But wait, another circumcision story!

Circumcise and use condoms

For sure, circumcised men should not throw away condoms.

"Even with circumcised men, safe sex practices should be encouraged. Crcumcision may have a huge impact at societal level, it may not be so at individual level if misused," warns Professor Robert Bailey.

Professor Bailey - one of key speakers at the 4th IAS Conference in Sydney, Australia - has been involved in circumcision-related issues in Kenya, Uganda, Malawi, Zambia and the United States of America since 1995.

Over all, it has been found that circumcision reduces infection rates by about 50 to 60 percent. Interestingly, it is in Sub-Saharan Africa where HIV has so far hit most, accounting for over 40 percent of the world's infections.

Bailey's fears are embedded in the fact that men generally do not like condoms. And with revelations of this rate of reduction in infection rates, it is feared some 'rude' circumcised men would want to have their women believe they need no artificial covering because, after all, they have a "natural remedy."

This is what the Professor of the Epidemiology at the School of Public Health of the University of Illinois, in the US, wants to highlight.

Professor Bailey, who is also a Research Associate at the Field Museum in Chicago, believes that proper education needs to be attached to advocacy for widespread male circumcision, particularly in tribes that do not culturally circumcise.

It is known that to many tribes in Africa, male circumcision is a norm at puberty, as a way of initiating boys into manhood. But the bad thing is: it's done in bushes to the detriment of the boys, some of whom bleed profusely and even die.

This is where advocates' emphasis should lie, for, according to Professor Bailey, a good number of clinical officers at health centres in these countries are not good enough in carrying out circumcision.

But, if properly done to a proportional number of males, it is likely to avert HIV infections in Sub-Saharan Africa, claims the medic-cum-academician.

All in all, his message today has been: circumcise and abide by all prevention measures, including using condoms properly.

- report by Ansbert Ngurumo

AIDS conferences and global warming

It's almost over.
On Thursday, Imelda Abano leaves on a bus at 4h30 am for her flight to the Phillipines. Christina Scott, Robert Mukandiwa and Padma Tata (among many others) leave 6h30 am to catch flights out at 10 am on Thursday.
Which raises the question ... has anyone calculated the carbon footprint of AIDS conferences? I hear there's a climate change conference in Bali in December .... and there's an AIDS conference coming up in Colombo, Sri Lanka, next month. Maybe we'll get Nalaka Gunawardene to link his blog to this one, since he'll certainly be there.
Until next time!

quote of the week

"rectally challenged monkeys"

This is what happens when you listen to a recognised authority on microbicides, the gels and toothpaste-like substances designed to prevent HIV/AIDS from crossing the lining of the vagina or the rectum (and if a virus does sneak through, to make the environment inside that part of the body so hostile that it has as little chance as possible of making it into the safe haven of a immune cell).

Authorities like Dr Ian McGowan, a Brit from University of Liverpool who is co-principal investigator of the Microbicide Trials Network (MTN) at the University of Pittsburgh in the USA.

Professor McGowan's big issue is making sure that microbicides designed to empower women are safe for use in other body cavities, not just the vagina. And this is not just something of interest to men who have sex with men. McGowan showed research (large sample sizes, too) indicating that up to 40 per cent of heterosexual women in both Africa and the western world had had anal sex on a fairly regular basis.

"You can be sure that the day after a vaginal microbicide comes out, it's going to be used in the rectum," he predicted.

But how do you make sure that microbicides are safe in both the vagina and the rectum, which has a much thinner protective lining and so may be more vulnerable? That's where the rectally challenged monkeys come in.

McGowan tests things in the lab. Once he's got the go-ahead from ethics committees, before testing on humans, he's legally obliged to test them on animals. So he gives monkeys microbicides up their bum, basically. And then he tries to give them HIV, and see if it infects them or not. That's called challenging, because you want to see if the monkey can fight off the virus or not. And of course if it's in the rectum - voila! a rectally challenged monkey.

Rakai, Rakai, Rakai

Rakai is famous. Rakai doesn't want to be famous. Rakai is a small district (in the red on the map) in south-central Uganda.

Rakai's home to Uganda's first known AIDS case, many years ago. Rakai is now also the home of a vast amount of research in many of the poster exhibitions at the 4th International Aids Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Sydney.

Walk through the poster exhibitions (often interesting research which isn't ready yet for panel debate or sometimes a way for young researchers to gain experience) on the ground floor of the Sydney conference centre.

Rakai crops up in about 10 different research posters. It's probably the only town in the developing world to have so much data about HIV research to its name.

Many of the research findings will be relevant to the greater part of the developing world. Rakai's rural residents have helped show that putting HIV+ people on anti-retroviral drugs when their immune system begins to collapse does not increase risky sexual behaviours. This dispels the often-stated fear that ARV users infect others. ARVs don't just help the person with HIV. The ARV drugs help every one of his or her sexual partners. And their kids, parents, employers and friends.

One of the posters says that in a rural setting like Rakai, people under HIV drug treatment increase their use of condoms. They also stopped or reduced taking alcohol before having sex and most of them disclosed their sero-status to their partners. This is incredibly good news.

Dr. Gertrude Nakigozi an implementing officer with the USA President's Emergency Plan for AIDS Relief (PEPFAR), said the study was important in determining whether being on ART increases high risk sexual behaviours amonh HIV positive patients.

A similar study in the US found worrying evidence of behavioral disinhibition among men who have sex with men and those who inject drugs like heroin intravenously.

Fredrick Makumbi, a biostatistician with the Rakai Health Sciences Program, said the reduction in risky sexual behaviors may be attributed to the frequent health education.

“These people often get counseling every month they come to pick drugs and we think that is influencing their behavior,” said Makumbi.

Other studies on Rakai include pediatrics HIV, discordant couples and infections, adherence to HIV and Prevention of Mother to Child transmission of HIV.

Blog contributed by Esther Nakkazi, a correspondent with the East African newspaper and a member of the World Federation of Science Journalists.

the patient matters

Put the patient's needs first when implementing public health policies, says renowned Australian High Court judge, Michael Kirby.

Justice Kirby, a prominent advocate for human rights and a gay activist as well, said this at a panel discussion on HIV Testing - Increasing Access, Increasing Uptake and Protecting Human Rights, on the third day of the 4th IAS conference in Sydney, Australia.

