The INFO Project Blog

The last full day of sessions was great.  I was able to sit in on interesting lectures covering everything from male circumcision and HIV prevention to HIV prevention among injection drug users in Iran.  The highlight of the day - respondent driven sampling - a new way to recruit research subjects based on social networking!

Oh - Given my new found knowledge of vasectomy (see - Vasectomy: Reaching Out to New Users)  I asked if male circumcision programs have adopted any lessons learned from vasectomy programs in sub-Saharan Africa as vasectomy uptake is very low (less than 1 percent) and involves similar issues of gender-norms and culture.   I was told no, but now that I brought this to the panel’s attention, perhaps it would be investigated!

Male Circumcision: To cut or not to cut
Unfortunately my camera batteries went dead this morning so I wasn’t able to get photos of some of the great slides.   The session started with the conference chair from the International AIDS Alliance (whose name I unfortunately missed and is not in the program) discussing what we already know and don’t know about male circumcision (hereon referred to as MC) and HIV prevention.  WHO and UNAIDS have made a statement about the efficacy of male circumcision and recommends beyond a reasonable doubt male circumcision in countries where there is a generalized HIV epidemic and services cab be safely performed.  Three randomized trials in high prevalence countries, Uganda, South Africa and Kenya have shown that male circumcision reduced male-female heterosexual HIV transmission by 50-60 percent. There has already been high uptake in some clinics and lengthy waiting lists to receive services.  There is no direct evidence to show that male circumcision in effective in prevention transmission among men who have sex with men (MSM).

What we don’t know is the impact of  a large scale rollout of MC, as this has not yet been completed.  We also do not have evidence to show whether or not men would increase the amount of unprotected sex they engage in following circumcision, because they think it may be a magic cure or vaccine (the session emphasized that condoms still need to be used with MC as MC is only about 60 percent effective in preventing transmission).   It will be challenging to meet the demand for MC in already stretched health sectors. 

• The meaning of male circumcision for young men - M. Mafalapitsa, EngenderHealth, South Africa - Circumcision is a ritual, showing a covenant between man and God in Judaism, Islam and several African tribes.  The health MC has gender implications which need to be addressed as males who undergo ritual circumcision in sub-Saharan Africa  as a right of passage attend “circumcision schools” (classes received before ritual circumcision) that teach men that they have to be  a man, strong, and not feel pain, leading to increased incidents of violence against women.  MC should be part of a comprehensive SRH program and a gender approach to combat harmful masculinities must be incorporated where MC programs take place.
• Cultural and religious sensitivities - Karen Smith, Indonesia - Social relations and culture norms will influence attitudes toward mail circumcision.  Values are changeable (and thus may welcome circumcision, however this change does not occur over time. In terms of a public health perspective, MC should be performed, however you have to know the culture and people you are working with, give full considerations to their cultural concerns
•  The implications for women - Margaret Bewrer, Editor, Reproductive Health Matters:   MC is only partially protective for men and men and their partners a must use condoms in addition to MC.  MC is not beneficial for men who are already HIV+.  There is still no agreement on how to assess MC programs in real life - we must know how many men are being circumcised, where they are, why they sough circumcision, how many are positive/negative. MC programs should involve women and be for men and their partners.  Prevention programs should before men and their partners.  Priority setting may or may not include MC.  If men “get the snip” and there is no follow up to encourage safer sex, it will not be beneficial.  The partners of circumcised men have an equal right of protection. 

The question and answer session was a little controversial, as there were many advocates against medical circumcision, arguing that a man should remain whole and intact, and that circumcision is not necessary, since condoms will still need to be used.   Read the rest of this entry »

So I finally ventured out of the Holiday Inn Tlalplan for dinner - not because of lack of wanting to but because of convenience.  The hotel is about an hour and a half away from the conference and with Mexico City traffic, by the time you get back you’re exhausted and just want to eat at the not very good hotel restaurant.  But I stopped at the metro at Zocalo, the main plaza and ate there.  Enough about food - here’s a round-up of today’s sessions that I attended.

Session 1: Impact of HIV/AIDS on Human Reproductive Development in the Social Context

• Prevention, treatment  and reproductive choices, M. Stevens, South Africa: The interaction between  ARVs and contraception, esepecially hormonal contraception is not very well understood.  There is a need for specific drug guidelines for pregnant women which will contribute to adherence and prevent resitsance.  Prevention messages need to be life affirming and not treat women solely as vectors of disease.  Positive women need to be given the correct information to make informed choices about motherhood.

