The hunt for the perfect condom continues

Condoms prevent the spread of disease and, of course, unwanted pregnancy. Globally, more than 5 billion are sold each year, but is there still room for improvement?

Since 1988, the 1st of December has been dedicated to raising awareness, fighting stigma and commemorating those lost to the disease.

World AIDS Day was the first global health day, and each year since 1995, the president of the United States has made an official proclamation.

By the end of 2012, there were 3.5 million people living with HIVglobally and an estimated 2.3 million new HIV infections.

Sub-Saharan Africa is the worst hit by the epidemic. In some countries, 20% of the population are infected. However, nowadays, Central Asia and Eastern Europe are experiencing the fastest spread of the disease.

On a positive note, since 2001, new infections have fallen by 33% and the number of children newly infected by HIV has dropped by 52%.

The battle is clearly not over. Science is dedicated to discovering better treatment, more effective prevention and, eventually, the cure for this most pervasive and destructive disease.

Mahua Choudhury, PhD, assistant professor at the Texas A&M Health Science Center Irma Lerma Rangel College of Pharmacy, is part of this push.
The future of condoms

Chowdhury has come up with an ingenious and revolutionary design for a new condom. Rather than latex, which many people are either allergic to or simply dislike, she plans to use a hydrogel infused with plant-based antioxidants.

The hydrogel in question is a strong, elastic polymer that consists predominantly of water. It is already used in contact lenses, so the challenge of safety testing is at least partially removed.

What makes this condom particularly special is the addition of a plant-based antioxidant. This compound has been found to have anti-AIDS properties. If this innovative condom breaks, the antioxidant is released and prevents the virus from replicating.

But the innovation does not end there. These particular antioxidants - flavonoids - are also predicted to heighten sexual enjoyment.
What is a flavonoid antioxidant?

Flavonoid antioxidants are found in many fruits, vegetables, leaves and grains. Some types of flavonoids, like quercetin, are already available in supplement form.

These flavonoid antioxidants can enhance feelings of pleasure by promoting the relaxation of smooth muscle and raising arterial blood flow. Thirdly, flavonoids help keep nitric oxide levels elevated, which work to stimulate and maintain erection.

Chowdhury's mission was to create a condom that would not only be an effective AIDS barrier, but also something that people would actually want to use. She says:

"If you can make it really affordable, and really appealing, it could be a life-saving thing."

Funding will come from the Grand Challenge in Global Health award courtesy of the Bill & Melinda Gates Foundation. The award was set up to fund individuals working to solve pressing global health challenges.

The competition this year was focused on finding an extremely low-cost, latex-free condom. Choudhury was one of 54 applicants selected out of 1,700 to receive the funding.

The condom is not yet ready for market - extra testing is needed - but the product is well underway. "We are trying to find how fast the enmeshed antioxidant can release, and we don't know if it will automatically release, or if you have to apply pressure," Chowdhury says.

Over the next 6 months or so, the final testing will have been completed. The potential benefits of a condom that people actively want to wear and that protects against AIDS with a double-edged attack are obvious.

also see:

World’s first condom specifically designed for anal sex 2013

Alarm rings on low uptake of existing prevention options for anal STIs and HIV

Despite overall progress in HIV prevention, rates of HIV infection among key affected populations such as men who have sex with men (MSM) and transgender people remain alarmingly high. For example, recent data indicates that MSM are up to 19 times more likely to have HIV than the general population – transgender women are almost 50 times more likely. Overall new HIV infection rates have dipped by 26% in Asia and the Pacific region since 2001,but not for MSM and transgender.

According to a 2013 UNAIDS report, estimated population of MSM in the region is between 10.5 million to 27 million. HIV incidence continues to remain very high among MSM in cities such as Bangkok, Ho Chi Minh City, Jakarta among others.

(L-R) Dr I Gilada, Midnight P,Dr V Chakrapani, Dr Suwat C Midnight Poonkasetwattana, Executive Director of Asia Pacific Coalition on Male Sexual Health (APCOM) addressed a press conference jointly organized at 20th International AIDS Conference (AIDS 2014) by AIDS Society of India, APCOM, AVAC - Global Advocacy for HIV Prevention, Citizen News Service (CNS), International Rectal Microbicide Advocates (IRMA) and Research Institute for Health Sciences (RIHES), Chiang Mai University.

Midnight said: "Key affected communities should be in the heart of the delivery of services by the government, then only perhaps the impact will be maximal. Commission on AIDS in Asia (2008) had predicted that if no action was taken to increase the investment to MSM programming then they will account for nearly 50% of new HIV infections by 2020. That is a cause of serious concern. Punitive laws and practices that criminalize same-sex behaviour are still prevalent in many Asia Pacific countries. Such laws deter MSM and transgender people to have access to existing health services they need. We need to work on destigmatisation of healthcare services, and working with the law enforcers for supportive health policies. At policy level we need to advocate with the government, we need to ensure that policy barriers get removed so that MSM can actually access those services."

Investment continues to remain very low in MSM programming. "Less than 7% of the money is going for HIV prevention among MSM. To be strategic we need to increase investment for MSM programming especially younger MSM in cities" said Midnight.

Dr Ishwar Gilada, ASI

Dr Ishwar Gilada, President of AIDS Society of India, and a noted HIV physician who was among the first few medical professionals who responded to HIV care when first case was diagnosed in India, was moderating this panel discussion at AIDS 2014. "Unsafe sexual practices among transgender women were rare at that time when I did my study with Hijra community in 1983-1984. We could never have imagined then that Hijra community will come to International conferences. People used to laugh at them when transgender people used to come to JJ Hospital for care. I started a special clinic in OPD from 2pm-4pm in 1983 at JJ Hospital for transgender people. Back then we used to write male or female H (Hijra) as sex, but it took decades for government to finally recognize the third gender."

Dr BN Saxena

Dr Badri N Saxena, Chair of Microbicides Expert Group of Indian Council of Medical Research (ICMR) said (via web link) that there is hardly any choice under national HIV or STI prevention programmes except barrier method such as male condoms (female condoms are limited to very few targeted interventions or other social marketing initiatives). Few more options are available in private healthcare sector such as vaginal creams. Dr Saxena pointed out that there are 30 million episodes of STIs annually. Dr Saxena also advocated for a need-based phased introduction of Pre-Exposure Prophylaxis (PrEP) to provide another option to MSM people who might benefit from expanded range of HIV and non-HIV STI prevention options.