In some countries, apparently, medical practitioners had been forced to work hand in glove with police to enforce a policy on universal HIV testing.

In such cases, it was argued, patients were "screwed."

Public service physicans were torn between loyalty to either patients or their paymasters, represented by government police, in an evironment that denied patients' individual consent and confidentiality.

"It's the patient that matters," said Justice Kirby. Individuals should take ownership of consent.

"The informed consent we are speaking of shouldn't be a top-down approach... We need to involve patients, every patient, though the way we involve them may differ from place to place," he said.

On stigma faced by HIV positive people, Kirby said it would end with familiarity, when everyone found out that the same people being discriminated against are "our neighbours, relatives, and friends." Blog by Ansbert Ngurumo of the WFSJ and the Tanazania Daima newspaper.

quote of the day

"Oh, this is great, I don't have to wrap it up."

A delegate from a Canadian organisation for women living with HIV/AIDS, channeling the fears of women she met at a conference in Nairobi, Kenya, that their men would seize on circumcision as one more excuse for why they didn't have to wear a condom.

Sounds like a takeaway (take-out) to us.

Sending out a MSM SMS

Kenya may be one of the African countries to get funding for the prevention of the spread of HIV among Men who have Sex with Men (MSM), through a new initiative that seeks to build awareness about this issue in the face of the HIV epidemic.

Speaking about the 4th International Aids Society (IAS) conference in Sydney, Australia, Sam Avrett, a consultant to the Foundation for Aids Research (amFAR) said the MSM funds would initially target seriously affected regions of the world.

"Our funds are still small compared to the need but by the end of the year we are hoping to make initial grants to seriously affected regions of the world such as south Asia, the Caribbean and Africa," said Avrett. He did not disclose the amounts the country would benefit.

Kenya is the most affected country in Africa. According to sero-prevalence studies among small groups of MSM in Nairobi and Mombasa, done by the International AIDS Vaccine Initiative (IAVI), the Population Council, and others last year, Kenya has documented up to a 40 percent HIV prevalence rate among men who have sex with men, the highest reported rate in Africa followed by Senegal at 22 percent prevalence.

Other countries have documented MSM HIV prevalence rates at 28 percent for Bangkok, Thailand, 27 percent in the Ukraine, 21 percent for Uruguay and 16 and 17 percent for Andhra Pradesh and Mahashtra in India respectively.

Foundation for AIDS Research officials said the world's inability to prevent widespread HIV infection among MSM is one of the greatest public health failures in the fight against AIDS-denial, discrimination, and criminalisation lie at the root of this failure.

The high prevalence rates in Kenya and other developing countries are blamed on lack of appropriate health messages and support which makes many men who have sex with men unknowingly engage in behavior that increases their risk of infection.

In Kenya up to half the men who engage in MSM do not use condoms and most of them have no access to HIV prevention, treatment and care services as well as information and they are largely ignored by the government because it is illegal.

Even those who seek Voluntary Counseling and Testing services (VCT) are not advised because the curriculum used to train counselors does not include specialised advice for sex between men. Another missed opportunity for prevention.

With no data available yet as to how many men are engaged in MSM in Kenya, the practice increases the risk of transmission among the populations because some of the men are bisexual, transgendered or heterosexual.

The UNAIDS report on Global Aids epidemic 2006 says globally less than one in 20 men who have sex with men have access to the HIV prevention, treatment and care services they need.

Sex between men is significant in the HIV epidemic because it can involve anal sex, which when unprotected carries a very high risk. At least 5-10 percent of HIV infections worldwide are estimated to occur through sex between men, though this figure varies considerably between countries and regions, says the report.

But Avrett says most governments have also failed to acknowledge that sex between men happens and that unprotected sex contributes to transmission of HIV thus denying their programmes funding.

Kenya like other developing countries is a place where most HIV transmission is through heterosexual relationships and mother-to-child-transmission of HIV/Aids (MTCT) during child birth and breastfeeding.

Sex between men carries a lot of stigma and discrimination and men are not likely to take up HIV prevention, care, support and treatment services. MSM is the most prominent mode of HIV transmission in nearly all Latin American countries, USA, Canada and some Western Europe countries.

The MSM initiative to be launched by the amFAR in Sydney will be with the grassroots organizations providing small, target grants to provide prevention, treatment, care and support services to MSM.

Grassroots organizations have been at the forefront since the beginning of the epidemic, delivering services to vulnerable populations and demanding for greater actions from governments so they will be targeted. In Kenya GayKenya and Galebitra are some of the groups that have been working with MSM.

Grants will also be used to foster increased collaboration among organizations by supporting efforts to share information, and address new challenges, said Avrett to journalists under the National Press Foundation in Sydney, Australia.

"These grants will have an immediate and significant impact on poorer communities with limited resources for MSM. They could also have a multiplier effect helping to attract funding from additional donors," he said.

With sufficient funding and support these organizations are expected to transform community attitudes, drive policy change and mobilize the necessary funding to reverse the alarming spread of HVI among MSM around the world.

Even when countries are beginning to recognize the HIV/AIDS needs of vulnerable groups like sex workers and injectable drug users, MSM are still largely ignored which is fueling the crisis.

Esther Nakkazi
Special Correspondent
The EastAfrican newspaper
1st Floor Short Tower
Crested Towers, Hannington Road
P.O.Box 6100 Kampala, Uganda
Mob: 256-77-2491950
email:nakkazie@yahoo.com

Sydney Declaration

The Sydney Declaration is not a declaration that we love the city. Although we do. The Sydney declaration is a wake-up call to people involved in funding, preventing and treating HIV/AIDS. A reminder that without research, we are all whistling in the dark.

Yet not one East African country has allocated the recommended 15 percent of their 2007/8 budgets to their health sectors, which includes HIV programmes. This is despite the 2005 Group of Eight (G8) most industrialised countries conference urging all governments to commit a minimum of 15 percent of their national budgets to health.

But there is progress. Uganda, Kenya and Tanzania substantially increased their spending on health, giving it at least 10 percent of their current budgets.

Now the Sydney Declaration is here at the International AIDS Society meeting. It urges all countries and donors to spend at least 10 percent of the resources allocated to HIV programmes on research.

