HIV/AIDS, STDs, Condoms
August 27, 2012
July 21 , 2012 Population Action International
In One Place, an infographic by Population Action Internationalshows why integrating family planning, reproductive health and HIV/AIDS is a priority for women and young people in sub-Saharan Africa.
Integration means offering family planning/ reproductive health and HIV services together at the same time and in the same facility. It is a client-centered, rights-based approach that improves lives for women and youth living with and at risk of HIV.
The U.S. government's international HIV/AIDS program, PEPFAR, has $1.5 billion of its funds which have remained unspent for more than a year and a half. PEPFAR has said it will spend it on commodities (condoms, HIV rapid test kits and voluntary medical male circumcision kits), systems and institutions, and program strengthening.
Condoms play an important role, but a focus on broader voluntary family planning methods would help reduce the spread of HIV, especially mother-to-child. It is critical in the fight against HIV/AIDS and for the health and well-being of women and girls. Voluntary contraception has been called "the best kept secret in HIV prevention" and has a proven evidence-base.
New World Health Organization guidelines on couples HIV testing and counseling include family planning as part of the package of information and linked services offered in counseling sessions. Both PMTCT and counseling and testing are listed as priority areas for this money.
This is also a matter of rights. All women, including those living with HIV, have a right to decide whether and when to have children, and how many to have. Right now, there are 215 million women who want access to modern contraception but do not have it. Moreover, women in their childbearing years are also those most likely to be living with HIV in PEPFAR countries.
The Global Health Initiative's aim is a more integrated, women-centered and country driven global health program. Where needed, funding for family planning activities should be made available as part of the laudable, U.S.-endorsed, goals of creating an AIDS-free generation and eliminating mother-to-child transmission of HIV.
Zambia: Community Radio Effective in Fostering Behavioural ChangeApril 18, 2011 The Times of Zambia
Community radio is effective in fostering behavioural change in combating HIV/AIDS in parts of Southern Africa that are hardest hit by the pandemic.
Television, newspapers and others may not be able to penetrate poor and vulnerable communities like radio can. Radios are listened to at community centres in villages where people gather.
In Zambia, Afya Mzuri community radio programs are used by a local NGO called Corridors of Hope (CoH) III to empower communities to change their attitudes towards risky behaviours and practices.
A 2009 Zambia sexual behaviour survey shows that 99% of Zambians have heard about HIV and AIDS and 95% are aware that HIV can be avoided. Unfortunately only "23% of those interviewed have voluntarily requested for an HIV test, received the test and received the results," CoH programme director for Zambia Leslie Long said.
Multiple concurrent sexual partnerships is one of the leading drivers of the transmission of the virus. But with these partnerships, there are different understandings among different communities on what is meant by 'being faithful,' according to a 2010 report from the FHI, National Aids Council (NAC), USAID, and the International Organisation for Migration (IOM).
CoH is a five-year comprehensive HIV/AIDS prevention project funded by the United States government President's Emergency Plan for AIDS Relief (Pepfar) through USAID.
Sexual cleansing, one of the key drivers of HIV, was halted after radio programs about the risks involved in such practices were intensified.
Other negative practices which have since recorded a decline include gender- based violence, alcohol abuse and child abuse. Now radio programmes educate the community on the dangers of alcohol abuse, in relation to increased HIV infections and low condom use.
Some of the radio programs focused on the negative effects of early marriages, and a lot of young girls who had initially dropped out of school in preference for marriages have realized the importance of education and most of them have made efforts to return to school.
Kenya: 73 Million Condoms on the Way to End ShortageMarch 30, 2011 The Daily Nation (Kenya)
73 million condoms will be delivered to Kenya in April and May to end the acute shortage of the contraceptive in various parts of the country.
The condoms are needed in the government's war against AIDS, particularly in marginalised areas of northern Kenya, where most people depend on the free condoms supplied by the government.
Counselling Key to Success of Male CutNovember 2, 2010 PlusNews (Johannesburg)
When Kenya launched its national voluntary male circumcision campaign in 2008, critics worried that it could lead to greater sexual risk-taking - but men in the western Nyanza Province seem to be disproving this theory.
For example, a 23-year-old said: "When I heard people say male circumcision helps in reducing HIV infection, I went there with the sole purpose that it would lessen the burden of having to use a condom. But after that, I have known a lot through the counselling I received; I use a condom every time with anybody ... I am not married so I am not going to trust anybody."
