AIDS Care Watch

Friday, March 30, 2007

WHO, UNAIDS urge heterosexual males be circumcised to reduce HIV infections

By, Associated Press, March 28, 2007

U.N. health agencies recommended Wednesday that heterosexual men undergo circumcision because of ”compelling” evidence that it can reduce their chances of contracting HIV by up to 60 percent.

But World Health Organization and UNAIDS experts said men need to be aware that circumcision is only partial protection against the virus and must be used with other measures.

”We must be clear,” said Catherine Hankins of UNAIDS. ”Male circumcision does not provide complete protection against HIV.”

Studies suggest 5.7 million new cases of HIV infection and 3 million deaths over 20 years could be prevented by male circumcision in sub-Saharan Africa, the agencies said.

Still, men and women who consider male circumcision as an HIV preventive method need to continue using other forms of protection such as male and female condoms, abstinence, delaying the start of sexual activity and reducing the number of sexual partners, she said.

Otherwise, they could develop a false sense of security and engage in high-risk behaviors that could undermine the partial protection provided by male circumcision, the agencies said.

Men also should be warned that they are at a higher risk of being infected with HIV if they resume sex before their wound has healed. Likewise an HIV-positive man can more easily pass on the disease to his partner if the wound is still unhealed.

The recommendations were based on a meeting earlier this month in Montreux, Switzerland, where experts discussed three trials _ in Kenya, Uganda and South Africa _ that produced ”strong evidence” of the risk reduction resulting from heterosexual male circumcision.

”Based on the evidence presented, which was considered to be compelling, experts attending the consultation recommended that male circumcision now be recognized as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men,” a joint statement said.

The agencies said much depends on the situation in a given country, and little general benefit will result in countries where the HIV epidemic is concentrated among sex workers, injecting drug users or men who have sex with men.

The public health impact is likely to be most rapid where there is a high rate of HIV infection among men having sex with women.

”It was therefore recommended that countries with high prevalence, generalized heterosexual HIV epidemics that currently have low rates of male circumcision consider urgently scaling up access to male circumcision services,” the agencies said.

More study is needed to determine whether male circumcision will cut the transmission of HIV to women. More study also is required to find out whether male circumcision will reduce HIV infection in homosexual intercourse, it said, but it said promoting circumcision of HIV-positive men was not recommended.

”The recommendations represent a significant step forward in HIV prevention,” said Dr. Kevin De Cock, director of WHO’s HIV/AIDS department. ”Countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention which can reduce the risk of HIV infection in heterosexual men.”

Increasing male circumcision in areas where it the procedure is rare will result in immediate benefit to the men circumcised, but it will take years before there will be an impact on the epidemic.

Although the rate of circumcision varies considerably from country to country, globally an estimated 665 million men, or 30 percent of men in the world, are circumcised, the statement said.

The agencies said the risks involved in male circumcision are generally low, but can be serious if the operation is performed in unhygienic settings by poorly trained, ill-equipped health workers.

Priority should be given to providing circumcision to age groups at highest risk of acquiring HIV because it will have the most immediate impact on the disease. But, it said, circumcising younger males also will have a public health impact over the longer term.

It gave no estimate how much providing the service would cost, but said more money would be needed, but that donors should regard it as ”an important, evidence-based intervention.”


Tuesday, March 27, 2007

Women Empowerment, Cornerstone of HIV Prevention

Anirudha Alam, News from Bangladesh, March 26, 2007

There are some forms of risky behavior that directly makes women vulnerable to HIV/AIDS in the developing countries like Bangladesh. It should be cornerstone of life to get rid of risky behavior through improving living standard any how. For the greater involvement of vulnerable women in every aspect of curbing epidemic, they have to be able to respond to the epidemic in a meaningful manner.

In a society, if women and girls are not empowered to develop life skills they are severely vulnerable to HIV/AIDS. Gender discrimination, sexual violence, women trafficking, dowry, early marriage and low levels of reproductive health literacy are considered as key factors in the spread of STIs.

A large proportion of women is infected with HIV from regular partners who were infected during paid sex. For instance, in Mumbai and Pune (in Maharashtra), 54% and 49% of sex workers, respectively, had been found to be HIV-infected in 2005. Across sub-Saharan Africa, women are more likely than men to be infected with HIV. The unfortunate fact is that vulnerability among women is mounting all over the world. Only women empowerment can contain this vulnerability.

Profound advocacy can be an important and familiar way of breaking down barriers for undermining gender discrimination and stigma. The spread of HIV/AIDS is being fueled among the women of developing countries through such risky factors as exorbitant prevalence of HIV in the neighboring countries, increased population movement both internal & external, existence of commercial sex with multiple clients, high prevalence of STIs among the commercial sex workers, unsafe sex practice through bridging population, sexual bondage, the trend of rise of HIV among injecting drug users, unprotected pre-marital sex as well as dire poverty. On the other hand, sustainable family bondage as well as integrated praxis of religious and social values make these countries less vulnerable comparatively.

According to AIDS researcher Mohammad Khairul Alam, “Women empowerment is the first step to stamp out gender discrimination and stigmatization. If we promote gender equality poverty will be reduced significantly. It is recognized that poverty helps to trigger vulnerability to HIV/AIDS. So women empowerment through development initiatives should be ensured to keep HIV/AIDS in bay. In this aspect, such promotional activities as organizing gender sensitization workshop, seminar, symposium, open discussion, popular theatre, door to door work, advocacy session and so on may play important role bringing about effective social mobilization. Thus counting on local resource mobilization and capitalizing on collective action, women empowerment program may be led by integrated approach more efficiently to undermine vulnerabilities to HIV/AIDS.”

It is estimated that more than 14,000 people are getting infected with HIV all over the world every day. Among of them, 2000 are children under 15 years mostly getting infection of HIV through mother to child transmission. So mother to child transmission (MTCT) is considered as an important issue in spreading HIV/AIDS. There is scientific evidence of likely presence of HIV virus in breast milk. Therefore gender issues comprising improved services as to maternal & child care should be ensured through the HIV/AIDS prevention program.

As per the findings of National Assessment of Situation and Responses to Opioid/Opiate use in Bangladesh (NASROB) conducted in 2001, 14% of the female heroin smokers started heroin use below 18 years of age and 38% by 18 year. 22% of the current female injectors started injecting drug by 19 years of age. BEES (Bangladesh Extension Education Services) found that 90% young girls (15-25 years) of Bangladesh are very much vulnerable to AIDS and STIs that they do not know how to take care of their reproductive and sexual health. They have no inclination or are not enough empowered to believe it necessary to seek advice on safe reproductive health as well.

