God, AIDS, Africa & HOPE

Reflections / Gedanken

09.09.2009 a new arrest in Germany

A 49-year-old man is arrested in Germany for having sex without a condom with two women. It is alleged that the man did not disclose his status before having intercourse. I must say that the German tabloids are at their best when it comes to such stories. First the German singer, arrested with lots of publicity – and now the next case.

I must say that I don’t agree with the basics of such cases. If consent adults have a sexual relationship or a sexual affair both parties are responsible to negotiate safe or unsafe sex. It cannot be that only one of the two takes the full blame and consequently legal punishment while the others are portrait as pure victim. My sense of justice and fairness does not agree.

I do agree that there must be consequences when somebody lies in knowledge of his or her HIV infection when asked before having sex or he or she is not insisting on condom to prevent infection.

For the prevention work of HIV and the quest to de-stigmatise the infection, those cases are a nightmare – and they are handled in a fashion which basically adds to stigmatization and will produce at the end less testing and more infections. The criminal code is not a good tool to prevent infections or combat HIV and AIDS.

Filed under: General, HIV and AIDS, HIV Prevention, Politics and Society, , , , , , , , , ,

24.09.2009 HIV & vaccine

An experimental HIV vaccine has for the first time cut the risk of infection, researchers say.

Half of the volunteers were given the vaccine, while the other half were given a placebo – and all were given counselling on HIV/Aids prevention.

The vaccine – a combination of two earlier experimental vaccines – was given to 16,000 people in Thailand, in the largest ever such vaccine trial. Researchers found that it reduced by nearly a third the risk of contracting HIV, the virus that leads to Aids. It has been hailed as a significant, scientific breakthrough, but a global vaccine is still some way off. The study was carried out by the US army and the Thai government over seven years on volunteers – all HIV-negative men and women aged between 18 and 30 – in parts of Thailand. The vaccine was a combination of two older vaccines that on their own had not cut infection rates. Participants were tested for HIV infection every six months for three years.

The results found that the chances of catching HIV were 31.2% less for those who had taken the vaccine – with 74 people who did not get the vaccine infected and 51 of the vaccinated group infected. The vaccine is based on B and E strains of HIV that most commonly circulate in Thailand not the C strain which predominates in Africa. “This result is tantalisingly encouraging. The numbers are small and the difference may have been due to chance, but this finding is the first positive news in the Aids vaccine field for a decade,” said Dr Richard Horton, editor of the Lancet medical journal. “We should be cautious, but hopeful. The discovery needs urgent replication and investigation.” Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases said: “For the first time, an investigational HIV vaccine has demonstrated some ability to prevent HIV infection among vaccinated individuals. “Additional research is needed to better understand how this vaccine regimen reduced the risk of HIV infection, but this is certainly an encouraging advance for the HIV vaccine field. The findings were hailed by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/Aids (UN/Aids). They said while the results were “characterised as modestly protective… [they] have instilled new hope in the HIV vaccine research field”. Some 33 million people around the world have HIV.
Story from BBC NEWS: http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/8272113.stm

Encouraging news indeed but also we have to be careful: too often first results did not bring further good news when it came to vaccines in this field. A vaccine is still far away and 31% is not the world. It is a first step in a whole set of steps to understand the dynamics of a possible vaccine solution.  So it is exciting news but we should wait and see the next steps to be sure that we are on the right track. I know I sound pessimistic, but I guess, I would describe it rather as careful. Too much hope produces too much frustration afterwards. Lets stay realistic. laude the researchers and encourage them not to give up the hope of finding a vaccine, be it preventative or therapeutic. Both is needed in our days.

Filed under: HIV and AIDS, HIV Prevention, Medical and Research, ,

21.09.2009 Stop pre-test counselling

After writing about the mandatory testing law to be introduced by our MEC of Health next year – at least that is his plan – I reflected more on it and I came to the conclusion, that mandatory testing indeed once again would medically stigmatize people.  Patients are entitled to refuse examinations and treatment options – and that also goes in my humble opinion for HIV and AIDS.  When I go to a doctor and he recommends a full blood test it is on me to say “yes” or “no” – if I am diagnosed with cancer it is on me whether I chose a treatment option or I let the cancer have its way without any further treatment. So I would suggest to include a HIV test into the normal full blood test, but with a clear “opt out” option.