'Invisible' key population

Dr RR Gangakhedkar, NARI, ICMR (CNS Image library: December 2012)

Dr RR Gangakhedkar, Deputy Director, National AIDS Research Institute, ICMR said (via web link) that according to the mapping estimates there are 0.412 million MSM in India. Overall HIV prevalence rate among MSM is 4.4% and TGs is 8.8% (2011). There are targetted interventions (TIs) for both key populations in India offering STI services, linkage with HIV testing and care services, condom promotion, peer education, outreach, among others. There are over 201 MSM TIs that include over 37 community-based organizations-led TIs. Coverage as per the MSM population estimates is over 70%. Additionally, a program named "Pehchan" is also being implemented. 20 TIs are exclusively for transgender people.

Dr Gangakhedkar added: Though the overall coverage is high among MSM TIs, very little is known about the coverage in 'invisible' part of MSM population. With re-criminalization of same sex behaviour perhaps more MSM may opt to be 'invisible'.

Stigma lurks

(L-R) Dr I Gilada, Midnight P, Dr V Chakrapani, Dr Suwat C

Although situation has changed some shades for the better, but still stigma in healthcare settings rages high and often blocks access to existing services for MSM and transgender people even today.Dr Venkatesh Chakrapani, Director, Centre for Sexuality, Health Research and Policy, said: "Knowledge about HIV and STIs is perhaps not that big a challenge because despite knowledge, condom use among MSM and transgender people is low. For example they may not like to use condoms with their regular partners. If I need treatment for anal STIs I need to disclose to the doctor that I am MSM. Likewise talking about partner notification and simultaneous treatment of STIs in both partners becomes a huge challenge if stigma lurks in healthcare settings in India. Another issue is that condoms are free but lubes are not. Including lubes will help with dealing with issues such as condom breakage and augmenting HIV prevention among MSM and transgender."

Dr Chakrapani remarked that re-criminalization of consensual same-sex activity in India is having negative impact on health services for MSM and transgender people. "We spoke with few doctors this year and some of them were not clear if they should report to police if any MSM and transgender person comes to seek treatment for anal STIs. Some doctors were also not clear on whether they are abetting a crime by managing anal STIs among MSM and transgender people. No wonder MSM and transgender people are often reluctant to seek care in government hospital."

Unique needs and contexts of transgender people

Simran Shaikh, India HIV/AIDS Alliance

Simran Shaikh, a leading transgender activist with India HIV/AIDS Alliance, lamented that despite advocacy transgender related issues still get overshadowed by MSM related issues. She called for more space for addressing transgender issues as they are unique and need special attention. She said that there are exclusive transgender and Hijra interventions taking place now in India but we need to accelerate the scale up. Simran said that national HIV rates among transgender and Hijras are as high as 8.4% in India (general population HIV rate is about 0.27%). She mentioned specific situations that escalate this risk for transgender and Hijra community such as lack of opportunities for education, employment, or other social support systems.

Simran too echoed concerns that current STI and HIV prevention options are not working well enough and uptake remains low. Condom negotiation is very difficult for a transgender person to do with a client or regular partner, said Simran. She identified high consumption of alcohol and substance abuse among transgender people in India as another key challenge that ups their vulnerability to HIV and abuse.

Rectal Microbicides provide hope

(L-R) Midnight P, Dr V Chakrapani, Dr Suwat Chariyalertsa, RIHES

Dr Suwat Chariyalertsak, Director, Research Institute for Health Sciences (RIHES), Chiang Mai University, Thailand, who is a key researcher at this site for a rectal microbicide phase II study (MTN017), explained that we need to expand the range of HIV prevention options for those practicing anal sex.

Rectal microbicides– in the form of gels or lubricants – are products that are currently under research and are being developed and tested to reduce a person's risk of HIV or other sexually transmitted infections from anal sex. The risk of becoming infected with HIV during unprotected anal sex is 10 to 20 times greater than unprotected vaginal sex because as the rectal lining is only one-cell thick, the virus can more easily reach the immune cells and infect them.

Dr Suwat shared that the first-ever phase-II extended-safety study (formally called MTN017) of a rectal microbicide in the Asia-Pacific region has begun in Chiang Mai, Thailand since February 2014. In total, there are 8 study sites including Chiang Mai, such as: CDC Bangkok (where study will commence very soon), South Africa, Peru and in US. The objective of this rectal microbicide study is to study the safety and acceptability of a rectal microbicide gel for now. This study will perhaps also give information on issues such as adherence of study participants to the study product. Depending upon the outcome of this study (if study product is found safe and acceptable) efficacy studies will be conducted later. In this study, every MSM and female transgender study participant will have the same duration of exposure (eight weeks) to three different regimens (with a one week gap between each regimen): oral Truvada/PrEP daily for eight weeks, rectal gel (reduced glycerin and tenofovir gel) daily for eight weeks, and sex dependent rectal gel for eight weeks (applied anytime during the window period of 12 hours before and 12 hours after having anal sex).

Brian Kanyemba

Brian Kanyemba, Desmond Tutu HIV Centre, Cape Town, South Africa said that phase II study of rectal microbicide (MTN017) has also started at their site which is the only site in Africa. 7 out of 24 study participants have been enrolled so far.

Condoms... and lubes!
Jim Pickett, Chair of International Rectal Microbicide Advocates (IRMA) said in a press conference at AIDS 2014 (via web-link): Project ARM (Africa for Rectal Microbicides) was started by the IRMA few years ago to make sure that as the HIV prevention field moves ahead for research and development of rectal microbicides, these products [when eventually made available] are safe, accessible, and affordable to the people who need them [in African context]. There was a realization that we need to do some specific work in Africa in context that there are many countries where anal sex is illegal, people can be prosecuted and there is lot of [anal sex related] stigma and discrimination too."

Jim Pickett (CNS image library: July'12)

"Project ARM was born out of the growing need to create a research and advocacy agenda for rectal microbicides in Africa. Project ARM shows us what are the priorities in terms of research, advocacy and community mobilization around rectal microbicides in African context. One of the priorities that came out of Project ARM discussions was lube access. The reason was that people who practice anal sex cannot access lubricants."

"We have to recognize that it is not just MSM and transgender people who have anal sex but also men and women in heterosexual relationships. If that route of HIV transmission is not looked at then HIV rates are bound to rise in those practicing anal sex."

Jim briefed about "Global Lube Access Mobilization - GLAM". He said "Having safer lubes will not be enough unless policies and programmes start addressing access to lubes. This is how GLAM came into being. If we provide condoms to people and not provide lubes then it is a big problem because then people use whatever they can find and at times they use lubricants or products that are not condom compatible. Lack of condom compatible lubricants in Africa was acute. With no lubes people often resort to body lotions, cooking oil, pre-cum, creams or other things that are not necessarily condom compatible."

