August 19, 2006
Category: The Science of HIV/AIDS
Razib over at Gene Expression has an excellent post about cultural issues affecting HIV and circumcision, elaborating on Lindsay's mention here of the limitations of trying to increase circumcision as a way to reduce viral spread:
There was a strong undercurrent of resistance to the approach throughout the session. It finally erupted during the question period. One man asked the panelists whether they considered circumcision a form of mutilation, and what kind of counseling or support services they would put in place to offset the traumatic effects of the surgery? When Auvert pointed out that all the studies are looking at voluntary, adult male circumcision, the man retorted, "It's not because you're an adult that you might not be traumatized by the loss of your foreskin." This is an extreme example, but several social scientists chastised the panelists for "decontextualizing" the debate about circumcision, and rallied against the label "biological technology," as some of the panelists had referred to it.
All prevention efforts must take culture into consideration, but because of the extreme and irreversible nature of circumcision, and the intermingling of the practice with significant cultural traditions in many areas, clearly it's a tougher sell than something like condom use. Whether it will play a significant role in future prevention efforts or not is difficult to tell.
Posted by Tara C. Smith at 6:00 PM • 0 Comments
Category: The Science of HIV/AIDS
One catchphrase that permeated the conference this past week was "scaling up." I just want to wrap up my posting here with a brief discussion of what that is, and what that means as far as HIV/AIDS prevention and treatment.
Readers who are scientists or who have some kind of science background will probably be famililar with the concept of a "pilot study." This is a study, generally small in scale, where new ideas are tested, and preliminary data are gathered. For example, a pilot study looking at how the ABCs of prevention work may take 100 individuals and split them into two groups: 50 who are taught about Abstinence, Be faithful, and Condoms, while the other group may be given no additional information, or be taught only about abstinence, for example. These two populations then can be followed and, depending on the study, outcomes measured. (Did they acquire HIV at a similar rate over, say, the next 2 years? Did faithfulness within a relationship increase in the group who were taught the ABCs? Did the abstinence-only group actually practice abstinence outside of the context of a marriage?) When the final data were examined, then, the researchers will decide whether the pilot study has achieved the outcomes specified in the beginning. If it had, these interventions could then be applied to a much larger group; it can be "scaled up" in terms of money and population.
"Scaling up" doesn't always mean going from a pilot study to a larger, more inclusive study, however. Imagine now that the researchers had now carried out that second-phase study, and wanted to implement these prevention measures nation-wide. This is another scale-up; moving from scientific research to public policy. There are obstacles at each scale-up, of course. Researchers need to prove their case in order to secure funding for large studies, which can be difficult. Even more difficult, generally, is scaling up from a scientific study to a matter of policy, because this involves, in some cases, major infrastructure building.
For example, using the ABC scenario I outlined above. If this becomes policy, who will fund the employment of educators to reach out to the population, especially those at high risk of acquiring HIV? How, exactly, will these educators even identify people to teach? Will this be done through existing clinics, schools, community organizations? Or will new physical structures be built to cater to this need?
Similar concerns exist for any kind of massive scale-up. For treatments, who pays for them? How are the drugs delivered? How are testing and anti-retroviral treatment coordinated? Can one create a comprehensive program for prevention, education, testing, and treatment, or are separate entities in charge of the various components?
"Scaling up" is the goal of many programs centering on HIV/AIDS, whether it's scaling up efforts aimed at prevention, treatment, or other facets that come into play. But going from demonstrated success in research studies to successful programs at the level of a nation (or even a city) is a difficult and massive undertaking, fraught with red tape and other trappings of politics.
Posted by Tara C. Smith at 3:10 PM • 0 Comments
Category: Miscellaneous
...from a non-attendee.
As Hannah and Lindsay (and others around the blogosphere and news media) submitted their stories from the front lines, so to speak, a few things jumped out at me regarding how this conference seems to be a bit different from the ones I've attended.
Scientific conferences vary widely with respect to size. I've been to some national meetings where it's a very small niche, and there were just a few hundred people in attendance. (And of course, some local meetings are lucky if a hundred people show up). This was an international meeting on a very noteworthy topic, so the size reported (~20,000) is in line with that. That's pretty closely in line with the annual meetings of the American Society for Microbiology (technically a national meeting, but always draws many international researchers).
However, there are many notable differences between this week's AIDS conference and the annual ASM meeting. First, obviously, is the sheer amount of coverage in the press. While some talks and research news do occasionally get highlighted from ASM's conference, it's nothing like I saw this past week. Second, and most striking, is the level of involvement from celebrities and politicians. Much was made regarding Canadian Prime Minister Harper's absence from the conference. This is only notable because so many other politicians and celebs were their to affirm their committment to AIDS relief; this is something one defintely doesn't see at ASM, for a few reasons. One, that we're not focused on a single infectious disease, but on all of them; and two, because there's just not a lot of celebrity influence regarding most infectious diseases. Few notables here in the US speak out about TB, or malaria, or even growing threats like antibiotic-resistant staph. It's just not sexy.