• Women, AIDS, Fertility and desire: Vioelta Ross, Bolivia, member of Bolivian people living with HIV network:  Violeta, a positive women, discussed her intentions and desires to be a mother.  She could not discuss these with her father, as he is ap preacher, holiding conservative views about motherhood prior to marriage.  Violeta’s emotional charge stated that positive mothers should have the opportunity to have children.  She discussed her worries that her ARVs may not be available in Bolvia at the time she gets pregnant, as supply is not reliable.

• Mother and child dyad issues: Breastfeeding and child survival, A. Coutsoudis, UKZN, South Africa: Dicussed the change in UN/WHO guidelines which state that HIV positive women should exclusively breastfeed for the first six months of a child’s life, if there is not criteria in place for safe alternative feeding, including safe water.  Positiev women may treat their breast milk with the flash heating/pasteurization method to enusre safety.  HAART should be provided to breastfeeding mothers if possible to diminish the risk of transmission.

• The economics of social reproduction: inheritance, land, and emplyment ussues for women, P. Nanda, ICRW, India:  Property rights can protect women from HIV through giving them better decision making within the household and and economic security. More quantitative studies on land ownership and women and its relation to HIV transmission need to be conducted.

• Widowhood:  P. Koussalla, Positive Women’s Network, India: Widows living with AIDS face double discrimination - they are blamed for transmiting the disease to their deceased husband, and as a result of discrimination can not obtain services such as land rights and pensions.

 Sessions 2: Implementing Novel Prevention Programs.  This session presented examples from innovative HIV prevention programs from around the world.

• Community-based alcohol-related HIV risk reduction for men and women in Cape Town Africa, L. Simbayle, South Africa:

85 percent of new sex partners in Cape Town meet at “shebeens”, or small informal bars.  Research participants were recruited from the shebeens.  A test group was given a three hour HIV/alcohol  intervention and the control group received only 1 hour of HIV/alcohol education.  Participants were followed up for 3 and 6 month and were given questionnaires about their drinking habits prior to enrollment.  Those light drinkers showed decreased unprotected intercourse after the three hour session, however heavy drinkers showed no change.  Additionally, light drinkers showed a decrease in use of alcoholbefore sex after the intervention.

• Effects of peer-intervention on work-related HIV prevention for urban health workers in Malawi, C. Kaponda, University of Malawi:  This study examined the effect of of HIV peer intervention on health worker knowledge regarding universal precautions.  The intervention included 6 sessions on HIV/AIDS and condom use and four sessions related to AIDS treatment, compliance and universal precautions.  Participants exposed to the intervention had a s significant increase in knoweldge about universal precautions, increased hand-washing behavior and increased the amount of time they spent teaching their clients about HIV.   
• Building national capacity for the implementation of safer-sex mass media campaignss in Eastern Europe and central Asia, Tatiana Grechukhina, Russian Federation: Illustrated campaigns across Eastern Europe that promoted safer sexual activities. Yeah communication! This presentation seemed quite in line with what CCP does.  Russia and Moldova have a high literacy rate and developed mass media, making it easier for the message sto penetrate the youth market.  Communication messages were designed based on research, adapted to the local context and pretested.  There was a 12 step model that was utilized to create these messages which began with exploratory missions and ended with evaluation.  The Moldova clip previewed was entitled “Pay attention to every detail of your life: be fashionable, stylish and safe” and showed a couple discussing sexual health while looking through clothes in a closet. Read the rest of this entry »

 The day  started with a session entitled “Positive Prevention” which discuss  how highly active antiretroviral therapy (HAART) can be used as a factor to decrease HIV infections. Research studies have shown that those who are adherent to HAART therapy and have an undetectable viral load are at low risk for passing HIV to someone else.  Research has shown that the risk of contracting HIV from someone on HAART with an undetectable load is extremely small, about 1 in 100,000.  The use of HAART and condoms has been shown to be more effective in preventing HIV transmission than the use of condoms alone.