IRMA grants announced
Jim Pickett announced in this press conference that few grants have been awarded to some projects to advocate for national and local-level access to safe, affordable, condom-compatible lubricant in Africa to improve the impact of HIV prevention services. These projects are based in African countries such as Cameroon, Ghana, Kenya, Nigeria, Tanzania among others. This is the second year for IRMA to support projects in Africa. This year the grants are supported by amfAR, AVAC - Global Advocacy for HIV Prevention, COC Netherlands, and IRMA.

PrEP and WHO Guidance for key populations

(L-R) Deirdre Grant, Dr Ishwar Gilada, Midnight Poonkasetwattana

Deirdre Grant from AVAC – Global Advocacy for HIV Prevention said that "WHO Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations" which were released at AIDS 2014, are first set of guidelines for key affected populations that not only addressed the common areas which affected them all, but also addressed population specific ones. Deirdre informed that these guidelines were for five key population groups which were: MSM, injecting drug users, sex workers, transgender people and people in prisons.

PrEP is recommended as an additional HIV prevention choice within comprehensive HIV prevention package for MSM in these guidelines. On use of PrEP by transgender people, Deirdre said that there needs to be more evidence before strong recommendation can be made for its use among this key population. Deirdre called for heightened advocacy around PrEP and noted that WHO guidance helps with agencies and funders but does not directly help people who want to access services. Lots of other issues such as barriers, investment needs, dearth of smart programming, lack of implementation science, etc must be addressed alongside rolling out the guidance.

Dr Seema Sahay,NARI,ICMR

Dr Seema Sahay, Deputy Director, National AIDS Research Institute (NARI), Indian Council of Medical Research (ICMR), who is a noted social scientist said: "We are focussing on how to reach ‘hidden’ MSM especially adolescent MSM as this population is also surfacing right now. This is one problem we will like to have some advocacy and challenge we face. We conducted a small qualitative study and realized that knowledge about PrEP is very low. 2/39 MSM had heard of that. There should be some education programme and advocacy for PrEP as message about PrEP has not reached majority of MSM."

Vijay Nair, who demonstrated leadership years ago in India to organize HIV positive MSM as a network called NIPASHA+. Currently he is involved with India HIV/AIDS Alliance. Vijay expressed concerns if new HIV prevention technologies will ever reach those MSM who are in need.

VIjay Nair

Discussions about these new HIV prevention technologies are often limited to global conferences or meetings with little ground work taking place in our countries. He expressed concern why it has taken over two decades to do female condom programming after US FDA approved it in 1993? PrEP was approved by US FDA in July 2012 but still there is no clear sense how PrEP will reach MSM in need. He agreed with Dr Seema Sahay's observation that there are 'hidden' MSM in India who are not part of (or perhaps do not want to be part of) targetted interventions for MSM, and PrEP could be an option for them.

source

Gay Men Are Receptive to Sexual Health Info on Hookup Sites says Scottish Study

Something that most us from the front lines already knew in Jamaica but when oh when are our HIV prevention strategists going to finally be proactive or at least sensible to recognise what has worked and use them? Lest we forget we have 33/4% infection rate in MSM. 

On Facebook even now in on of my groups we often times raise such issues such as hook-up safety tips as recent incidents have raised some concerns and HIV safer sex tips in the heat of the moment, I can remember even the days of GLABCOM when the short lived blog was used to such effect as well. Now comes a study that help us to understand better.

A survey of men who have sex with men in Scotland has found that sexual health promotion is acceptable in online cruising environments such as Gaydar and Grindr, but that a significant minority of men object to health workers initiating contact with them while using these websites and apps.

The researchers from Glasgow Caledonian University make several recommendations for online health promotion with gay and other men who have sex with men. Their online survey was conducted with 1,326 men who were recruited through a social networking website (Facebook), sexual networking websites (Gaydar, Recon, Squirt) and sexual networking apps (Grindr, Gaydar).

Given the recruitment methods, it’s unsurprising that very large numbers of respondents used sexual networking websites (86.8%) and sexual networking apps (56.4%). Around four in ten respondents used one of these websites (38.0%) or apps (42.8%) on a daily basis.

Fewer respondents used BBRT and other sites focused on barebacking (14.7%), with only 4.6% using them every day. Unsurprisingly, unprotected anal intercourse was widely reported by men using these sites. But while it is often thought that they are mostly used by HIV-positive men who want to serosort, this survey found that a significant number of users of those sites believed themselves to be HIV-negative.

As expected, the websites and apps were primarily used for sexual reasons, but they also served a social purpose for some men, especially those living away from the big cities. The main reasons to use them were to meet men for sex, for dating and to swap erotic photos or messages, but around a third of men used sexual networking websites to make new friends or to be connected to the gay community.

‘Killing time’ was also a reason that a third of men used these websites and apps.

The researchers were interested in what kinds of health promotion interventions would be acceptable in these environments. Of note, less than 5% of website users and 2% of app users said they used these services to access sexual health information.

Few respondents objected to health workers taking a ‘passive’ approach. On sexual networking websites such as Gaydar, Recon or Squirt, 85.7% said it was acceptable for workers to have a profile or identity and to wait to be approached by users. Slightly fewer (74.5%) supported this approach on smartphone apps such as Grindr.

There was less support for a more ‘active’ approach, in which health workers approach participants and solicit engagement. On websites this was supported by 54.6% of respondents; on apps it was acceptable to 40.5%.

The researchers note that while the sexual nature of these online environments – and the higher rates of unprotected sex reported by frequent users - would seem to make them appropriate locations for sexual health interventions, proactive interventions may be met with resistance from some users. They say this resonates with research in public sex environments, which has found that specific social and sexual areas are delineated - sexual health promotion is only acceptable in the ‘social’ areas.

Utilising existing social spaces on websites or apps – or creating new ones – for health interventions may be culturally more appropriate than outreach within main areas, they argue. However it remains to be seen whether such an approach would be effective in reaching large numbers of men, especially those with higher-risk behaviours.

The authors also point to the importance of finding acceptable ways to interact with men on the specialist barebacking websites, who are likely to be at higher risk of sexually transmitted infections or of being involved in HIV transmission. Furthermore their qualitative research found that some HIV-positive men reporting these sites being important locations of community support (mentioned more often in interviews than websites established by health agencies.) While this role could possibly be harnessed, health organisations may be uncomfortable doing so. “Orthodox public health systems may have trouble engaging with the transgressive sites favoured by some gay men with HIV,” the authors comment.

