asked to name celebrity role models from the Black LGBT community. We spent 30 minutes thinking and we could hardly come up with a name.

The problem was not lack of Black LGBT celebrity or role models, it is just that we could not relate with them, at least after 30 minutes, many of us remember Steven K Amos, but again you asked yourself what really has he done for the Black LGBT community apart from coming out, and then we also remember John Ameachi.

I was worried why we found it pretty difficult in the UK to find a Black LGBT role model, but then I got the answer when I went to America in December with my partner. I was in New York for some days, and there I heard about a strong organizing of Black LGBT people, they have great representation and the community is very strong. The same can be said of Chicago where I had a wonderful reception and met influential Black gay men and we talked about their struggles and how it is very easy for them to organize.

I was worried about the lack of same thing here. But one thing the Americans have going for them was the Black liberation movement of the 60's, a battle that created a great sense of consciousness in the people and has taught them that if you do not represent yourself, no one will do it for you, something the Black community in the UK does not have.

The fight in the UK is more of Black community fighting against each other rather than fighting for each other. I have only lived in London for 3 years, but I can still recollect attending many Black gay men's meeting most of which are dead by now, due to bickering, hatred and quest for leadership. The community is in disarry and the so called leaders are busy individualizing the struggle for personal gains.

The fight against stigma and discrimination within the Black community in UK is one that can not be won unless there are strong Black LGBT movement and people out there. The demand for a significant figure in the Black community is one that is urgently needed.

I am not looking for a role model like Sir Elton John or Sir Ian Mcknelle, but I am looking forward to a more proactive Black LGBT community that has a leader, one that is built on the struggle for freedom within and without. One that will start an anti discriminatory campaign within the Black communities and in our schools. One that is strong enough to push for Black LGBT agenda in all fields.

As I await this day, I call on the ones that I know to please take the chance, take the risk and lead your people to the promise land. No one will do it for us.