Roundup: Science Based Approach to HIV/AIDS Returns to South Africa

Science Based Approach to HIV/AIDS Returns to South Africa

South Africa's new Health Minister, Barbara Hogan, said on Monday at the International AIDS Vaccine Conference 2008 in Cape Town that Thabo Mbeki's government wasted time in fighting HIV/AIDS and vowed to step up efforts after years of controversy when her predecessor advocated beetroot and garlic as treatment.  South Africa, which has one of the world's heaviest HIV caseloads, has been accused by activists of dragging its feet in dealing with the disease which kills an estimated 1,000 people every day.  No longer: 

At the opening of the International AIDS Vaccine Conference 2008 in Cape Town the new Minister of Health, Barbara Hogan, repeatedly stressed the importance of scientific, "evidence-based responses" to stop HIV.

...

Hogan said to the South African government and people about the vaccine conference: "There can’t be any other more important meeting at this time."

Vice-Chancellor of the University of KwaZulu-Natal, Professor Malegapuru Makgoba, won applause from the delegates when he welcomed the new attitude to HIV science by the ministers.

"We (can say) confidently that HIV causes Aids without threats. It is liberating."

In striking contrast to the previous health minister, Hogan acknowledged that South Africa had "lost ground" to the epidemic and that Aids was killing young South Africans.

She said the government was committed "to scale-up mother-to-child prevention programmes" and stated that HIV and TB were the primary health challenges in South Africa.

"We know that HIV causes AIDS," said Hogan, a point that former president Thabo Mbeki publicly contested.

"... It was imperative to get ahead of the curve of this epidemic ten years ago. We all, for various reasons, have lost ground. We also wasted time despite having one of the best plans to cope with the epidemic," Hogan said, adding South Africa must now show more urgency in implementing a national program launched last year to fight HIV/AIDS.

Mbeki drew sharp criticism shortly after coming to power in 1999 when he questioned accepted AIDS science and failed to make life-prolonging anti-retroviral drugs (ARVs) widely available. Tshabalala-Msimang has been lampooned by leading scientists and activists for recommending garlic and beetroot as treatments.

Famous Indian Authors Tell Real Stories of HIV and Sex Worker Suffering

Time Magazine today reviewed a new book, AIDS Sutra: Untold Stories From India, in which acclaimed Indian authors, like Salman Rushdie, Siddhartha Deb and William Dalrymple, travel around the country and memorialize the accounts of those who suffer most from the HIV pandemic:

With its diversity of perspectives and voices, this collection provides a uniquely intimate glimpse into a disease that is either sterilized by statistics or ignored altogether. Each story reveals a government and culture that, like so many other nations, still denies the HIV's impact. Yet even with its pages filled with so much injustice and pain, the book also contains its fair share of triumphant moments. An HIV-positive doctor who fought for his constitutional right to marry a "negative" woman — and won; a group of HIV-positive children who found a home when no one else would take them, a sex worker who braves police corruption and abuse to spread condoms to her colleagues. As one women explained: "I know I am HIV positive, but it is only a condition, not a curse. I have the right to live a normal life."

Researchers Work on Cream that Can Stop HIV Transmission

Despite the long road microbicide research has traveled with little success hope remains that this method of defense against the spread of HIV will eventually arrive at success.  Dr. James Hildreth and his team at the Center for AIDS Health Disparities Research at Meharry Medical College are developing a cream that could potentially block the transmission of HIV during sex.  The cream is designed with women in mind, especially women in Africa who "have no way of protecting themselves from HIV transmission, as well as black women in the United States who are disproportionately affected by the disease." 

The vaginal cream, described as a "chemical condom," relies on a sugar found in toothpaste and mouthwash to remove cholesterol the HIV virus needs to spread. The cream is odorless and is designed to be undetectable to a woman's sexual partner.

"In many parts of the world, women are not in the position to negotiate how sex is practiced," including the use of condoms, Hildreth said. "We have been trying to formulate something transparent to the act of having sex. Women might be able to use it without getting permission or even letting the men know they are using it."

