Rectal Microbicides Open New Frontier in Turning HIV Tide

By Chief K. Masimba Biriwasha | OpEd

Microbicide research has gained momentum in recent years with focus largely on products to prevent HIV during vaginal sex. However, there is a growing momentum to develop rectal microbicides for women, men, and transgender individuals around the world who engage in anal intercourse.

Microbicides are products designed to prevent or reduce the sexual transmission of HIV or other sexually transmitted infections when applied inside the vagina or rectum. Most vaginal microbicides are being tested as gels or rings, while rectal microbicides are primarily being tested as gels.

Rectal microbicides are products – that could take the form of gels or lubricants – being developed and tested to reduce a person’s risk of HIV or other sexually transmitted infections from anal sex. In spite of the public health need for rectal microbicide research, there is serious institutional, socio-cultural and political stigma around the issue.

According to estimates, the risk of becoming infected with HIV through anal sex is 10 to 20 times greater than vaginal sex because the rectal lining, the mucosa, is thinner and much more fragile than the lining of the vagina.  Because the rectal lining is only one-cell thick, the virus can more easily reach immune cells to infect.

Although the rate of new infections is stabilizing in many countries around the world, HIV continues to disproportionately affect racial minorities and men who have sex with men. It is estimated that five to ten percent of the world’s population engages in anal sex.

Globally, men who have sex with men are 19 times more likely to be infected with HIV than the general population. Unprotected anal sex is the primary driver of the HIV epidemic among this population.

For decades, the primary approach to HIV prevention for anal sex has been consistent and correct use of male condoms. Male condoms are an extremely effective method to prevent HIV, but many people are unable or reluctant to use them.

Rectal microbicides are products – that could take the form of gels or lubricants – being developed and tested to reduce a person’s risk of HIV or other sexually transmitted infections from anal sex.

If proven effective, rectal microbicides could protect against HIV in people who are unable or reluctant to use condoms. Unlike condoms, they could provide an alternative way to reduce risk that is not controlled by one’s sexual partner and possibly enhance sexual pleasure, helping to motivate consistent use.

Rectal microbicides could offer both primary protection in the absence of condoms and back-up protection if a condom breaks or slips off during anal intercourse. Such an alternative is essential if we are to address the full spectrum of prevalent sexual practices and the basic human need for accessible, user-controlled HIV and STD prevention tools

Rectal microbicides research is in the early phase of clinical development due in part to scientific challenges related to the biology of the rectum, and cultural reluctance to address anal sex.

Most critically testing the safety and acceptability of microbicides designed specifically for rectal use is key to ensuring their effectiveness in preventing HIV infection among people who engage in anal sex.

Researchers need to first be sure rectal microbicides are safe and then conduct additional studies to find out whether they are effective against HIV.

GlobalPOWER Women Network Africa Conference Opens in Harare

By Chief K.Masimba Biriwashs | iZiviso Global Editor At Large

HARARE, Zimbabwe – Women parliamentarians, leading African women entrepreneurs, civil society leaders, and development partners from Africa are meeting in Harare over the next two days for the inauguration and launch of the GlobalPOWER Women Network Africa.

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The conference, being attended by approximately 300 participants, is aimed at providing a strategic political platform to accelerate game changing approaches to HIV prevention and sexual and reproductive health and rights responses for women and girls. The idea to create an Africa-specific GlobalPOWER Women Network stemmed fom a September 2010 meeting in Washington DC that saw prominent female decision makers come together alongside their US peers to discuss how to accelerate the implementation of the UNAIDS Agenda for Women and Girls.

Participants at the conference are expected to address the key issues affecting girls and women in Africa including eliminating new HIV infections among children, keeping mothers alive and maternal and child health. The meeting will result in the “Harare Call to Action” to advance women’s empowerment and gender equality through HIV and Sexual and Reproductive Health and Rights responses.

President of the GlobalPOWER Women Network Africa and Zimbabwe Deputy Prime Minister, Thokozani Khupe said that women must take an active role in ensuring their empowerment.

“To achieve the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths, it is critical to recognise women and girls as key agents in making this vision a reality – society has to invest in the health of women and girls,” Khupe said.

Addressing the conference, Zimbabwe President Robert Gabrial Mugabe said the launch of the network will take the issue of women’s emancipation and empowerment a step further.

