Saturday, March 21, 2009


GLAAD's View of Anal Condoms and Gays;
Two Rebuttals


Last week, after I blogged about the FDA giving approval to a new version of the Reality female condom, a device that can and is used for anal sex, as barrier to HIV and STDs and pregnancy, I spoke with my friend Richard Ferraro in NYC who works as the spokesman for the Gay and Lesbian Alliance Against Defamation.

I asked him to have GLAAD issue an action alert over the news accounts on the FDA approval, because the reporters failed to mention Reality's role in stopping new HIV infections among gay men. He promised to look into the matter and get back to me, which he did yesterday.

Richard's reply disappointed me because GLAAD so narrowly focused on the federal agencies involved in researching and potentially promoting new HIV barriers, agencies not known for being gay-friendly nor actively looking for new ways to work with the gay community for better gay health.

It's so tiresome to see GLAAD not engaged in creative thinking either about recent Reality stories omitting gay men, or the need for more scientific studies on use of anal condoms during male-on-male sex. Has this group lost all urgency to promote better ways of stopping new gay HIV and STD infections? If GLAAD has, well, then it's not alone. Lots of gay and HIV/AIDS nonprofits are complacent about advocating for improved prevention methods.

Regardless of the studies or federal approval, the Stop AIDS Project of San Francisco, a group run by and for gay men, has long distributed the anal condom as an effective barrier to halting new anal transmission of HIV. The San Francisco Department of Public Health funds distribution of Reality through such groups, and also makes anal condoms available at city-run clinics.

If the Stop AIDS Project and the SF DPH can promote and hand out Reality to gays, it would be wise of GLAAD to speak with those organizations and work with them to renew attention on anal condoms and reinvigorating the debate about HIV prevention.

I shared Richard Ferraro's thoughtful reply with Thomas Kraemer, a gay scholar and researcher based in Oregon, who has tracked new developments in science-based HIV prevention on his blog. You can read his response after GLAAD's reply below.

Even though GLAAD is not mobilizing any resources about Reality and its coverage regarding gay men, I"m still pleased Richard wrote back because his reply is a small contribution to the debate about better HIV prevention for our community in the new century.

The reply from GLAAD:

Hi Michael,

As we always do, our Programs department researched this issue before determining if our media advocacy work is appropriate and spent a great deal of time doing so to ensure accuracy - which is cause for the delay in my reply to you.

The female condom is not approved by the FDA and clinical trials have been inconclusive. The FDA has included that “Female condoms are neither approved nor for anal sex, either for MSM or heterosexual women.” Studies that we reviewed conclude that there is difficulty inserting and keeping the female condom in place for men who have sex with men. Design modifications and trainings may be needed before MSM can use the product safely. The FDA, CDC and studies our Programs team reviewed conclude that without being educated on proper usage and without design modifications, the product at times can be dangerous. Media outlets rely on the work and official statements and stances of the FDA and CDC.

It would be a disservice to advocate that the media report on off-label use at this point. The education and instructions for proper use by men who have sex with men is not readily available and the studies we reviewed call for design modifications.

Please let me know if you have any additional questions.

Best, Rich

And here is the response from Thomas Kraemer:

Dear Michael,

GLAAD's concerns about the "female condom" being used for gay anal sex are well-known, but they ignore the underlying political problem that anti-gay policies of the Republicans and Bush administration eliminated funding of the research needed to adapt the "female condom" to be an FDA approved "anal condom" for HIV prevention among gay men.

Right now, most research efforts are being directed toward reducing heterosexual HIV-2 infections in Africa because of anti-gay Bush policies. Researchers are afraid of losing funding if they apply their work also to gay men in America.

Also, GLAAD is missing that the required FDA research studies on the "female condom" for anal sex were done in the 1990s, but the company did not have the financial resources to seek final FDA approval, especially given that sodomy was not legalized in the U.S. until 2003.

In fact, many gay men have been using the female condom despite the lack of FDA approval.

Other new alternatives needing research funding include PEG-ES enemas that can be used either by itself to reduce intestinal wall damage, or as a delivery mechanism for a rectal microbicide to prevent new HIV infections.

Where is the leadership needed to obtain research funding support for new methods, such as the "female condom" and PEG-ES enemas, to prevent HIV-1 infections from gay anal sex in America?

Best, Thomas

Thank you, Thomas, for not only discussing Reality with common sense, but for also calling attention to the other methods of unapproved ways to stop HIV in the gay community. We need more thinking like yours.

3 comments:

Anonymous said...

This situation just vindicates me even further in my contention that for the last 8 years or more, anti-gay Bush Administration policies have resulted in nearly silence about the entire topic of preventing HIV transmission among gay men. As such, we have the least-educated generation of young men yet on HIV topics, leaving them to "fend for themselves" and "make things up", with no funding for formal prevention education, and no funding for additional research. In other words, Bush and his usually religious Right-wing cronies put anti-gay sentiment over the cause of the public health. It's time that REAL HIV prevention came back on the Federal agenda, and not with moralistic outright falsehoods like "condoms don't work", but with science-based, evidence-based prevention strategies that are taught in various advertising and social marketing campaigns to gay men and others at risk. Bush is to blame for many needless HIV infections.

Anonymous said...

I agree that the understudied efficacy of the female condom for anal sex use (no matter who's butt is up in the air) is a direct homo- and sex-phobic reaction to the unpleasant topic of butt fucking. And that sex act's use is increasing in the young people around the world.

I am happy to inform that a large, multi-site MSM and HIV outreach effort in Burma (Myanmar) features it's own re-packaged for men female condom - 10s of 1000s every year. The clients love them. AND -- something I did know from by time in SF, CA: you can use them like an ordinary condom (bag it first, then insert)-- much easier (but take the ring out first, of course). Not to mention the ease of using it with all types of lube - water-based is a rare commodity in most developing countries.

