One of the results of the exceptionalization of HIV is that other health conditions end up being ignored, including sexually transmitted infections (STI). Given the HIV industry's obsession with sexually transmitted HIV, it might be expected that STIs such as syphilis might get a bit of attention.
However, many women can be tested and treated for HIV, and receive prevention of mother to child transmission (PMTCT), without being tested for syphilis and other STIs. These preventable and treatable STIs can be passed on to children, despite most women attending antenatal care facilities at least once during their pregnancy.
WHO estimates that two million pregnant women are infected with syphilis every year and about 1.2 million of them will transmit the infection to their child. Far fewer children are infected with HIV. And the number of deaths from syphilis during pregnancy is higher than the number of infants infected with HIV.
At one time, a lot of attention was given to treating STIs as a means of reducing HIV tranmsission. Trials showed that this had very little impact on HIV transmission and a recent Cochrane Review makes it clear that STI control is not an effective HIV prevention strategy.
But, importantly, the review concluded that there are "other compelling reasons why STI treatment services should be strengthened, and the available evidence suggests that when an intervention is accepted it can substantially improve quality of services provided."
Syphilis and many other STIs are preventable and treatable, yet they often seem to be ignored. And it sounds as if they have only received much recent attention because of the possibility that they may reduce HIV transmission.
Surely STIs should be prevented and treated where possible because they are diseases, not just because this might have an impact on HIV transmission? HIV is debilitating and incurable, but other STIs are debilitating and curable.
Whether STI treatment has an impact on HIV transmission or not, people should not have to suffer from them or risk passing them on to their partners and their children, especially when this is entirely avoidable. They have a right to prevention and treatment for all diseases, not just HIV.
Showing posts with label sexually transmitted infections. Show all posts
Showing posts with label sexually transmitted infections. Show all posts
Monday, May 2, 2011
Tuesday, March 30, 2010
More Good News for Big Pharma: Resistant Gonorrhoea
Yesterday, I blogged about the fact that TB is on the rise worldwide. Funding for TB prevention, and even for treatment, are not commensurate with the threat to global health that this epidemic poses. And the rise of TB is often blamed on the current HIV pandemic. I would suggest that there is a TB epidemic of a level that can not wholly be explained by the HIV pandemic and that, like almost every disease and health issue aside from HIV, TB is being ignored.
Those heavily involved in the HIV industry, such as Michel Sidibe, the head of UNAIDS and Michel Kazatchkine, head of the UN Global Fund for HIV, TB and Malaria, deny that high levels of HIV funding have starved other diseases of cash. Kazatchkine claims that 'over a third of of overall funding of the Global Fund is actually going to strengthening health systems'. I don't know how he came up with this estimate but it seems to me that there are only certain aspects of health systems that are benefitting from HIV cash, and those aspects relate to HIV.
Kazatchkine says the money is not just going on condoms and drugs. I sometimes wonder if the money is even going on condoms, along with the logistics of ensuring that people use condoms all the time and properly. Even the claim that a lot of money is being spent on drugs can seem hollow when people supposed to be taking them often cannot do so because of lack of food. And 20% of the new HIV cases in Kenya every year come from vertical infection, from mothers transmitting HIV to their babies.
Treatment of people with HIV may well have exceeded expectations. And I would like to see every HIV positive person who needs treatment receiving the drugs and support they need. But since the recent expansion of HIV treatment, millions more have become infected. Prevention has been forgotten about. People like Kazatchkine and Sidibe like to argue that distinguishing between treatment and prevention is a false dichotomy, but this is not so. If treatment played such a huge role in preventing further infection, transmission rates would be much lower than they are. In fact, the majority of people in Kenya who are HIV positive do not know their status. Perhaps there shouldn't be a dichotomy between treatment and prevention, but there is.
And if you think the programmes to teach people about safe sex and to persuade them to use condoms have been successful, consider the figures for preventable and treatable sexually transmitted infections (STI). There are an estimated 340 million new cases of curable STIs every year. This is after over 20 years of preaching about safe sex in every country in the world. If people were practicing safe sex, transmission of most STIs would also be reduced. Prevention involves taking steps to ensure the infection is not transmitted. In the case of STIs, that could involve the correct use of condoms, minimally.
HIV treatment and care has received much of the money available for the disease. Kenya's official strategy papers make this quite clear. Prevention has received very little money and has been pretty unsuccessful, with 5 new infections for every two put on HIV treatment, globally. And HIV has been treated as if it's just an easy matter to round up people and give them some drugs. As a result, there is growing resistance to the few HIV drugs available in developing countries. This can be compared to TB, where it has long been recognised that you can't just send people away with some drugs and expect them to take them religiously for 9 months and never see them again.
