Notebook: Rising food costs, the tanking dollar, sexual behavior in multiples, and PrEP, like condoms, may be a true pillar of AIDS prevention

The New York Times reports that American food aid to Africa is in a pinch due to rising costs. The reasons are varied. However, the primary reasons are a higher demand for food stocks for ethanol and higher transportation and logistical costs. Food aid purchases (as opposed to total allocations) fell from $105 million to $70 million between 2002 and 2006.

Implicitly, the tanking US dollar, which hit a record low against the Euro this week at $1.41 plus, can't be helping. And the dollar's problems are in some ways related to the energy issues, tying this all up in a nice little bow.

The article makes the observation that food aid has never been as altruistic an endeavor as one would hope. A solution to higher demand for US corn crops for ethanol production could be buying these same crops elsewhere where production costs are less. However, the article quotes an American ship owner representative, Gloria Tosi,  who suggested "buying commodities abroad would erode domestic political support for the program and lead to lower food aid budgets from Congress. She said it was 'politically naïve' to think the food commodity groups and ship owners that have for decades supported food aid in Congress would favor buying commodities abroad."

Clearly, one lesson seems to be that acts of charity don't happen on their own. They happen when interests coalesce and business or careers advance. This obviously implicates the bit of luck necessary in just about everything. Still, individual efforts are valuable and necessary if anyone feels like throwing up his or her hands on the circumcision issue.

The dollar

In the last few weeks, the US dollar has hit parity with the Canadian dollar for the first time since the 1960s and reached a new low against the Euro, having lost fully 69% of its value against that currency since 2001. This is extraordinary on a number of levels. First for the issues this blog is concerned with, the dollar's buying power is clearly being eroded across all currencies, although not at the same rate. For example, the Thai baht is fetching 25% more now than it did a few years ago. Circumcisions are therefore escalating in cost, for what it's worth.

Never underestimate the power of unexpected forces to change the calculus in this game.

Gay Sex: three times more potent than straight sex

A recent study has demonstrated that heterosexuals require up to three times more unprotected sexual encounters to reach the levels of infection of gay men. Not sure of the implications here, but it seems this is not so difficult to explain. Gay men may adopt both passive and insertive roles in intercourse. Heterosexual vaginal intercourse is logically believed to be less conducive to HIV infection. As a percentage, more gay men than heterosexual pairings combine drug use and sexual encounters in the major urban centers of HIV prevalence, which has been identified as a risk factor.

Maybe the researchers that be should conduct some studies in sub-Saharan Africa to determine whether heterosexuals exhibit any extraordinary risk factors similar to that of gay men in the West, particularly the US, and that are decidedly absent in Western heterosexual pairings. That would explain super low rates of infection among the intact Europeans.

Condoms and a pill: a death blow to new HIV infection

In the last post, I talked a bit about a study that suggested that risk reduction strategies were much less effective on an individual basis than had been hoped for. Well, how about a new strategy with an effectiveness rate approaching that of condoms.

Animal studies have shown a 100% prophylactic effectiveness rate with two drugs, tenofovir and FTC (emtricitabine, Emtriva). Taken daily by HIV negative monkeys, not necessarily together, repeated exposure to HIV resulted in no new infections. That's pretty amazing. It would be the first and only female controlled method of prevention. Combined with the inevitable incomplete use of condoms and we may have a winner.

Comments

[J]

Quite a bit of interesting information here. It's funny you post this kind of article as I was recently reading an older report criticizing PEPFAR for similar reasons, meaning help and money is given but with strings attached.

http://www.aegis.com/news/ips/2004/IP040512.html

In your case, food aid programs are constructed in such a way as to benefit US interests; if a ton of corn can be found cheaper in China, too bad. In my example PEPFAR countries are restricted in how and which drug brands are bought, generics seem to be off the table. They also point out the focus on abstinence-based programmes as opposed to condoms and, even I didn't believe this sh*t,
"...the exclusion of severely HIV-afflicted countries such as Zimbabwe, Malawi and Swaziland as evidence that the choice of states was politically-motivated. Relations between the U.S. and Zimbabwe, for instance, have been frosty in recent years...."

Now perhaps I am being naive but why would an agency exclude support to countries most affected by HIV for some petty political tiff. These are among the highest prevalence countries and they get cut off?

Seems to me you should take your pile of money buy the most food you can get, the most ARVs you can get (generic or whatever), and leave the politics out of it. Sick, starving, and dying people don't care about politics. As long as the aid can be safely delivered to those who need it, no one should be cut off.

The theme seems to run into your third article. A seemingly strong prophylactic effect from a combination of available drugs and "...incentives to run large trials of PrEP and finance its eventual use are still lacking..." they said what? These are already approved drugs whats the hold up? OH I see "..human studies using tenofovir (Viread) have been troubled by ethical disputes..." last I checked we were throwing our ethics in to the wind in Africa. I can't believe they are all over this.

The one part of the treatment I could see being a bit of a rub is how it is continuous. For one reason or another it is difficult enough to get condoms into regular usage I am not sure how successful popping a daily pill (actually the article said it's a needle drug) would be but it's more than worth a shot.

BTW Dave, the Looney last reach parity with the dollar in Oct or Nov of 76 last I read; going down, next stop the Peso. ;)