But, neither do many of these diseases carry the stigma that HIV/AIDS still does--which is why Harper's no-show makes headlines. I think it's important to keep emphasizing the message that this is a critical worldwide problem, and that no one deserves to be treated as a second-class citizen merely because they have been diagnosed with HIV. So, the International AIDS conferences can keep their celebrities and I'll be content that, although my work doesn't garner quite so much attention, neither does it cause so much stigma for those who are affected.
Posted by Tara C. Smith at 2:40 PM • 0 Comments
August 18, 2006
Category: Miscellaneous
As the conference wraps up, I just want to be sure to point you to some other areas where AIDS is being covered on ScienceBlogs.
Every week, our Seed overlords pose a question to us (originally titled, "Ask a ScienceBlogger.") This week's question is:
To what extent do you worry about AIDS, either with respect to yourself, your children, or the world at large?...
You can find the collection of responses here.
In more basic science, Sandra of Discovering Biology in a Digital World is starting a series on using HIV to prove some points about evolution. Looks like a great start to the series; be sure to check in as she updates it.
Posted by Tara C. Smith at 4:30 PM • 0 Comments
Category: Conference Sessions
The theme of the conference was Time to Deliver. But did they?
At the closing ceremony UN Special Envoy for HIV/AIDS in Africa Stephen Lewis called upon the governments of all nations to deliver on their funding promises.
"We are on the cusp of a huge financial crisis,'' Lewis warned the gathering, noting that the G-8 countries haven't lived up to the pledging promises they made to the Global Fund for AIDS, Tuberculosis and Malaria at their 2005 summit in Gleneagles, Scotland.
"No one is asking for any more than was promised,'' Lewis said. "Everything in the battle against AIDS is being jeopardized by the G-8.''
Will they?
I asked the woman, a South African, sitting next to me at the closing ceremonies what she thought of the closing session, of the conference. It's been good and well organized, but long, she said. "Finally!" she remarked when the co-chairs of the Toronto officially passed the emblamatic globe over to the chairs of the Mexico conference. Too many long speeches by officials, I sensed.
On the way out, I ran into a friend, a member of the Canadian AIDS Society, and asked whether she thought these conferences and the speeches did any good. It's inspiration, at least, to keep going until the next conference, she said, adding that Stephen Lewis's precise 15-point action plan is better than vague statements like "Empower women!"
To sum up his points:
1. Abstinence only programs do not work.
2. Harm reduction does work.
3. Circumcision should be promoted.
4. Microbicides must be made available.
5. Stop using second-rate drugs to prevent mother-to-child transmission of HIV in Africa and other parts of the world.
6. Fund the World Food Program with the money it needs to provide proper nutrition to those taking anti-retroviral treatment.
7. Stop violence against women. (There hasn't been enough talk of this at the conference, he added.)
8. Resolve the debate over HIV testing and counseling. (Watch the Know Your Status Campaign in Lesotho.)
9. Stop child sexual abuse.
10. Provide support to the orphans.
11. Recognize the contributions of grandmothers to society, and provide them with sustainable incomes, food and school fees.
12. Continue to roll out treatment...and speed it up!
13. Deliver the funding that has been promised.
14. Provide programs for youth.
15. Right gender inequalities, by establishing a UN agency for women's rights.
Lewis, whose term will conclude come year end, asked that his successor be African, but most importantly an African woman.
His speech was received with a standing ovation that lasted more than a minute. "Amazing. Just amazing," a woman behind me cheered.
Did they deliver? I think we'll still have to wait and see if the Global Fund's goal is met, if pseudoscience is washed away, if vulnerable groups receive the counseling and care they require, and if more human resources can be roused up to help in developing countries. Certainly, the public is more aware, but in a few months when the glow of the conference has dulled, perhaps a new slogan should be adopted: Time to Remember.
Posted by Hannah Hoag at 4:09 PM • 0 Comments
Category: Conference Sessions
For a serious conference, there were a lot of laughs at the closing ceremony.
Mark Wainberg: "Many people have said that this was one of the best conferences ever at linking the north and the south. I hope they were not talking about the long walks that we have subjected you to between the two separate buildings of this conference site."
(To get from the Global Village, the Media Centre and the main entrance to the main session rooms, the delegates had to ascend one escalator, traverse a skybridge that crossed a dozen-or-so train tracks, and descend another three-or was it four-escalators.)
Later in his address, Wainberg reiterated his disappointment at the absence of Canadian Prime Minister Stephen Harper, yet praised the Government of Canada had been generous in its support of the conference before adding, "I think it is safe to assume that the president of Mexico will attend the next conference."