I have been honored to be involved in a new "movement" to put MSM (some use "gay, transgender and other MSM") at the center of the HIV agenda thru the Asia Pacific Coalition on Male Sexual Health (APCOM)-- msmasia.org for details.

I would ask/demand that GLAAD reveal the studies that they are referring to; I am unaware of such negative indications of the female condom and doubt, as is pointed out above, that Stop AIDS Project and SF DPH would distribute these (as they do now for free) if such studies are as conclusive as is implied by Rich from GLAAD.

Unknown said...

hi paul,

in a follow up email, richard did provide me with exactly the info you want to see:

Michael,



Here are some of the studies that we reviewed:



Experiences of 100 men who have sex with men using the Reality condom for anal sex.

Gibson S; McFarland W; Wohlfeiler D; Scheer K; Katz MH. AIDS Education and Prevention. 1999 Feb;11(1):65-71.



Abstract: Reality, a polyurethane pouch designed to line the vagina, was developed mainly to provide women with a contraceptive and STD prevention option. A removable inner ring and fixed outer ring keep the device in place. Some MSM use Reality when having anal sex. 750 free Reality kits were distributed by the STOP AIDS Project in San Francisco at venues frequented by MSM. Kits included 2 female condoms, instructions, a self-administered questionnaire on the users' experiences with Reality, and a stamped return envelope. 108 surveys were returned, with 100 MSM reporting use of Reality during the past 6 months in 147 episodes of insertive and 187 episodes of receptive anal sex. 86 men reported that they would use Reality again, and 54 said they would rather use Reality than conventional male condoms. Generally most liked about

Reality were its heightened sensitivity and spontaneity, while insertion difficulties and high cost were the factors least liked. Acceptability was higher among MSM who were HIV-positive, in nonmonogamous relationships, or who had serodiscordant sex partners. Negative experiences included difficulty inserting (33%), irritation (17%), bunching up (12%), unpleasant texture (10%), and noise (9%). Breakage was reported 3 times in 334 episodes of use. Reality appears to be a welcome alternative for some MSM who do not consistently use penile condoms. Although use of the method probably reduces HIV transmission compared to unprotected anal sex, more research is needed to definitively assess its effectiveness as a risk reduction method for MSM.



Use of Reality "female condoms" for anal sex by US men who have sex with men. Gross M;

Buchbinder SP; Holte S; Celum CL; Koblin BA; Douglas JM Jr, American Journal of Public Health..1999 Nov;89(11):1739-41.



Abstract: This observational sample assesses the use of Reality female condoms for anal sex by HIV-seronegative men who have sex with men. A total of 2277 men from Boston, Chicago, Denver, New York, San Francisco, and Seattle completed the self-administered 2 questionnaires. Results showed that of the 1084 men who had heard of using the female condom for anal sex, 145 (13%) reported using it in the prior 6 months, 95 used it for receptive sex, 94 used it for insertive sex, and 44 used it for both. 49% of the receptive users cited problems, which included pain, discomfort, and difficulty in inserting and keeping the device in place. For the insertive users, 37% complained of lack of pleasure and difficulty in inserting and keeping it in place during sex. 2 receptive and 2 insertive users reported bleeding by the receptive partner. In view of these complaints, there is a need to redesign female condoms so as to increase acceptability and use by men. This is important for the prevention of HIV transmission.



Acceptability and safety of the reality condom for anal sex. CL Celum, C Renzi, S Tabet,

N Eaton, P Heagerty, MoPeD3656, Presented at the XIV International AIDS Conference, July 2002



Conclusions: Safety outcomes (condom breakage, semen spillage, rectal bleeding) were not significantly different for male and Reality condoms, but slippage was more frequent with Reality condoms than male condoms, and design modifications and training may be needed for anal sex. The Reality condom may be a reasonable alternative to the male condom for some subgroups of MSM, particularly those with past problems with male condoms.





Safety and acceptability of the Reality condom for anal sex among men who have sex with men.

Renzi, C.; Tabet S.R.; Eaton, N.; Coletti, A.S; Surawicz, C.M.; Agoff, S.N.; Heagerty P.;

Gross, M.; and Celum, C. AIDS. 1999 Mar;17(5):727-731.



Conclusions: Men reported more frequent problems with Reality condoms than male latex condoms used for anal intercourse, particularly slippage, discomfort, and rectal bleeding. Design modifications, training, and research on the clinical significance of safety outcomes are needed for use of Reality condoms with anal sex.



Centers for Disease Control and Prevention (CDC):

· “Female Condoms: Laboratory studies indicate that the female condom (Reality™), which consists of a lubricated polyurethane sheath with a ring on each end that is inserted into the vagina, is an effective mechanical barrier to viruses, including HIV, and to semen (21). A limited number of clinical studies have evaluated the efficacy of female condoms in providing protection from STDs, including HIV (22). If used consistently and correctly, the female condom might substantially reduce the risk for STDs. When a male condom cannot be used properly, sex partners should consider using a female condom. Female condoms are costly compared with male condoms. The female condom also has been used for STD/HIV protection during receptive anal intercourse (23). Whereas it might provide some protection in this setting, its efficacy is undefined.” (2006 STD Treatment Guidelines)

Food and Drug Administration (FDA):

· Female condoms are neither approved nor for anal sex, either for MSM or heterosexual women. (2007)

World Health Organization (WHO):

Female condoms are neither approved nor recommended for anal sex, either for MSM or heterosexual women. (2007)