HIV/AIDS

HARARE, 4 July 2011 (PlusNews) - Zimbabwe has set a goal of circumcising 1.2 million men by 2015 - a bold target for a country that has been slow to get its circumcision programme off the ground but is now rapidly making up for lost time.

When the national circumcision policy was launched two years ago there was widespread scepticism as to whether the country had the capacity to provide mass male circumcision, in view of a health system that had been starved of resources, drugs and equipment for years.

Tinashe Damba, 29, is one of almost 30,000 men who have taken advantage of the free circumcision scheme offered by the ministry of health in conjunction with Population Services International (PSI), an NGO, and other partners.

"I thought the circumcision procedure was going to be very painful but I did not feel a thing," said a relieved Damba after leaving the operating room at a clinic in the capital, Harare. The only pain he felt was when his penis was injected with the anaesthetic that made it numb during the procedure.

"I heard that if you get circumcised you have a better chance of not contracting the deadly HIV. It's not 100 percent prevention, but you reduce the chances of contracting that disease."

A large study in Kenya, South Africa and Uganda in 2006 found that the procedure could reduce a man's risk of contracting HIV through vaginal intercourse by as much as 60 percent.

Before Zimbabwe launched its campaign, male circumcision had only been available at private health institutions and mostly for reasons other than as an HIV intervention measure.

"Blessing in disguise"

Zimbabwe is not the only country that has been slow to introduce free male circumcision in state facilities. In neighbouring Malawi, the government has yet to implement mass male circumcision, while South Africa has been criticized for moving too slowly in developing a national circumcision strategy.

"I do not think we were too far behind other countries," said Minister of Health and Child Welfare Dr Henry Madzorera, "but then we were going through a rough patch politically and economically, and the public health system was close to collapse."

A health worker strike that began in November 2008 shut down public health services for several months. The loss of qualified nurses and doctors who left to work in other countries made it even more difficult to deliver the service.

The delay was, according to PSI circumcision programme manager Roy Dhlamini, a blessing in disguise. "Only very small pockets of the Zimbabwean population practice circumcision [as a cultural rite]. People needed to be educated on the benefits, so a nationwide campaign to sell male circumcision was launched."

The findings of research in Zimbabwe’s rural areas, published in the May issue of the Tropical Medicine & International Health journal, show that 52 percent of the men surveyed were prepared to undergo the procedure.

Dhlamini said Zimbabwe was also benefiting from the success and challenges of those who had started earlier, resulting in the lowest rate of "complications" - less than 1 percent - compared to a regional average of more than 3 percent.

Two years ago, the programme had the capacity to circumcise only eight people per day at its flagship facility, the Spilhaus Family Planning Centre in Harare. From the time a client walked into the centre included up to two hours of mandatory counselling and an HIV test, with another half hour for the procedure, to when he walked out without his foreskin.

Staff shortages were another major problem. "We only had eight doctors and 18 nurses, now we have 40 doctors and 160 nurses and training is ongoing," Dhlamini said. The ideal is to have at least a doctor and eight nurses at a health centre in each of Zimbabwe's 62 districts.

The programme currently has five stationary and two mobile centres. "People have been travelling from as far as 500 kilometres to the few centres available. We want to make it more accessible for them by establishing the district centres and taking the service to them, using the mobile centres."

The process also had to be speeded up. "We devised the Model of Optimising Volumes and Efficiency (MOVE), whereby doctors now work in teams of three - one anaesthetizes, the other carries out the procedure, and the third one bandages the penis," Dhlamini said.

This has reduced the operation to fifteen minutes and counselling now takes one and a half hours.

The campaign was largely financed by external donors but the cash-strapped government has also contributed. "This programme is part of the health delivery system. It is carried out primarily in already established government health facilities, and we provide the staff," Health Minister Madzorera said. The government will also pay allowances to those involved in field work.

Earlier in 2011, PSI and the ministry of education targeted adolescents older than 13 during school holidays, resulting in a 200 percent jump in the number of circumcisions. "We plan to repeat the exercise in the next school holidays," PSI’s Dhlamini said.

Nevertheless, some are still sceptical about whether circumcision will bring down the incidence of HIV. Mary Sandasi, Executive Director of the Women's AIDS Support Network (WASN), feels that male circumcision does not protect women and may lead some men, especially younger ones, to believe it is the silver bullet against HIV.

"Thirty years after the first AIDS case was identified we are still getting infections, even in countries where men are circumcised as infants, so this may not be the answer," she said, adding that the only solution for sexually active people is the correct and consistent use of condoms. "They need to remind men after the operation."

Health minister Madzorera said Sandasi's concerns would be valid in the absence of pre-circumcision counselling, which makes it clear that the procedure has to be used with other HIV prevention interventions.

"The message is repeated during the obligatory visits to a medical centre after the procedure. After these visits we keep on reminding those circumcised through multi-media campaigns, so there is no let-up."

Madzorera is confident the target can be reached. "The success to date of this programme is due to the fact that Zimbabweans are quick to adapt to new ideas. We have rural chiefs encouraging their people to get circumcised - that is a good sign."