Reproductive health is still a taboo in Bangladesh, particularly with adolescent girls. With very limited access to health care facilities, knowledge and education, they have no understanding about the ways of protecting themselves. But women should be empowered through developing life skills that they can have more control over their reproductive and sexual health. Consequently HIV/AIDS prevention program will sustain comprehensively attaining high watermark of success in reducing vulnerabilities to STIs.


Sunday, March 25, 2007

WHO to help SA with XDR-TB

By, SABC News, March 24, 2007

The World Health Organisation (WHO) is sending an expert to South Africa to assist with extremely drug resistant tuberculosis (XDR-TB), detected in 10 more people in the Eastern Cape, the provincial health department said today, World TB Day.

The latest cases bring to 54 the number of people affected by the illness in the province since November 2006, said Sizwe Kupelo, the department spokesperson.

Jeff Radebe, the acting health minister, who was in the area to mark the international focus day, said the WHO official would arrive next week to give technical assistance, advice on training and the management of XDR-TB cases, infection control and improvement of surveillance system and laboratory services.

The official would also conduct an epidemiological assessment of the number of cases that were reported in Tugela Ferry in KwaZulu-Natal last year.

Radebe also announced R3.6 million in funding for infection control measures in all health facilities across the country and urged TB patients to continue taking their medication, Kupelo said. He said all the people diagnosed with the illness were being treated in hospital.

Although TB was a curable disease, patients' non compliance with TB control programmes and an increase in HIV/Aids infection levels contributed to the emergence of drug-resistant strains of TB, said Kupelo.

About 1 422 unemployed youth have been hired at a cost of R17 million to drive the directly observed treatment supervision which ensures regular treatment taking by patients and avoids developing drug resistance. - Sapa


Friday, March 23, 2007

Drug-resistant tuberculosis threatens the Pacific

By, World Health Organisation, March 22, 2007

Drug-resistant tuberculosis threatens the Western Pacific Region
Manila , 22 March 2007—Tuberculosis will be 200 times more costly to treat and might even become almost impossible to cure unless bolder steps are taken to tackle drug-resistant tuberculosis, the World Health Organization (WHO) has warned.

Drug-resistant TB is widespread in the Western Pacific Region. High levels of drug-resistance have been documented in countries such as China, Mongolia and the Philippines. In some countries, the management of multidrug-resistant TB (MDR-TB) is not yet available or has failed to meet acceptable standards.

WHO warned that failure to address this threat will mean more deaths and chronic cases of MDR-TB and more drug-resistant TB (XDR-TB). XDR-TB develops when the second–line drugs used to treat drug-resistant TB are misused or mismanaged, thus becoming ineffective.

“Just one case is enough to set alarm bells ringing,” said Dr Shigeru Omi, WHO Regional Director for the Western Pacific, referring to deadly XDR-TB, which has begun to wreak havoc in several parts of the world, including Western Pacific Region. A rapid surge in the number of XDR-TB cases is likely if MDR-TB is not controlled quickly, Dr Omi said.

“Drug-resistant TB: Treat it. Prevent it”, the theme of this year's World Stop TB Day, brings home the message that instituting proper treatment is the most effective way to head off drug-resistant TB.

Nearly 2 million people in the Western Pacific Region develop TB every year. Dr Omi warned that unless rapid and systematic action is taken to combat tuberculosis, MDR-TB threatens to reverse the gains already made in TB control. He urged countries to equip their national TB programmes with innovative and robust strategies in treating and preventing drug-resistant TB.

Dr Omi urged Member States to:

put in place a strong TB drug-resistance surveillance system;

establish adequate laboratory capacity to diagnose MDR-TB;

make services available for MDR-TB treatment free of charge; and

put in place infection-control policies to prevent the transmission of drug-resistant TB in health facilities, including protecting people at risk, such as health workers and people with HIV/AIDS. ADVERTISEMENT
Treating only a small proportion of multidrug-resistant TB will not be sufficient to stop the spread of MDR-TB, Dr Omi said. Close to US$ 2 billion is needed to implement high-quality TB control in the Region, with more than $200 million needed for MDR-TB.

Drug-resistant TB, which does not respond to first-line anti-TB drugs, is just as easily transmissible as ordinary TB and is spread mostly through air from one person with drug-resistance TB to another. People can develop or acquire drug-resistant TB because of incorrect, incomplete drug regimens or poor-quality drugs, as well as by being infected with TB bacteria that are already resistant to anti-TB drugs.



Thursday, March 22, 2007

EU: Surge in HIV/AIDS Cases in 2005

By, Andreas Roditis, ERT, March 20, 2007

More than 20,000 new HIV/AIDS cases were diagnosed in the EU nations in 2005, read a press released of the European Commission, on the occasion of Tuesday’s session held between the European Centre for Disease Prevention and Control (ECDC) and the Member State health authorities. European Commissioner for Health, Markos Kyprianou called on the Member States to implement more measures against HIV/AIDS and tuberculosis, also urging the ECDC to ensure comprehensive surveillance of HIV/AIDS in the entire EU.

“Fighting the resurgence of HIV/AIDS in Europe has become a top priority for the EU in recent years. I fully endorse the declaration from the German Presidency’s HIV/AIDS conference in Bremen last week and look forward to EU Heads of Government debating HIV/AIDS at the European Council. EU countries need to work together to ensure comprehensive surveillance of this disease and to review strategies and actions that are most effective in fighting HIV/AIDS," argued Kyprianou.

With regard to HIV/AIDS, the EU’s executive arm stated that more than 20,000 new HIV/AIDS cases were diagnosed in the EU in 2005. This figure, however, does not include data from two major EU nations, therefore the actual number of new cases is feared to near 30,000. Furthermore, the number of new cases diagnosed annually fails to demonstrate the full picture of HIV transmission in the EU, as 30% of those infected with the HIV virus are estimated to be unaware of it. In particular, heterosexuals accounted for 55% of the new HIV infections, while sex between men accounted for 1/3 of the cases.


Monday, March 19, 2007

South Africa fighting 1,500 new HIV infections a day

By,, March 14, 2007

JOHANNESBURG, South Africa (Reuters) -- South Africa launched a revamped national AIDS plan on Wednesday as new research showed the high cost of government inaction on the epidemic -- 1,500 South Africans infected with HIV every day.

South Africa's National Strategic Plan, submitted for approval at a conference, aims to cut new HIV infections by 50 percent and bring treatment and support to at least 80 percent of HIV-positive people by 2011.