Äfter the launch, the real work will begin and call for the same passion, unity of purpose and consistency in pursuing the goals which have characterized this Women’s Network thus far. Of particular note will be the challenge of giving unstinting support to women candidates of every hue and cry; of varying professional qualifications, driven by different talents and capabilities to realise their potential in the collaborative work of Global Power Women Network, the Africa Union and UNAIDS,”said Mugabe.

In Africa, women and girls carry a disproportionate burden of the HIV epidemic – they constitute 59 percent of all people living with the disease. To make matters worse, gender inequality compounded by gender-based vioence, increase women and girl’s risk of HIV infection.

Ëmpowering women and girls to protect themselves against HIV infection and gender-based violence is a non-negotiable in the AIDS response,”said UNAIDS Executive Director, Michel Sidibe.

TB in Children: Why Zimbabwe Must Act Now

By Chief K.Masimba Biriwasha | iZiviso Editor-in-Chief

Harare, Zimbabwe – Tuberculosis (TB) is a major public health problem in Zimbabwe yet very little is known about the impact of the disease on children. Without a functional health-care system and research into pediatric TB, Zimbabwe is likely to continue losing its children to this hidden epidemic.Image

Among African nations, Zimbabwe is one of those most heavily affected by TB. The 2009 Global Tuberculosis Control Report from the World Health Organisation (WHO) ranks Zimbabwe 17th among 22 countries worldwide with the highest TB burden.

Zimbabwe had an estimated 71 961 new TB cases in 2007, with an estimated incidence rate of 539 cases per 100,000 people. While, Zimbabwe has fought TB fairly successfully since attaining statehood in 1980, in the past few years the disease has re-emerged as a leading killer, especially among people living with HIV, who are often not identified through long-established TB tests. Put simply, the TB control programme has been adversely affected by a lack of adequate financial, human and material resources.

As it is, there’s very little epidemiological data on the extent of TB among children in the country. Experts say that child TB is widely under-reported and can represent as much as 40% of the TB caseload in some TB high burden settings such as Zimbabwe. Children are at high risk of TB, are prone to disseminated disease and the diagnosis of paediatric TB may be difficult, since complaints often are unspecific and contacts may not been known.

To make matters worse, the HIV epidemic has affected TB in children enormously, as it has adults. It has increased the risk that infants and young children will be exposed to TB, since many adults with TB-HIV are young parents.

HIV-infected children have a 20-fold risk of developing TB compared to HIV-uninfected children. It also makes diagnosis and treatment more complicated and increases the risk of TB-related death about 5-fold.  The HIV epidemic has also orphaned many children (with or without TB-HIV themselves).

Unfortunately, Zimbabwe’s national tuberculosis programme has historically not given child TB high priority because of diagnostic challenges (e.g., children under 10 have difficulty producing enough sputum for microscopy and the majority are smear-negative); children are not a major source of the spread of the disease; resources are limited; recording and reporting forms did not include boxes for recording ages 0–4 and 5–14 until 2006.

“Our ability to even assess the magnitude of the problem is severely hampered by the lack of diagnostics in children. The problem is that diagnostic tools, both current and in development, do not adequately take into account the special requirements for assessing children,” said Dr Steve Graham, chair of Stop TB’s Child TB Subgroup of the DOTS Expansion Working Group.

Once infected with TB, infants and young children are at greater risk than adults for developing active TB disease, as well as of having the TB disseminate throughout the body, including to the brain, where it causes meningitis. This type of TB is often fatal or leaves the child with major disability.

Many health workers regard the management of a child with suspected TB as ‘difficult cases’, especially with regard to diagnosis. Children are thought of as needing specialised care.

Against this background, TB case-finding efforts should target children under 5 years of age living in a household with a sputum-smear positive adult. If the children are well, they should receive isoniazid preventive treatment (IPT) to help prevent their developing active TB disease.  If they are not well, TB treatment should be considered and a clinical examination is recommended.

Suggestions for national tuberculosis programmes include:

  • Establish a dedicated child TB working group that includes National Tuberculosis Control Programme (NTP) staff and national child TB experts.
  • Use the working group to set practical priorities and goals, develop guidelines, implement activities for child TB, support health workers managing child TB and raise awareness through advocacy and health education.
  • Include the needs of child TB in routine NTP activities, such as training, drug procurement, strategic plans and recording and reporting.

Cervical Cancer Kills Women in Developing Countries

By Chief K.Masimba Biriwasha

CERVICAL cancer, caused by infection with some type of human papillomavirus (HPV), is the leading cancer-related cause of death among women in developing countries.