Kenya's programme aims to circumcise more than one million men by 2013, while doing HIV testing and compulsory counselling on HIV prevention, including messages about the importance of continued condom use, since circumcision does not offer full protection from the virus.
A small 2010 study by the University of Illinois in Kisumu found that most respondents - whether circumcised traditionally or in health facilities - reported either no behaviour change or improved protective behaviour, such as increased condom use and fewer sexual partners. Respondents understood that that male circumcision only provided partial protection against HIV.
Another study found that circumcised men did not engage in more risky sexual behaviours than uncircumcised men in the first year after the operation.
Most men in Kenya are circumcised as teenagers during rites of passage into adulthood that do not generally feature HIV education. One young man told the story about how, after he was circumcised during the traditional ceremony of western Kenya's Bukusu community, he was told that he was man enough to have sex with as many girls as he chose. But he heard it being talked about on the radio and everywhere that "circumcision cannot prevent you from HIV unless you use a condom or are faithful." Studies show that not all traditionally circumcised men heed the message about the HIV risk with unprotected sex. rw
A new, easy-to-use pack for pregnant, HIV-positive women could significantly reduce rates of mother-to-child HIV transmission (MTCT) in Kenya.
The "mother-baby pack" contains antiretroviral drugs (ARVs) and antibiotics that women can easily administer themselves at home to reduce the risk of infecting their babies and is colour-coded to make it easy to use even for illiterate mothers. The packs form part of the "Maisha MTCT-free Zone Initiative", launched in the western city of Kisumu by the Kenyan government and the UN Children's Fund (UNICEF), which aims to eliminate paediatric HIV from the country by 2015.
"This initiative has the potential to save many lives and I believe it is component towards the realization of our goal," Anthony Lake, UNICEF executive director, said at the launch on 29 October.
Health workers will distribute the mother-baby packs to pregnant women living with HIV who do not yet need ARV treatment for their own health. It is hoped the programme will reach HIV-positive pregnant women who might not return to the clinic following an initial diagnosis.
The packs will be available at antenatal clinics in four districts in the western provinces of Nyanza and Rift Valley with the aim of virtually eliminating paediatric HIV from both provinces by 2013; the two provinces account for about 50% of all children living with HIV/AIDS nationally.
Currently 4,000 out of 4,500 antenatal clinics in Kenya provide HIV treatment for mothers and children. While many mothers make at least one antenatal visit during their pregnancy, most do not have their babies at hospitals and clinics.
In Nyanza, 92% of HIV-positive pregnant women know their HIV status but only 24% deliver in health facilities," said Ojuang Lusi, director of medical services in Nyanza Province.
An estimated 22,000 Kenyan children are infected with HIV annually through mother-to-child transmission. The country has around 81,000 pregnant women living with HIV; according to UNICEF, 72% of them received ARVs for PMTCT in 2009.
"We must strengthen other components like reproductive health and also give women a reason to deliver in health facilities for good outcomes," Lusi added.
Lessons from southern Africa The mother-baby pack was launched in Lesotho and Zambia earlier this year and, according to Charles Lyons, president of the Elizabeth Glaser Paediatric AIDS Foundation, a key partner in Lesotho, the southern African experience could provide valuable lessons for the programme in Kenya.
"We must continue with efforts... that would make mothers not afraid of taking the packs - continuous persuasion of mothers that this is important for the health of their children and themselves is very important," she said.
The "Maisha MTCT-free Zone Initiative" will also involve the use of "mentor mothers" to support pregnant women living with HIV; a strategy for early infant diagnosis that includes the use of mobile phone short message service (SMS) technology; and encouraging pregnant women's male partners to get more involved. rw
Other Sexually Transmitted Diseases
New HIV infections and unintended pregnancies can better be reduced by integrating family planning, reproductive health and HIV services. This combination also serves to promote gender equality and human rights. Since both are related to sexual relationships, and because women are vulnerable to both HIV infections and unintended pregnancies, addressing these two problems simultaneously is more necessary now than ever before.
Emphasizing the importance of this type of integration are the facts that: 1) 200 million women in the world have an unmet need for contraception to prevent an unintended pregnancy, 2) more than 80% of new HIV infections are sexually transmitted, 3) despite a massive increase in resources devoted to fighting HIV/AIDS, only a negligible reduction in new HIV infections has been achieved.
