SciDev.Net HIV/AIDS dossier

http://www.scidev.net/dossiers/index.cfm?fuseaction=dossierItem&Dossier=22

That's where you want to go for the real stories about AIDS. Online at SciDev.Net. Spotlights on all the big issues - microbicides, mother to child transmission. Everything. Go to www.SciDev.Net and you'll see it in the list of dossiers on the righthand side. Let us know what you think.

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.