The disease affects an estimated 500,000 women every year and kills a nearly quarter million worldwide. Eighty percent of the cases occur in developing countries where women have limited access to screening and treatment services.

“Among the most tragic public health failures of the last decade are the preventable deaths of young women in developing countries from maternal mortality and cervical cancer,” says Sue J. Goldie, a professor in the Department of Health Policy and Management at the Harvard School of Public Health.

HIV positive women are significantly more susceptible to having an HPV infection turn into cervical cancer.

This is despite the fact that there are tools available that can reverse this trend. Many governments in the affected countries have not prioritized the problem of cervical cancer in their national and health programs.

“We are now facing unprecedented opportunities to prevent these unnecessary and tragic deaths. In fact, recent concerted efforts have been made to assemble, synthesize, and interpret the available data with an eye towards actionable steps, and to comprehensively reflect on what has worked and what has not,” says Goldie. “Moreover, researchers, public health scientists, and policymakers are beginning to engage with the distinct purpose of agreeing on the most promising strategic approaches to eradicating preventable deaths in women.”

In developing countries, the vast majority of women with cervical cancer are diagnosed in late stages of the condition, and usually have little chances for long-term survival. To make matters worse, treatment for cervical cancer is rarely available even where the condition has been diagnosed.

“Unlike most cancers, cervical cancer is preventable through screening to detect and treat precancerous lesions. A conventional screening program, based on the cytological examination of cervical smears, can require up to three visits: an initial screening visit, colposcopic evaluation of abnormalities, and treatment. In countries that have been able to achieve broad cervical cancer screening coverage using cytology at frequent intervals, deaths have decreased considerably,” says Goldie.

For many developing countries, especially in sub-Saharan Africa, where poverty is endemic, and where health systems are in a state of dilapidation, cervical cancer is killing more women than necessary.

“In the vast majority of resource-poor settings such screening programs have proven difficult to implement and sustain due to a lack of human, technical, and monetary resources, and often inadequate health infrastructure,” says Goldie. “Additionally, the requirement for multiple visits, together with the need to screen at frequent intervals, has made it impossible to implement and sustain widespread organized screening in most poor countries.”

There’s need for a greater awareness of the severity of cervical cancer among women in developing countries. Also, there’s need for low-cost interventions that can be applied over a wide-scale.

Breast Ironing: Say What?

BREAST ironing, an old-age practice that is likened to the widely condemned practice of female genital mutilation, is widespread in many parts of West and Central Africa, including Cameroon, Chad, Togo, Benin, Guinea-Conakry among others.

Breast ironing is aimed to flatten the breast tissue of pubescent girls. The procedure is carried out specifically to make young women less attractive to men and boys. According to Wikipedia, the most widely used implement for breast ironing is a wooden pestle normally used for pounding tubers; other tools used include bananas, coconut shells, grinding stones, ladles, spatulas, and hammers heated over coals.

According to the UN, approximately 3.8 million or 1 in 4 girls in Cameroon alone, face the risk of having their breasts ironed often by their mothers. Unfortunately, many governments in the region do not have any policies or programmes in place to stem this heinous practices aimed at reversing pubescent growth. The onus rests on the government to empower women and make them more enlightened Continue reading

Lack of HIV Prevention Services for the Displaced

The power of education in fostering a better and effective response to HIV and AIDS is undeniable.

Education promotes knowledge and with knowledge about HIV and AIDS, individuals, families and communities have the ability to make informed choices about their behavior.

However, governments and international donor organizations often underplay this important intervention, particularly in the emergency phase of the cycle of displacement, says a report recently issued by UNHCR and UNESCO on the importance of education to populations that find themselves victims of displacement due to conflict, disaster or other emergencies.

Education can play a key role in helping refugees and internally displaced persons (IDPs) cope with the negative excesses of their circumstances, such as ignorance, exploitation, violence and the risk of HIV infection.

Many factors combine to put IDPs and refugees at the risk of HIV infection, including loss of livelihoods, lack of access to basic services, poverty, alcohol and drug abuse, and violence. Continue reading

The Great Vasectomy Fear

For most men, the idea of vasectomy, a surgical procedure to cut and close off the tubes that deliver sperm from the testicles, is a complete no-can-do associated with being sexually dysfunctional in the male psyche.