With hardly enough resources for health in most of the developing world, this may sound like a far cry from reality. Most of these governments spend at least half of their limited HIV resources on buying drugs for HIV infected people.

But limited research is a problem when it comes to reacting to drug resistance and sustainable access to drugs.

The 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention in Sydney has called for increased research to inform and strengthen the global response to HIV.

“Good research drives good policy,” says the declaration, signed by over 2000 delegates from around the world.

If the declaration is adhered to, at least $2 billion will be allocated for research next year. UNAIDS estimates that resources amounting to $22 billion will be needed for AIDS programmes in 2008. (in comparison, only $18 billion was allocated for spending this year.

But this trend is not sustainable. Scientists have to find proven ways that can be used for prevention of the disease. This can only be done through research, said Pedro Cahn, IAS president.

HIV/AIDS funding agencies must understand that good programming can only succeed on the back of solid research, said Cahn.

UNAIDS estimates that at least half of the 60 million people that will be infected by 2010 could have been avoided with the use of effective research-proven approaches like male circumcision, constant condom use, microbicides and vaccines.

An effective response to HIV/AIDS requires sustained commitment and continuous improvement.

For example, as current first-line antiretroviral regimens become increasingly available in resource-limited settings, there is an urgent need to identify their successors: optimum, durable, and well-tolerated standardised first-line and second-line regimens. We need to monitor and respond to resistance patterns as they emerge. Outcomes will not necessarily be the same in diverse settings across the globe.

IAS is hosted by in partnership with the Australasian Society for HIV Medicine (ASHM). Esther Nakkazi, who wrote this report, is a Uganda-based correspondent for the East African weekly and is a member of the World Federation of Science Journalists.

Sex, oldies and HIV drugs

There was some serious stuff in the opening ceremony and first two Monday morning plenaries of the fourth International AIDS Society.

It was left to Brian Gazzard, research director at the department of HIV/GU medicine, Chelsea Westminster Hospital, UK, to inject some humour at the third plenary on ageing and HIV.

Dressed in a wild pink striped coat and equally pink tie, Professor Gazzard pointed out that many scientists simply assumed that either HIV-infected people die young, or older people don't have a sex life.

Not so. In UK alone, there is an increasing percentage of older people – old as in over 55 years – diagnosed as infected with HIV.

Age and sex continue, with the 55-plusers believing there is no need for contraception. And unlike teenagers, wrinklies are seldom targeted for sex education. (Among the few things that get better with age: adherence to HIV treatment.)

Be that as it may, Gazzard reminded scientists that signs of ageing such as dementia, chronic renal disease and liver disease are common to HIV infection as well. Ditto social problems such as isolation and dementia!

Recent research indicates that HIV infection may predispose people to Alzheimers while highly active anti-retroviral therapy (HAART) may contribute to dementia.

There are several questions for scientists to address. Will HIV accelerate the process of ageing? Will HIV accelerate neuro-degenerative diseases such as Alzheimers? Will ARVs reverse or accelerate these processes?

Till such questions are answered, Gazzard reminded scientists of British poet John Donne’s solemn pronouncement in 1631: “Death be not proud, though some have called thee/mighty and dreadful for thou are not so.”

coffee and condoms

It's a crisis! There's no coffee in the newsroom at the Sydney Convention Centre at the opening of the International AIDS Society!
And a highly-placed source - OK, Bob Meyers of the National Press Foundation, who just wandered past - says coffee costs a mere three Australian dollars outside these doors. Scary stuff. Or it would be, if innumerate journalists could calculate currency exchanges.
On Sunday, there are so many satellite sessions - even one called speaker orientation, which sounds like gender issues but in fact is for novice speakers on how to improve their presentations - that it feels more like an astronomy conference than one of the big science-of-AIDS conferences.
The big drug company Pfizer is hosting one satellite session on preventing viral entry, which is an interesting issue. It's clear that a lot of the research into vaccines (and microbicides too, for that matter) is focusing on multi-tasking - something that can achieve a variety of aims.
For example, do you put all your efforts into preventing the virus from sneaking through the lining of the vagina or the rectum? And then what? What if one does manage to sneak through - do you make the environment just within the body totally hostile to the virus? And then what? What if the virus sneaks into a cell and starts replicating? So something needs to be useful there, too.
Sounds to us like the fight against AIDS requires the army, the navy and the airforce, because the enemy has to be fought on several different levels. And it sounds as well like it would be far easier just not to get it.
But all the time that researchers (or proponents of abstinence campaigns) talk about behavioural modification, some of us are reminded of South Africa's astonishingly high rape statistics. Most young women are not exactly volunteering for their first sexual experience, and the situation does not improve as they get older.
So a vaccine, a diaphragm that can be inserted and ignored, a slow-release microbicide that doesn't have to be used just before sex and the female condom all sound like a good thing.
Of course, there aren't very many teenage girls at this conference.
And our guess is that if they had the cash, they'd rather top up their cellphone/mobile phone airtime. Now there's an idea - a year's worth of condoms or microbicides with each new cellphone.

Science journalists and circumcision

Professor Andrew Grulich of Australia's National Centre in HIV Epidemiology and Clinic Research (NCHECR) confirmed that at least with the ‘cut’ HIV infection can be down by 50/60 percent among men.

Are science journalists practicing what the science suggests? I started my investigations.

"I am Jewish so it was done at birth," said Kenny Goldberg from the National Public Radio affiliate KPBS-FM in San Diego, USA.

Abdul Basti Ashaba from The Emirates Evening Post in the United Arab Emirates (and seen here in the photo) said he was glad that, as a Muslim, he was circumcised: "it makes me feel safe when having sex even without a condom."

Basti's inaccurate comment appears to confirm a worrying trend mentioned by Dr Andrew Grulich of Australia's National Centre in HIV Epidemiology and Clinical Research (NCHECR) in a session at the journalist to journalist training run by the US National Press Foundation.

Grulich said doctors in one well-run Kenyan circumcision study detected a slight but statistically significant increase in HIV infections among circumcised men at the end of the study, when they seemed to have become overly confident that circumcision would protect them completely from HIV and did away with using condoms, despite the warnings of the study organisers. Despite the slight increase in the number of circumcised men who became infected with HIV, it should be noted that overall, far fewer of the circumcised men became infected, in comparison with the control group of uncircumcised men.