Health analysts hope South Africa is undergoing a basic shift in its official approach to a disease that infects about 5.5 million of the country's 47 million people and kills an estimated 1,000 South Africans every day.

"The indications are there has been a genuine change of heart at the highest level," the influential Business Day newspaper said in an editorial on Wednesday.

President Thabo Mbeki's government has long been accused by activists of underplaying the threat of the epidemic, soliciting views of "AIDS denialist" scientists and questioning the efficacy and safety of anti-retroviral (ARV) drugs.

While public pressure forced South Africa to launch one of the world's largest public ARV programs -- with more than 200,000 people enrolled and up to a million seen getting the drugs by 2011 -- many political observers have continued to question government commitment to fighting the disease.

Much of the hope around South Africa's new AIDS strategy has been fueled by the sidelining of combative Health Minister Manto Tshabalala-Msimang -- now on sick leave -- and the naming of Deputy President Phumzile Mlambo-Ngcuka as the country's top official on HIV policy.

AIDS activists have praised Mlambo-Ngcuka for her willingness to take a fresh approach to battling the epidemic, and she said on Wednesday she would be targeting men in particular to get serious about the disease.

"We know the linkage between gender-based violence and the spread of AIDS. The indifference and non-action of so-called good men is unhelpful," she told the meeting.

The human costs of South Africa's foot-dragging on AIDS were highlighted on Wednesday with the release of a study which showed an estimated 571,000 new HIV infections in 2005: roughly 1,500 people a day -- well above Health Ministry projections.

The research, published in the March edition of the South African Medical Association Journal, said young people and particularly young women were not being reached by current AIDS prevention efforts.

"Among young people in the 15-to-24-year age group, women accounted for 90 percent of all recent HIV infections," the researchers said.

The study also said a "substantial" number of children were infected with HIV through means other than mother-to-child transmission, which could fuel concern over child sexual abuse, and that residents of South Africa's sprawling urban shantytowns had by far the highest incidence rates of the disease.

Government officials said last week the new plan had a preliminary budget of about $3.3 billion, but other estimates have put the costs as high as $6 billion, leaving questions on where the extra money would come from.


Wednesday, March 14, 2007

HIV in late childhood and adolescence a growing problem

By, Craig Brierley, EurekAlert, March 12, 2007

Needs of HIV-infected adolescents not being met, say researchers
Scientists have highlighted for the first time the plight of the growing number of older children and adolescents living with undiagnosed HIV and AIDS in Africa. In a study published today in Clinical Infectious Diseases, Wellcome Trust researchers claim that delay in recognising this problem means that the needs of this important group are not being met.

It is estimated that half a million babies were infected with HIV during birth or breastfeeding in 2006, passed down from their mothers. It was assumed that their chances of survival to adulthood were negligible. However, a new study, carried out by researchers based at the Connaught Clinic in Harare, Zimbabwe, shows that older children and adolescent with AIDS have all of the features that would be expected from long-term survivors of infant HIV infection.

"The findings are quite extraordinary," says Dr Liz Corbett, a Wellcome Trust Senior Clinical Fellow in Tropical Medicine from the London School of Hygiene and Tropical Medicine, based in Zimbabwe. "The phenomenon of long-term survival is poorly recognised and until recently has been almost positively resisted by the international HIV community because of the strongly held assumptions that HIV in late childhood is very unusual, and that survival from birth to adolescence with HIV was so unlikely without treatment as to be negligible. This just doesn’t fit with what we see in Zimbabwe and hear from neighbouring counties.

"It is now being realised that these earlier assumptions were wrong and that instead somewhere around 1 in 10 infected infants – and perhaps even as high as 1 in 4 – may survive into late childhood or early adolescence without diagnosis or treatment."

However, late diagnosis is likely to have a significant effect on their future health and long term survival, warn the researchers.

"Early diagnosis of HIV is very important," says Dr Rashida Ferrand, a Wellcome Trust Research Training Fellow. "A delayed diagnosis means that patients have a much higher risk of developing serious opportunistic infections and may have significant and irreversible damage to vital organs such as heart and lung as well as a higher risk of death. We also know that antiretroviral therapies (ART) are less effective if started in patients with advanced disease."

Dr Ferrand and Dr Corbett argue that there is a need for more services aimed at older children and adolescents to provide accessible and sympathetic HIV testing and treatment services, counselling and support, and drug formulations for low-weight individuals whose growth may have been stunted by undiagnosed HIV.

"Because of the previous assumption that HIV-infected infants did not survive to adolescence, no concerted effort has been made to provide diagnostic or treatment programmes for this age-group, despite an epidemic that is becoming increasingly obvious to anyone providing routine medical care in Southern or East Africa," says Dr Corbett.

It is important to recognise that these children may have already suffered terribly from the indirect effects of HIV, such as orphanhood, impoverishment and the psychological trauma of prolonged illness in parents and siblings, argues Dr Ferrand.

"Simply caring for these patients in existing services is not ideal because they have problems unique to their age-group and circumstances, over and above coping with their own illness," she says. "These include a lack of awareness of their own diagnosis, their emerging puberty and sexuality, caring for sick parents and coping with the social and economic consequences of orphanhood. Hence, provision of effective HIV care and treatment will require additional support and special services to deal with these problems."

The researchers believe that adolescents would benefit from earlier diagnosis of HIV status, help to parents or guardians who may be reluctant to tell the child what their problem is; adolescent-focused support to ensure adherence to treatment regimes; a focus on the chronic problems associated with HIV (such as short stature and delayed puberty) and the complications of antiretroviral therapy; and support for those undergoing puberty or who are sexually active, such as counselling on prevention of transmission and contraception, and disclosure to sexual partners.



Gender Awareness, Stepping Stone to HIV Prevention

By, Anirudha Alam, News from Bangladesh, March 12, 2007

The spread of HIV and STI is mounting in developing countries through gender inequality and taboos around sexuality. It results in discrimination and stigma associated with drastic poverty and marginalization. Leading to empowerment, happiness and well being, gender awareness can help to promote both rights to be free of violence and coercion around sexuality. Sexual rights, an inclusive framework, guide to have knowledge of the links between different sexuality issues thoroughly recognizing that campaign against sexual violence must continue.

The number of women living with HIV is mushrooming than the number of men through out the world. In 2004, the number of women (15+) living with HIV was 12.7 million in Sub-Saharan Africa. But the number was increased to 13.3 million in 2006. HIV epidemic is disproportionately affecting women of South Africa. Young women (15-24 years) are four times more likely to be infected by HIV than are young men in this region. Prevalence among young women was 17% compared with 4.4% among young men in 2005.

