Last Wednesday (September 27) marked the annual National Gay Men’s HIV/AIDS Awareness Day, and this month (October) is LGBTQ History Month. But in today’s times, I need more than awareness. I need action. I want us not only to be aware of the epidemic facing gay, bi, same gender loving, queer and other men who have sex with men globally—but also to think about a commitment. A new relationship of sorts. I want you to do something that can have a profound impact on your viewpoint of life. I ask that you consider a good throuple.

A what? A mixing of three intimate pieces to form a relationship. Unlike some of your other commitments, this one will be easy. I’m asking you to join the throuple of prevention, the booty, and choice when it comes to HIV and that you support rectal microbicides. As an HIV prevention research advocate, I have long supported the right for individuals to have options in their prevention activities. After all, there will never be a one-size-fits-all approach to something as complex as sex, human nature, desire, pleasure and HIV. We need as many options as possible so that people can select something that works for them.

You might be thinking to yourself, What is a rectal microbicide? The term is a fancy name for a medicated product that you could apply rectally, either as a douche, suppository, gel, dissolvable insert—or even films oh my! Yes, a product that many people already use at the time of sex with very little effort can also act as an HIV prevention tool.

Perhaps these products in the pipeline might be useful to you, your friends, yours partners and lovers. Many drugs and formulations are currently in early phase studies; there is no guarantee this research will lead to products on the shelf of your local store, but it’s exciting —and helpful—science.

Things that we know at this point:

  • That oral PrEP—i.e., the daily pill Truvada as pre-exposure prophylaxis—is not for everyone

  • That various studies in the field have shown as that prevention options improve overall adherence

  • That there is a desire for products that conform to commonly practiced anal sex behaviors, e.g., a lube or douche

  • Finally, we know that behaviorally congruent formulations “piggy-back” onto common sexual practices to potentially improve uptake & adherence

However, this hunt for rectal prevention products is in danger. Threats to the microbicide field come from multiple angles. However, action today and not just awareness can help continue the search for adequate, sustained resources for the development of user-desired, user-initiated, short-term, non-systemic, pleasure-enhancing HIV prevention options—including rectal microbicides.

Thanks and a hat tip to Jim Pickett, a tireless advocate for rectal microbicides, who has this to say about the importance of rectal microbicides and how we can fight to ensure the research continues:

The U.S. National Institute of Allergy and Infectious Diseases and the Division of AIDS (NIAID/NAIDS) is planning its research agenda for 2021–2027, and it’s looking more and more dire for on-demand, non-systemic topical agents such as gels, douches, suppositories and inserts.

 

Regarding a rectal product, there are a number of important, promising studies testing different drugs and modalities, but there has never been a Phase III efficacy trial to prove a rectal microbicide’s efficacy. We need NIAID, the largest global funder of rectal microbicides, to see its substantial rectal investments all the way through, adequately sustain the rectal pipeline, and support at least one large-scale rectal microbicide efficacy study

 

NIAID is soliciting feedback through November 30, 2017, on future directions for prevention research. Go here to let DAIDS know that there is a desire for a topical microbicide as an alternative to systemic, long-acting prevention. To put all of the research funding and support into long-acting systemic prevention ignores the needs of the community and the considerable investments over the last 10 years, not to mention the science.”

So take a moment during this month that we highlight awareness of LGBT issues (which include HIV) and think about the throuple of prevention, the booty, and choice—and think about a commitment to giving people options when it comes to preventing HIV.

If you need a suggestion of what you can say it can be as simple as:

I want scientists and advocates to continue the search for adequate, sustained resources for the development of user-desired, user-initiated, short-term, non-systemic, pleasure-enhancing HIV prevention options — including rectal microbicides.

We are making great strides in fighting HIV, but when it comes to prevention, we need to think about options—and creating new options that fit in to the various contexts of a variety of people’s lives. Things that meet their needs and desires while also helping them maximize their health. We have to continue listening to the community of gay, bisexual, same-gender-loving and other MSM. If we do, we’ll find more options to help us conquer this epidemic.