Safe sex is still important, circumcised or not, as another reporter pointed out. "I would not get circumcised if I had not already, just have safe sex," said Naimal Haq, a senior reporter with Bangladesh News 24 Hours website.

Hilary Bainemigisha is from The New Vision newspaper in Uganda, a country whose HIV prevalence was once controlled but is now going up. Bainemigisha said he had the cut after the research was published showing that it was circumcision, and not cultural practices, that was responsible for the lower HIV rate in Muslim African countries.

But was it for purely health reasons?

"Sometime last year I took the cut after reading about these study results but afterwards I failed to recognize it as my own,'' said Hilary. "My partners were singing louder praises for those that had it and I decided to take it,” he said.

“At this time of my age I can not do it because if I have not been infected by now I probably never will,” said 39-year-old Wandera Ojanji, science reporter with the Standard Group from Kenya.

And yet, Wandera's belief is not borne out by the facts. A presentation by Professor John Ziegler of Sydney Children's Hospital, using data from Botswana, showed quite clearly that people in Wandera's age range were dying of AIDS. And in the USA and other affluent countries, older citizens - some in retirement - are contracting AIDS because they somehow think that their age will render them immune.

The 40 percent of my informal study of 15 journalists who were not circumcised were willing to have it done. But they have not done so, for varying reasons.

Khin Zaw Win, a freelance consultant from Myanmar said he is not circumcised but would get circumcised for health reasons. "Two of my younger brothers were circumcised and that is OK."

Edner Boucicaut, with the Centre for Communications on AIDS in Haiti, said, "No I have not been circumcised but I would consider it because it is a good measure to reduce the incidence of HIV. But it is not OK to have the cut in some communities. I can imagine that people look at those who have it and laugh."

"I am not and I would not because most people in China are not circumcised. It is very private and people who do it do not talk about it. HIV is not caused by sex but infected blood," claimed Yu Chun, a journalist from Science and Technology Daily in China. Again, this is scientifically inaccurate: HIV is spread by sexual contact, and the virus is present in the bloodstream (and the lymph nodes, and in fact pretty much everywhere in the body.) Although it is true that infected blood donors and the reuse of equipment in blood donations has been responsible for a surge in HIV cases in China. So maybe it was a case of misunderstanding my question.

Robert Mukondiwa of The Sunday Mail in Zimbabwe tried to insist that physical confirmation was required. His word was not enough. "I did it and I do not regret it. It was for surgical reasons but I do not feel different because in Zimbabwe we do not have cultural or religious attachments. Anybody can do it,” said Mukondiwa.

"No I am not circumcised and I would not do it because it is not in our tradition," said Meelis Suld from Radio Estonia. "The research was not convincing enough. Some more information is needed if I have to do it," said Ansbert Ngurumo from Tanzania.

But at 50% protection, there is nothing better than circumcision right now for men.

OK, condoms work brilliantly. But people don't use them. (For example, Ansbert has two children, so presumably he didn't use condoms at least twice in his life. And look at all those men, circumcised or not, who were told to use condoms and didn't in the Kenyan study.)

With circumcision, a man doesn't have to remember!

- Esther Nakkazi. Additional reporting by Christina Scott

Testing Times

Journalists write stories to encourage people to test for HIV, but they may hardly get there themselves. And yet, research at the South African AIDS conference in Durban in April was quite clear that many people only begin to practice safe sex and alter their behaviour in healthy, protective ways once they know their HIV/AIDS status. (Sadly, only two percent of South Africa's population of about 45 million people has ever been tested and got their results.)

A random survey showed diverse opinions among reporters from selected countries in sub-Saharan Africa attending a journalist-to-journalist training programme ahead of the 4th International Aids Society 2007 conference in Sydney, Australia.

Mugove Hamadziripi, The Communicator Project, Zimbabwe, says he been writing about health stories for six years and has encouraged readers to test for HIV but has never tested. He says:"I have not tested. Voluntary testing is difficult, not only to me but to many people."

Robert Mukondiwa, The Sunday Mail newspaper, Zimbabwe, has reported on health for five years, and has been 'preaching' to others on the need for an HIV test, but has never thought of testing himself. "I am not yet inspired to test personally,” said Mukondiwa, who was a Henry Kaiser Foundation fellow in Mozambique and Canada in 2006. “The main reason is, in Zimbabwe we use condoms very often. To us, condom use is a currency, so we all use them. Above all, there is a general knowledge that most of those who go for voluntary testing are suspicious of their character because of their sexual life. My sex life has not been very active. On this issue I have been a good preacher, not a follower."

Hillary Bainemigisha, health editor for The New Vision Newspaper, Uganda, tells a different story. "I have tested five times. The first two times, I was so scared I didn't go to collect the results. But I received results three times, all negative. I am afraid I may live forever if I don't die of an accident," he says. Hillary's wife, a nurse, went for her last test this year and encouraged her husband to do the same, as parts of Uganda have a very high percentage of discordant couples (one partner is HIV+, the other is HIV -). And his children, by the way, are fluent in the terms used in fighting HIV/AIDS: his four-year-old son knows what a condom is.

Ansbert Ngurumo, Sunday Editor for Tanzania Daima newspaper, Tanzania, says: "I tested once, on request by the doctor, when I was sick in bed. That was May 2006; the results were negative... Voluntary testing is a big challenge to may of us, but testing and getting negative results is a life-giving exercise."

Esther Nakkazi, special correspondent with The East African newspaper (circulated mainly in Kenya, Tanzania and Uganda) says she tested once when she was still at university. The results were negative. "Then I was not really sexually active... I had no boyfriend, so I knew for sure the results were going to be fine. I haven't tested since then," she says.

* Story by Ansbert Ngurumo, whose picture you see here. Ansbert is a renowned Swahili blogger and writer of the column Maswali Magumu (Hard Questions) and will be attending the Highway Africa conference in Grahamstown, South Africa, later this year.

brilliant flashes of dictatorship

"Occasional brilliant flashes of dictatorship".This was the subtle phrase uttered by Robert Mukondiwa of the state-owned newspaper The Sunday Mail in Harare, Zimbabwe, to describe his country's political situation.