HIV/AIDS entrenches gender inequality, denial and as well as threats to basic human rights. The relationship between HIV, gender and sexuality may be intertwined as a vicious circle. Unfortunately this aftermath limits women’s access to reproductive health information, STI (Sexually Transmitted Infection) prevention technologies and treatment. There is no doubt that gender inequality makes women experience poverty and vulnerable to STIs gravely.

According to the findings of BEES (Bangladesh Extension Education Services), 95% of the rural adolescent girls in Bangladesh are vulnerable to STIs and ill health due to gender discrimination, sexual violence and lack of knowledge regarding reproductive health. They do not know how to protect themselves from HIV/AIDS. Rainbow Nari O Shishu Kallyan Foundation found that adolescent girls are two times more vulnerable to HIV and STD (Sexually Transmitted Disease) than the adolescent boys in urban areas of Bangladesh because of sexual harassment. In the name of so called gender equality, their reckless free mixing subculture is making them vulnerable significantly as well.

To curb the spread of HIV/AIDS, it is necessary to challenge the stigmatization and discrimination faced by women living with HIV/AIDS. Counting on collective action at all levels from community to national level, gender equality can strengthen the HIV and STI prevention through a coordinated action for establishing the right of safe sex. In 2005, half of the new HIV infections occurred due to unprotected sex in China. Moreover with HIV spreading successively from most-at-risk population to general population, the number of HIV infections among women is increasing fast.

In the developing countries, most of the women have very little or no knowledge about HIV transmission as well as risk before they are diagnosed HIV positive. Married women do not want to think that they may be at risk of infection. In Bangladesh, the women are induced by their family members to conceive. On the other hand, they feel under presser from healthcare workers to avoid conception. But in most cases, none of them provides necessary information clearly to help the vulnerable women conceive safely or to lessen risk of mother to child transmissions.

Involving women living with HIV, national social welfare organizations, community based organizations (CBOs), academies and policymakers, there may be a promising plan to develop advocacy strategies and extend counseling to women diagnosed in antenatal clinics. It will highlight the necessity to ameliorate the plight as for gendered response to the needs and desires of vulnerable women. Consequently it will be possible to build their life skills to enable them to work with field workers, researchers, monitors, evaluators, policymakers at all levels of program design and implementation, research, monitoring, evaluation and policymaking. Then it would be possible to keep HIV in bay effectively stamping out discrimination, stigmatization and sexual violence through gender awareness as a whole.


South Africa: The Risks in Hiding the HIV/Aids Truth

By, James Chin, Business Day (Johannesburg), March 12, 2007

MANY myths and misconceptions about the AIDS pandemic are spread by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and other mainstream AIDS agencies and activists, either unintentionally out of ignorance or intentionally by distortion or exaggeration, including fear of a generalised epidemic.

UNAIDS continues to perpetuate the fallacy that only aggressive HIV/AIDS prevention programmes -- especially directed at youth -- can prevent the eruption of heterosexual HIV epidemics where prevalence is currently low. However, more than two decades of observation and analysis point to far different conclusions -- there are no "next waves" of HIV epidemics just around the corner and the AIDS pandemic is now in its post-epidemic phase.

The highest HIV infection rates are found in many sub-Saharan African populations because up to 40% of adolescent and adult males and females in these populations routinely have multiple and concurrent sex partners, and they also have the highest prevalence of factors that can greatly facilitate sexual HIV transmission. In most other heterosexual populations, the patterns and frequency of sex-partner exchanges are not sufficient to sustain epidemic sexual HIV transmission.

UNAIDS and most AIDS activists reject this analysis as socially and politically incorrect, saying it further stigmatises groups such as injecting drug users (IDU), sex workers and male homosexuals (men who have sex with men -- MSM). But all available epidemiological data show that only the highest-risk sexual behaviour (multiple, concurrent and a high frequency of changing partners) drives HIV epidemics among heterosexuals or MSM, anywhere in the world.

Most AIDS activists claim, without any supporting data, that the high HIV prevalence in MSM and IDU groups will inevitably "bridge" over to the rest of the population and lead to "generalised" HIV epidemics. This myth persists even though there is little, if any, HIV spread into any "general" population except from infected IDU and MSM or bisexuals to their regular sex partners.

Without a constant flow of alarming news releases warning about HIV being on the brink of spreading into general populations, AIDS activists fear that the public and policy makers will not continue to give AIDS programmes the highest priority, hence these "glorious myths" -- lies told for a noble cause.

This alarmism goes against all the evidence. Global and regional HIV rates have remained stable or have been decreasing during the past decade (except possibly among drug users in eastern Europe). HIV has remained concentrated in groups with the riskiest behaviour. Several decades of experience support the conclusion that HIV is incapable of epidemic spread among the vast majority of heterosexuals.

Most of the public, policy makers and media have no inkling that the UNAIDS working assumption is inconsistent with established facts -- indeed, until last year, no major public health or international development agency had openly challenged this assumption.

Some cracks in this wall of silence began to appear last year, with the publication of several studies that questioned the UNAIDS view.

Since 2000, dozens of population-based HIV sero-surveys have forced UNAIDS to reduce its overestimates in most high-HIV-prevalence countries by about 50% or more: examples include Kenya's estimate in 2001 of 14% reduced to 6,7% and Haiti's 2001 estimate of 6,1% reduced to 2,2% last year.

Estimates of HIV prevalence in China have been decreasing, rather than increasing and the current estimate of more than 50-million HIV infections in India is likely to be cut by half or more as the result of recent, more accurate, studies.

This year, UNAIDS needs to come up with more realistic HIV estimates and projections, especially when more mainstream epidemiologists and the news media begin to question the basis of the UNAIDS assumption.

Continued denial of these realities will lead to further erosion of the credibility of UNAIDS and other mainstream AIDS agencies, raising the danger of people underestimating the real threats.

Regardless of my epidemiological disagreements with UNAIDS, I totally agree with mainstream AIDS experts who declare that this is no time to be complacent about strengthening HIV treatment and, above all, HIV prevention programmes. Although many countries have overestimated their numbers, there are now at least 20-million HIV-infected people in sub-Saharan Africa and several million in Asia and these numbers can be expected to remain close to these levels for a decade or more.

AIDS is a severe problem in sub-Saharan Africa and, to a lesser extent, in Caribbean countries and a few southeast Asian countries, as well as among MSM, IDU and sex workers throughout the world.

This means that scarce health resources in countries with low HIV prevalence should be targeted primarily at those who are at the highest HIV risk instead of being misdirected to the wider public.