Socially marginalized people and adolescents are impeded from accessing HIV prevention, care and treatment by the stigma against AIDS and discrimination. Illiterate, socially restricted women and girls have severely limited opportunities to learn how to protect themselves. Gender inequality and stigma against AIDS are the leading factors contributing to HIV risk, according to UNAIDs.
Integrating services means fewer trips to a clinic, less expense, and fewer missed opportunities for health care when it is necessary for a woman to address two or more health issues at a time. When girls and women are able to spend their time earning income, studying, caring for their children and families, or participating in community life, the economic sector as well as households benefit.
Integration also avoids the stigma associated with HIV and STD clinics because the testing and counseling is part of routine care. But over a decade after integration of HIV and reproductive health services was proposed, widespread integration remain an unrealized goal.
Quality services for family planning or HIV allow sexually active individuals to make safe and responsible decisions about their intimate lives. Education is more comprehensive when HIV prevention is discussed in the context of maternal health and family planning services, and knowing about family planning and contraceptives when a woman seeks HIV services allows her to exercise her rights to plan and space her births, to conceive more safely if she chooses to become pregnant, and to negotiate safer sex with a partner.
Tens of millions of women want to delay their next pregnancy for at least two years or stop having children altogether, but are not using a modern method of contraception. Women with an unmet need for contraception also need information on how to avoid contracting HIV. Women represent nearly half of the 33 million people living with HIV, and several studies suggest that a majority of them also have an unmet need for family planning.
Thailand: Your Holiness, Meet the Condom KingMarch 20, 2009 The Dothan Eagle
In Bangkok, Soi 12, is a street off the main drag. Here it's easy to forget Bangkok's reputation as a destination for sex tourism. Then you see the sign for Mechai Viravaidya's restaurant: Cabbages and Condoms.
Mechai, known locally as the Condom King, has been a vocal proponent of condom use for years, later, as HIV infection spread, as a weapon in the war on AIDS.
Mechai was minister of tourism, and instrumental in the promotion of Thailand's 100 Percent Condom Campaign, which has been credited with the country's decline in the rate of HIV infection.
In a visit to Africa the pope took a position against condom use as a tool in AIDS prevention. "You can't resolve it with condoms, it increases the problem."
The pope underscores the position that rejects condoms as artificial contraception, and that marital fidelity and pre-marital abstinence are the key weapons against HIV.
In Third World and developing nations, those are hollow concepts. With 22 million people infected in sub-Saharan Africa, altering the trajectory of the disease will require far more than philosophical suggestions.
The pope is right, distribution of condoms will not resolve the crisis. Perhaps his visit to an area that saw three-quarters of all 2007 AIDS deaths will convince him that fidelity, abstinence and education won't do it, either. Broad-based efforts incorporating the promotion of condom use and education on sexual health offer the best chance to rein in the pandemic. rw
Warning as Sex-Related Disease Cases Rise SharplyApril 13, 2007 New Zealand Herald
The number of people suffering from gonorrhoea has risen sharply, particularly among the young. Antibiotic-resistant cases are increasing in Auckland as the disease charts a steady increase in New Zealand.
A third of 204 gonorrhoea cases were resistant to treatment with ciprofloxacin.
New Zealand has high rates of the disease compared with other developed countries, with a steady increase over the last five years.
In Auckland, the rate was 45 cases per 100,000 people in the first quarter of 2006, compared to around 27 cases over the same period in 2001.
In the Bay of Plenty, incidence rates over the same period have risen from 14 to 38 per 100,000.
Roughly one person in every 1000 aged 20 to 24 in Auckland had the disease in the first quarter of 2006, with 53% of infections occurring in people 15 to 24.
The incidence rate of ciprofloxacin-resistant gonorrhoea 33% was higher than lab results for Auckland 19%, which was attributed to the Auckland sexual health clinics serving a "high-risk population".
The rate of antibiotic-resistant gonorrhoea was hovering around 3% in the 1990s until an outbreak in South Auckland in 2001 raised the prevalence to over 10%.
Of patients diagnosed with the disease between September 2003 and March 2004, 50% were in patients under 25. Patients of Maori and Pacific ethnicity made up nearly half of all cases. 80% were heterosexual. 58% never used condoms.