We'll get to the science and HIV/AIDS link in a minute. But first, an explanation.

OK, technically speaking, only 49% of the newspaper is owned by ZANU-PF, the only political party allowed to function in the country. The interesting thing is that nobody knows who owns the remaining 51% of the newspaper. A good guess would be very, very close friends of high-ranking government officials. Now, the last time a Zimbabwean newspaper had a mystery owner, it turned out to be the Central Intelligence Organisation.

All of which is a roundabout way of saying that it is very difficult to do good science within such a context. Probably good science reporting is also a rather difficult thing to do when basic human rights are ... shall we say ... less than a priority?

Back to the science. Robert was talking about Zimbabwean health department campaigns in which children were forcibly vaccinated against the wishes of their parents, who appear to have fallen victim to some of the ridiculous rumours about vaccination.

And this led to a really interesting discussion about rights and responsibilities, which are often to the public as a whole - and the individual does not have a right to put other people's health at risk just because they don't believe in vaccination.

On the other hand, this scenario tend to apply to highly infectious illnesses (bird flu? Extremely drug resistant tuberculosis?) and easy techniques for prevention ... like vaccines. Nobody's advocating forcibly testing people for HIV, for example.

So while Zimbabwe might be a dictatorship, a health worker wielding a syringe against common childhood illnesses is not a dictator.

Domesticating the condom

This catchy phrase, "domesticating the condom," was uttered by Dr Debrework Zewdie, head of the Global HIV/AIDS programme at the World Bank.

Before you have images of big game hunters carefully aiming their sights at a circle of latex, Dr Zewdie meant that AIDS activists have failed to persuade married couples to use condoms.

And as married couples are the most likely group in Africa to become infected with AIDS (and Africa itself is the most likely place for people to become infected with AIDS), our inability to domesticate the condom is a crisis. Imagine if we hadn't domesticated the cow. Or the horse. Or the dog. We have to evolve to another level.

rubbish balances nothing

In South Africa, one of the global epicentres of the AIDS epidemic, the health ministry was incredibly slow to dish out life-prolonging anti-retroviral drugs in public clinics and hospitals.

Meanwhile, the South African health minister is known as Dr Beetroot, because she keeps advocating veggie cures.

Dr Beetroot (OK, properly known as Dr Manto Tshabalala-Msimang) should have been at reporter Ruth Pollard's talk today, called Rubbish Balances Nothing, on why journalists trying to be objective should consider ignoring AIDS dissidents.

Pollard was here at the journalist to journalist training along with Dr John Kaldor of the University of New South Wales, and Dr Mark Wainberg, professor of medicine and organiser of a couple of absolutely pivotal AIDS conferences. Hope IAS 2007, opening on Saturday, is also pivotal.

packet racket

What do you call a condom in Pakistan? Sometimes as a packet. The advertisements refer to it in a very roundabout manner, involving visuals of a man hugging his wife, a woman and the voiceover mentioning the word sathi (the word for companion in Urdu, which is also the brand name for the condom) according to Khawar Ghumman of the English-language Islamabad daily newspaper Dawn.

A picture such as this would never ever be used in articles or in advertisements. In his reporting, he said, a condom would not be mentioned by name but would be lumped in under the catch-all phrase "contraceptives." In Pakistan, the world's sixth-most-populous nation, UNAIDS says that the percentage of the population infected with the sexually-transmitted virus is only 0.1% - but it's classified as high-risk because of increasing numbers of injecting drug users and lonely truck drivers, who are known throughout the world for spreading the virus along the transportation routes.

This emerged in a discussion about how to report on HIV/AIDS today - and how to avoid journalists turning into loudspeakers for AIDS dissidents with not a shred of evidence to their claims.

Speakers today included Ruth Pollard, a reporter with the Sydney Morning Herald in Australia, and Dr Mark Wainberg of McGill University in Canada, who has survived (bloody but unbowed) from clashes with a series of AIDS-denying, AIDS-minimising, beetroot, olive oil, lemon juice and potato-advocating South African health ministers (otherwise known as the salad option on the menu of powerful anti-retroviral drugs available).

Zimbabwean paranoia

Ooooh. The two Zimbabwean reporters at the journalist to journalist training undertaken by the US-based National Press Foundation didn't respond at all well to the interesting discussion today with Ethiopian Dr Debrework Zewdie, who directs the Global HIV/AIDS Programme for the World Bank.
Dr Zewdie was responding to queries about why the World Bank's AIDS programme wasn't involved in specific countries with significant AIDS epidemics, including South Africa, Zimbabwe and Myanmar.
Queries came from Robert Mukondiwa of the Zimbabwean government-owned Harare newspaper The Sunday Mail, Tamar Kahn of the Cape Town bureau of South Africa's Business Day newspaper and by Khin Zaw Win, an author and freelance journalist from Myanmar (formerly Burma).
"You can isolate a country. You can't isolate a disease," said Khin Zaw Win, who as a democracy activist who spent over a decade in jail, made it clear that he was not speaking on behalf of the military junta currently controlling the country.
"Myanmar is on our radar screen"," Dr Zewdie responded, noting that the bank worked through partners and non-governmental organisations in cases where it could not work with whoever controlled the nation.
Regarding South Africa, Dr Zewdie called it "embarassing" that the World Bank wasn't involved in a country where one in three adults had HIV/AIDS but noted that the African National Congress government had rejected their offers. Nonetheless, the World Bank was involved through partners such as the Global Fund and the USA government's PEPFAR (President's Emergency Plan For AIDS Relief) plan. She also praised the South African government's new evidence-based strategic plan, but said the next step would be to ensure that there were resources to implement the plan.
And the third country?
"Zimbabwe is in arrears. It did not repay money it had taken from the bank," Dr Zewdie explained at the session, which was an introduction to a plenary debate which will happen next week at the International AIDS Society's fourth conference here in Sydney, Australia. "At the end of the day, the bank is a bank."
But Mugove Hamadziripi, who chairs the society of freelance journalists in Zimbabwe, a country with the interesting habit of requiring reporters and newspapers to support the ZANU-PF government of leader-for-life Robert Mugabe through legislation and registration, disagreed strongly.
The thing is, Hamad refused to ask her the question. He sat there silently during the question and answer session. Afterwards, he just limped around the room (he's still recovering from a car accident) and confidently told other journalists that she was not telling the truth. "Zambia and Mozambique didn't pay their debts and they still get World Bank funding," he whined. Or maybe he muttered. Or said.
Interesting. So he was asked to raise the issue with Dr Zewdie, who was fielding more questions from a wide variety of interested journalists. And he refused, saying there was no point. Legitimate gripe? Or character assassination? You be the judge.