If health solely involves treating sick people, how will you ensure the continuing health of those who are not (yet) sick? In the field of sexually transmitted diseases, gonorrhoea is now also developing resistance to the most commonly available drugs. There has been little recent research into alternative treatments for gonorrhoea (or TB) because, I would suggest, most of the money has been spent on other 'priorities' (Oh, and big pharma are waiting for public funding for their research, a very important component for these (private) companies). One of those priorities is HIV and despite ploughing a lot of money into condoms and safe sex campaigns, prevention has not received the level of funding it needs.
Yet more evidence of the lack of success of HIV prevention work is the level of pregnancies among women receiving HIV treatment. Women with untreated HIV have far lower fertility levels, so treatment should increase fertility. But women on HIV treatment should also be receiving advice about having unprotected sex and about unplanned pregnancies. I don't believe that all these HIV positive women are choosing to have more children, though some of them may be. Because other research has shown that the vast majority of pregnancies among women who are HIV positive were not planned.
Sidibe even seems to think that the global recession and climate change are distractions to the industry's fight against Aids. I would be hard pressed to find an attitude to which I am more opposed. He even has the cheek to suggest that HIV funding has not led to the neglect of other diseases because it has increased attention for TB, the two diseases being 'integrated', and that HIV prevention should take on a 'holistic approach'. Damn right, but I don't think his use of 'holistic' is the same as mine. But when is all this HIV money going to be spent on the many health issues that I and many others would claim have been ignored? Apparently, Sidibe and Kazatchkine think that's already taking place, and Sidibe feels that support from the big pharmaceutical companies is essential. Very funny.
Saturday, March 6, 2010
Political and Religious Leaders Overseeing the Spread of HIV
There's an interesting article on Aidsmap.com about how Ugandans who think they may be HIV positive are less likely to refer other family members for HIV testing. In a survey, people were asked before testing if they thought they were likely to be HIV positive. A majority said they thought they were likely to be. Of course, only some of them were. But most of those who are HIV positive in the country do not know their status. This doesn't bode well for a country that is said to have been so successful and progressive in its fight against the disease.
The very people who are most likely to be HIV positive are least likely to go for testing. So you would think that the Ugandan government would aim to target these people, make it easier for them to get tested, increase access to HIV facilities, reduce discrimination and stigma. Instead, the government is going in the opposite direction, trying to whip up anti gay feelings and making such strong threats against people even suspected of being gay that most people will be less willing to find out their HIV status, whatever their circumstances.
The Bahati Bill will make a lot of people avoid even discussing HIV or sexuality because if someone is found to be gay, HIV positive and sexually active, they will face the death sentence. In order to cover up their sexuality, many gay people are said to have heterosexual relationships, even to marry a heterosexual partner. Their partner will even face a lengthy prison sentence for not reporting that they were married to a gay person. Currently, only an estimated one quarter of HIV positive people know their status. If this bill becomes law, that figure should go down even further.
Some leading American Christians are said to be behind Bahati's bill. But the Catholic church is equally adamant that condoms shouldn't be used to prevent unplanned pregnancy, HIV or other sexually transmitted infections. They even lie about the effectiveness of condoms, which would seem to be in breach of the ninth commandment. But as far as they are concerned, it is 'artificial contraception', and therefore immoral. The use of condoms is currently being debated in The Philippines, where HIV prevalence is low, but rising.
You would think that political and church leaders would aim to reduce transmission of HIV and to stamp out stigma and discrimination. But, on the contrary, they seem to be against any measures that target some of the most significant channels to HIV infection. We must look beyond political and religious leadership if we are to have any hope of making progress in the fight against HIV.
The very people who are most likely to be HIV positive are least likely to go for testing. So you would think that the Ugandan government would aim to target these people, make it easier for them to get tested, increase access to HIV facilities, reduce discrimination and stigma. Instead, the government is going in the opposite direction, trying to whip up anti gay feelings and making such strong threats against people even suspected of being gay that most people will be less willing to find out their HIV status, whatever their circumstances.
The Bahati Bill will make a lot of people avoid even discussing HIV or sexuality because if someone is found to be gay, HIV positive and sexually active, they will face the death sentence. In order to cover up their sexuality, many gay people are said to have heterosexual relationships, even to marry a heterosexual partner. Their partner will even face a lengthy prison sentence for not reporting that they were married to a gay person. Currently, only an estimated one quarter of HIV positive people know their status. If this bill becomes law, that figure should go down even further.