Men responding to the survey supported sexual health promotion in various online media – around half said they would be likely to use an app allowing a 1-2-1 chat with a sexual health adviser (52.7%) or a service which would send a text message when it’s time to go for a sexual health check-up (49.4%). The latter was most acceptable to men who would benefit the most – those who reported unprotected sex with multiple partners and those who did not report annual HIV and STI testing.

But the researchers urge local health bodies – such as those who commissioned the research – to collaborate with and promote existing sexual health websites, rather than to create new local services.

They also suggest that sexual health promoters should consider how the negotiation of safer sex occurs in digital settings, where more direct negotiation is possible than in face-to-face encounters and intentions can be signalled by profile options. Health promotion could provide guidance to men who have sex with men on minimising the risks of online cruising - addressing issues such as managing information and disclosure; dealing with truth, ambiguity and omissions within online relationships; and the transfer of relationships from the digital to the physical world.

References

Frankis J et al. Social Media, Men who have Sex with Men and Sexual Health in Lanarkshire: quantitative report. Glasgow Caledonian University, 2014.

Frankis J et al. Social Media, Lanarkshire Men who have Sex with Men and Sexual Health: An Experiential Qualitative Analysis. Glasgow Caledonian University, 2014.

also see:

13,328 Jamaican MSM Reached by HIV Prevention says report on National HIV Program ........ but

New Efforts To Halt Spread Of HIV Among Gay Jamaica Men

Concerns for HIV prevalence rate in MSM in Jamaica & connected matters

Health Minister Ferguson on WAD '13 & FBOs fear of a Buggery repeal with future parachuted gay marriage rights

Incestuous messes, poor NGO monitoring & ever deepening mistrust about "gay rights"

Why did CVCC & JFJ not Fund a Project/Home for Homeless LGBT Youth in New Kingston instead of the Children’s Home Fiasco ...........

YOUNG MSM/TRANSGENDER WANT TO BE TREATED AS CITIZENS NOT POTENTIAL HIV/AIDS VICTIMS from March 2014

HIV and MSM community: Should we care? — Pt 2

Layered Stigma among Health Facility and Social Services Staff toward Most-at-Risk Populations in Jamaica

Big AIDS fight boost - Ja gets US$3.8 million from US$7-b fund

2007 MSM Study Reminder

New HIV infections rising in region, Unprotected straight, anal and bisexual intercourse blamed 2011

Review condom policy for prisoners

Continued oversight of same gender loving women in HIV response

German Study: Gay men who discuss HIV status with sexual partners are less likely to acquire HIV

Source

A case-control study, examining the sexual behaviour of German gay men receiving HIV-negative and HIV-positive test results, identified two key factors which distinguish the groups – consistent condom use with casual partners and discussing HIV status with partners.

The results, recently published in BMC Public Health, lend some support to the idea of serosorting (choosing a partner who has the same HIV status), but only when HIV status is ascertained through a clear and unambiguous conversation. Men who didn’t use condoms because they assumed their partner was HIV negative had a greater risk of acquiring HIV than other men.

This was a case-control study – in other words, an observational study in which a group of people with an infection (called ‘cases’) are compared with a group of people without the infection (called ‘controls’). The past events and behaviour of the two groups are compared in order to help us understand the risk factors for acquiring the infection.

Cases were gay men who attended one of a variety of HIV testing facilities in Germany, were diagnosed with HIV and who were determined to have acquired their HIV infection within the previous five months (based on a Recent Infection Testing Algorithm or RITA). Controls were gay men who took an HIV test and received a negative result, matched to the cases on the basis of their age and country of birth.

Information about the sexual behaviour of cases and controls was collected before receiving HIV test results.

Data were collected between 2008 and 2010. There were 105 cases and 105 controls, who had an average age of 34 years. Nine out of ten were born in Germany and they were generally well educated.

There were numerous variables for which no differences were observed between cases and controls:

Education.
Knowledge of HIV transmission risks during different sexual acts.
Recent HIV testing.
Recent diagnosis of a sexually transmitted infection.
Being single.
Inconsistent condom use in a primary relationship.

However some behavioural factors did distinguish cases (men who acquired HIV) from controls (men who did not) in the first analysis.

More cases (22 men) than controls (10 men) reported having been in a relationship of less than six months duration, and cases were also less likely to be in a relationship lasting more than a year. This points to the risks of HIV transmission during the early stages of romantic relationships.

While equal numbers of cases and controls had only had one sexual partner in the past six months (14 men in each group), average partner numbers were higher for cases (mean 11.8 partners, median 5) than controls (mean 6.6, median 4).

Whereas 60 cases reported having unprotected anal intercourse with a partner of unknown HIV status, this was only reported by 36 controls. There was a marked difference in terms of having unprotected receptive anal intercourse with a partner of unknown status (reported by 43 cases and 18 controls). Cases were also more likely to report inconsistent condom use outside of a primary relationship, with partners met online and with acquaintances.

Moreover, cases were less likely to report ‘always being safe’ with non-primary partners – in other words, consistent condom use or no anal sex. This was reported by 9 cases and 30 controls.

As can be seen only a minority of participants – including the controls – reported consistent condom use. When asked why condoms hadn’t been used on the last occasion of unprotected sex, many responses did not differ between cases and controls. For example, men in both groups said that they hoped nothing would happen, that condoms would have disturbed the mood, or that condoms caused erection problems.

However not using a condom because the respondent had assumed his partner was HIV negative was reported by more cases (25 men) than controls (8 men). Furthermore, while relatively few men said that they didn’t use condoms because they had talked to their partner about HIV status, this was reported much less frequently by cases (3 men) than controls (16 men).

The key results come from the multivariable analysis, which uses statistical techniques to identify the most important factors associated with HIV infection. Only two variables remained statistically significant. Demonstrating the continued relevance of consistent condom use, men who reported ‘always being safe’ were less likely to be diagnosed with HIV (odds ratio 0.23, 95% confidence interval 0.08 – 0.62).

In addition, men who did not use condoms having previously talked to their partner about HIV status were less likely to be diagnosed with HIV (odds ratio, 0.18, 95% confidence interval 0.05 – 0.71).

“One of the key findings was that having an explicit conversation about HIV serostatus before sexual activity reduces the risk of acquiring HIV,” conclude the researchers. “This might be attributable to the mode of serostatus communication: namely a direct and explicit conversation might be protective, whereas other ways of serosorting, such as relying on online profiles, or guessing/assuming HIV status based on appearance, might be much less effective.”

Reference

Santos-Hövener C et al. Conversation about Serostatus decreases risk of acquiring HIV: results from a case control study comparing MSM with recent HIV infection and HIV negative controls. BMC Public Health 14:453, 2014. (Full text available freely available here).