We must cut through the overestimates of HIV prevalence and the exaggerated potential for generalised HIV epidemics so we can concentrate money and efforts on prevention and palliative care where it really matters.

--Chin, of the University of California at Berkeley, is a former chief of the surveillance, forecasting, and impact assessment unit of the Global Programme on AIDS of the World Health Organisation. His book, The AIDS Pandemic: the collision of epidemiology with political correctness, was published in January.


Monday, March 12, 2007

Sexual Rights: Critical To Reproductive Health

By, Population Action International, March 5, 2007

Integrating sexual rights into family planning and reproductive health programs is essential to ensuring that people have safe and healthy sexual lives, according to a new report issued by the World Health Organization. This confirms what many sexual and reproductive health and rights advocates have known for years: A comprehensive, rights-based approach to reproductive health that includes non-judgmental, culture and gender sensitive services is the most effective way to improve reproductive health around the world. For the sake of their citizens, international governments and policy leaders need to heed the advice of this report and include sexual rights as a key component of all family planning and reproductive health programs.

Sexual rights should not be controversial: They include the right to choose a partner, and engage in consensual sexual relations and consensual marriage. The report, Defining Sexual Health: Report of a Technical Consultation on Sexual Health, states that reproductive health programs “must be accessible, affordable, confidential, of high quality, and age- and culture-appropriate.” People deserve to have the information, services and supplies necessary to protect themselves from sexually transmitted infections and to choose the number and spacing of their children. Nothing is gained when information is withheld—as is the case in some so-called abstinence-only programs, where information about condom use is conspicuously absent.

The Sexual Rights Campaign in South Africa is getting it right. The program, highlighted by the report, encourages policy makers to integrate sexual rights into their work addressing HIV/AIDS, violence against women, and adolescent reproductive health. Their success will allow them to witness the power of sexual rights: By creating reproductive health programs that respect the sexual rights of all people, regardless of their sex, age or background individuals and families live longer, happier, healthier lives.

This report builds on the groundbreaking International Conference on Population and Development (ICPD), which defined reproductive rights as including “the right to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents.” But defining sexual rights is only the first step—it is political will that can make them a reality.


Yes, really: Get ready for AIDS, the video game

By, Ted Chen, The Michigan Daily, March 8, 2007

Your sexual health is about to get digital.

mtvU has teamed up with the Kaiser Family Foundation to challenge college students across the country to come up with concepts for a computer game promoting HIV prevention. Who needs pamphlets and hard science when you have an allegorical Mario to teach you how to protect yourself?

The game should be similar to "Darfur is Dying," the result of last year's Darfur Digital Activist Contest, also organized by mtvU. That game has understandably taken some flack for trivializing the ongoing crisis in Africa, but it purports merely to use a popular virtual medium to attract attention to its cause. Thus far it has been played more than two million times in six months.

Since AIDS has already claimed more than 25 million lives worldwide, expectations for this new game are much higher. And because HIV is a more immediately global issue than the tragedy in Darfur, an HIV prevention game may be more accessible to its target audience.

"Sexual health is (an issue) that so many young people are dealing with, and so many don't know that they're dealing with the issue of AIDS," said Stephen Friedman, general manager of mtvU.

AIDS awareness is already pervasive in documentaries, books and television, but Friedman said a fresh voice from an unlikely medium might make some kind of difference.

mtvU will accept concept ideas through March 16. The winning team will receive a $5,000 cash prize and can expect to see their concept fully developed by the end of the semester.


Circumcising HIV-infected men may spread virus

By, Jonathan Bor, The Baltimore Sun, March 9, 2007

Circumcising HIV-infected men to prevent them from spreading the virus to their female partners might have the opposite effect, according to preliminary results of a study in Uganda by the Johns Hopkins Bloomberg School of Public Health.

Scientists found that infected men who resumed sexual activity before their circumcision wounds healed were more likely to spread the virus than infected men who didn't have the surgery.

"This is a complicated situation ... but it seems that HIV-positive men initiating sex before wound healing is potentially dangerous for transmitting HIV," said Dr. Kevin M. De Cock, head of the World Health Organization's HIV/AIDS department.

The results of the research so far are not statistically significant, scientists noted. Also, they said the findings do nothing to discredit an earlier study that showed circumcising uninfected men reduced their chances of becoming infected by 50 percent to 60 percent.

Yet researchers said they must approach with caution the idea that circumcision could make sex between an infected man and his partner less risky. They spoke this week at a teleconference during an international meeting in Montreux, Switzerland.

Public health leaders from around the world are gathering there to consider the role that adult circumcision might play in the battle against AIDS, particularly in hard-hit southern Africa. The meeting is sponsored by the WHO and UNAIDS, a program of the United Nations.

Increasing numbers of adult men in Uganda and Swaziland have decided to have the surgical procedure since scientists announced in December that circumcision drastically reduced a man's chance of becoming infected.

In the second study, 70 infected men had healthy partners at the time of their circumcision. Among these couples, 11 men transmitted the virus to the women over the course of two years after their surgery.

A control group of 54 uncircumcised men showed better results: Only four of the women became infected.

"These numbers are very small, and they could have arisen by chance alone," said Dr. Maria J. Wawer, a professor at Bloomberg and the study's principal investigator. "It's impossible to draw a firm conclusion."

Moreover, the study also found that most of the circumcised men who infected their partners had resumed sex before their wounds healed, despite warnings.

De Cock said those men might have exposed their partners to virus lurking in surgical wounds or in tears that occur during intercourse.

Scientists say they believe that circumcision protects men from becoming infected, because the foreskin - removed during the surgical procedure - contains millions of cells targeted by the AIDS virus.

Similarly, they speculate that circumcising infected men could protect women by reducing their exposure to viral particles. Still, circumcising infected men would not completely protect women, because ejaculate also contains virus, the scientists said yesterday.

Despite enthusiasm over the potential of circumcision to curb the epidemic, public health officials say men must take precautions such as practicing abstinence or wearing condoms.

Dr. David Serwadda, principal investigator from the Rakai Health Sciences Program in Uganda, said circumcision will remain a powerful weapon against AIDS even if further analysis shows that circumcising infected men does not protect their partners.

"Eighty to 90 percent of sexually active men are negative," said Serwadda. "The importance of the trial in HIV-negative men still applies to the majority of men who are sexually active in Africa."