Some leading American Christians are said to be behind Bahati's bill. But the Catholic church is equally adamant that condoms shouldn't be used to prevent unplanned pregnancy, HIV or other sexually transmitted infections. They even lie about the effectiveness of condoms, which would seem to be in breach of the ninth commandment. But as far as they are concerned, it is 'artificial contraception', and therefore immoral. The use of condoms is currently being debated in The Philippines, where HIV prevalence is low, but rising.
You would think that political and church leaders would aim to reduce transmission of HIV and to stamp out stigma and discrimination. But, on the contrary, they seem to be against any measures that target some of the most significant channels to HIV infection. We must look beyond political and religious leadership if we are to have any hope of making progress in the fight against HIV.
Sunday, January 10, 2010
PSI: Throwing Bad Money After Bad
At one time, the leading paradigm of development was the control of population, the belief that poor countries would develop if they would only have fewer children. One of the foremost organizations persuading people to use condoms and employ other family planning techniques was Population Services International (PSI). They were not very successful and family planning and reproductive health in developing countries is still woeful, despite large sums of money being thrown at these problems.
PSI is still a powerful organization with lots of money to throw at the problems of development. But now, much of their money goes into HIV, where they (along with various other powerful and rich organizations) have also been relatively unsuccessful. PSI's aim is to use the 'power of marketing' to persuade people to change their sexual behaviour and use condoms and other modern contraceptive methods.
Strangely enough, PSI don't seem to know that the road up is also the road down, that contraception to prevent unplanned pregnancy can also prevent sexually transmitted infections (STI), such as HIV. The goal of reducing unplanned pregnancy was lost in the scramble to persuade people to change their sexual behaviour to avoid being infected with HIV (never mind about other STIs). However, many HIV positive women having babies did not plan to get pregnant in the first place. And the whole issue of sexual activity and reproduction has become so confused that people are apt to concentrate on one thing, such as unplanned pregnancy, and completely ignore two other important considerations: HIV and other STIs.
Not that long ago, it was reported that many women would prefer to run the risk of contracting HIV than that of getting pregnant. They would have unprotected sex with a partner, often a person they didn't know very well, then they would resort to emergency contraception (EC). This EC is not appropriate as a general contraceptive and it does not protect from HIV or other STIs.
Why would people be willing to take this risk? Is it because they simply don't see contracting HIV as a very high risk? They could be right, they may be more likely to become pregnant than to contract HIV or some other STI, but the risk is still there and the odds go against them the longer they continue to have unprotected sex. Actually, the chances of becoming pregnant also become higher the longer they continue to use EC as a substitute for more appropriate contraception.
I'm singling out PSI because they have been big fans of marketing EC in developing countries and because of their dependence on marketing. Marketing may well be appropriate in the commercial world, where everything has to seem cooler or newer or better than what went before. But contraception, family planning, reproductive health and things like that are not good because they are cool or funky or with it, they are good because they work.
If PSI have been successful at marketing EC, they have done so irresponsibly. After all their decades in developing countries they should know by now that what people need is good basic education, good basic health services and good sexual health services, particularly for women and girls. Fancy (and expensive) marketing is not a substitute for proper education and health. The message has now been fluffed, so that people have all sorts of muddled ideas about contraception, sexualy behaviour, pregnancy and anything else organizations like PSI have been involved in.
If organizations like PSI are really interested in people's health and welfare, they should pay a little less attention to marketing expensive products and services and spend some time advocating for the levels of health and education spending that countries like Kenya really need. Contraception such as condoms is not cool, it's vital for people to be able to live their lives without risking serious disease or unplanned pregnancy.
People, adults and children alike, just don't know enough about HIV, reproductive or sexual health. There is no amount of advertising and campaigning that will give them access to the information, services and products they need to ensure their sexual and reproductive health. HIV, and even high levels of unplanned pregnancies, are not emergencies. They are part of everyday life and a factor of how little has been done to improve people's health and education over the past few decades.
Contraception of any kind is useless without adequate levels of spending on education and health, especially those relating to sexual and reproductive health.
PSI is still a powerful organization with lots of money to throw at the problems of development. But now, much of their money goes into HIV, where they (along with various other powerful and rich organizations) have also been relatively unsuccessful. PSI's aim is to use the 'power of marketing' to persuade people to change their sexual behaviour and use condoms and other modern contraceptive methods.
