Bay Windows - October 14, 2004
Ethan Jacobs, ejacobs@baywindows.com.

The mysteries of microbicides

Dr. Kenneth Mayer, the principal investigator in the microbicide study, said at present there is no microbicide ready to be tested for use during anal sex. He said the National Institutes of Health (NIH) is currently funding studies of vaginal microbicides with the hope they might prove useful in stemming the spread of HIV in parts the Third World; in cultures where men refuse to wear condoms, women would be able to use microbicides to protect themselves from HIV infection.

When researchers eventually find an effective microbicide for vaginal sex, Mayer said, health advocates will need to test the microbicide for use during anal sex.

"It may be that because the physiology of the vagina is different than the rectum, you may have to make the product differently," said Mayer.

The present study at the Fenway is part of a larger effort by researchers at multiple institutions to answer questions about what makes a microbicide viable for anal sex. The Fenway's goal is to find out how much lubricant, and consequently how much microbicide, people are likely to use.

To that end, the center is recruiting 120 HIV-negative men who have been receptive partners in the last year to help out with some hands-on lube research.

"Initially men in the study are trying out different amounts of lubricant without having sex," Mayer said. Participants will rate which amount of lube feels best, said Mayer, and the lube will be a fairly neutral compound, something that scientists could conceivably mix with a microbicide.

Once researchers collect these initial results, they will determine a standard amount of lube that will be acceptable to most of the participants. Then volunteers will go home to help the Fenway with some more hands-on research.

"We're asking them to have protective [anal] intercourse several times" using the standardized amount of lube, Mayer said. After trying out the standardized volume of lube several times participants will come back to the Fenway for interviews to find out if the amount of lube is acceptable.

In addition to the men, the study will also begin some tentative research into women and anal sex. Only 28 women will take part in the study, and they will come in to the Fenway for one in-depth interview on their anal sex practices. Mayer said researchers know far less about women who have anal sex than they do about men, and this study is an attempt to get the ball rolling.

The Fenway has worked to recruit both men and women by running ads in local papers, including the Boston Metro, distributed for free at T stations around the city, and Bay Windows. While mainstream culture may not be as comfortable talking about anal sex as the gay male community, Mayer said the response from women to the study thus far has been positive.

He said Liz Salomon, the Fenway researcher who has been working with female volunteers, has "had some wonderful stories of women who have seen the ad in the Metro and were really excited."

Mayer said he expects the study to last a couple of years, and then there will be another year spent analyzing the data. He urged people interested in volunteering for the study to call the Fenway's volunteer line, 617-927-6450.

Trans-friendly healthcare

Dr. Randi Kaufman, the coordinator of the Fenway's new Transgender Health program, said the program is designed to address many of the obstacles faced by transgender people seeking healthcare.

"I think a lot of people that are trans don't seek services at all. They don't have primary care," said Kaufman. She said many transgender people fear discrimination by medical staff.

"And then when people do come in there's a lot of doctors and nurses who don't know how to treat trans clients," said Kaufman.

To reverse that trend Kaufman said her staff of ten medical and mental health providers, outreach workers, and safer sex educators have taken a two-pronged approach: to offer comprehensive healthcare for transgender clients at the Fenway and to do outreach and education to local health providers about how to provide trans-friendly healthcare.

The program officially opened in July, and Kaufman said she currently has about 150 clients. The Fenway currently provides the full range of healthcare for transgender clients, including both medical and mental health services.

Kaufman said one of the goals of the program is to change some of the medical community's basic assumptions about gender and transgender people.

"I think that over the last several years we've seen a large increase in the number of people who don't identify as male or female," said Kaufman. She said the Fenway has responded to suggestions from clients over the years about changing the gender terminology on their forms to be more inclusive of trans people, and she hopes other healthcare providers will rethink their approach to treating transgender clients as well.

Another change Kaufman hopes to make is the medical community's understanding of the hormones and surgical procedures used by transgender people.

"Not everyone who identifies as trans or gender variant needs to go on hormones," said Kaufman. Each individual has different needs, she said, and providers should work with clients to determine whether hormones are appropriate in their particular case.

Kaufman believes the standards and protocols for evaluating whether transgender people should have surgery are also too strict and standardized, and she hopes to educate doctors to modify those standards to be more responsive to the individual needs of their clients.

Kaufman said the program is currently organizing a town hall discussion for providers and the trans community on transgender health issues, and she hopes to hold the discussion sometime this fall. She said one of the major obstacles transgender people face in healthcare is that providers often only seek education in transgender health issues after their first transgender client walks through the door. She hopes the town hall and other educational efforts will help providers learn about trans health issues before they are faced with their first transgender client.

"I don't think it should wait until [a transgender client] presents themselves," said Kaufman.

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