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.

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.

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.

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.

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.