Strangely enough, PSI don't seem to know that the road up is also the road down, that contraception to prevent unplanned pregnancy can also prevent sexually transmitted infections (STI), such as HIV. The goal of reducing unplanned pregnancy was lost in the scramble to persuade people to change their sexual behaviour to avoid being infected with HIV (never mind about other STIs). However, many HIV positive women having babies did not plan to get pregnant in the first place. And the whole issue of sexual activity and reproduction has become so confused that people are apt to concentrate on one thing, such as unplanned pregnancy, and completely ignore two other important considerations: HIV and other STIs.
Not that long ago, it was reported that many women would prefer to run the risk of contracting HIV than that of getting pregnant. They would have unprotected sex with a partner, often a person they didn't know very well, then they would resort to emergency contraception (EC). This EC is not appropriate as a general contraceptive and it does not protect from HIV or other STIs.
Why would people be willing to take this risk? Is it because they simply don't see contracting HIV as a very high risk? They could be right, they may be more likely to become pregnant than to contract HIV or some other STI, but the risk is still there and the odds go against them the longer they continue to have unprotected sex. Actually, the chances of becoming pregnant also become higher the longer they continue to use EC as a substitute for more appropriate contraception.
I'm singling out PSI because they have been big fans of marketing EC in developing countries and because of their dependence on marketing. Marketing may well be appropriate in the commercial world, where everything has to seem cooler or newer or better than what went before. But contraception, family planning, reproductive health and things like that are not good because they are cool or funky or with it, they are good because they work.
If PSI have been successful at marketing EC, they have done so irresponsibly. After all their decades in developing countries they should know by now that what people need is good basic education, good basic health services and good sexual health services, particularly for women and girls. Fancy (and expensive) marketing is not a substitute for proper education and health. The message has now been fluffed, so that people have all sorts of muddled ideas about contraception, sexualy behaviour, pregnancy and anything else organizations like PSI have been involved in.
If organizations like PSI are really interested in people's health and welfare, they should pay a little less attention to marketing expensive products and services and spend some time advocating for the levels of health and education spending that countries like Kenya really need. Contraception such as condoms is not cool, it's vital for people to be able to live their lives without risking serious disease or unplanned pregnancy.
People, adults and children alike, just don't know enough about HIV, reproductive or sexual health. There is no amount of advertising and campaigning that will give them access to the information, services and products they need to ensure their sexual and reproductive health. HIV, and even high levels of unplanned pregnancies, are not emergencies. They are part of everyday life and a factor of how little has been done to improve people's health and education over the past few decades.
Contraception of any kind is useless without adequate levels of spending on education and health, especially those relating to sexual and reproductive health.
Thursday, May 21, 2009
Last Night, Condoms Saved Many Lives
IRIN (Integrated Regional Information Networks) had an article recently about Tanzanian bars and nightclubs getting condom vending machines soon. These machines would be placed in toilets as part of the national HIV prevention programme.
From reading HIV literature over the years, you would have thought there would already be dispensers in all bars, clubs, restaurants, hotels and anywhere else possible. But that is not the case. I have stayed in over 50 low budget hotels, eaten in over 100 restaurants, drunk in nearly as many bars and been to plenty of nightclubs and other places where people gather. And very few of them had an obvious supply of condoms.
Occasionally, when you are leaving a nightclub or late opening venue, you will find an enterprising stallholder outside, selling condoms. A little more frequently, you will see a box of condoms or even a selection of brands behind bars. I have little doubt that if you asked in some places you would get condoms.
Recently I stayed in a hotel and happened to open a drawer to find over 100 unbranded (donor supplied) condoms in an unmarked bag. Wonderful, except that they were manufactured in 2004 and will all expire in August.
But the problem is that people often don’t ask for condoms, for various reasons. And I’ve tried asking in some places, without success. As a result, people can be without condoms when it is too late to turn back. Or they are stuck with a vendor who only has expensive brands, so they don’t bother.
Condoms are too important to leave to chance. It’s true that they are an individual’s responsibility. But not everyone thinks of them at the right time; you can be taken by surprise and not everyone is as responsible as they should be. The Tanzanian programme is starting in Dar es Salaam, the commercial capital. But this is one place where you are much more likely to be able to find condoms, especially late at night. Let's hope the programme moves away from the capital to where the need for condoms and condom related education is far more urgent.
A young man who works for a HIV/Aids related community based organization recently told me that he thinks the only thing standing between Kenya and a far more serious HIV epidemic is condoms. He is a Muslim, a faith opposed to the use of condoms. But he works with people who are poor and marginalized. He knows a lot about why HIV spreads and he knows a lot about preventing it from spreading further.