FIVE female scientists, from Stellenbosch University and UCT, are among a group of 10 “inspiring women scientists” who have been honoured with 2011 L’Oréal-Unesco Regional Fellowships For Women in Science.

The ceremony took place in Joburg last night.

The L’Oréal Corporate Foundation created the For Women in Science partnership with Unesco in 1998, and since then more than 1 000 women scientists across the world have received awards or support in pursuing their careers, through various fellowship programmes.

Each of last night’s winners receive R180 000 towards the completion of their PhDs in the fields of microbiology, environmental science, medical virology, chemistry and agriculture.

The local recipients are:

lDalene de Swardt, 31, is doing her PhD in medical virology at Stellenbosch University.

She said her research, in the field of HIV/Aids, focused on a specific immune cell, the dendritic cell.

Swardt explained that the cells contributed towards the activation of the immune system, and that she was investigating what happened to these cells in people with HIV.

She was developing a natural agent that she hoped would block HIV from entering healthy cells, while also curbing the activation status of the HIV virus “so that it (the agent) can attack and clear out the infection”.

l Jeanne de Waal, 27, who is doing her PhD in agricultural sciences, also at Stellenbosch.

De Waal said she grew up in Pretoria and had to swop her high heels for gumboots when she began her studies, “but it is quite fun being a girl in the field of agriculture”.

Receiving the award was a great honour, she said, adding that it was a wonderful reward for her hard work and long hours spent working on her PhD.

De Waal is looking at environmentally friendly pest management practices, and is developing a biological pest control agent (a worm) to effectively control pests on apples and pears.

She said that biological control agents were already commercialised in parts of Europe and the US, but not in South Africa.

“We want to develop agents that are endemic to South Africa because insects are building up resistance to antibiotics and pest control.”

De Waal added that the demand for organic and sustainably produced food had also helped drive the process towards more environmentally friendly pest control management.

l Kim Trollope, 34, is focusing on yeast microbiology for her PhD. Her research focuses on producing an enzyme used for the production of sweeteners from cane sugar (sucrose).

The sweeteners are lower in calories and safe for use by diabetics. Trollope explained that her PhD would supplement existing work being done in this regard, by potentially providing an understanding of how the enzyme functioned, and by producing a novel enzyme with improved properties.

All three said they would use the money to attend international conferences which were important for networking with others in their field.

l The other two fellowship recipients, Olutayo K Boyinbode, 37, from Nigeria, and Rachel Muigai, from Kenya, both live in Cape Town and are studying at UCT.

Boyinbode is completing her PhD in computer science.

Muigai’s PhD is focusing on the sustainability of concrete structures.

JOHANNESBURG, 27 June 2011 (PlusNews) -  In theory, it should go something like this: pregnant woman tests HIV-positive as part of prevention of mother-to-child HIV transmission (PMTCT) services at her antenatal clinic, and tells dad-to-be; dad tests for HIV and they support each other, start treatment if need be, and prevent HIV transmission to baby or dad.

It seldom turns out that way. In a small, qualitative study of about 60 women in two clinics in the Durban area, Tamaryn Crankshaw, a PMTCT programme manager at McCord hospital in Durban, South Africa found that while two-thirds of the women did tell their partners they were HIV positive, only half of them reported that their partner had been tested for HIV as a result.

"There were some positive outcomes but mostly there was a lot of blame, recrimination, and silences,"Crankshaw told IRIN/PlusNews. "HIV was never raised again within the context of the relationship, and in a lot of cases it was actively discouraged."

As in previous studies, the women also reported being physically, verbally and emotionally abused after disclosing their HIV-positive status.

Surprisingly, the women's disclosure sometimes prompted men to disclose that they were also HIV-positive, or to consider their partner’s HIV-positive diagnosis as a proxy for their own HIV status.

In two cases, women reported that their disclosure had prompted unprotected sex as their partners, who purported to be HIV-negative, intentionally exposed themselves to HIV infection to show their commitment to the relationship and to starting a family, said Crankshaw, who presented her findings at the recent 1st International HIV Social Sciences and Humanities Conference in Durban.

"In South Africa, HIV disclosure is a very prominent component of HIV prevention and treatment because it’s assumed to mediate sexual risk behaviour, and is widely regarded as important to... supporting [adherence to] antiretrovirals," she told IRIN/PlusNews.

"In the PMTCT setting, HIV disclosure receives particular emphasis because of [HIV] prevention aims however... very little attention has been paid to the success of these strategies, and whether they do reduce risks or change behaviour."

What's love got to do with it?

About 30 percent of women choose to keep silent about their HIV-positive diagnosis. New research shows how a lack of trust between partners in some communities may be interfering with the expected HIV prevention benefits of HIV disclosure. This may merit a new take on HIV counselling and testing for couples.

For most women, multiple concurrent partnerships are a relationship reality. There is also mutual suspicion, a very low expectation of permanency, and their own emotional baggage, like being unwilling to trust. This may affect a partner’s willingness to disclose his HIV status, Crankshaw said.