Risky Behaviors Fuels AIDS Epidemic in Low Prevalence Country

By Anirudha Alam, News from Bangladesh, March 8, 2007

HIV/AIDS is mounting in every country in the world. The people of Bangladesh are not very much conscious of their healthiness due to reason of illiteracy and poverty. Bangladesh where spread of HIV/AIDS is relatively slow nowadays has a window of opportunity to avoid more serious epidemics. Comprehensive access to HIV prevention, treatment, care and support in low prevalence countries should be ensured through strengthening integrated HIV/AIDS prevention programs and projects. In this regard, highlighting the priorities of an effective response to the epidemic, it is very much essential to take the exclusive scope to keep HIV at bay. It should be recognized that to scale up prevention, treatment, care and support is a vital right for all.

Encompassing enhanced access to inclusive treatment and prevention programs, significant developments have been found in recent years in global efforts to address the HIV/AIDS epidemic. But due to practicing risky behavior, the number of people living with HIV is increasing consecutively. Diminution of national HIV prevalence is being brought about in some sub-Saharan African countries, though this kind of trend is neither remarkable nor long-lasting satisfactorily.

If there is low prevalence of HIV in a country it does not indicate that HIV prevention is low priority. Comprehensive access to HIV prevention, treatment, care and support in low prevalence countries may be promoted through developing a holistic and integrated national strategy plan with far-seeing and pragmatic targets for being achieved by 2010. To contain the spread of HIV epidemic, innovative HIV/AIDS prevention activities have to be initiated complementing government efforts to orchestrate national strategic plan successfully through effective partnership as a whole.

Ensuring the involvement of civil society, NGOs, young groups, religious leader as well as people living with HIV, a potential national AIDS coordinating authority comes in for maintaining profound linkages between national strategic plans and such other relevant programs as tuberculosis, sexual transmitted infection, reproductive health, general health care and so on. There is no alternative to mobilize human resources through improved management and capacity building for all aspects of HIV and AIDS prevention.

Greater availability of injectable drugs, stigma and discrimination towards people infected or affected by HIV/AIDS, women trafficking, polygamy and early marriage may trigger epidemics on a large scale. Countries with low levels of HIV infection need sufficient funding, challenging and well-defined targets, and much-admired political and cultural commitment as well as community based well-planned social mobilization to strengthen support for national HIV/AIDS prevention programs. With an effective focus on prevention , enough financial and technical support have to be ensured to implement national strategic plans increasing significant participatory involvement in program design, implementation, advocacy and monitoring & evaluation.

In the context of developing countries, drug use is mostly a hidden subculture in the urban communities. According to the findings of “Bangladesh Extension Education Services” BEES, 85% young people addicted in injecting regularly are severely vulnerable to ill health, HIV/AIDS and Hepatitis-C in Bangladesh. Therefore a great urgency exists to ensure availability of health care services which protect young drug users from contracting blood-borne viruses all along the country. On the other hand, “Rainbow Nari O Shishu Kallyan Foundation” estimated that Sexually Transmitted Diseases (STDs) and HIV/AIDS prevalence among adolescent girls involved in such risky behavior as using drugs is higher than 60% in urban and suburban areas of Bangladesh. They must have access to health and social care services which provide support to change their high risk behavior and reduce the vulnerability caused by transmission of STDs/STIs and HIV/AIDS.

Injecting drug use, unprotected paid sex as well as unprotected sex between men considered as the centrality of high-risk behavior are fueling the skyrocketing spread of HIV/AIDS in Asia, Eastern Europe and Latin America. Two in three (67%) prevalent HIV infections in 2005 were caused by drug abuse in central Asia and Eastern Europe. Near about 13% of HIV infections was due to use of non-sterile injecting drug use equipment among sex workers and their clients in the same countries. So the countries with low levels of HIV infections have to improve surveillance systems that they may better understand the factors identifying obstacles and opportunities for scaling up national HIV prevention, treatment, care and support efforts.

Program helps girls avoid HIV

By, Bob Lamendola, Bradenton Herald, March 11, 2007

Fort Lauderdale - There were no balloons or cigars for one birth at Plantation General Hospital last week. The mother is 14. The father is in his late 20s and not around. He gave the girl HIV, and she may have passed it to her baby.

An uncommon tragedy, but health officials said teens contracting HIV/AIDS through unprotected sex with older men and sexual abuse has become a persistent problem, especially in South Florida.

The men want underage partners, health officials said, while the teens - usually girls but also some boys - are drawn in by the attention, thrills or material things the men offer. Few men get caught and fewer get prosecuted, officials said, because teens seldom file charges against them.

"It's a tragedy," said Dr. Ana Puga, an HIV/AIDS specialist at the Children's Diagnostic and Treatment Center in Fort Lauderdale who will be treating the Plantation girl. "These guys take advantage of a child's mind and they get away with it. We had a girl 13 infected by a man who was 52."

Alarming statistics

At least 776 Florida teens ages 13 to 17 have been infected with the virus since mid-1997, about 2 percent of the statewide total of 37,250. About half of the teens come from South Florida, state figures show.

That doesn't count 809 Florida teens 13 to 19 living with AIDS - 5,000 nationally - the lion's share of whom inherited the virus from their mothers.

Teen infections took center stage Saturday for National Women and Girls HIV/AIDS Awareness Day, highlighted by a workshop open to the public focusing on showing females how to protect themselves better.

Looking for love

Men prowl for teens at malls, fast food restaurants, movie theaters, skating rinks, school events, street corners, flea markets, online and on telephone chat lines, health officials said.

Some teens can be talked into sex in return for cell phones, hair styling, jewelry, clothes, drugs or cash, said Katrina, 18, who got HIV at age 15 from a boyfriend in his 20s. She spoke on the condition that her full name not be used.

"She says, 'I'm waiting for you to give me money,' " Katrina said. "They want what they see everyone else has. Some young girls, they don't have love at home. They look for the guys to show them love. She's willing to lay down with that person. While she's laying down with him, she thinks, 'He loves me.' "

No one tracks how many teen cases were caused by adults, but health experts note a national report in the 1990s that found men older than 25 fathered twice as many teen pregnancies as teen boys.

The picture has grown more hopeful for newborns. The number of Florida babies born with HIV has plunged 83 percent since 1992, thanks to drugs that prevent mothers from passing it via the womb. But at least three-fourths of Florida teens with HIV were infected through unsafe sex, 80 percent of them girls involved with males, state figures show. Many girls - and young women - do not feel the need or the strength to demand that their partners use condoms, HIV counselors say.

"They don't know how to negotiate safer sex because of lack of self-esteem, lack of education," said Yolette Bonnet, director of the Comprehensive AIDS Program of Palm Beach County. "They want to get their hair done and the guy on the corner has money."

Said Katrina: "They feel, 'That's my boyfriend, why should we use a condom?' "

Some girls may engage in risky sex to rebel, to shock friends or to get attention, said Stephanie Moreau, a program manager for the CAP in Delray Beach.