According to the latest issue of Population Reports, titled “Vasectomy: Reaching Out to New Users,” published by the Johns Hopkins Bloomberg School of Public Health, vasectomy is simpler and more cost effective than female sterilization and offers men a way to share responsibility for family planning.

“The most entrenched and powerful rumors concern manhood, masculinity, and sexual performance. Many men confuse vasectomy with castration and fear, incorrectly, that vasectomy will make them impotent,” says the report.  But in fact, “Castration involves removal of the testicles. In contrast, vasectomy leaves the testicles intact, and they continue to produce male hormones.”

The procedure which typically takes from 15-30 minutes and usually causes few complications and no change in sexual function is one of the most reliable forms of contraception. Though it does not offer protection against sexually transmitted infections or HIV, for couples it is a way for men to be directly involved in family planning. Family planning has been largely seen as the responsibility of women but vasectomies allow men to play a part.

The report states that the largest number of vasectomized men are in China, where almost 7% of women in relationships — or more than 17 million couples — rely on vasectomy for birth control. Continue reading

In Jamaica and Globally AIDS Stigma Barrier to Progress

In 2005, Jamaica – a country notorious for homophobia predominantly channeled through musical lyrics – received global attention for the killing of Lenford “Steve” Harvey, a gay man and an AIDS activist.

Harvey’s murder was blamed on stigma and discrimination against gays, and led to a huge outcry within the AIDS community.

The witch hunt against homosexuals in the country is regarded as a factor contributing to the spread of HIV, the virus that causes AIDS.

According UNAIDS, the national HIV infection rate in Jamaica is 1.5 percent among an estimated 2,700,000 people, and AIDS is the leading cause of death among 15- to 44-year-olds. Predominant modes of HIV transmission include multiple sex partners, history of sexually transmitted infections, drug use, and unprotected sex among men who have sex with men.

It is estimated that 33 percent of gay men in Kingston, Jamaica’s capital city, are HIV positive, but many of them opt to stay underground, away from public health services due to fear of stigma and discrimination. Continue reading

In Zambia Young People Have Sex to “Prove a Point” or Make Money

Young men and women in Zambia are under pressure to engage in multiple sexual relationships due to prevailing societal attitudes about masculinity and for economic benefits, respectively, according to a study recently published in the African Journal of AIDS Research.

 

The study states that young men are likely to engage in high-risk sexual behaviour because that is the way men are expected to behave, with the majority believing that their identity is defined by their sexual prowess.

 

On the other hand, young women have multiple sexual partners as a way to escape poverty, which affects approximately 68 percent of the population.

 

“Among young women in the study, the practice of multiple sexual partnerships seemed fairly widespread and it typically involved powerful socio-economic ties, making it difficult for individuals to change their own behaviour,” said the study.

 

Young people’s sexual attitudes and behaviours comes against a backdrop of high rates of HIV and AIDS which have shortened life expectancy in the country.

 

According to UNAIDS, an estimated 16,5 percent (1,200,000) of people aged 15-49 in Zambia are living with HIV, of which 57 percent are women with the main mode of HIV transmission being heterosexual intercourse.

 

To make matters worse, UNAIDS reports that in Zambia there is also pressure on women to demonstrate their fertility, so they do not use condoms and a cultural trend for inter-generational relationships also puts girls at risk.

 

Statistics show that HIV prevalence peaks in men between the ages of 29 and 34; in women it is 15 and 24.Among young people ages 15-24, the estimated number of young women living with HIV in Zambia is more than twice that of young men.

 

In Zambia, like many countries in sub-Saharan Africa, epidemiological evidence shows that multiple sexual partnerships are contributing considerably to HIV transmission.

 

In light of this, there is need for increased emphasis on fidelity and partner reduction in the prevention of HIV transmission. However, a combination of cultural and economic factors push young people into potentially risky sexual engagement with multiple partners.

 

According to the study, although young people were aware of the risk associated with having multiple sexual partnerships, they described several barriers to translating safer-sex knowledge into health-promoting safer-sex behaviours.

 

“For many young men, having many partners was a way of demonstrating their virility and manliness,” states the study titled “Reasons for multiple sexual partnerships: perspectives of young people in Zambia”.

 

“It was seen as more acceptable for men than women to have multiple sexual partners.”

 

The study adds that a traditional culture that associates masculinity with having multiple sexual partners does exist among youth in Zambia.

 

“When respondents spoke about young men having multiple sexual partnerships in order to “prove a point,” it is evident that in essence the point they were trying to “prove” was that they could live up to the cultural expectations of masculinity in Zambia,” says the report.

