The keys to good anal health
The practice that makes HIV transmission more likely is to receive unprotected anal sex. But the taboo hinders the dissemination of information to enjoy it in a healthy and hygienic way.
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There is little talk of anal sex. It is, at least, what scientists and activists think about health and the pleasures of the place where the digestive system ends. They argue that the taboo that surrounds this practice makes it difficult for those who enjoy it to be well informed and do so in the most healthy and hygienic way.
For this reason, one of the sessions of the 22nd International AIDS Conference, held at the end of July in Amsterdam , was dedicated to the topic. Top-down anal sex, beliefs, behaviors and policies for better health was the title of the round table around which a dozen researchers and activists of the LGTBIQ collective sat.
What makes a talk like that in a congress like this? Although their own organizers were suspicious of associating AIDS and anal sex, they did not want to miss the opportunity to bring up the subject. Not in vain, it is the sexual practice that most likely makes the transmission of HIV: only a blood transfusion, which causes an almost safe infection (more than 92%), generates more risk of receiving the virus of a person who carries it who receives anal sex without protection. This is so, as dermatologist Henry de Vries explained, because the layer of cells that form this cavity is very thin, so it is easier to break it allowing the virus to enter the body.
The probabilities of transmission (see the graph below) may vary depending on the proliferation of the virus in the body. If a person with HIV gets their viral load undetectable, which is usually achieved when the antiretroviral treatment is taken correctly, the possibility of contagion is zero. A new study presented in Amsterdam made this evidence even stronger; In the experiment, with more than 70,000 serodiscordant couples, not a single contagion occurred.
This reality and drugs like PreP, a prophylactic drug that prevents transmission if taken before and after sexual contact, are tools that the AIDS community considers crucial to stop the epidemic . A movement is emerging in the community of men who have sex with men who are even abandoning the condom. "For years I have lived with fear and I have undermined my pleasure using condoms, not for years," said Kenyan activist Mutisya Leonard. "If we recognize that sex without a condom is more pleasant, perhaps we would change the way of research so that there are other types of products that people can use," he argued.
Although little has been studied about anal sex and health, most studies are focused on men, while more and more women are practicing it.
The scientists, however, insist that PreP should not be presented - which is not even available in many countries yet - as an alternative to condoms. Abandoning the prophylactic is the opposite of what doctors recommend, since not only prevent HIV infection, but also other sexually transmitted diseases. However, it is a reality to which researchers do not turn their backs. Several groups are studying the action of topical microbicides that are applied to the anus before or after having sex and avoid infection. According to a study presented by Alex Carballo-Dieguez , almost nine out of ten men who have sex with men have used anal showers (enemas) before having sex. "Getting a substance that is diluted in water and can be part of that shower would be a great advantage," he says. This interior cleaning, until now, has only proven an improvement in hygiene, but does not bring any added health benefits.
Substances that are also widely used in anal intercourse are lubricants. In the talk Introduction to anal health , De Vries, explained the pros and cons of each of them. Thus, while those based on water are safe in combination with prophylactics, being more aggressive for the mucosa, without them they can increase the risk of HIV transmission. Compounds with oils are not safe with condoms, but without them they have the advantage of lasting longer. Finally, those that rely on silicone, can be used with condoms safely, but are not compatible with toys of the same material, because they "create a dirty and sticky feeling."
Most likely, the condom
The condom is still the safest and recommended method to prevent HIV and other venereal diseases that are also transmitted in anal sex, with even more likely in many cases because of the fragility of this cavity. Syphilis, hepatitis, gonorrhea, lymphogranuloma venereum or herpes simplex also often enter through the exit door of the human body. Some have better treatment than others. One of the biggest problems of global health is that of bacteria resistant to antibiotics , which can cause 2050 more deaths than cancer. There is already a supergonorrhea that does not respond to any of the drugs that exist, something that can become a major threat to public health.
Although alternative methods to prevent HIV transmission are advancing, condoms are still recommended for protection against other diseases
The human papilloma virus is another microorganism that is transmitted through sexual contact. Although it may not even give symptoms, it increases the risk of cancer in the places of contact: penis, mouth, vagina (cervix) and anus. As it is a disease that is very associated with age, a few years ago it was not very present among the seropositive, who used to die before. But since the turn of the century, HIV has gone from causing a deadly disease to a chronic disease. More and more people age with the virus and anal cancer is growing among them (although, in any case, it is still very unlikely). "We need to do more research to learn more about epidemiology," said De Vries.
"There is still a lot we do not know about health and anal sex," according to Jose Bauermeister, of the Center for AIDS Studies at Harvard University. Studies are scarce and focused on homosexual men, while the practice is also growing in other groups. A 2010 survey in the United States revealed that it increased among women: one in four aged 20 to 29 had practiced it, a portion that was decreasing at older ages.
Kimberley Vance, director of the organization ARC International, which fights for the rights of the LGTB community, claimed that it is a practice that they can also enjoy: "They do it with a great lack of information because of the taboo that it supposes. Traditionally it has been used as an alternative to pregnancy, so it is more common that precautions are not taken and health is put at risk, "he says. This reality is also evident in countries where homosexuality is prohibited and punished. In them, according to the Kenyan Leonard, besides not being present in the conversation, any anal disease is hidden for fear of reprisals. The activists are challenged to put the issue on the table. In the words of Paraguayan Sergio López, from Somosgay, "the revolution starts in the ass".