Stephen Lewis recounted a story from a recent visit to Swaziland: "He revealed that he was circumcised, I revealed that I was, and there was a joyous frenzy of male bonding among all the circumcisees."
Lewis recounted the story to denounce the bureaucratic shufflling that have delayed the official acceptance of circumcision as a prevention tool.
Many of the closing remarks addressed human rights--universal access to medical care as a human right; women's' rights as a human right--and the stigmatization of groups with a higher risk of contracting the virus. The chair of the 2008 Mexico conference, Dr. Luis Soto Ramirez, made a strong point: The only thing the virus asks is, Are you human?
Posted by Hannah Hoag at 3:17 PM • 0 Comments
Category: Dispatches From Toronto
The closing day of the AIDS conference, when delegates were celebrating their accomplishments over the past two years and renewing their pledge to bring an end to the HIV pandemic, brought news of the arrest of prominent AIDS activist Zackie Achmat, the founder and chairman of South Africa's Treatment Action Campaign, and 44 fellow protestors for trespassing in a government office.
While occupying the office, Achmat and the others apparently called for homicide charges to be pressed against two cabinet ministers for the death of an HIV+ prisoner in South Africa's Westville correctional center. According to The Associated Press, the prisoner was one of 15 inmates who had recently won a court case against the government forcing it to provide ant-retroviral drugs to the prison population.
Click here for a detailed report in Capetown's Mail & Globe newspaper, and here for a report from The Associated Press.
This story is a timely reminder of the ignorance, stigma and discrimination associated with HIV/AIDS, particularly in marginalized populations such as prisoners, injection drug users and sex workers. Calls here this week to make univeral access to health care a fundamental human right now seem all the more pressing.
Posted by Lindsay Borthwick at 1:57 PM • 0 Comments
Category: The Science of HIV/AIDS
I mentioned yesterday that one way to help prevent new HIV infections is to treat people who are infected with herpes, another sexually-transmittted virus that infects as much as 20% of the population in the United States. That may seem odd; how does treating one viral infection prevent infection with a second virus?
Studies have shown that, generally, HIV isn't one of the more highly infectious viruses out there. For example, the hepatitis B and C viruses are transmitted via many of the same routes as HIV (such as sexual activity shared needles), but vary in their infectivity. If, for example, a health care worker gets stuck with a needle from an HIV+ patient, they have a very low probability of becoming infected with the virus; so low that less than 150 occupationally-acquired HIV transmissions have been positively documented in the literature. With hepatitis B virus, however, the risk is orders of magnitude greater: chance of infection following a needlestick is almost 1 in 3. The hepatitis C virus is between them, with about a 1 in 50 chance of becoming infected following such a needlestick.
The reasons for the differences in infectivity vary. Some viruses are present at higher levels in the blood or other body fluids, meaning that more particles are transmitted during each contact. Some have a lower infectious dose, meaning that it takes fewer viral particles to actually start an infection. However, host factors are also involved in transmission of pathogens, and one of these is the presence of other pathogens in the body.
Read on »
Posted by Tara C. Smith at 11:40 AM • 0 Comments
Category: Conference Sessions
I saw my first pillowcase stenciled with the words "Fight AIDS: Fund Health Workers Now" at the opening ceremonies. Then, Wednesday night, I nearly tripped over the one pictured at right as I exited the conference center. On opening night, the message struck me as obvious and the issue of human resources in the health sector, quite frankly, as dull.
No longer.
The extent of the human resource crisis--and my use of the word crisis here is well founded--was driven home to me that very afternoon. It was the statistic that the world needs 1 million health-care workers to cope with AIDS that swayed me. It was also the nurse who reminded us that it is primarily nurses who care for AIDS patients in rural areas--in Zimbabwe and elsewhere--where there are no doctors (or pain killers or IV fluids). And it was the 79-year-old Zambian doctor who's still rallying on behalf of his sick patients everyday, and who called on the experts not to overlook what his generation may still have to offer. It was the appalling fact that in Botswana between 1999 and 2005, 17 percent of health-care workers died of AIDS.
Leonard Rubenstein, director of Physicians for Human Rights, moderated the session entitled "Human Resources and HIV/AIDS: Advancing Health Workforce Capacity in Delivering Care, Treatment and Support," along with Shoji Nishimoto from UNDP. (Rubenstein noted that the bland title belied the crisis at hand.) People weren't talking about human resource shortages, even two years ago in Bangkok, according to Rubenstein. Yet, it's been on the horizon for decades, and has emerged as one of the major themes of the conference. The countries hardest hit are in Sub-Saharan Africa, the countries also carrying the highest disease burden, as well as Bangladesh, Indonesia, and India.
Read on »
Posted by Lindsay Borthwick at 10:00 AM • 0 Comments
A blog about the 16th International AIDS Conference, Toronto, Canada, August 13-18, 2006.