"The thing is, we also have our ups and downs," said one 29-year-old mum. "I am not sure about our future... so I don't see the need to tell him something so confidential [like my HIV-positive status]."

Multiple concurrent partnerships, in which men and women have more than one sexual partner at the same time, are thought to be one of the main drivers of HIV in southern Africa.

Data from a larger sample of 656 men and women in rural KwaZulu-Natal, analysed by researcher Deborah Mindry of the University of California, Los Angeles, reinforced many of Crankshaw's observations about relationships.
 

Mindry found that awareness of the HIV risks associated with multiple concurrent partnerships and fear of contracting HIV led many men to monitor their partner's behaviour in order to assess their own HIV risk. This included, for example, asking a girlfriend's family to confirm her whereabouts over a weekend, or sending male friends to ask their girlfriends out as a test of the woman's fidelity.

"Sometimes men… end up controlling a person... this is what I feel when it comes to using condoms," said one HIV-positive new mum, who spoke to Crankshaw about the guilt she felt after not being able to negotiate safe sex with her partner. "I felt I was not in control of the situation but… I was counselled here and I knew everything."

Crankshaw said the reality that disclosure by HIV-positive mums did not always spark partner testing or risk reduction should lead to a rethink of PMTCT programme design:

"We forget to look at the fact that what drove prior risky behaviour will continue to drive future risky behaviour. Disclosure is not going to change that," she told IRIN/PlusNews. "We have to stop accessing only the pregnant woman because she's the easy one to access, because she's already in care."

What's best for baby

Crankshaw suggested that couples counselling might help share the burden of behaviour change between new mums and dads. Couples counselling has gained popularity in recent years, but it is still not easy to get couples, especially with complicated relationship dynamics, to test together in large numbers.

Mindry found that many couples were grappling with major issues and were reluctant to address HIV, but many were better able to talk about HIV and risky behaviours within discussions about existing or future children.

Crankshaw said Mindry's findings are part of a growing body of research showing that voluntary HIV testing and counselling - and subsequent behaviour change - may be more palatable to couples when presented in the context of reproductive services. As a result, McCord Hospital will begin offering reproductive services to people living with HIV.

"People have very serious issues in their relationships already, and HIV just adds another dimension," she told IRIN/PlusNews. "We have to start addressing these lived realities, and see how we might address broader issues in their lives and... how this can help us address HIV."

NAIROBI, 27 June 2011 (PlusNews) - Certain antiretroviral (ARV) drugs commonly used in the developing world may be responsible for premature ageing, according to the authors of a new study published in the journal, Nature Genetics. Newer, less toxic but more expensive ARVs are more commonly used in the Western world.

Nucleoside analogue reverse-transcriptase inhibitors (NRTIs) - including Zidovudine, Lamivudine and Abacavir - have enabled millions of people living with HIV to prolong their lives. The UN World Health Organization has recommended that countries phase out Stavudine, an NRTI commonly used in Africa, due to long-term, irreversible side effects.

"We noticed that people in their 40s who had been on NRTIs for the past several years had signatures of ageing in their muscles commonly found in healthy people in their 70s and 80s," said Prof Patrick Chinnery of the University of Newcastle in the UK, one of the study's lead authors.

The researchers studied skeletal muscle from 33 HIV-infected adults, all aged 50 years or under, and 10 uninfected control subjects of comparable age. They found that in patients on NRTI treatment there was an expansion in mutations of mitochondrial DNA - the energy-producing part of the cell - similar to the mutations found in healthy older individuals.

"What we saw in our study is similar to patterns described by people who have been on ART [antiretroviral therapy] for a long time," said Chinnery.

Studies have found that despite a significant drop in mortality, people living with HIV are often affected by an increased risk of non-AIDS complications, including osteoporosis and heart attacks, which undermine their life-expectancy.

"The findings suggest that we need to look carefully at the effects of these drugs because some of the diseases caused by the abnormalities - diabetes, heart failure and so on - are serious and can cause progressive disability," Chinnery noted.

"But at the same time, clearly the patients need their drugs in order to keep them alive... but our study suggests that it may be beneficial to move to newer classes of drugs."

Chinnery said there was a need to conduct prospective studies on the likely effects of long-term use of different ARVs in order to catch and address potentially harmful side effects.

In Namibia, HIV-positive women are being tricked into sterilisation. Is this a country desperate to curb Aids, or just a blatant human rights violation? Marion Stevens of the Women and HIV/AIDS Gauge, Health Systems Trust, came across this recent article, which exposes the reality of what’s happening in Namibia’s state hospitals.

The theme of AIDS 2010 is Rights Here, Right Now

President Bill Clinton and South African Health Minister Aaron Motsoaledi to Join 25,000 Scientists, People Living with HIV, and Other Stakeholders at XVIII International AIDS Conference in Vienna, Austria.

The Conference Will Explore Latest Developments in HIV Science, Emphasize the Importance of an Evidenced-based Response to HIV and Drug Policy, and Urge World Leaders to Follow Through on Commitment to Universal Access

More information: http://www.aids2010.org/