Kaisernetwork.org (Washington, DC)
8 October 2008
Science & Medicine
Circumcision Not Effective in Preventing HIV Among MSM, Study Finds
[Oct 08, 2008]
Despite research showing circumcision can reduce a man's risk of HIV during heterosexual intercourse, a study published Wednesday in the Journal of the American Medical Association found that the procedure offers little protection against the virus for men who have sex with men, AFP/Yahoo! News reports. According to the study, there was minimal difference in HIV infections between those MSM who were circumcised and those who were not (AFP/Yahoo! News, 10/7).
For the study, researchers at CDC, led by Gregorio Millett, reviewed 15 previous studies on circumcision that included 53,567 MSM from Australia, Great Britain, Canada, India, the Netherlands, Peru, Taiwan and the U.S. Circumcised MSM were 14% less likely to be HIV-positive than those who were not, a rate that was not statistically significant, according to the researchers. Millett said, "You can't necessarily say with confidence that we're seeing a true effect there," adding, "Overall, we're not finding a protective effect associated with circumcision" for MSM (Dunham, Reuters, 10/7).
However, when examining studies carried out before the introduction of highly active antiretroviral therapy in 1996, the researchers found evidence that circumcision in the past had a protective effect for MSM, BBC News reports. The researchers said one explanation for the reduced effectiveness of circumcision among MSM following the introduction of HAART is that the efficacy of drugs diminished the perceived need to practice safer sex to avoid contracting HIV. In addition, the study noted that HAART might help reduce the risk of HIV transmission to a level that circumcision does not provide further benefits. The researchers also said that there may have been a smaller proportion of men in the pre-HAART trials who engaged primarily in receptive anal sex, which carries the greatest risk of HIV among MSM (BBC News, 10/7).
CDC's Peter Kilmarx, who was not involved in the study, said the agency is set to release a draft of formal recommendations on circumcision early next year. Although Millett said circumcision cannot be recommended as a strategy for HIV prevention among MSM in the U.S., he added that there are signs the procedure could protect certain MSM depending on sexual practices. For example, Millett said that studies in Australia and Peru have shown that men who engaged only in insertive anal sex and were not being penetrated by male sex partners experienced a greater level of protection from circumcision (Reuters, 10/7). However, Millett said, "Even if we find that insertive men are protected, that might be such a small proportion that we wouldn't get the effect on the overall population that we'd like. As it stands now, circumcision is unlikely to have the same kind of benefit [in the U.S.] that it's projected to have in Africa" (Lauerman, Bloomberg, 10/7).
According to the authors, more research might be needed to determine the amount of protection provided by circumcision for insertive MSM (AFP/Yahoo! News, 10/7). "These studies weren't designed to answer this question in the first place, and it's possible that they're too varied to show an effect," Millet said, adding, "The idea makes sense, but there just aren't enough data out there right now to show whether there's a benefit" (Bloomberg, 10/7). In a related editorial also published in JAMA, a team of peer reviewers from Vanderbilt University wrote that "circumcision would likely be insufficiently efficient to be universally effective in reducing HIV and will have to be combined with other prevention modalities to have a substantial and sustained prevention effect" (AFP/Yahoo! News, 10/7).
The study is available online. The related editorial also is available online.
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Global Challenges
Vietnam Launches Nationwide HIV/AIDS Initiative
[Oct 08, 2008]
Vietnam on Monday announced the launch of a nationwide initiative, called "Every Citizen is Involved in HIV/AIDS Control and Prevention Activities at Community Level," to curb the spread of the disease in the country, the Vietnam News Agency reports. The program will be implemented by the Ministry of Health, the Ministry of Culture, Sports and Tourism and the Vietnamese Fatherland Front Control Committee and will run through 2012. Health Minister Nguyen Quoc Trieu said the initiative's goals are to raise awareness of prevention and control methods. He added that the program aims to encourage and create opportunities for families with HIV-positive members, commercial sex workers and injection drug users to become involved in prevention and control activities. Nguyen Thanh Long, head of the Department of HIV/AIDS Control at the health ministry, said that many people in remote, rural areas of Vietnam are unaware of HIV prevention methods (Vietnam News Agency, 10/6).
Link to this story.
UNESCO Program To Help Teachers in Zimbabwe Access Drugs, Other Services
[Oct 08, 2008]
UNESCO plans to launch a network of HIV-positive teachers in Zimbabwe to help the group access no-cost antiretroviral drugs and other services, Zimbabwe's The Herald reports. Bekezela Mapanda -- UNESCO program assistant for education and HIV/AIDS -- said that the network aims to provide assistance to teachers, who often are poorly paid, to manage the rising price of drugs and other services. "We all know their salaries are very poor," Mapanda said, adding, "They cannot afford all the procedures needed before one is put on antiretroviral treatment; worse still, the drugs are required monthly." Teachers in Zimbabwe earn an average of 12,000 Zimbabwean dollars, or about $78, monthly, and antiretrovirals cost an average of $225,000 Zimbabwean dollars -- or about $1,460 -- monthly. The cost of antiretrovirals can fluctuate daily, The Herald reports.