Following this session, I got on a bus to downtown Mexico to take a trip to Mexfam.  Mexfam is a private network of sexual and reproductive health clinics throughout Mexico. Mexfam can be found in 17 states throughout Mexico and provides services mainly to marginalized populations.  Mexfam has over 500 staff and 1,000 volunteers throughout Mexico.  Mexfam has a history of providing sexual and reproductive health services to youth. 

Mexfam provides family planning counseling and methods to clients at a discounted charge, in addition to gynaecological exams, pregnancy testing and HIV/STI testing.  Mexfam, Mexico City where I visited provides gynaecological exams, condoms, IUDs, implants, pills and injectables.  If a client wanted a permanent method they would be referred to a central clinic with surgical capacity.  In terms of integration, if a client is found to be HIV+ they are referred to La Clinica de la Condesa, one of the largest and most comprehensive HIV clinics in Latin America.Mexfam also is a leader in promoting breast and cervical cancer screening for young women.  Read the rest of this entry »

So… first I promised to post some pictures from yesterday.  Here are some:

Panel from Monday presentation “Linking Sexual and Reproductive Health”  (L to R) Feliclity Daly, Interact Worldwide, Suni Nanda, International AIDS Alliance, India, Malcolm McNeil, DFID, Fiona Petit, International Community of Women Living with AIDS

Part of Panel from “Meeting the Sexual and Reproductive Health Needs of People Living with HIV”, Sunday August 4

Rose Wilcher, Family Health International, “Contraception - the best kept secret in HIV prevention”,  panel discussion “Meeting the Sexual and Reproductive Health Needs of People Living with HIV”, Sunday August 4, 2008

I first attended a fabulous lecture entitled “Responding to the  HIV Epidemic among Men Who Have Sex with Men”.  During this session, our friends at PSI discussed an excellent program they are currently supporting in Togo designed to create community among MSM, provide HIV prevention education and appropriate referral of services.

Following, I was fortunate to hear former President Bill Clinton speak about his foundation.  Bill Clinton compared AIDS to a dragon stating that “AIDS is a very big dragon… we cannot end until the dragon is slain.” The title of President Clinton’s talk was “HIV and Health Systems Reform: Achieving Universal Access.”  He gave examples of his work and emphasized that successful HIV interventions will naturally positively influence health systems of countries.  In Malawi, there is limited lab capability so the Clinton Foundation recruited lab workers and focused on increasing lab capacity, which in turn strengthened the health system.  In Zambia, with the advent of ART, there has been an increased demand for health services, but workers were in short supply.  So, the foundation has worked with the government to increase the supply and train workers, which again strengthened the health system while providing access to treatment. Read the rest of this entry »

So I first must apologize for the lack of actual photos in this first blog piece.  You see, there were strict security requirements to enter the opening ceremony.  The opening ceremony was in a separate spot from the convention in order to accommodate the 25,000 delegates.  All of my bags had to be left at the convention center.  All buses returned to the hotels after the opening and thus my bags are still at the convention center with pictures from today’s sessions.  I also didn’t get any pictures of the amazing opening, due to the fact they lead us to believe we weren’t able to carry anything in.

I think I’ll describe the opening since it’s fresh in my mind and then move on to the two integration sessions I attended.  After several entertaining pieces by the Ballet Folklorico, the speakers began.  One of the notable speakers included Peter Piot, Executive Director of of UNAIDS, who told delegates to “get up, stand up, don’t give up your fight.” In line with Mr. Marley, Dr. Piot told delegates to never give up their fight against HIV/AIDS.  Dr. Margaret Chan, Secretary General of the World Health Organization,  Ban Ki Moon, Secretary General of the United Nations and Mexican President Felipe Calderon all stressed the need to combat stigma, homophobia, and discrimination to fight HIV/AIDS  and to ensure that vulnerable populations including sex workers, men who have sex with men and IDUs are targeted in prevention efforts and receive necessary services. President Calderon also announced that he would allow other countries to introduce anti-retroviral medications into Mexico, drastically lowering the price of such drugs.  His commitment received much applause.

The theme ”Universal Action Now/Acción Universal !Ya!” was also echoed by all of the speakers, including Mony Pen, a Cambodian activist, the former President of Botswana Mr. Festus Mogae and the 12 year old Honduran activist who received a standing ovation, Keren-Dunway Gonzalez.  Citizens and civil society must pressure their governments to take greater action to ensure that all people have access to HIV prevention, treatment and care services. Read the rest of this entry »