And consequently  I would do away with the pre-test-counselling. I think it is rather a nice way of keeping thousands of people voluntarily or with low pay busy, but it once again segregates this virus. No one is counseled according to a book when he or she might have cancer or any other disease. It is done after a proper diagnose has been done – and that is how we should also treat the patient, who get’s a positive result.  I strongly believe that with all the – very often very unprofessional counseling – we scare people away and make the situation more complicated than it is necessary. Again, if somebody wants to have more information before a test – so it be like with every other test; but not more and not less. Let’s start to de-stigmatise HIV first in the medical field…

Filed under: HIV and AIDS, HIV Prevention, HIV Treatment, Medical and Research, Reflection, , , , , , , , , , ,

20.09.2009 Beyond the condoms…

Having written a blog entry about the criminalization of  HIV and seeing the response so far, I just realise that there are quite some moral and ethical issues we still have to deal with in the fields of HIV and AIDS. One is used to hear only about the condom story when talking about or talking with the Catholic Church, but there are more things coming to my mind:
– Equality of man and women
– Criminal Code and HIV
– Travel restrictions or travel ban and human rights
– Commencement and possible cessation of treatment
– Dealing of the Catholic Church (or any church) with their own clergy being positive
– Understanding of sexuality in the context of Europe, Africa and Asia as well as Latin America
– Abstinence only or diverse approach towards prevention work

I wish I could convince the German and the Southern African Bishops Conference to set up a study group on all these issues and surely a couple of more questions, which will come up in a brainstorming session. It would make such a difference.

Filed under: HIV and AIDS, HIV Prevention, HIV Treatment, Medical and Research, Politics and Society, Reflection, , , , , , , , , , , , , , , , , ,

20.09.2009 Mandatory testing

Mandatory HIV testing ‘violates their rights’
(IOL website 19.09.09)

Mandatory testing for HIV would violate the rights of people, the SA Human Rights Commission said on Friday. This comes after provincial Health MEC Theuns Botha announced plans to introduce legislation in the Western Cape to have every patient at every health facility tested for the virus. Botha says the move is the final onslaught in the fight against the disease.
Currently 200 000 people in the Western Cape are estimated to be HIV-positive and 63 000 are on ARV treatment. Botha has started the ball rolling to draw up legislation which he anticipates will be ready by next March. He said the legislation was necessary as people had “avoidance” behaviour and chose to not be tested.
Dr Mark Heywood, of the Aids Law Project, agrees with the rights commission. The Treatment Action Campaign was divided on the issue, spokesperson Rebecca Hodes said. Steven Ngobeni, the national HIV and Aids health rights co-ordinator for the commission, said yesterday mandatory testing “does not make sense”. People, he said, often did not know their rights, counselling at voluntary testing centres was not up to scratch and universal access to treatment was not readily available.  Both Ngobeni and Heywood said the provincial government would make a greater impact by educating people about HIV and testing.  Heywood said: “There is no way that you could justify a law to introduce mandatory testing.” It was also wrong from a public health and HIV management perspective.  “I would suggest a public campaign to get people to go for testing. Right now people are avoiding being tested as there is too little information and routine offerings are haphazard.”  He said a law would not work. “People will still be scared of a diagnosis and they could in fact completely avoid health care facilities.”  The TAC’s Hodes said mandatory testing in Botswana had been successful but it had been rolled out as part of a broader ARV treatment campaign.
“Some say mandatory testing will increase stigma, others say it will destigmatise the disease. But if testing becomes mandatory there should be proper support,” she said.  Botha said on Friday it was a two-pronged approach – testing as well as getting people into treatment sooner.   “We would introduce people much earlier into a treatment programme,” he said.

An interesting article and I would like to add: We have to make HIV testing as normal as any other testing. Which would mean in a first step to remove all “extra doors & extra benches” for HIV testing, counseling, treatment and so on..” I even think we can stop the pretest counseling. Like any other diseases we have to advise after a diagnose and not before. If somebody has cancer, we also do not put him or her through a lengthy intimate process before he or she is allowed to have a result.

Being HIV positive is a medical condition in this frameset, let’s treat it as such.

Filed under: HIV Prevention, HIV Treatment, Politics and Society, Society and living environment, , , , , , , , , ,

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