Minister of Education says no to condoms in schools & grooming of children to see homosexuality as accepted

The last time I looked at this was via two podcasts entered on October 28, 2012 and September 18, 2012 and written entries as well on the withdrawal of a teachers’ manual on sex and sexuality. As today is also Children’s Day I decided to release this entry today although it was ready from the moment the story broke. On his feet in parliament on May 15, 2013 the Minister of Education Reverend Ronald Thwaites said that condoms will not be distributed in schools neither will children be “groomed” into seeing homosexuality as accepted in Jamaica. Coming just days before the International Day against Homophobia and Transphobia, IDAHOT to be observed on May 17th his exact words were:

“This government led by this Prime Minister lifts up to our children the ideal of faithful love and marriage between a man and a woman as the basis of a family even as we insist on tolerance and love for those who are exposed to homosexuality but let it be clear Mr Speaker we will not be grooming children towards same sex unions and we will not be distributing condoms in schools. Guidance counsellors and their counterparts in the school and community health care systems they must know what to do when a student is in danger of sexual abuse but school is not a ramping shop, restraint must be taught by example and precepts, sex education yes, condoms no” 

He continued regarding the withdrawn yet forward thinking Home and Family Life Education manual that in part spoke to homosexuality, anal sex and a guided imagery exercise of role reversal which was to be conducted in a supervised environment by specially trained counsellors/teachers he said “ .... A positive value laidened age appropriate health and family life curriculum has been revised by a broad based working group for required use in all schools by September.”

Some lunacy here from the goodly minister or playing to the gallery seeing the party/administration has lost some major political capital post the IMF negotiations and confidence in the economy. It is not the first time of course we have seen the issue of homosexuality being made a platform for great pontificating and moral material while playing to the religious right’s imperative. What was also interesting is that the withdrawn HFLE manual is a voluminous document that spoke to several other wholesome developmental issues yet for one section it was removed out of fear.

Lasmay cartoonist from the Gleaner captures it best

So teaching children how to think on tolerance in regards to homosexuality is seen as grooming them to accept gay marriage? It is unbelievable the fear and paranoia coming from the powers that be in the education ministry, some people are gay, bisexual or the other variants we all have to come to that realization sooner or later. I am not surprised regarding the gay marriage bit and lumping all of that as a drive to homosexualize the nation as it were, it was in 2009 when the Bruce Golding administration rode the invented gay marriage discussion as a ploy to cloud the then Charter of Rights debate when the powerful religious lobby Lawyers’ Christian Fellowship, LCF also took part in seeing to it that certain key words were removed from the language in fear of any supposed loop holes for any rights or recognition of homosexuality in their eyes. Also at that time the then opposition leader who is now the Prime Minister referred to by Minister Thwaites sided with the Bruce Golding administration on not to gay marriage On October 20, 2009 where she said “Mr Speaker when we accepted the final report from the committee that looked at the bill we were completely satisfied with their recommendation of a provision to restrict marriage and liked relationships to one man and one woman within Jamaica and that the provision should specifically spelt out so that there could be no ambiguity (applause) yes! One man one woman and if you are Jamaican and you go overseas the same applies.” (applause) she continued that on highly sensitive matters such as these overseas supporters and governments must recognize the voice of the majority, she also continued that if same sex marriage was legalized it will lead to chaos in the country. The same charter also spoke to non-discrimination in terms of class, moving about and association but apparently certain things must not apply to some minorities;

The tyranny of the majority?

Red herrings here as per usual? ...... Of course to get everyone worked up

Scared or coward politicians who can’t make the bold decisions needed?

Where is the real tolerance in all of this?

We seem to have a different sense for human rights as it is not universal as is espoused prior to that as well during the P. J. Patterson administration in 2006 the then Minister of Justice A. J Nicholson prepared a statement on No To Gay Marriage at the time and given the recent dodge by the present administration now on the suggested buggery review by Mrs Simpson Miller during the last leadership debate prior to the December 2011 election it is clear that the issues of homosexuality and condoms are being lumped to make it into a political football for mileage. Let us also not forget that at no time was there any agitation for gay marriage rights or state benefits for same sex couples in Jamaica when we can’t even get passed just privacy, consensual sex and more progressive legislation alongside the deep seated cultural rejection so engrained in our psyche. I was not fooled from the start as was some advocates who hailed Mrs Simpson Miller’s suggestion as a promise only to have their hopes dashed, we must get used to Jamaican politicians by now and how they operate and with a powerful religious group and churches right behind them they will feel justified to take the so called higher ground yet look at the hypocrisy where children in lockups, the indigent and other afflicted groups are treated and silence from those same churches not to mention the politically skewed Jamaica Council of Churches who only seem to be very vocal when the Jamaica Labour Party is in power. 

Besides the law as in the marriage act in Jamaica presently will not allow gay marriages in the first place as it clearly states it is between a man and a woman and will take major amendments to include same gender loving persons. In 2001 there was a presentation made to the committee deliberating the Charter at the time with regards to discrimination but it was avoided via intellectual gymnastics as per usual. 

The avenue of challenging the marriage act has not been used even though the avenue exists and the reason why the discrimination clause was overlooked was due to a fear that such a challenge would come in the future counter to the charter. In other words no loopholes must be left for gays to get any rights now and in the future, a principle that was used also in the Sexual Offences Bill debate and the parliamentary submission regarding the buggery law in 1998.


Teenage pregnancies are up as much as 18%; HIV/AIDS rates are of concern with teenage girls in particular as the trends suggest older men are having sexual contact quite regularly. Initiation is also a challenge and withholding information and instilling an abstinence only messaging is not practical in today’s world. I will admit I was not pleased with the way the discourse on the suggestion of condom distribution in schools was handled properly by the press, the church (who owns and runs several high schools) the respective stake holders including the Ministry of Health’s and related national HIV programs and the public, what should have been made clear is distribution from a certain age upwards with the relevant information and skill sets provided and shared. Schools would not just become a condom slot machine where teens can simply get condoms as they please, there will have to be monitoring, counselling, information dissemination and other alternative activities presented as options for sexually active teens.