Adult males who prey on teens may be pedophiles, or looking for someone free of disease or someone they can dominate, counselors said.

Men viewed as boyfriends

A few men get arrested under state laws that make it illegal to have sex with children younger than 16 or family members younger than 18.

In 2004, Miramar police busted Cosme Caballero, 32, in a van for having sex with a girl of 15. He didn't tell her he was HIV-positive and infected her, a prosecution report shows. He pleaded no contest to sexual battery and criminal transmission of the virus and was sentenced to 25 years in state prison. Florida forbids people with HIV to have sex unless they disclose their status.

But such cases are rare. Often, the teen views the man as a boyfriend and doesn't want to get him in trouble by filing charges, prosecutors said. Officials cannot test a suspect's DNA without probable cause, said Lanna Belohlavek, supervisor of crimes against children for the Palm Beach County state attorney.

"Sometimes they just want to move forward," said Vanice Rolle, an HIV/AIDS specialist at the Broward County Health Department.

In Palm Beach County, agencies will soon start a nationally recognized program called All-Stars that targets girls 11 to 14. It aims to prevent substance abuse, violence and sex by stressing self-esteem, ambitions, parental involvement, personal commitment and thinking about consequences before acting, said organizer Doris Carroll, of the Palm Beach County Substance Abuse Coalition.


Friday, March 09, 2007

The pros and cons of snipping

By, IRIN PlusNews, February 21, 2007

Angola - Friends Paula and Marta giggle at the suggestion of having sex with an uncircumcised man; both say they have only tried it once.

"That little piece of skin, it hurts," said Marta, 28, a domestic worker in the Angolan capital, Luanda. "No-one warned me that it was painful for the woman - I wouldn't want to do it again."

PlusNews spoke to about a dozen Angolan women, most of whom said they would prefer a circumcised man as a sexual partner. Their reasons included perceptions of greater hygiene, virility and a more pleasing aesthetic.

The small casual survey reflects a reality in Angola, where around 90 percent of men are circumcised, according to Americo Kwononoka, director of the country's National Museum of Anthropology.

In most ethnic groups, especially in rural areas, the removal of some or all of the foreskin is a procedure associated with entering manhood, and normally takes place when a boy is aged between 12 and 14.

"The process usually starts with a party, then the candidates are taken away from the community to a camp," Kwononoka explained. "The prepuce is cut in cold blood, without anaesthetic." Circumcision is also widely practiced in urban areas, although it not steeped in as much ritual and symbolism.

Low HIV, high male circumcision

Recent data indicates that circumcision correlates with a significantly reduced risk of HIV transmission during heterosexual intercourse, but this is still the subject of ongoing research and debate in the medical community.

Official 2004 statistics, based on tests conducted on 12,440 pregnant women in Angola, put the overall HIV prevalence at 2.8 percent - low in a region where several countries have infection levels above 20 percent.

"If it is true that almost all men are circumcised in Angola, it would suggest that circumcision acts as a buffer against infection and slows down the spread of the epidemic," said Daniel Halperin, an AIDS researcher.

"However, if this pattern of nearly universal male circumcision were to change, given the level of risky sexual behaviour in Angola, the epidemic could explode," he commented.

Having multiple partners is the norm in Angola. Marta's boyfriend of five years also has another girlfriend, with whom he lives and has a child. Marta, who also has a child from a previous relationship, wants to move out of her mother's home so that she and her boyfriend can live together.

Her colleague, Paula, 34, and the mother of five, has been seeing her boyfriend, who is also married, for four months. "It's normal here for a man to have several wives. Sometimes they have three or four wives and they usually split their time between each home," she said. "But I always use a condom with my boyfriend."

Not the full story?

Ana Leitao, of the World Bank's HIV/AIDS, Malaria and TB Control project (HAMSET), said it was too soon to assess the impact of widespread circumcision on HIV prevalence in Angola; national statistics have been heavily contested and many believe the rate is significantly higher than the figures portray.

Even if they are correct, other factors could also have contributed to lower rates: the country's borders were largely closed during the 27-year civil war that finally ended in 2002.

But in southern Cunene Province, where the majority ethnic group in the area, the Kwanyama, do not traditionally practice circumcision, statistics show HIV prevalence at 9.1 percent, significantly higher than the national average.

This could be one reason for the higher rate, but it may not be the full story. "Remember that Cunene shares a border with Namibia, where the rate is very high, and there is a lot of movement between the two countries," said Leitao. "There may also be specific reasons why HIV is so much more prevalent in Namibia than in Cunene, or maybe we don't know the real rate of infection in Cunene - it could be a lot higher."

There are also fears that some might mistakenly believe circumcision alone will protect them against HIV, and could see it as an alternative to condom use.

Experts say the introduction of any policy encouraging circumcision would have to be included as part of a broader package to help slow down the spread of the virus. "Angola has an opportunity not to make the same mistakes as other countries [by controlling the epidemic]," said Halperin. "Angola should concentrate on prevention among sex workers, truck drivers and other high-risk groups, and on sexual partner reduction among youth."

Other risks besides HIV

There are risks associated with traditional male circumcision: complications resulting from poorly conducted procedures, post-operative bleeding and infection can have catastrophic and sometimes fatal consequences because circumcisions are not always carried out in bona fide hospitals or clinics.

The health structure is still in tatters five years after the war's end and many circumcisions are carried out by a traditional doctor or elder rather than a qualified medical practitioner. "In most cases, instruments aren't sterilised, people don't necessarily have the training to carry out the procedure, and sometimes several people are circumcised in one session," said Leitao.

While other countries in the region are seriously weighing a national policy on circumcision, in view of Angola's pressing need to improve basic public health services, such a decision could be premature.



KENYA: Circumcision demand increases, but guidance crucial

By, IRIN PlusNews, Febraury 23, 2007

Requests for male circumcision have tripled in western Kenya since studies found the procedure reduces the risk of contracting HIV by more than half.

The people of Nyanza Province do not traditionally practice circumcision. But Dr Reuben Okioma, a physician at New Nyanza Provincial District Hospital told PlusNews there had been a three-fold increase in requests for the procedure since the study results were released in December 2006.

"The results of this study are definitely challenging the traditional views of the community," he said, adding that male circumcision was a simple procedure, requiring only a local anaesthetic and a check up three days later.

Hospitals in the region have so far been able to meet the increased demand, but Okioma noted that many more men would request the procedure if the 500 Kenya shillings (US$7) the hospital charged for it were scrapped.