It's not enough for people to be able to see the numerous signs and billboards about HIV and condoms, they need to be able to see the condoms, they need to know where to get them. And the times and places people are most likely to need condoms are no secret. People go to bars, clubs and other places to meet up with other people and have fun. Sometimes having fun involves having sex. Denying that this happens or arguing that it shouldn't happen is not going to prevent transmission of HIV, other sexually transmitted infections or unplanned pregnancies.
A reliable and accessible supply of condoms should become part of the country's national infrastructure. Yet, you still come across people who say they don't see them as much any more or you don't hear about them as much or they subscribe to one of the many myths about condoms not working or having holes in them that let viruses through. They do not have holes in them and they do work.
Of course they are not 100% safe. People say the only thing that is 100% safe is abstinence. The problem is that abstinence does not always work. People can have the best intentions but find themselves in a position where they are unable or unwilling to keep to them. The decision to abstain does not remove the possibility of circumstances and temptations.
I hope Tanzania and other African countries with a HIV epidemic, 'serious' or otherwise, make condoms more obviously available. This is one of the most important steps towards reducing transmission of HIV, sexually transmitted infections and unplanned pregnancies. To those who think that to promote condoms is to promote promiscuity I would say this: some people are promiscuous and until there is a feasible means of reducing promiscuity, condoms are one of the few things they have got to protect themselves from becoming infected and from infecting others with sexually transmitted infections.
From reading HIV literature over the years, you would have thought there would already be dispensers in all bars, clubs, restaurants, hotels and anywhere else possible. But that is not the case. I have stayed in over 50 low budget hotels, eaten in over 100 restaurants, drunk in nearly as many bars and been to plenty of nightclubs and other places where people gather. And very few of them had an obvious supply of condoms.
Occasionally, when you are leaving a nightclub or late opening venue, you will find an enterprising stallholder outside, selling condoms. A little more frequently, you will see a box of condoms or even a selection of brands behind bars. I have little doubt that if you asked in some places you would get condoms.
Recently I stayed in a hotel and happened to open a drawer to find over 100 unbranded (donor supplied) condoms in an unmarked bag. Wonderful, except that they were manufactured in 2004 and will all expire in August.
But the problem is that people often don’t ask for condoms, for various reasons. And I’ve tried asking in some places, without success. As a result, people can be without condoms when it is too late to turn back. Or they are stuck with a vendor who only has expensive brands, so they don’t bother.
Condoms are too important to leave to chance. It’s true that they are an individual’s responsibility. But not everyone thinks of them at the right time; you can be taken by surprise and not everyone is as responsible as they should be. The Tanzanian programme is starting in Dar es Salaam, the commercial capital. But this is one place where you are much more likely to be able to find condoms, especially late at night. Let's hope the programme moves away from the capital to where the need for condoms and condom related education is far more urgent.
A young man who works for a HIV/Aids related community based organization recently told me that he thinks the only thing standing between Kenya and a far more serious HIV epidemic is condoms. He is a Muslim, a faith opposed to the use of condoms. But he works with people who are poor and marginalized. He knows a lot about why HIV spreads and he knows a lot about preventing it from spreading further.
It's not enough for people to be able to see the numerous signs and billboards about HIV and condoms, they need to be able to see the condoms, they need to know where to get them. And the times and places people are most likely to need condoms are no secret. People go to bars, clubs and other places to meet up with other people and have fun. Sometimes having fun involves having sex. Denying that this happens or arguing that it shouldn't happen is not going to prevent transmission of HIV, other sexually transmitted infections or unplanned pregnancies.
A reliable and accessible supply of condoms should become part of the country's national infrastructure. Yet, you still come across people who say they don't see them as much any more or you don't hear about them as much or they subscribe to one of the many myths about condoms not working or having holes in them that let viruses through. They do not have holes in them and they do work.
Of course they are not 100% safe. People say the only thing that is 100% safe is abstinence. The problem is that abstinence does not always work. People can have the best intentions but find themselves in a position where they are unable or unwilling to keep to them. The decision to abstain does not remove the possibility of circumstances and temptations.
I hope Tanzania and other African countries with a HIV epidemic, 'serious' or otherwise, make condoms more obviously available. This is one of the most important steps towards reducing transmission of HIV, sexually transmitted infections and unplanned pregnancies. To those who think that to promote condoms is to promote promiscuity I would say this: some people are promiscuous and until there is a feasible means of reducing promiscuity, condoms are one of the few things they have got to protect themselves from becoming infected and from infecting others with sexually transmitted infections.
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