If we were to follow the authorities one would walk away thinking that the present set of adults were not young once with urges and desires, attractions and indeed initiation and experimentation and as the austerity measures take effect of sorts all kinds of methods are now being found to cut where possible and this cop out from handling sex and sexuality matters even as the minister himself recognises initiation and despite the finding that 60% girls of one class at a Kingston school were mothers, he also said in his presentation, “The education system in Jamaica recognizes that many children are initiated into sexual activity during their classroom years, some of the mass media, the carnival culture and confused family values are among forces who weaken the truth that premature sex is seat if true love”

As he imputes motive in the line with the word “forces” his continued belief that some invisible hand somewhere is trying to force homosexuality on the nation’s children during the preparation of the previous version of the HFLE manual that he now says is revised and now our kids will get a sanitized version and yet again we hide the real truth from them when they themselves know more about sex than the adults who teach them. He however encouraged school administrators to re-engage pregnant teens and not to shun them. The occasional preachy scripture related lines must be noted as well in his presentation.

And what about prevention of HIV and other sexually transmitted infection in the face of the fact that many teens are not going to remain sexless or virgins by thirteen years of age? Many students during the waiting period of the review of the withdrawn HFLE manual were not attending related classes according a small check I did. My neighbour’s grand daughter who attends Alpha Academy has the textbook equivalent to the manual at level 3 and when I quizzed her about the classes she said that no classes has happened and the students welcomed the free period on that given day on the time table. So valuable time has been lost, God knows what mistakes have been made or what could have been avoided.

Fear is a hell of a thing why is there the conflation with same gender sex and abuse or homo-paedophilia so pronounced and how can it be addressed? The teaching of same sex couples as a form of the newer family unit is not precluding the traditional heterosexual unit or taking away rights from such persons. Of course the gay lobby predominantly JFLAG whose stewardship by now you my readers realize am not pleased with will be relying on the law suit coming up in May and June by two persons on the ad rejection by both television stations and the challenge to the buggery law in a sense by activist/blogger Javed Jaghai. Very little came from the aforementioned persons/groups when the HFLE manual was withdrawn earlier this year possible showing how out of touch they are with how connected all of this is to the homophobia we have faced over the decades. I have long concluded that it is because of the lack of the proper curriculum on sex and sexuality over generations why we are at the chronic homophobic position. If we were taught not to fear sex, see homosexuality as orientation and not to hate but seek to understand the issues, abstinence as well as sexual negotiations with safer sex, self esteem and sexuality we would not have the psyche of fear and hate of the feminine and the unknown.

The latter mentioned fears has made homophobia well grounded in our nation and is going to take generations to change the thinking despite persons well travelled or exposed to other cultures. The so called family values that are used as reasons to avoid discussing difference and sexualities but the pathologies of said family life issues in a Christian sense are hidden or driven from a pulpit without any room for engagement for persons who have issues in their lives, marriage for example a discussion on Love 101FM on May 16, 2013 openly spoke to this in a very rare occasion marriage is pushed forward as if once one gets married in the church with God as its centre then all is well when this could not be further from the truth as the same issues of discovered incompatibilities show up after the ring is on, domestic violence, cheating, high rates of divorces within the church itself and down low issues as well where persons struggling with homosexual or bisexual urges marry to avoid, try to change or suppress such feelings and orientation.

Even as May is observed as Family month in certain church denominations it is clear that the very family values that more and more seem to be adopting very exclusionary ideologies is going against the very word of God and he sent his son to embrace the outcast yet homosexuals are supposedly viewed as poisoned individuals where even some anti gay voices have gone as far as creating “others” by using very degrading description to make scapegoats for their hate, what about the basic premise of judge not and not be judged or do unto others? Misplaced aggression hidden under a platform of religiosity here is at work I think and it reminds me of the fact that it was the Scribes (similar to modern day theologians) and Pharisees who were Jesus’ strongest opponents simply because he reached the poor and the ordinary yet it was Rome’s intellectual, political and legal systems that were made as weapons to crucify him with deception becoming a major tool for this new type of theocracy in other words enemies and fraudsters within who pontificate on virtuous platforms. 

The theology is in the sociology basically, if the church or religiosity is not willing to step into the present reality or become accommodative to difference then how long can it survive being insular and holding fast to some older ideologies that do not make sense in today’s world?

And if winning souls for the kingdom is supposed to be the work involved here for the church on earth then using derogatory terms, separatists ideology hidden in theological mumbo jumbo and hypocrisy in the name of Christ to create “others” so they can be made infectious, then where is the witness component here, is it only preaching to the converted and keeping themselves to themselves the ultimate goal here is that what Christian witness has come to or where is the leadership by example?

So we remain at a standstill as the education ministry decides to remain in the old ages regarding sex and sexuality at the expense of our young.

In a follow up press briefing the minister made it clear he was not afraid of a backlash from the gay lobby, “Fear is not an issue in this it’s a question of what is right” he continued that advocating the homosexual lifestyle is not in line with the mood of the Jamaican people or what is right and moral, “We must be very careful that in the interest of tolerance we do not allow minority groups to defeat majority sentiments.” In other words I interpret that as stay in your place as minority voices and protection are unimportant in his eyes.

Peace and tolerance

H 

Some background:

Urgent need to discuss Sex & sexuality nationally

Urgent need to discuss Sex & sexuality nationally part 2

from the earlier HFLE Fiasco in 2012

Flashback to 2012

Shirley Richards on Truth On Sodomy And Sex Diseases

After another hiatus Miss Richards of the Lawyers' Christian Fellowship strikes again of course following on the recent news and ari time the Gay community has been getting in the challenge launched by a coalition of rights activists and AIDSFREEWORLD, The LCF were the ones who basically got the Buggery Law kept on the books in the late nineties when a more active Jamaica Forum for Lesbians Allsexuals and Gays JFLAG made a parliamentary submission. 

Here is her letter to the Gleaner published today:

Truth On Sodomy And Sex Diseases

THE EDITOR, Sir:


 At the recently held Common-wealth Heads of Government Meeting in Australia, among the issues was a call for all member states to repeal sodomy laws. The laws being referred to are found in 41 of the 54 member states. While the report calls for the repeal of these laws, it frames the issue as one of disease control, stating that such laws "impede the effective response of Commonwealth countries to the HIV/AIDS epidemic". The Commonwealth Eminent Persons Group is reported to have "blamed the British influence on the former colonies for high rates of HIV/AIDS.


Most of these countries outlaw homosexual practices, which the rival French empire legalised in 1791". The reference to France in this context is interesting, for if what I have been told is correct, in France, there is full access to all the antiretroviral drugs. Moreover, such drugs are free. One would expect to find that HIV/AIDS is a non-issue among homosexuals there. Spread among msm Instead, French researchers reported in the Lancet Infect Dis (October 2010): "HIV transmission seems to be out of control in the MSM population." Reports in medical journals indicate that this is generally the situation in Europe as well as Australia.