The increase in ciprofloxacin resistance was worrying, as the alternative, ceftriaxone, was difficult to access in primary care.
Singapore;: NGOs Call for Change in Way Sex Education is Taught to StudentsDecember 05, 2006 Channel NewsAsia
NGO's are calling for a change in the way sex education is taught in Singapore schools as a way to tackle the AIDS epidemic. They believe schools should start teaching about safe sex and protection from the disease.
The number of new HIV/AIDS cases in Singapore is bound for a new record high this year.
Removing the stigma of AIDS is one challenge the HIV / AIDS Policy Committee will be addressing.
Focus on the gay community is a problem because the highest rise in incidence is among heterosexuals. 61% of women with HIV in the last 5 years have been homemakers.
Singapore is studying having routine voluntary HIV screening at clinics and hospitals, but many believe the high cost will stand in the way.
Activists say Singapore must update its awareness campaign on AIDS. With infections on the rise, some say schools must teach the young how to protect themselves.
The policy committee will coordinate strategies for HIV prevention, treatment and care.
They Got it Right About Women's HealthJuly 21, 2006 Seattle Post-Intelligencer
The FDA approved a vaccine against the human papilloma virus that is responsible for genital warts and 70% of cervical cancer. It can also cause penile, anal and oral cancer in men.
The CDC recommended this be approved for all girls and women between 11 and 26. The vaccine is most effective for those who have had no prior exposure to HPV and before sexual activity.
Let's hope the HPV vaccine quickly makes its way to the Vaccines for Children program that would defray the cost of the injections ($360). The vaccine can eventually be made available to developing nations.
Cervical cancer kills almost 4,000 U.S. women a year, almost 300,000 worldwide annually. Cervical cancer disproportionately affects the poor.
U.S.: Science Over IdeologyJuly 06, 2006 Palm Beach Post
The Centers for Disease Control has urged all girls ages 11 to 26 to receive a new vaccine that prevents most cases of cervical cancer. The vaccine prevents infection from four strains of the most common sexually transmitted disease in the United States, the human papillomavirus.
It can cause cervical cancer, which is the second-most common cancer in women and, worldwide, is estimated to cause over 233,000 deaths each year.
States and public health departments must educate the public about the benefits of the three doses over six months. If the committee's recommendation, are followed, the federal government would spend an estimated $2 billion to vaccinate poor girls and teenagers.
Vaccine opponents stress abstinence-only to prevent HPV and say the vaccine would encourage promiscuity. The advisory panel's recommendation reflects that not all youngsters will delay intercourse and other risky sexual behaviors. The panel focused on the health benefit of living disease-free. The FDA acted quickly in approving the vaccine after overwhelmingly successful clinical trials. By aiming to prevent potentially fatal cervical cancer, the advisory group kept the emphasis where it belongs: on saving lives. rw
Safe-Sex Message Failing as Cases of Disease Double to Record 20,000July 05, 2006 Press Association (UK)
Statistics showed safe-sex was not getting through to the public and more educational campaigns are required. A total of 20,138 sexually transmitted infections (STIs) diagnosed in Scotland last year - up 7% from 2004.
The figures showed cases increasing more in Scotland than England, which saw STIs rise by just 2% last year.
Scottish cases of chlamydia climbed 14% in 2005 to 8,095, compared with a 4% rise in England. There has been an increase of 457% in chlamydia cases in Scotland since 1996. People having sex is a normal, occurrence but we are still struggling to get people to talk about it. Greater efforts were needed to educate the public about the risks of STIs.
Health messages should focus on sex education in schools, but also on adults and gay men who also have high rates of infections.
Figures also showed that gonorrhoea increased by 10% between 2004 and last year, to 834. The UK as a whole saw gonorrhoea drop by 13% per cent.
There were 188 cases of syphilis in Scotland in 2005 compared with 21 in 1996. These figures demonstrate that the public-health message we have at the moment is not being communicated with the public.
The increase in cases of chlamydia was due to increased screening and detection of STIs.
More people have the confidence to come forward and visit clinics and, can access the treatment they need.
More men needed to be tested for chlamydia to prevent a cycle of re-infecting women that can lead to infertility and pelvic inflammatory disease. Between 5,000 and 10,000 women needed IVF treatment each year because of fertility problems caused by chlamydia.