Sydney Opera House

The one thing scientists seldom admit about their work is that they also get to travel to amazing places and meet amazing people. Science journalists get to do the same. So far this week, in addition to meeting renowned scientists, we've had an amazing discussion with Australia sex workers like Janelle Fawkes from the Scarlet Alliance and two gay male AIDS survivors from the very earliest days of the epidemic.

There's a microbicide conference coming up next year in New Delhi. The next IAS conference is in Mexico City. The UN climate change people are going to Bali at the end of the year.

Us, we'd be tempted by any offer to stay in Sydney. What a city. Had our first free evening and went out on a cruise of Darling Harbour, under the iconic bridge (yes, people do climb the top part) and fell in love with the Sydney Opera House.

Now we're making plans to get INSIDE the Sydney Opera House...finances permitting. It's simply the most beautiful building.

But journalists, like scientists, don't want to always admit that some of this work stuff can be fun...why can't science be fun AND important? How will you get the next generation to become scientists if it's all dour and Calvinist?

Freedom of The Press

We would like to apologise for being offline for 24 hours or so - so much material has been posted on this website that blogspot decided we were a computer generated spammer and shut us out of our own website before they decided we really were human after all.

In the meantime, we would like to know if there is any statistically significant correlation between height and an interest in science journalism.

Seen here at the Sydney Convention Centre is Imelda Visaya Abaňo, a SciDev.Net contributor from Manila in the Philippines, Christina Scott, the Africa news editor for SciDev.Net, who is suffering from a bad case of hat hair, and Padma Tata, who co-ordinates the Asian subcontinent for SciDev.Net. They're all within spitting distance of five feet tall (what is the metric equivalent?).

In other words, they're all normal and you tall people at this conference (like Meelis Suld of Estonian Radio and Vladimir Voloshin, editor in chief for the Russian gay magazine Kvir) who towers over us, are the human equivalent of gas-guzzling global-warming-causing SUVs.

At least, that's what the evidence says.

And evidence, as Dr Ian McGowan, co-principal investigator of the Microbicide Trials Network, is what is going to get us through the AIDS epidemic. Of course, his sample sizes are a little bit bigger than ours. So there's only one conclusion to be drawn: further research needs to be done.

Men Who Have Sex With Men

Clear evidence exists that the HIV epidemic in the developing world among men who have sex with men (MSM) is accelerating.

The infection rate among samples of men who have sex with men (and who may be married and have children at the same time - just to make this clear) was reported to be 40% in Nairobi, Kenya, and in a separate study was 28% in Bangkok, Thailand.

Other studies put the rate of HIV among men who have sex with men at 17% in Maharashtra, India, 27% in the Ukraine in Eastern Europe and 21% in Uruguay in Latin America, according to the latest figures compiled by the Foundation for AIDS Research (amFAR).

Without prompt and effective action, other countries may well witness similar acceleration of HIV rates in men who have sex with men, according to Sam Avrett of amfAR.

Avrett, speaking at the Journalist to Journalist programme of the US-based National Press Foundation in Sydney, Australia, ahead of the International AIDS Society conference, said HIV/AIDS is spreading rapidly among men who have sex with men in Asia.

“Despite the vulnerability of MSM to HIV/AIDS, insufficient attention is being focused on these communities”. According to a recent amfAR special report, there is a growing epidemic of HIV prevalence among men who have sex with men, with 6 to 8% in Ho Chi Minh City in Vietnam and 8% in Taipei, Taiwan.

Unless rising infection rates are stemmed, gay men in Asia may well face a crisis more devastating than that experienced by gay men in the West during the epidemic’s earliest years, Avrett explained.

Avrett pointed out that globally, fewer than one in 20 homosexual men have access to HIV prevention, treatment and care services.

amfAR will formally launch a new MSM Initiative at the International AIDS Society Conference on HIV Pathogenesis and Treatment here in Sydney on Tuesday (July 24, 2007).

Among their objectives: support and empower MSM organisations to create safe space for HIV interventions in the face of poverty, homophobia and poor access to health care and to develop locally appropriate, population-specific interventions for prevention treatment and care. amFAR builds awareness and understanding of HIV epidemics and ensures strong policies and increased public funding for HIV interventions by and for the gay community

* Imelda Visaya Abaňo is a Filipina journalist with the Women's Feature Service website and a member of the AIDS Media Network. She is based in Manila.

Lose that foreskin

African health departments should scale up male circumcision, according to this report by Esther Nakkazi, the Uganda-based science correspondent of the East African newspaper.
Andrew Grulich, the head of HIV epidemiology and prevention program at Australia's National Centre in HIV Epidemiology and Clinical Research (NCHECR) yesterday told the National Press Foundation training programme in Sydney that there was no reason to delay a circumcision roll-out in the developing world.
Studies in Kenya, Uganda and South Africa have proved that condoms can halve men's chances of contracting HIV infection. The World Health Organization (WHO) has already said that circumcision should be done under hygienic conditions and warned against adult males who undergo circumcision and then resume sex before complete healing of the wound six weeks later, as they may face an increased risk of HIV infection.
But whether governments have the resources to implement the WHO guidelines is another issue. It is not known how much cash-strapped African governments would spend on mass male circumcision if the WHO pro-circumcision policy is passed, although it would certainly be cheaper to do it on newborns.
However, Ugandan ministry of health officials have already recommended mass male circumcision. The letter C has already been added to the famous ABC - abstinence, be faithful and condomise. Now it's ABCC, in spite of Ugandan president Yoweri Museveni’s public skepticism about the strategy. Without giving it political support no one knows what will happen but the health workers are bent on convincing him.
As a result of study results, it would appear that more Ugandan men are heading to hospitals for the ‘cut’. Many hospitals are not prepared for the demand, with the exception of hospitals affiliated to religions, in particularly the ones for Muslims like Kibuli hospital in the national capital, Kampala.
Hillary Bainemigisha, the health editor of the leading daily English-language newspaper in Uganda said the practice was not widespread but that there were four groups of people currently practicing circumcision.”
“People from the east of Uganda, the Bagisu, practice circumcision but it is not safe, with the same knife being used,” he pointed out. ''In the Muslim population, Imams are licenced by the Supreme Muslim Council, a religious body, to carry out circumcision and there is no medical training.”
The New Vision editor said two smaller groups were those who volunteered for circumcision, generally as adults, and those who required it for medical reasons.
The point to remember is that circumcision is NOT instead of condoms. The mantra is circumcision AND condoms.
“It would be a complete disaster if men stopped using condoms after being circumcised. It would be a public health disaster everywhere,” said Grulich.