 In the United States, the Centers for Disease Control and Prevention reports: "The sexual health of gay, bisexual and other men who have sex with men in the United States is not getting better despite considerable social, political and human rights advances. Instead of improving, HIV and STIs remain disproportionately high among MSM and have been increasing for almost two decades." In light of the foregoing, it is inexplicable that leaders of countries which are experiencing these challenges would be trying to foist them upon other members of the Commonwealth. Should it not be the reverse?


 S. RICHARDS
 Kingston 10

ENDS

- Miss Shirley Richards 


Why are you still linking HIV/AIDS to be a gay disease?


Antiretroviral therapy does not cure or definitively control the viral loads of infected persons even when they have found the comfortable cocktail mix or HAART (highly active antiretroviral therapies) that work for each person, strict adherence is also a KEY requirement. ARVs are not like diabetic or high pertension drugs where the three or four standards ones available for e.g Metformin can apply to almost everyone while it's just a matter of dosage levels and timing or where someone can miss some doses, it is far more complex than that with HIV. To simply suggest as you have that ARVS should fix the infection problem in MSMs is disingenuous. Access to ARV or HAART alone in your argument is after the fact where someone is positive already if you want to argue about ARVs as a prevention method which coincidentally is a debate raging in the certain parts of the research community about using ARVS for HIV negative persons to take prior to sex so as to mitigate a person contracting the virus then properly do so and get the facts before you pen these letters pleaase. 


 Men who have sex with men not only practice anal sex as you would like to believe but there are outercoursal practices as well though possibly lesser done in our highly sexualised society such as mutual masturbation and intercrural sex aka gay missionary which the penis is NOT inserted in the excretory orifice but placed between the legs as is commonly known on the streets as "leggins" which is also practiced by HETEROSEXUAL couples when the female is seeing her "monthly" but her male partner wants some sort of sexual play, this is then used as an alternative. 


 Yes the infection rates are high in the MSM populations locally and are expected to climb this year after a recent study but there are many interventions that are tackling that and also literally over the counter items and cleansing agents that can help to mitigate that which may include in the near future microbicidal technology that like some spermicides on condoms can kill viruses before during and after the sex act despite sexual orientation. Vaginal microbicides for example are already being tested and proven to a certain extent in the US and Africa which include elements of some of ARVs you alluded to (tenofovir). 


The prevention messages and interventions on the ground are impeded by the law presently on the books simply because of the act of buggery the outreach officers, social workers and agencies cannot directly handle some of the advocacy issues that attend to these populations coupled with the stigma associated with the law and the Leviticusal rhetoric the religious fanatics throw at the same gender loving community, the difficulties encountered by individuals to access care and treatment despite some enlightenment .... theocracy has no place here Miss Richards. If we are out of many one people as a nation then let's live it instead of trying to cock block me or any other man (including non gay men who practice anal sex with men and other women) who wants to practice or live as a homosexual providing he is not interfering with others rights and privileges. What are you afraid of, do you think gay men in particular are somehow going to penetrate every butt they see or go after children especially boys when you know fully well that paedophilia is NOT the same as consenting same sex adults attracted to each other.? 


 Some people are gay ............. Get over it .............. 


 When last I checked however Jamaica was not named as one of those possible states to loose this funding avenue that the UK Prime Minister Mr. Cameron has proposed or threatened to remove. It seemed more targeted at African states and while it may seem as an imposition take a look at it seriously, the umpteen asylum seekers from that continent due to persecution because of stigma and homophobia, the violence in some instances far more pronounced and graphic than ours and to talk about imposition the use of powerful religious figures there funded by American conservatives to push the anti gay messages while reinforcing hate and then they like you say you are Christians, your purpose as far as I see it when one publicly accepts Christ is to win souls for the kingdom not pry through my keyhole or cockblocking, the particular "Sin" of the temperal body for that soul is not your concern, leave all judgement to God. I also suggest you do some proper research and analysis of the difference between a paedophile and hebephile and an adult male homosexual disinterested in boys or pre-pubescent persons or hire a non partisan expert in the social sciences or psychological fields to guide you and your team at the Lawyers' Christian Fellowship. 


 Peace and tolerance 


 H

Bugchasers in Jamaica ??? man asks for the "gift"

Bugchasing is a slang term for the practice of pursuing sexual intercourse with HIV infected individuals in order to contract HIV. Individuals engaged in this activity are referred to as Bugchasers. Bugchasers may seek HIV infection for a variety of reasons.
Bugchasers seek sexual partners who are HIV positive for the purpose of having unprotected sex and becoming HIV positive; giftgivers are HIV positive individuals who comply with the bugchaser's efforts to become infected with HIV.

Bugchasers indicate various reasons for this activity. Some bugchasers engage in the activity for the excitement inherent in pursuing such a dangerous activity, but do not implicitly desire to contract HIV. Some researchers suggest that the behavior may stem from a "resistance to dominant heterosexual norms and mores" due to a defensive response by gay men to repudiate stigmatization and rejection by society.
Some people consider bugchasing "intensely erotic" and the act of being infected as the "ultimate taboo, the most extreme sex act left." A number of people who are HIV negative and in a relationship with someone who is HIV positive seek infection as a way to remain in the relationship, particularly when the HIV positive partner may wish to break up to avoid infecting the HIV negative partner.

Some workers in the US HIV community report that a number of younger people seek infection as a way to receive benefits, a "free ride," because they would qualify to receive Section 8, Social Security and other benefits from getting infected with HIV.Some contend that this behaviour stems from feelings of inevitability towards HIV among the gay community and the empowerment of choosing when to contract the virus.

Others have suggested that some people who feel lonely desire the nurturing community that supports persons with AIDS.
By design, bug chasing involves bareback sex, but members of the bareback subculture are not necessarily bugchasers. The difference is intent:

“In reviewing the scarce unpublished and published materials on bugchasing, as well as general healthcare speculations, a common theme appears- the lumping of bug chasers with barebackers...Although these two groups share some of the same practices, namely unprotected anal intercourse (UAI), there are distinctions that differentiate bug chasing...even though all bug chasers are indeed barebackers, not all barebackers are bugchasers.

Imagine my shock in here in Jamaica where we are more conservative to a point terms of sexuality even in same gender loving terms to hear or see someone express only they wish to be penetrated by a HIV+ man bare backed with sperm left in his rectum, this is the face of persistent social marketing both from the national level through the ministry of health and other private institutions and non governmental agencies.
The young man in a recent online group chat and subsequent one on one exchange was clear in his desire. He said he likes bareback sex and wished he could be in an orgy typed scenario with several HIV+ but healthy looking men as he feels he can survive the infection non the less, this is even after my trying to explain that there are different strains of HIV and that getting multiple infections can lead to a faster deterioration in health.