According to Mapanda, teachers have "dominated cross-border trade business to raise extra income, causing them to engage in risky behavior, exposing them to risks of contracting HIV." She added that the network will allow teachers to access no-cost antiretrovirals, take part in national HIV/AIDS programs, and review workplace initiatives and policies. The UNESCO program follows recent comments from HIV-positive teachers in the country about their inability to access antiretrovirals from the government's program, as well as the high costs of the drugs at private pharmacies. According to some HIV-positive teachers who attended World Teachers' Day events in the capital of Harare last week, Zimbabwe's National AIDS Council should consider them when allocating budgetary assistance as it does for the armed forces. "I am lucky to be accessing free drugs, but my fear is that my health is deteriorating because of lack of a balanced diet and overworking catering for my family," teacher and HIV/AIDS advocate Joana Kasirori said. She also called on teachers to undergo voluntary HIV/AIDS testing and counseling and develop a network of HIV-positive teachers. Zimbabwe Teachers' Association President Tendai Chikowore said that teachers affected by HIV/AIDS feel most of the effects of inflation and other economic issues. "The situation is worse for our colleagues living with HIV and AIDS owing to prohibitive medical costs versus the teachers' meager salaries," she said (The Herald, 10/7).
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HIV/AIDS Workshop in Ghana Addresses Women's Issues, Media's Role in Fight Against Disease
[Oct 08, 2008]
At a recent workshop held by Women, Media and Change, Afua Ansre, national coordinator of the United Nations Development Fund for Women in Ghana, said that obstacles to HIV/AIDS prevention -- including a lack of access to information, education and health care -- are compounded by a deficit of sex-specific data on monitoring systems, Ghana's Public Agenda reports. Ansre also said that women should be provided with education about the disease, particularly for the prevention of mother-to-child transmission. She added that governments, nongovernmental organizations and individuals must work together "to implement structured programs to prevent the spread" of HIV/AIDS.
According to the Public Agenda, the workshop aimed to provide female members of the media with the skills to effectively report about women living with HIV/AIDS and give them relevant information about HIV/AIDS prevention among at-risk groups, particularly women and girls. Charity Binka, a WOMEC facilitator, said that the specific objectives of the workshop were to train female journalists on the gender and rights aspects of HIV/AIDS reporting and supply them with the opportunity to collect first-hand information on the challenges of living with the disease. She added that workshop organizers hope to create a network of peers reporting on HIV/AIDS in Ghana.
Oliver Commey of the Korle Bu Teaching Hospital said that women's biology, their economic status, forced marriages and unstable environments such as conflict are some factors that contribute to women being at risk of contracting HIV. Commey added that issues such as marriage, stigma, disclosure, and access to treatment and care are important to address among women living with HIV/AIDS. According to Commey, media should be responsible for advocating for those without power. He added, "You need to gather, analyze and disseminate accurate information on HIV. This should be continuous to keep authorities on their toes" (Amankwah, Public Agenda, 10/6).
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Uganda Sees Rise in Non-Tribal Circumcisions; Government Developing Plan To Promote Procedure in Effort To Reduce Spread of HIV
[Oct 08, 2008]
An increasing number of men from tribes in Uganda and other parts of East Africa that traditionally do not practice circumcision have undergone the procedure, prompting the government to begin developing a plan to promote male circumcision as a method of curbing the spread of HIV, AFP/Mail & Guardian reports. Alex Opio of the country's Ministry of Health said that male circumcision has "overwhelming support in the country" and that the ministry hopes to begin the program by targeting adolescent males, circumcising them before they become sexually active. Kihumuro Apuuli, head of the Uganda AIDS Commission, said the government decided to go forward with the program despite some concerns surrounding male circumcision and HIV/AIDS because "if you get an intervention that can contribute to the reduction of infections, you have to support it." He also said the government does not plan to advocate methods of circumcision already practiced by some tribes because the "ceremonies associated with that ritual are not safe. Using the same knife on different people. Having sex before the wounds heal. We are talking about safe circumcision." Geofrey Natubu -- vice chair of the Bududa District, where male circumcisions already are practiced -- said he would like to see more tribes embrace the procedure. "If it is true that is one of the preventive measures against HIV/AIDS, then it is better for us all to take it, irrespective of the way through which you do it. You can do it the way you want," he said. Natubu said that the community about 10 years ago recognized the threat of HIV/AIDS and began using one knife per circumcision (Simon, AFP/Mail & Guardian, 10/7).
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Opinion
China Has Made 'Substantial Progress' in Fight Against HIV/AIDS, Still 'Long Way To Go,' Opinion Piece Says
[Oct 08, 2008]
China "had made substantial progress in checking the spread of HIV but there is still a long way to go," UNAIDS Executive Director Peter Piot writes in a China Daily opinion piece. Although more than 34,000 people in China now have access to antiretroviral drugs -- compared with 5,000 in 2003 -- "we cannot slow down in our vigilance," Piot writes, adding, "Whereas substantial progress has been achieved in this country, the number of people receiving HIV drugs is still less than half the number who require them." In addition, the "epidemic continues to run ahead of the response: for every two people who start taking antiretroviral drugs, another five become newly infected with HIV," according to Piot.
Many HIV cases occur "in situations that are illegal or outside of mainstream society," Piot writes, adding, "These give rise to apparent contradictions between respect for the law and protecting the health of people who inject drugs or are sex workers, between sexuality and morality, between needs of public security and public health, drug control and safe injections." To "confront AIDS is to confront contradictions in society," according to Piot, who adds, "On closer investigation, however, most of these contradictions prove to be false contradictions. A scientifically based AIDS response can solve them for the greater well-being of more people."
These issues make HIV/AIDS "such a complex problem to deal with," Piot writes, adding, "Complex problems require complex solutions. They also respond best to collective approaches." According to Piot, working "with community groups, for example, can greatly increase the impact -- and effectiveness -- of AIDS strategies." He adds, "In fact, given that most infections are happening in situations outside the mainstream norm, it is often very difficult for government alone to reach those who need to be reached." China has "solid policies in place and has made significant progress in the fight against AIDS," Piot writes, concluding, "It is time now to use the tremendous array of resources at its disposal to build on that progress and to tackle new, tough challenges like harm reduction and increasing civil society involvement" (Piot, China Daily, 10/8).
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