Since the 1980’s we’ve all been repeatedly exposed to the life-saving slogan, “Always use a condom with water-based lube for anal sex…”. For many guys this message has become banal (excuse the irresistible pun) due to factors such as condom fatigue and some guys opting to go the bareback route. Indeed, the primary focus of the message has been to get men to use condoms in order to prevent rectal exposure to HIV-carrying semen. The chorus-like addition of water-based lube in the message was to stop men using oil-based lubricants which damage latex condoms. Time to sit up and take note guys, because the responsible sex message has been revised.
While consistent use of condoms remain your best defence against HIV and other sexually transmitted infection (STIs), evidence has emerged that some water-based lubricants may be harmful to your rectum. This applies equally to top-of-the-range, expensive imported brands and locally manufactured lubricants.
These findings emerged when researchers trying to develop rectal microbicides started poking around and asking questions about the effects of sexual lubricants on the mucosal lining of the rectum. Mircobicides are products that will hopefully reduce the transmission of HIV when used during anal intercourse, offering protection in the absence of condoms as well as additional protection when condoms are being used. In essence, the easiest way to get guys to use an effective anal microbicide would be to produce a lubricant that prevents HIV transmission (for more info on microbicides visit http://www.global-campaign.org/rectal.htm).
The new buzz word when discussing the relative safety of water-based lubricants is osmolality. Those of us who did biology at school will recall the word osmosis: “the natural tendency for water to pass through a membrane separating two solutions of different concentrations… water will pass from the weaker (less concentrated) solution containing fewer particles of dissolved substance to the stronger (more concentrated) solution containing more particles of a dissolved substance…”.
In the case of lubricants, the two solutions referred to would be the sexual lubricant in your rectum and the fluid inside the cells that line your rectum, respectively. The membrane referred to is the wall of each cell in the very delicate lining of your rectum.
In essence this is how it works: if you use a lubricant that contains a high concentration of dissolved substances (such as sugars or salts) it will naturally absorb water from the cells that line your rectum. These cells will lose water and literally shrivel up somewhat. On the other hand, if you use a lubricant that contains too few dissolved substances, water from the lubricant will be absorbed into the cells lining your rectum. If these cells lose too much water they collapse and gaps may open up between them, and if they absorb too much water they burst. Either way, lubricants can cause short-term damage to the lining of your rectum, with significant implications for HIV transmission; any weakening of this lining provides a very easy entry point for the HI virus and increases your risk of infection.
This certainly isn’t merely a storm in a teacup. Many well-known brands have been scientifically tested and been found to be unacceptable. One report states that “…ID Glide, Elbow Grease, and Astroglide are similarly toxic for cells, cell lines, and tissues, with Astroglide being the most toxic”. Astroglide is an expensive American water-based lubricant that has been available in South Africa. Silicon-based lubricants currently appear safe but are expensive and not accessible for many men.
So where does this leave us? First off, this is an issue that everyone who engages in anal sex must be aware of. Labels on lubricants do not indicate whether they have been tested for osmolality, probably because the manufacturers haven’t had their products tested or because they may not want us to know the results. Health4Men is currently conducting tests on many commonly used water-based lubricants available in South Africa and will publish these findings imminently. The organisation is also working with local lubricant manufacturers to ensure that their products are safer for anal sex.
Most importantly, consistent use of condoms and water-based lubricant remain your best defence against HIV transmission! Although some water-based lubes will harm the cells in your rectum, using condoms will ensure that HIV-containing semen will not enter your ass. Guys who bareback, especially if they bottom for bareback anal sex, must take note that using water-based lubricant without using condoms could increase their risk of transmission. Any lubricant that contains oils should not be used with latex condoms or gloves.
Glenn is the programme manager of Health4Men, a project of the Anova Health Institute funded by PEPFAR/USAID. Health4Men provides free sexual healthcare to men who have sex with men (MSM) through their seven clinics located in Soweto, Yeoville, Khayelitsha, Bellville and Cape Town with an additional site being planned in Mopani District in Limpopo Province. Health4Men also undertakes prevention, outreach, training and research. The project is finalising an online survey of South African gay men’s sexual practices which will include questions on lubricant use. For info visit http://www.health4men.co.za