HIV
AIDS Advocacy- How to Do It, How Not To
Published August 28, 2009 @ 07:48PM PT
This week saw some really outstanding writing and thinking about global HIV advocacy, and some ugly stereotypes. This includes incredible videos, disturbing print graphics, and a blogger training manual for how to write about AIDS
IRIN , the United Nations news network, has produced four amazing videos about HIV. Each films profiles someone fighting AIDS, including an activist, an educator, a Catholic bishop, and a TV presenter. It’s hard to make a film about HIV that contains a sense of hope without being previous or overly romantic. These films manage to do it.
The Sociological Images blog features two print ads about HIV. Both of them seem to blame women for the spread of AIDS, and feature the naked female body. I know the ad featured about is supposed to tell us that HIV can happen to everyone, but I don’t think that is the message it sends. Both images just seem to tell me that women are dirty spreaders of disease, and I doubt I’m alone in that. (This blog post on how cool alone is not a marketing strategy might shed some light on what went wrong.)
Maybe the advertisers could have learned something from the Blogging Positively Guide, which is a resource for how to write about HIV. My favorite piece of advice is to remember that although in practice most blogs only have about twelve readers, anything you write could end up seen by a million people. I also really liked their examples of organizations and individuals who use blogging to fight AIDS.
Bonus related link: This isn’t about HIV, but it is about advocacy. The Aid Watch blog has a post criticizing a new cinema ad campaign from Doctors With Borders. Aid Watch hates the video, and thinks it’s way over the line, demonizing Africa and creating a sense of hopelessness. The Aid Watch commenters disagree.
Yesterday Was US National HIV Testing Day
Published June 28, 2009 @ 09:48AM PT
I've been getting tested for HIV on and off since 1996, mostly to get visas for travel to restrictive countries. The first time I got tested, it freaked me out. I was getting tested so I could get an Egyptian visa; I didn't have any risk reason for the test. But I made up a whole (deeply implausible) story about how I could have been infected anyway. Then I pretty much just twitched until I got my test results. The second time, I made up the infection story, but I didn't do any twitching. The third time I only spent about three minutes worrying and then I pretty much forgot about the test until my results came.
The last time I got tested for HIV was four years ago, when I was pregnant with my son. It was part of my doctor's standard package of tests for pregnant women. I didn't see any reason for the test, but I didn't see any reason not to, either. And no, I still didn't have HIV. But I could. We all could.
I have a point here. Getting tested for HIV is hard the first time, but it gets easier. And if you do have HIV, getting tested will save your life.
If you want to get involved with global health, getting tested for HIV is your first step. You are part of global health - not just your advocacy or your donations, but your own health. Global pandemics don't just happen somewhere else. They happen in your city, and in your town. HIV is scarier and more urgent than swine flu. Make sure that you're not part of its spread.
Recommended Readings: June 16, 2009
Published June 16, 2009 @ 10:43AM PT
(photo credit: Science Speaks)
Ruth Levine talks about Advance Market Commitments for vaccines on the Center for Global Development blog. CGD has every right to be proud of this; they were a major player in making this happen. Now that it's finally - finally - going to happen, read all about it.
Physicians for Human Rights has a new report out about the targeting of physicians in Kosovo. It's ugly stuff. "in the period 1998 and early 1999, Serbian police and paramilitary forces targeted Kosovar Albanian physicians for allegedly providing care to members of the Kosovo Liberation Army. This persecution breached the requirements of human rights law and the Geneva Conventions by failing to respect physicians' ethical obligation to provide medical care to patients..."
The Science Speaks blog has several great posts from the recent 2009 HIV/AIDS implementers meeting in Namibia. I especially liked this post from Dr. John Idoko, Director General of Nigeria's National Agency for the Control of AIDS, on cost effectiveness, and this detailed look at HIV prevention. For highlights of the meeting overall, this post is useful.
This week the WHO declared swine flu to be a pandemic. (see my other post today). Maryn McKenna reminds us that we could have caught the spread of H1N1 a lot faster if anyone had been doing surveillance in pigs. That's a problem not just for swine flu, but for all diseases that pass from animals to humans.
