Mail & Guardian (Johannesburg) - May 24, 2006
Jonathan Berger

But that changed after attending a satellite session on microbicides for gay men, other men who have sex with men and -- in the words of the Sex and the City gals -- "up-the-butt" girls.

I should have guessed that an afternoon dedicated to anal sex would prove interesting, if not entertaining. Held in the farthest reaches of the International Convention Centre, where the regular pounding of the ground at the adjacent building site literally made the earth move, science combined with sex to turn data into dinner party conversation. Too bad I eat alone most evenings.

Surprisingly, I was unprepared for what was to come. For example, how was I to know that there are an estimated five times as many acts of unprotected anal intercourse between heterosexuals as there are between men who have sex with men? Or that semen can travel two to three feet up the colon? Who would have figured? Who would have measured?

Perhaps the most fascinating snippet of information was the matter-of-fact reference to the practice of anal bleaching, apparently quite common among moneyed, white, west coast boys. (For the record, that's LA and San Francisco, not Paternoster or Saldana Bay!) Too embarrassed to admit that I had never heard of the practice, I sms'd a couple of friends for help. The only other friend I was prepared to ask was already sitting next to me, equally bewildered.

J, an HIV and health media activist, advised me that his outfit warned against the use of common household products. I assumed this to include baby oil. N, an HIV treatment activist, promised to quiz his dinner guests. It subsequently transpired that not a single one of them -- all conference delegates -- had ever heard of the practice. I had to swallow my pride and ask a gay United States federal employee -- yes, Dubya, gay -- for help.

Turns out, anal bleaching is, well, anal bleaching. Ouch!

Sexual innuendos aside, rectal microbicide research is unfortunately very unsexy. The International Rectal Microbicides Working Group estimates that it will cost about $70-million to develop a single rectal microbicide candidate over a 10 to 15-year period.

It suggests that at least five candidates should be developed over this period, meaning a total of $350-million -- or about $35-million a year. Current expenditure stands at a miserable $7,2-million. Ouch indeed!

In the past six years, this research has attracted a total of $34-million of funding, including only $6,6-million from the National Institutes of Health (NIH) and "in-kind" donations from the private sector valued at about $100 000. Vaginal microbicides seem to have fared substantially better, currently attracting annual funding of about $140-million. But this is nowhere close to other areas of research. Consider, for example, that the NIH spent $1,7-billion on bio-terrorism last year alone. For 2006, the US Congress approved $3,3-billion for bird flu research. Beware the virus that may come, but don't worry about the one that's already here!

Granted, the science of rectal microbicides is complex, significantly more so than that of their vaginal counterparts. And unfortunately, that science is hardly simple. To date, only six candidate vaginal microbicides have completed safety trials and been cleared for large-scale phase three efficacy trials. Optimists believe that these female-controlled technologies -- which will reduce but not eliminate the risk of HIV infection -- will be available in five to seven years. The back door will have to wait even longer before it can be similarly protected.

So what about my epiphany about the compartment that dares not speak its name in polite gay society? I was to learn that it is a remarkable organ that is stronger than the rectum, more easily protected and home to an entire forest of microflora that scientists believe have the potential to be genetically modified to protect against pathogens such as HIV. Fancy that! Despite my initial ignorance and disinterest, not to mention my penchant for the penis, the vagina had finally found its way into my life.

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