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.