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