New Circumcision Effort in Swaziland and Zambia
Published June 11, 2009 @ 09:23AM PT
I know I promised to stop posting about circumcision, but considering the last post, I had to share this press release I just received. The implementation and outcome of the effort will certainly teach us a lot about male circumcision in practice. Here's the release:
(June 11, 2009 - Washington, D.C.) In a significant move from research on male circumcision to full-scale implementation, the Male Circumcision Partnership is launching a massive scale-up of voluntary male circumcision services in Swaziland and Zambia. The Partnership is supported by a five-year, $50 million grant from the Bill & Melinda Gates Foundation to Population Services International (PSI). PSI and partners Marie Stopes International, Jhpiego, The Population Council and the governments of Swaziland and Zambia estimate that the project will provide voluntary male circumcision services to nearly 650,000 men.
The Male Circumcision Partnership program in Swaziland and Zambia also builds upon the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supported medical male circumcision activities in each country. This partnership is evidence of a strong and growing coordination among the Gates Foundation, PEPFAR and other partners under the leadership of host country governments to support evidence-based medical male circumcision for the purpose of HIV prevention.
Cited by both the World Health Organization and UNAIDS as an "important intervention," male circumcision reduces HIV infections among men by 60%, according to scientific research - more effective than any vaccine currently in development.
"Safe male circumcision in combination with other prevention programs has a critical role to play in the global effort to fight HIV/AIDS," said Regina Rabinovich, Director of Infectious Disease Development in the Gates Foundation Global Health Program. "Studies confirm that safe, voluntary male circumcision has been shown to reduce HIV transmission rates and help save lives."
In order to ensure quality scale-up and to meet the current demand for voluntary male circumcision, the Partnership is establishing a network of nearly 250 providers across the public, private and NGO sectors to deliver quality male circumcision services. This collaboration with the Swaziland and Zambia governments supports their national HIV prevention strategies by greatly expanding access to this important prevention intervention.
The Partnership will also launch a series of innovative behavior change communication campaigns focused on post-circumcision issues, such as the need for ongoing safe sex practices and continued condom use.
Circumcision Is a Red Herring
Published June 08, 2009 @ 02:04AM PT
Editor's Note: This is a guest post from Steve Jackson, who currently works on HIV in Cameroon and blogs at Our Man in Cameroon. He left this as a comment, but I thought it was important, and got his permission to put it up as a guest post.
I'm not going to argue with the science behind these circumcision pieces. That's not to say I either agree or disagree with it - I think the science is beside the point because this is not even remotely practical. I work for an organization in Cameroon that supports local villages in helping to stop the spread of AIDS while assisting people living with HIV/AIDS to hopefully have as normal lives as possible.
If you can imagine what we are battling with in terms of getting messages across - I have some issues with ABC (abstinence, be-faithful, condom). Personally I'd go with condom, condom, condom and let people choose their own ideals - but I can work with this. Now even within that area I can show you the picture above. This is proudly on display at a local Catholic church. And people believe this stuff. Recently the Pope decided to pay this country a visit and told everyone that condoms were making the problem worse.
On top of that you have traditional healers - recently my boss told me of one that had claimed to have cured two AIDS patients. It turns out where it said "negative" on their medical records was next to Malaria not HIV. But these claims and rumors take hold. I haven't seen it here but we've all heard African tales of how having sex with a virgin will cure you of AIDS.
People have sex with partners who they know to have HIV. Even with the threat of being infected people take that risk. My point is this - there are already so many rumors and half truths and downright lies that people are entirely confused.
People are already willing to risk sex with people they know to carry the disease. You start telling them a simply surgical procedure will make them less likely to contract the disease and it will soon be widely understood that you CAN NOT become infected if you are circumcised.
And how would that circumcision take place? It's not like there are mobile, sterile, clinics on hand. How long before it becomes an extension of the body mutilation that is practiced here (not heard of female genital mutilation in this area but there is a practice of breast ironing which is quite horrific).