* Esther Nakkazi is the East Africa newspaper, a weekly business newspaper for Kenya, Rwanda, Uganda and Tanzania. She is also a member of the World Federation of Science Journalists' mentoring programme and later this year takes up a Knight fellowship at the Massachusetts Institute of Technology in the USA.

research and evaluation in the developing world

According to Ansbert Ngurumo, the Sunday editor for the Swahili-language newspaper Tanzania Daima, it has been a smooth start as 42 journalists from Estonia to Mexico began the tenth Journalist to Journalist programme organised by the US-based National Press Foundation (NPF) ahead of the International Aids Society (IAS) conference in Sydney Australia. Between 5,000 and 6,000 delegates from various countries are expected to attend the conference next week.

Ngurumo, who is also a member of the World Federation of Science Journalists' peer-to-peer mentoring programme, said NPF president Bob Meyers asked journalist to do two things: learn from each other, and ask presenters as many questions as possible.

Among speakers on the opening day was Dr David Cooper of Australia's National Centre for HIV Epidemiology and Clinical Research (NCHECR). Dr. Cooper, who is also co-chairing the IAS 2007 conference, emphasised the importance of research and evaluation of anti-retroviral drugs in developing countries. So far, he said, the research and evaluation of anti-AIDS drug roll out was still "negligible" - and the risk was that if anything went wrong, both researchers and governments might jump to the wrong conclusions about how to remedy the matter because of this lack of evaluation and research.

On the need for early treatment, Dr. Cooper noted that there have been cases whereby people who only accessed anti-retroviral drugs late in the progress of the disease have died in the first year of treatment. Their deaths gave rise to the myth about patients dying of the treatment, when in fact the cause was the delay (for a variety of reasons) in accessing the medication. "If this roll out doesn't go well, if there's a glitch, we won't have an evidence base on which to work it out," he warned. "We've to try to convince our people to come out earlier than they are doing now...to avert the myth of treatment killing patients."

In sub-Saharan Africa alone, about a million people are on anti-retroviral drug treatment. Dr. Cooper said the number should be as high as between 3 and 5 million.

He also said there was a need to do thorough research on the correct dosage required for patients in developing countries because there was a concern that most of the inexpensive drugs currently in use in the developing world might be too toxic. He said there was a concern that some patients were given doses, based on research from more affluent nations, that might not be appropriate for poorer patients' weight and nutrition.

The constraint, he noted, was in finding the research finance because most health departments in these countries were "highly stretched." Although optimistic about US President George W. Bush's emergency PEPFAR plan, he noted that the emergency funding specifically excluded research.

Among new findings to be revealed at the upcoming IAS conference, Dr Cooper highlighted the importance of treating the children of HIV+ mothers at an early age. The latest research now recommended that such children should be treated in their first year without waiting to verify if they were infected. This significantly reduced mortality among children, 20 to 30 percent of whom, untreated, die in their first year.

* In addition to his journalism work available at http://www.freemedia.co.tz/ every Sunday, Ansbert Ngurumo is studying for an MBA at the University of Hull in the UK, working night shift at a factory, helping to raise two daughters in two countries (Uganda and Tanzania), running a Swahili blog at http://www.ngurumo.blogspot.com/ and is sadly bereft of his luggage, which was lost on Qantas flight 32 from London.

Hello Sydney

Well, the southern African contingent of journalists has arrived in Sydney (if you crane your neck and look out the back of the bus en route to Dunmore Lang College in the wilder stretches of student suburbia, just after surfacing from the under harbour tunnel, the famous Opera House is visible for 10 seconds).
And we have only managed to lose one reporter, Alvin Chinga from the Zambia Daily Mail, who reportedly made it as far as Johannesburg.....end of that story, for now. Getting reporters together to focus on a science conference has a good deal in common with herding fish. Most of us didn't even pack the residential address somewhere handy, as if we were tourists waiting for a tour guide to hustle us off to visit the sights, so the customs and immigration forms at the airport are a little short on detail. On the bright side, we've now watched lots and lots and lots of recent movies on the 14 hour flight from Jozi, so we may be slow, but our cultural literacy references are upgraded.
And Sydney is cold, as cold as Johannesburg at night and colder during the day. Which is rough on those South Africans who arrived bearing the traditional winter greeting of (sniff, sniff) the flu. (Wrong virus, really, for a conference on AIDS).
But there's a heater in the rooms and nobody was fined at the stringent Aussie quarantine queues, which are really amazing value for money in terms of entertainment. Where else can you see a woman obediently turn around and place one leg at a time on the table for muddy shoe inspection duty? And when she failed the inspection, meekly relinquish the shoes, which were carted off for ritual cleansing. Really, it would provide a fabulous opportunity for some sciene theatre on evolution, or continental drift, or biodiversity. And a captive audience.

more abstract thoughts

There have been a record number of abstracts for the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention, which will be held in Sydney, Australia from 22-25 July 2007. And you can search their website, http://www.ias2007.org/ for abstracts to your heart's content. While there (probably practicing the correct way to say pathogenesis so it just rattles off your tongue) you may want to sign your support for the Sydney Declaration, which says that not less than 10% of all resources dedicated to HIV programming should be used for research. Well, it does go on to say "... towards optimizing interventions utilized and health outcomes achieved." But that seemed a little lengthy to the SciDev.Net team. We wouldn't want to consider the possibility of funding research so it would optimise unutilized interventions and unachieved health outcomes, now, would we?
You don't have to be here freezing in the southern hemisphere winter in order to follow the IAS conference next week, by the way. There will be podcasts on the website. Alternatively, sign up for a free daily email delivered during the week of the conference. Visit www.kaisernetwork.org/ias2007. The email will provide direct links to each day's coverage on kaisernetwork.org.