 

Notions of masculinity have long been singled out as a stumbling block to safe sexual practices between men and women.

 

The study recommends that there is a need to challenge traditional notions of masculinity which puts both men and women at risk of exposure to HIV. Respondents also cited polygamy, which is widely practiced in some parts of Zambia, as a factor which influences multiple sexual relationships for young people socialized in a polygamous environment.

 

Effective responses to HIV and AIDS in Zambia, like many countries in sub-Saharan Africa, need to continuously figure out how to tackle often-sensitive cultural issues that facilitate HIV transmission.

 

Among young men, existent concepts of masculinity need to be redefined so that the definition of manhood is not simply confined to sexual prowess or number or sexual encounters.

 

The study further recommends that young women need to be offered more opportunities to escape poverty because this will reduce the need to resort to multiple partners as a means of survival.

 

“While the majority of the young people were well aware that having multiple sexual partnerships increased their chance of contracting HIV, it is vital that youth be made aware of the sexual networks that are created as a result of this multiple partnering – and how the chance of becoming infected can depend on one’s position within the networks,” states the study.

 

Overall, sex education can play a key role in encouraging young people to either delay having sex or practice safer sex.

Young Couples Face Baby Pressures

Zimbabwean culture, like many cultures in sub-Saharan Africa, places a high value on procreation. Child-bearing is regarded as a rite of passage into becoming a normal adult member of society.

 

As a result, reproductive health choices and practices often play second fiddle to pressures to reproduce that are exerted by traditional and cultural norms. Usually, these pressures are covert so they tend to be ignored in the design of reproductive health programs and interventions.

 

Reproductive health generally implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.

 

But in Zimbabwe, men and women’s ability to exercise this right is curtailed by the unseen force of tradition and culture.

 

In many parts of the country, a woman is expected to have been married at roughly age 24, and within two years of marriage is expected to have a child. Young women, in spite of their educational status, are under immense pressure to fulfill this social expectation. On the other hand, a man who goes beyond 30 without getting married or having a child attracts significant social ridicule.

 

Failure to procreate especially in a marriage, even if it is by choice, is interpreted in negative light and is equated to reproductive health failure. For a man, becoming a father is associated with a sense of achievement, and failure to reproduce severely undermines the sense of masculinity. A woman’s place within a marriage is regarded as secure when she reproduces. If she fails to do so, she can become ostracized within the household and community.

 

“Failure to reproduce can strain family and other social relationships, particularly when the negative views of extended family members are taken to heart,” says a study conducted in Zimbabwe in 2001 titled Culture, Identity and Reproductive Failure in Zimbabwe.

 

“Generally speaking, about one year after entry into marriage or a stable sexual partnership, others expect there to be a child, irrespective of the reproductive choices of the partners.”

 

 

It is clear that traditional and cultural attitudes play a significant role in how both men and women construct their reproductive capabilities and choices.

 

As Danielle Toppin notes “given the often covert nature of socialization, certain gendered behaviours are often left untouched, resulting in reproductive health policies that fail to meet the specific needs of women, and of men”.

 

In Zimbabwe, the family, a primary unit of socialization, is often the root of pressure for men and women to prove that they can reproduce. The desire to conceive in order to gain social acceptance is given preference to adopting tools and methods that promote safe sex.

 

The social pressure on women to become pregnant and give birth leads them into conditions of vulnerability, where they have to acquiesce to their partner’s sexual demands. It can also lead men to have multiple sexual encounters exposing them to a high risk of contracting HIV.

 

Put simply, the effectiveness of sexual and reproductive health tools is inhibited by culturally and socially constructed layers that define people’s sexual behaviors.

 

However, instead of being an impediment, culture can be used as a stepping stone to promote reproductive health rights. To have effective reproductive health programs, therefore, a full understanding of a given society’s values and beliefs is required.

 

There’s need for an approach that is sensitive to contextual, cultural, traditional and gender practices that impact on reproductive health choices.

 

The traditional, spiritual and cultural beliefs that shape and define sexual identities and attitudes towards sexual and reproductive health need to be given serious attention in the design of programs and interventions. Traversing the cultural and traditional can be very difficult and requires a lot of sensitivity, investment and patience.

 

It’s imperative to involve the target communities in the design and implementation of reproductive health policy, planning and practice in order to challenge cultural norms that may put women and men at risk.