According to Wikipedia in the media there have been some references to this practice:
HIV positive man Ricky Dyer, who investigated the apparent bug chasing phenomenon for a 2006 BBC programme, I love being HIV+, said that an air of complacency about the realities of living with the virus may be one reason why infection rates have been rising.[18] However, the BBC also described bugchasing as more internet fantasy than reality, saying that, "Dyer finds that the overwhelming majority of the talk is pure fantasy." The article also quotes Will Nutland, head of health promotion at Terrence Higgins Trust, as saying, "The concepts of 'gift giving' and 'bug chasers' are definitely based more in fantasy than reality" as well as Deborah Jack, chief executive of the National AIDS Trust saying, "There is very little evidence of people trying to get infected with HIV."

In the Showtime series Queer as Folk a former student of Professor Ben Bruckner, asked Ben to infect him with HIV, wanting to experience "the gift." Ben refuses and writes a novel about the incident.
In the NBC series ER, season 7 episode 13 Dr Malucci treats a gay man who wants to contract HIV from his positive partner. Malucci asked they HIV- patient if he is 'bug chasing'

A character named Billy in a book by Dakota Chase called Changing Jamie is a bug chaser and attends a bug party in order to get "the gift" believing the man he has fallen in love with will accept him. He does test positive later in the novel, only to discover at the end of the book what a mistake it was.

This behaviour has been associated with some in the Caucasian bear MSM communities usually or even in some hobosexual groups as well now we see the tastes showing up here, maybe due to the fact HIV positive persons can now live almost ill free from opportunistic infections creating havoc running alongside HIV and decreasing one immune system.

Safer sex is still key but how do we meet this issue when it presents itself when would be participants insist on deriving "the gift" while enjoying themselves and thinking they are alright?

More is obviously needed to arrive at some workable solutions.

Peace and tolerance

H

Female Condom (FEMIDOM 2) recommended for Gay Sex

Ringonit.org has launched a social media blitz on the use of the Female Condom also known as FEMIDOM for anal sex, this is not new in fact in the days of GLABCOM (Gay Lesbian Bisexual Community) meetings a Jamaica AIDS Support for Life and also through the Ministry of Health PLACE (Priority for Local AIDS Control Efforts) Program there was some targeting of MSM populations in adopting the Femidom for gay sex use. It did not take off as many had thought as the condom was thought to be too big and cumbersome and may take away from the pleasure of a tight ass. Many felt they were screwing a big balloon bag instead of getting a real good fuck. Any way here are some excerpts from their upcoming campaign along with a link to their video.

Female condoms (FCs) help prevent unintended pregnancy and sexually transmitted infections (STIs), including HIV. They are a great safer sex option that can be used by both women and men for vaginal and anal sex. In terms of effectiveness, female and male condoms are equally effective, when used consistently and correctly. FCs are unique because they are the only barrier method that can be initiated by the receptive partner, which helps women and men take control of their own health.

Just like male condoms, FCs are shaped like an open-ended tube. The main difference is that female condoms have two rings, instead of just one! There’s a removable inner ring and an attached outer ring. Theinner ring must be kept in during vaginal sex, but for anal sex, keeping it in is a matter of taste. The outer ring helps protect against STIs that are spread by skin-to-skin contact, like herpes, because it covers more surface area around the vaginal or anal opening, depending on what type of sex you’re having.

Another bonus is that the FC is made out of a synthetic rubber called nitrile, which is hypo-allergenic. This makes FCs a great option for people with latex allergies. Nitrile can also be used with any kind of lubricant. This is different from male latex condoms, which can only be used with water-based lubricant.

The picture on the left is of the first generation female condom (FC1) and the picture on the right is of the second generation female condom (FC2). The FC1 was approved by the Food and Drug Administration (FDA) in 1993. It is no longer in production, because in March 2009, the FDA approved the FC2, the new and improved edition!

There are different positions you can use to insert the FC. For example, you can squat, lie down, or support your body on your hands and knees.

		Squeeze the inner ring between your thumb and middle finger.
		Insert the inner ring into the anal opening, using your index finger to guide it.
		Once the ring is part way in, put your finger inside the condom and gently push it into the anal cavity. The inner ring should be inserted past the sphincter; however some people chose to remove the inner ring once the condom has been inserted. It’s just a matter of taste.
Make sure the FC is not twisted and that the outer ring is outside of and covering the anal opening. Another method for anal use is to remove the inner ring, put the FC over and erect penis or a dildo, and then enter the anus. As always, you should use a lot of lube and enter the anus slowly. After the condom is inserted, more lubricant can be added to the inside of the condom and to your partner’s penis. When you and your partner are ready for insertion, hold the outer ring in place as you guide your partner’s penis into the FC. To remove the condom, twist the outer ring to keep the semen inside, gently pull it out, and throw it away. Why condoms are important Using condoms every time you have sex is the most effective way to protect yourself and your partner from sexually transmitted infections (STIs), including HIV, and unintended pregnancy. If you are sexually active, or think that you may become sexually active, be sure that you always have condoms on hand. Although talking about condoms can be uncomfortable, open communication is very important. It only takes one unprotected sexual encounter to contract HIV or another STI. Respect your body and your partner’s body and use a condom every time you have sex. How to talk to your partner about using condoms When you talk to your partner about condoms, you should be firm and make your expectations clear. If possible, have this discussion ahead of time, rather than in the heat of the moment. If your partner doesn’t want to use a male condom or is allergic to latex, you can suggest the female condom (FC). Check out our feel-good reasons to use FCs and share them with your partner. (Link to feel-good section.) Sometimes one partner can pressure the other to have unprotected sex. Here are a few things that someone who does not want to use a condom might say, and some suggestions for how to respond. Your partner says: Sex doesn’t feel as good when I’m using a condom. You can say: If we use a condom, I’ll feel more comfortable, which will make the sex better for both of us. Plus, you’ll last longer if we use one. Your partner says: I thought you trusted me. You can say: It’s not a matter of trust. People can have STIs and not know. Your partner says: I promise I’ll pull out. You can say: Pulling out won’t protect either of us from STIs. Plus, condoms are much better at preventing pregnancy. Your partner says: Condoms aren’t sexy. You can say: I think that protecting each other’s bodies while we make love is much sexier than getting chlamydia or HIV. Your partner says: But I love you. You can say: Then you’ll help me protect myself. Your partner says: But we’ve never used a condom before. You can say: I’m not going to take any more risks. Your partner says: No way. You say: Then no sex. See the demo video on YOUTUBE (embedding disabled so you have to go directly to view)