For seven, long, long days I dove into the deep end of the madness that was the International AIDS Conference (AIDS 2012) and various ancillary meetings held in Washington, D.C., last week. It was a mad, mad world of 20,000 plus people from every corner of the planet running to and from non-stop sessions, talks, organizing, networking, marches, protests and talking, talking, talking and noise, noise, noise.
Complete saturation of information, sensory, and emotional overload—by the end my brain felt like a wet sponge that couldn't take on one more drop. And that says nothing about the DC heat and humidity that made the rest of you soggy as well.
I contributed to that all that talking and organizing and noise, taking advantage of the world's largest AIDS gathering to help launch a new effort from the global network of more than 1,200 members I chair called IRMA (International Rectal Microbicide Advocates.) We've identified the critical need for advocacy around access to safe, condom-compatible lube in Africa as part of our new Project ARM—Africa for Rectal Microbicides initiative. Most Africans don't have access to safe, condom-compatible lube.
Condoms and no lube is a terrible great combination when it comes to anal sex. Vaginas have the ability to self-lubricate—our anuses and rectums need a little help from a friend to help ease entry and keep the condom intact. Because there is a paucity of appropriate lubricants in Africa, many people who have anal sex are using things like avocado oil, yogurt, Vaseline, even motor oil—or no lube at all.
The Project ARM effort seeks to ensure that Africa is fully engaged in rectal microbicide research and advocacy so that Africans who have anal sex are central to the development of safe, effective, and acceptable rectal microbicides (which may be produced as lubes with anti-HIV qualities.) Late last year, a group of African advocates and allies met in Addis Ababa, Ethiopia and strategized a set of priority actions to help pave the way for Africa to be on the rectal microbicide map. The highest priority action the group identified was far and away the issue of lube access. Rectal microbicides are about a decade away from being available—lube access needs to happen now … since it's already too late for yesterday.
So at AIDS 2012, as part of Project ARM, we launched the Global Lube Access Mobilization, or GLAM campaign, with the tagline "And Lube." The idea behind the tag is that when anyone says "condoms" we say "And Lube." It seems so simple, and yet is not the case in most of Africa. If we can't get proper lubricant to people, how in the world will we ever get rectal microbicides to them when they are available?
As it turns out, something we heard very clearly was that Africa is not alone in this problem. There is very little lube in India as well, and an advocate from Tennessee mentioned that in rural parts of his state, lube wasn't easily available either. Good thing the "G" in GLAM stands for "Global."
At the moment, GLAM efforts include an assessment of African national HIV plans, the documentation of the experiences of in-country non-governmental organizations who have tried, successfully or unsuccessfully, to implement lube distribution programs, and an awareness raising component. And because of feedback, we are expanding GLAM to reach beyond Africa in its advocacy.
To aid in raising awareness around the lack of lube, we created shocking pink and electric blue stickers highlighting the "And Lube" tag and pointing people to an URL for more info: tinyurl.com/AndLube. We debuted these beauties at AIDS 2012 and wore them, passed them out, stuck them to things, and said "And Lube" a LOT.
Then it came to my attention through some Kenyan friends and colleagues that despite there being literally close to a million condoms at the conference for free distribution, there was next to no lube. They were incredibly disappointed—as they had hoped to pack their luggage full of free lube sachets to take home and give to the men and women who so desperately want and need proper lube. I was incredulous—how could there be no lube at the International AIDS Conference? Adding to this absurdity—there were "lube-tasting stations" at the same spots where the hordes of condoms were being handed out. So, you could taste a variety of scrumptious lubricants, but sorry, couldn't take any of them with you.
In the tradition of taking lemons and making lemonade, we used the scarcity of lube at the conference to highlight the lack of lube in the real world. Members of our group talked this issue up—from the hallways to the podiums of plenaries we flashed our pretty stickers and yelled "Where's the lube?!"
It was Wednesday afternoon of the conference (July 25) and right before a big session the medical journal The Lancet sponsored on the dire state of the epidemic among gay men and other men who have sex with men all across the globe. I was complaining about the idiocy of a lube-free conference, and the ramifications it would have on the folks expecting their friends to bring some slippery goodness back home to Africa for them, when Jon Vincent of Fenway Health said, "Hey, I can get eight cases shipped here tomorrow. Should I do that?"
I said "yes," and immediately started texting, emailing and Facebooking African colleagues to be ready for an imminent lube shipment and to help with logistics.
Thursday morning world-renowned Ugandan AIDS advocate and LGBT-rights activist Dr. Paul Semugoma gave a rousing plenary talk, underscoring the absolute necessity of prioritizing gay men and other men who have sex with men who are, on average, 19 times more likely to be HIV-positive compared to the general global population. Programs including gay men are as rare as lube, despite that alarming statistic.
"Back to the basics," Semugoma said. "Let's promote condoms and let's remember that amongst MSM, condoms go with lube, let's remember, And Lube… There has to be condom compatible lubricant, which means water-based lubricant or silicone-based lubricant, but we should not let these people use oil-based lubricants which destroy the condoms and make the condoms useless." This was one of several applause lines. Another was when he told his partner, who was in the audience, that he loved him.
The eight cases of lube came in later than expected, arriving Friday afternoon, after the conference was officially over. But IRMA members like Paul and Brian Kanyemba (Paul's partner, and a research assistant at the Desmond Tutu HIV Foundation in Cape Town) jumped into "Operation Lube" action and were able to accept the delivery after Jon had already gone back to Boston and I was back in Chicago.
By Saturday morning, they had distributed lube to community leaders from Nigeria, Kenya, Uganda, Cameroon, and Zimbabwe before they all hopped on their respective planes home.
"I am so excited the initiative that you guys took was met with high regards and praises. If you could imagine the excitement the guys had on their faces when they got those boxes you would have got into tears," Brian said. "Thank you, thank you so much for this."
Sending cases of lube home with a handful of wily advocates does not begin to answer the huge structural issues that make lube so scarce in Africa. It is not a solution that is for sure. Nonetheless, the love, dedication, and commitment to making lives better for others exemplified by this little story is exactly how communities have tackled AIDS from the beginning—with pragmatism and a "no time to wait, let's just do this thing" attitude.
Too often we get stuck in "we can't." And there are so, so many reasons "we can't"—aren't there? But clearly, there are just as many ways "we can." We just need to get on with it. Jon, Paul, Brian and all the others who executed "Operation Lube" got on with.
"It always seems impossible until it's done," Nelson Mandela has said.
And Lube!