Two clinical trials in Kenya and Uganda were halted in December after an interim review of the data revealed that circumcision reduced a man's risk of acquiring HIV from heterosexual intercourse by about 50 percent. The National Institute of Allergy and Infectious Diseases in the United States, part of the National Institutes of Health, which sponsored the trials, decided it would be unethical to continue with them.

The Kenyan trial recruited almost 3,000 HIV-negative men from Kisumu, in western Kenya, and showed a 53 percent reduction in HIV infections among those who were circumcised. A similar trial in the Rakai District of central Uganda found a reduction in HIV acquisition of 48 percent in the circumcised men.

British medical journal The Lancet on Friday published a final evaluation of data that combined results of these two trials with an earlier trial in South Africa. Researchers concluded that circumcision could actually reduce a man's risk by as much as 65 percent.

Kevin De Cock, director of the World Health Organisation (WHO) HIV/AIDS Department today welcomed the findings, describing them as "a very important contribution to HIV prevention science."

But questions remain about the viability of male circumcision as a national HIV prevention tool.

Dr Kawango Agot, coordinator of the Kenyan trial, told PlusNews that health practitioners were awaiting guidance from the WHO before deciding on a course of action.

The WHO has scheduled an international consultation to discuss the policy, operational and ethical issues surrounding male circumcision for early March.

Agot predicted that more training would be needed before health centres in Kenya could handle a greatly increased demand for male circumcision.

Information about the protective effects of circumcision would also need to be packaged differently for those communities that already practiced it as part of a traditional rite of passage. With the support of local leaders, communities such as the Samburu, in northwestern Kenya, have already been introduced to the "one man, one knife" system.

Okioma believes that traditional surgeons, already accustomed to performing circumcisions, could help meet the demand providing they received training on how to perform the procedure safely.

Agot emphasised the need for people to understand that despite its benefits, circumcision was not a guarantee of protection from HIV. Abstinence and condom use would need to remain the mainstays of AIDS prevention campaigns, she said.

Another report published in The Lancet echoed some of Agot's concerns. "The global experience with access to antiretroviral drugs shows that strong science alone does not result in rapid, widespread rollout," wrote the authors, who went on to list 13 challenges and opportunities relating to implementing male circumcision as a prevention strategy.

Challenges included the need to communicate the relative benefits of the procedure as well as the small but significant risks. Finding sufficient qualified personnel to perform the procedure in the context of the region's already overburdened health systems was cited as another significant challenge.

The authors also recommended that circumcision form just one component of a "combination prevention strategy.




Friday, March 02, 2007

No glove, no love - young women take charge of condom use

By, IRIN PlusNews, March 1, 2007

Nairobi - Kenyan women are taking control of their sex lives, with recent research showing that more than 70 percent of young women use condoms to prevent pregnancy, HIV/AIDS and other sexually transmitted infections.

In a departure from the traditionally passive role of women in sexual matters, an increasing number of young women were now insisting on "no condom, no sex" to lower the risk of infection, according to a study conducted by research group Infotrak Research & Consulting, in conjunction with a local young women's magazine, 'Eve Girl'.

A total of 2,400 young women between the ages of 18 and 25 in Kenya's eight provinces were interviewed as part of the 'Sex Track' study, and the results showed that only 24 percent did not use condoms during intercourse, while 54 percent used them "persistently".

According to the government, the remarkable increase in the number of young women using condoms is no accident.

"The incorporation of HIV/AIDS in the primary and secondary school curricula since 2002 has had a positive impact," Alice Natecho, communications officer with the National AIDS Control Council, told PlusNews. "It has helped to break the silence over the pandemic, resulting in a dramatic rise in condom use among young women."

The ministry of health has made condoms easily accessible in its condom distribution programme, Decentralised AIDS and Research Health (DARE), sponsored by the World Bank, which has dramatically increased the number of condoms in circulation and contributed to their becoming more acceptable.

"Distribution figures showed a strong gain in the number of condoms being demanded: 50 million in 2002, 80 million in 2003 and 110 [million] in 2004," the ministry said in a December 2005 report.

"If trends continue, the next three-year procurement plan [2005-2007] should be for at least 500 million condoms. This figure does not include the 150 million condoms sold per year."

Allan Abong'o, one of the study's authors, said the high cost and side-effects of alternative contraceptives, such as pills and injections, coupled with the fact that they do not protect one from sexually transmitted infections, made the condom more appealing to young women.

Catherine Wanjiku, 22, a waitress at a popular restaurant in the capital, Nairobi, attributed the jump in the number of young women who insisted on condoms to vigorous AIDS campaigns featuring popular young musicians and television stars who encourage people always to carry condoms.

"You can't ignore the disease when the painting is on the wall. The information is all over about risky sexual behaviour: radio, TV, newspapers, billboards, posters and peers remind you of the imminent danger," Wanjiku said.

The cultural barriers that once prevented young women from taking control of their sex lives were falling before the onslaught of HIV/AIDS. "When you are out on a hot date, handbags store many secrets, among them condoms," she commented. "Aware of the temptation to engage in risky sex, young women would rather carry condoms when they are going to meet their boyfriends."

Livingstone Ruhuni, a young man in the Kenyan capital, agreed: "It is difficult to date a woman if you are not prepared to wear a condom."

Hold the applause

Despite these positive trends, the Infotrack survey also revealed some less-than-rosy statistics: most of the sample population said they had lost their virginity before the age of 16 and, despite high condom use during initial sexual encounters, young women tended to lose their guard subsequently, resulting in sexually transmitted infections or pregnancy, a trend that highlighted the need for more education.

More disturbingly, just 33 percent of the women interviewed admitted ever going for an HIV test. The low numbers could be attributed to the scarcity of voluntary counselling and testing centres in several parts of the country: only nine percent of respondents in the poor, semi-arid Eastern Province had taken an HIV test, compared with the better resourced Nairobi and Rift Valley provinces, where the figure rose to 25 percent.

Many also feared the stigma and discrimination they would face if they were HIV-positive, and just 31 percent discussed sexual matters with members of their families, a sign that the cultural barriers preventing women from discussing sex openly were still in place.

"The high percentage of women who fear HIV tests calls for mobilisation of the uninfected younger generation to determine their sero-status to protect them against risky sexual behaviour," said Infotrack's Abong'o.

NACC's Natecho said logistical issues, such as transport and inadequate storage, and conflicts among leading donors on strategies to fight the pandemic had also delayed the distribution of condoms across the country.

Kenya has a national HIV prevalence of 5.9 percent, but the infection level in young women is 7.7 percent, and they are almost twice as likely to be infected with the virus than their male counterparts.