In other words - how long before circumcision is carried out by a traditional healer, witch doctor, family member etc - in entirely unhygienic circumstances? Hugely painful for an adult - hugely dangerous for a child.
I am saying this without any doubt at all - if you tell people that circumcision helps reduce the risk of AIDS then they will think they can have sex without danger. The problem would get worse.
On top of that I do have huge ethical issues with this piece - and I do think that it has been treated relatively lightly. Certainly if we were talking about female genital mutilation I am not sure if either the research, or the reporting of it in such a positive manner, would have ever occurred.
If you want to fight AIDS then you need foolproof methods. It's not enough to just lower the odds. People here are already having sex with infected partners and taking the risk. You cannot further encourage people to take risks. Sexual practices have to be virtually 100% safe before people can be educated in such methods and ways of living.
And if we are unable or unwilling to provide the developing world with condoms and the consistent education to use them correctly - then why waste our time on circumcision - a less effective, more costly, more painful, more dangerous method?
This idea that - "say it won't work but don't deny the science" - is entirely beside the point.
If it won't work it won't work. So let's move on.
Truth is there is already perfectly good, cheap ways to defeat the spread of HIV/AIDS we just have to stop the misinformation (much of it coming from the developed world) and commit to teaching the same methods and same practices.
There are already enough red herrings without introducing another one.
Circumcision - Last Post, For Now
Published June 08, 2009 @ 01:01AM PT
I'd like to correct some misconceptions that have come up in the comments about the three circumcision studies which were reviewed by the Cochrane collaboration when it found that circumcision does reduce HIV transmission.
1) No one was "allowed" to get HIV because of this research. When you test a new medical intervention - a drug, a therapy, a surgery, you test it against current best practice. One group gets current best practice; in this case, HIV testing and counseling. The other gets current best practice (testing and counseling) PLUS the new intervention. Study descriptions here and here.
2) The reason that this review only found effects for 24 months was because the longest-running study was stopped after 24 months. The protective effect was so strong that they stopped the study in order to offer circumcision to the control group.
3) They did find the way that circumcision reduces HIV spread. I'll quote the part of the article that mentions it: "The protection is believed to come through removal of Langerhans cells in the foreskin, which are particularly susceptible to infection with HIV, and keratinisation of the glans, which provides greater barrier protection than mucosal tissue."
4) Because the research was on the risk of getting infected with HIV, all men were HIV-negative at the start of the study. They were chosen to have similiar demographic characterisitics and then randomized into two groups.
Weekly Highlights May 31- June 6
Published June 07, 2009 @ 07:51AM PT
If you want to buff up on your global health knowledge, check out Alanna's posts this week on Why Fighting Malaria is Hard and Five Things to Know About Indoor Air Pollution. Both include information that's enlightening and not immediately obvious.
Guest blogger Michael Keizer has written several posts on health and human rights. This week, he takes Another Look at Health As a Human Right, and focuses on what our moral obligations are regarding health.
For Career Wednesday, Alanna provides some useful advice on How to Leave a Job You Hate (which turns out to be the same as how to leave a job you love) and tips on preparing a Global Health Resume
Alanna's article on Circumcision and HIV prompted strong, emotional responses in the comments section. In a follow-up post, she further explained the scientific evidence that circumcision protects against HIV transmission, as well as other infectious diseases.
You may have noticed that global health is field filled with acronyms. Turns out Alanna has a few pet peeves. Check out this amusing post on Especially Annoying Global Health Acronyms, which includes acronyms that stand for different things, are misleading or include prepositions.
A new feature started this week called Comment of the Week, where the smartest, funniest, or most eye-catching comment is highlighted, and the author of the comment will receive Change.org coins to the charity of their choice. Congrats to Patrick Mayne for being this week's commenter of the week!
After all the media attention on swine flu in April and May, the latest public health scare seems to have disappeared off the radar. You may be wondering, What Happened to Swine Flu? Read on to learn about potential changes in WHO's pandemic alert system, silly rumors, and future possibilities.
