[Items on Nigeria and Denmark added, 12/29, other updates as noted below, 12/29]
By no means comprehensive, the following is a wrap up to the year with stories that we missed in 2008. Many of these weren't really missed. They were just not narrowly specific to circumcision and HIV. Some were actually written by Joe, but I never got around to editing and posting them. Here they are with a brief description and a link. If you can think of a story we didn't cover, add it to the comments.
Dissident Voices
A few dissident voices were heard in Africa. Dr. Frank Assiimwe Rubabinga, a general surgeon who holds the position of Medical Superintendent in Uganda, penned these questions in a September 14 editorial.
- How are women being protected by circumcision? Dr. Rubabinga asked whether men who are circumcised as children will experience sex differently, perhaps suffering less sensitivity thereby causing greater trauma to his partner.
- What are the inherent dangers of mixing circumcision with traditional and more effective approaches such as ABC?
- If you cannot abstain or cannot be faithful or cannot wear a condom, won't men, whether circumcised or not, still become infected eventually?
More Dissidence ...
Reports are increasingly coming in that the Aids threat has been overblown. In the UK, The Independent published a story headlined Threat of world AIDS pandemic among heterosexuals is over.
Dr. Peter De Cock is quoted as saying that, "It is very unlikely there will be a heterosexual epidemic in [non-African] countries. Ten years ago a lot of people were saying there would be a generalized epidemic in Asia – China was the big worry with its huge population. That doesn't look likely. But we have to be careful. As an epidemiologist it is better to describe what we can measure. There could be small outbreaks in some areas."
Statements like this are increasing, and the critics are becoming more outspoken. A common complaint is that the HIV industry is draining resources away from arguably equally or more critical public health needs.
A recently published Associated Press article quotes Jeremy Shiffman of Syracuse University, "AIDS is a terrible humanitarian tragedy, but it's just one of many terrible humanitarian tragedies." While many, such as Roger England of Health Systems Workshop, a think tank based in the Caribbean island of Grenada, go further arguing that many AIDS specific agencies should be shut down, having outgrown their usefulness.
Not sure how much I agree with these views. See Elisabeth Pisani's talk below on this issue.
India
India stated its intention to continue its HIV prevention strategies without incorporating male circumcision.
NACO director-general Sujatha Rao, says India has no plans to make circumcision a part of its national HIV prevention strategies. “We have to keep religious and cultural sensibilities in mind before introducing changes in prevention strategies. Preventive vaccine and microbicide trials have had disappointing results but drug development is a difficult and time-consuming process that takes years before showing results. The world hasn’t given up hope. Even if the world had a preventive vaccine, HIV prevention would continue to require a combination of strategies such as promoting behavioural change and strategies such as awareness programmes, consistent condom promotion and harm education services to injecting drug users, among others,” says Rao.
The HIV prevalence estimate in the Indian population has decreased by more than half based on better information gathering, The current estimates went from 5.7 million in 2006 to 2.5 million today, according to Robert Steinbrook, MD. HIV in India—A Downsized Epidemic. NEJM 358(2):107‐109. Similar decreases have been reported in other parts of the world.
Earlier this year, India formed a Medical Research Task Force that suggested a multi-site study to understand community comfort with male circumcision to prevent the spread of AIDS. The WHO and UNAIDS have said that, in India, where HIV is concentrated in specific population groups, there would be little public health benefit in promoting male circumcision in the general population.
Published Research Often Wrong
This blog post over on slashdot.org was so startling, I lifted it in its entirety.
Why Most Published Research Findings Are False
Posted by kdawson on Sunday October 19, @02:21PM from the peers-can-be-wrong-too dept.