Earlier this summer, Hildreth traveled to Lusaka, Zambia, to see how women and men reacted to the feel and the smell of the cream. About 1.1 million Zambians, 17 percent of the adult population, were living with HIV in 2005, according to the United Nations.

Researchers expected men to reject the cream, but most accepted it.

Catholic University Forces NPR Station to Refuse Funding From Planned Parenthood

(Via Feministe) Former Catholic Duquense University student Michelle Pilicki writes at HuffingtonPost.com that her alma mater asked its NPR affiliate station WDUQ to "refuse underwriting from Planned Parenthood."  Planned Parenthood was running the following underwriter statements on the air at WDUQ:

Support for DUQ comes from Planned Parenthood, offering healthcare services to men, including screenings for cancer and STDs. Planned Parenthood: Their mission is prevention.

Support for DUQ comes from Planned Parenthood, providing comprehensive sexuality education, including lessons on abstinence. Planned Parenthood: Their mission is prevention.

Support for DUQ comes from Planned Parenthood, whose community educators empower teens to make good choices by teaching self-esteem. Planned Parenthood: Their mission is prevention.

Support for DUQ comes from Planned Parenthood, offering cancer screenings for women and men. Planned Parenthood: Their mission is prevention.

Of course, Planned Parenthood's main business is education, screening for potential disease and dispensing subsidized birth control.  Despite the fact that all of the underwriter statements were focused only on these generally accepted and certainly much needed social services the university asked the NPR affiliate to refuse money from the organization. 

Pilecki goes on to argue for the evidence-based middle ground where more and more common-sense people are meeting on this issue:

Even more to the point, undercutting the efforts of Planned Parenthood is more likely to increase, not decrease the demand for abortion. Serendipitously, today's New York Times reported on a worldwide study of abortion rates, quoting Dr. Paul Van Look, director of the World Health Organization's department of reproductive health and research:

We now have a global picture of induced abortion in the world, covering both countries where it is legal and countries where laws are very restrictive. What we see is that the law does not influence a woman's decision to have an abortion. If there's an unplanned pregnancy, it does not matter if the law is restrictive or liberal.

The study, published in Lancet (you can read the 13-page pdf here), says the data also suggest that the best way to reduce abortion rates was not to make abortion illegal but to make contraception more widely available. The highest rates of abortion are in countries that outlaw abortion; not surprisingly, these are also the places with the highest rates of maternal death from abortion complications. The lowest abortion rates? In Western Europe, where abortion is not only legal, but contraception is also available as part of citizens' universal health coverage.

A Mother's Final Look at Life

In case you missed it, a special report in the Washington Post this past Sunday told the story of Fatmata Jollah who died at 18 while giving birth in Sierra Leone, which has the highest rate of maternal mortality in the world.  Fatmata's story provides a human face to the startling numbers of maternal deaths:

More than 500,000 women a year -- about one every minute -- die in childbirth across the globe, almost exclusively in the developing world, and almost always from causes preventable with basic medical care. The planet's worst rates are in this startlingly poor nation on West Africa's Atlantic coast, where a decade of civil war that ended in 2002 deepened chronic deprivation.

According to the United Nations, a woman's chance of dying in childbirth in the United States is 1 in 4,800. In Ireland, which has the best rate in the world, it is 1 in 48,000. In Sierra Leone, it is 1 in 8.

Maternal mortality rarely gets attention from international donors, who are far more focused on global health threats such as malaria, tuberculosis and HIV-AIDS. "Maternal death is an almost invisible death," said Thoraya A. Obaid, executive director of the U.N. Population Fund.

Amie recently wrote a great post taking a close look at the maternal health crisis our world faces that includes some scientifically accepted ways to start to reduce that number and achieve the fifth Millennium Development Goal, to reduce maternal deaths, including improved access to family planning services, prenatal care and maternal education.