Abstract thought

India is the Paris Hilton of abstracts, so far, on the website for the upcoming International AIDS Society conference in Sydney, Australia. The searchable website comes up with 50 abstracts mentioning India. This may be something that happens when you are the world's biggest democracy. (Padma Tata says it's because certain South Africa-based journalists are feeling jealous, but Christina Scott of SciDev.Net says that South Africa has lots and lots of really good research, including a couple of important studies on diaphragms, coming up at the conference. Anyhow, it's hard to get jealous about AIDS research search results.)
But what is up with Nepal? It is 40 on Wikipedia's list of countries ranked by population. It appears in 20 abstracts on the IAS website. (Nice flag, too) Pakistan, which is the world's sixth most populous nation, shows up precisely three times. That's three, as in one, two, three. The most uncharitable explanation so far is that a statistically significant group of AIDS researchers are also fanatic mountaineers who want to summit Mount Everest as well as find a vaccine for AIDS. In which case they should watch out - one IAS Nepalese abstract is on sex between trekkers and their guides through the famous mountains of Nepal.
We would suspect that organisers were trying to limit the number of abstracts per country in order to cope with reporters' famous inability to count - but then why would India have over 50 abstracts? A more lucid explanation will have to wait for the conference itself. * Christina Scott is based in Cape Town, South Africa, where she is Africa editor for SciDev.Net

happily married couples are a high-risk group

Stray things tend rather to preoccupy a hapless reporter's mind when reading abstracts, such as "oh, there's a Rwanda Zambia HIV Research Group at Emory University in Atlanta in the USA and Lusaka, Zambia - I didn't know that. Should I have known that?" Followed by "Hmmmm. Why Rwanda and Zambia? Rwanda is the land of a thousand hills, but none of the hills touch borders with Zambia. And one country is French-speaking; the other English. Meetings must be difficult. And why isn't there an office in Kigali mentioned? Are the researchers doing this because there's a particular sub-type of HIV that they want to focus on? why does it look like all the volunteers are from Zambia - maybe there's separate research being done in Rwanda?"
It is quite possible to get utterly sidetracked before realising that according to the abstract, the researchers are tracking volunteer "discordant couples," which sounds to non-scientists like the couples are incompatible and need marriage counselling. All "discordant couples" really means is that one partner has the virus; the other hasn't. As (and if) one partner infects the other (don't get self-righteous now - there's clearly lots of counselling and advice on risk reduction but behavioural change is not something that comes easily to humans, is it, or the diet industry would collapse tomorrow) the infection is tracked in order to gain valuable insight into how the virus levels explode in the bloodstream.
This process of Know Thy Enemy can appear a bit grisly: researchers tried to do the first test on 68 sero-converters as soon as possible after infection, with follow up blood tests at 6 months, 9 months and 12 months later (if the researchers could find the volunteers, of course - the numbers drop, suggesting it was a mission). You know how cautious scientists can be (even when they're not being compared to journalists). So when they say they've documented "a dramatic evolution of plasma viral loads," little alarm bells go off. Three newly-infected partners were on Highly Active Anti-Retroviral Therapy (HAART) within the year.
And by then, Hapless Reporter has wandered off the conference website and Googled the research group's very interesting website. They're tracking the world's biggest group of discordant couples, in Rwanda. Biggest in many senses: longest-standing (began in 1986, with a break induced by the 1994 genocide) and largest in terms of couple numbers. Thousands and thousands of heterosexual couples.
And the world's second-largest study? Same research group. Zambia. So there is a link between Rwanda and Zambia. Last word goes to the Rwanda-Zambia HIV Research Group, which suggests that single status is a healthy option: "While couples represent the largest risk group in Africa (60% of new HIV infections are acquired from a spouse), less than one percent of cohabiting couples have been tested together."
And all of this has very, very little to do with the picture, which is of Hedimo Santana, of the New South Wales state version of the non-governmental organisation People Living with HIV/AIDS. The organisation sent three riveting speakers, including two longterm survivors of HIV/AIDS, to address the National Press Foundation's Journalist to Journalist training week, ahead of the International Aids Conference in Sydney, Australia.

North Rude / North Ryde

Ansbert Ngurumo, the Tanzanian science journalist currently studying at the University of Hull in the United Kingdom, says he will spend "the entire Saturday on safari to London where I will catch my flight the next day from Heathrow."
Christina Scott, the Africa news editor of the Science and Development Network (SciDev.Net), flies out of Cape Town on Sunday to catch a connecting flight from Johannesburg. Once she's survived the strict rules required when flying to Australia (no moisturiser? sies!) she's planning to have a party on board: the same Qantas flight will carry Wandera Ojanji (Kenya), Gladys Gama Gandali (Malawi), Tamar Kahn and Olivia Rose-Innes (South Africa), Joseph Bainemigisha Hilary and Esther Nakkazi (Uganda), Mugove Hamadziripi and Robert Mukondiwa (Zimbabwe) and Alvin Chiinga (Zambia).
Around the time the southern Africa crew departs, Padma Tata will already have arrived in Sydney. Padma, the New Delhi-based Asia coordinator for SciDev.Net, seen here making friends with a kangaroo during an earlier visit this year to Melbourne for the World Conference of Science Journalists, has somehow managed to persuade the Australians to let her back into the country. And Imelda Abano, the Philipino journalist, who was also with Christina and Padma at the WCSJ, comes in on Monday via Singapore Airlines. They're all going to Dunmore Lang College in North Ryde, much to Christina's disappointment (in an earlier email, it was spelt North Rude, and she was looking forward to flourishing in her natural habitat).
Why? Because the National Press Foundation of the USA is holding a journalist-to-journalist training programme in the week ahead of the Fourth International AIDS Society conference in Sydney, Australia, from July 22 to 25 2007.
It's a great idea. And we've come prepared. We have lots and lots of abstracts (great website, IAS). We also have a copy of the New York Times' travel section's advice on what to do when you have 36 hours in Sydney. But we have to get there first ....