"Researchers have found that the winner's curse may apply to the publication of scientific papers and that incorrect findings are more likely to end up in print than correct findings. Dr John Ioannidis bases his argument about incorrect research partly on a study of 49 papers on the effectiveness of medical interventions published in leading journals that had been cited by more than 1,000 other scientists, and his finding that, within only a few years, almost a third of the papers had been refuted by other studies. Ioannidis argues that scientific research is so difficult — the sample sizes must be big and the analysis rigorous — that most research may end up being wrong, and the 'hotter' the field, the greater the competition is, and the more likely that published research in top journals could be wrong. Another study earlier this year found that among the studies submitted to the FDA about the effectiveness of antidepressants, almost all of those with positive results were published, whereas very few of those with negative results saw print, although negative results are potentially just as informative as positive (if less exciting)."
The implications for circumcision and HIV are obviously unfolding as I type.
Finally, A Cure? Yes. However, Death is Not Unlikely
A German doctor treated a Leukemia patient who was also HIV positive with a bone marrow transplant with an additional criterion for a match. Dr. Gero Hutter, who isn't an AIDS specialist, recalled research from the 1990s which focused on the CCR5 protean and the apparent resistance to HIV among high risk individuals.
Dr. Hutter, while searching for a matching donor, decided to see if adding the additional criterion that the parents of the donor possess this mutation would have any effect on the patient's HIV status, post transplant. After taking the patient off his HIV meds and eradicating the patients own immune system through radiation and other means, the transplant proceeded successfully. Dr. Hutter planned to continue the HIV therapy once the virus re-emerged. 600 days later the patient's HIV remained undetectable and has remained so.
The case was presented at the Conference on Retroviruses and Opportunistic Infections and later in September, the nonprofit Foundation for AIDS Research, or amFAR, convened a small scientific meeting on the case, scientists agree that the patient is "functionally cured." A number of studies are being designed to explore this treatment further.
Unfortunately, researchers noted, 30% of bone marrow transplants result in death from the procedure itself.
Indonesia
Indonesia is debating plans to "tag" HIV+ individuals using RFID technology. The effort is apparently being proposed because, in the words of MP Weynand Watari, "The health situation is extraordinary, so we have to take extraordinary action." The international community has condemned the suggestion.
A Public Policy HIV Cure in Plain Sight [Updated!]
Universal testing and treatment could reduce new HIV infections in southern Africa by 95% in 10 years, reports Aidsmap.
An opinion piece in the Washington Post asks why Americans haven't led the way in routine HIV testing. While the US does have a relatively low incidence of HIV prevalence, we have the tools to push it far lower.
We know that HIV+ people who control the infection with the available medications have extremely low infectivity. There is simply no rational reason not to routinely test. However, I suspect routine testing doesn't happen because of the deplorably fragmented health care system.
Nevertheless, the HIV transmission rate in the US has declined enormously, reports Aidsmap.
Circumcision Cuts the Competition
The Economist published an article concerning research that attempts to describe the process by which harmful cultural practices get started, focusing specifically on male circumcision. I was curious that this article even got published, as it is decidedly counterpoint to mainstream treatment of circumcision. Not specific to HIV, it is still worth a close read as it informs as to why male circumcision is so persistent in the world today.
Nigeria & Denmark (added 12/29)
Nigeria's Child Rights Law has forced the issue of neonatal or childhood circumcision. In Osun state, lawmakers are discussing whether the law permits circumcision on unconsenting children. This is a surprising development in an unlikely place.
Less surprising is Denmark's recent push to limit or even prohibit circumcision of children; that is boys as well as girls. You can read about that effort here and here.
Elisabeth Pisani on HIV/AIDS at The Frontline Club
And finally, an hour and a half of video well-spent ...
"Elizabeth Pisani has spent ten years working as a scientist in the bloated AIDS industry. In The Wisdom of Whores, she unfolds a universe of brothels and bureaucracies, of bickering junkies and squabbling charities, of men who sell sex and men who would rather prohibit it. Illustrating solid science with ribald tales from the frontlines of sex and drugs, The Wisdom of Whores explains how we could shut down HIV everywhere except sub-Saharan Africa. We could do it with a few, simple steps. We could do it with less money than we already have. But we won't."
