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Archive for the ‘HIV/AIDS’ Category

By Benjamin Castro

Condoms cannot cure Africa. They should not be at the forefront of HIV/AIDS prevention programs, nor should they be considered a top-priority.

These statements stand diametrically opposed to accepted conventional prevention strategies proposed by western nations. Many organizations, UNAids for instance, state that condoms should be at the vanguard of the continental struggle to prevent HIV/AIDS in Africa. Anything contrary to this statement is often labeled as ignorant, misguided, or a product of ultra-right wing radicalism, often religious. In a word, anti-scientific. However, Dr. Edward Green, who served as the director of  the AIDS Prevention Project at Harvard University as well as a member of the Presidential Advisory Council on HIV/AIDS (amongst many other positions), would agree with those statements. He provocatively states that condom use, while managing marginal amounts of risk in preventing HIV/AIDS, does not at all address the risky behavior which ought be the focus of prevention strategies. (more…)

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By Melanie Kirsh

HIV is often thought of as a global health issue that disproportionately affects people of color, regardless of income. This may be a result of inaccessibility to HIV education and effective interventions, or of the negative social factors that contribute to higher likelihood of unsafe sexual practices within the population. ABC programs (abstinence, being faithful, and condom use) were rolled out in sub-Saharan Africa in the 1990s; in Uganda, these programs resulted in significant declines in HIV prevalence. Despite this success, other sub-Saharan African countries’ HIV continues to affect women at disproportionate rates. In her book, Love, Money, & HIV: Becoming a Modern African Women in the Age of AIDS (2014) Sanyu A. Mojola illuminates the socioeconomic and environmental factors that may explain why her home province of Nyanza, Kenya demonstrates rates of HIV/AIDS that are much greater among young, wealthier women in comparison to men of the same age group and poorer women. She argues that the engagement in modern consumption and their perceived need to consume items like makeup, clothing, and feminine hygiene products contribute to their increased vulnerability to contracting the virus. In order to purchase these items, they need money, but since they are much less likely to be employed or receive substantial financial support from their families, they rely on relationships with men (Mojola 2014). Intimate heterosexual relations become complicated with social norms in regards to condom use: even though youth are taught about condom use, their behaviors do not reflect this education. Mojola’s male subjects believe that condoms may be uncomfortable or may (falsely) indicate that the woman is sleeping with other people (2014). This stigma, in combination with concurrency that men practice around the Lake Victoria region, results in the women’s increased risk of contracting HIV. Due to the quotidian nature of female hygiene product consumption, and the implicit need to aspire to European beauty standards with makeup and clothing that impresses their peers, women engage in transactional relationships that expose them to HIV/AIDS. In short, modernity is killing them.

I had the pleasure of meeting Mojola recently, as her book was assigned for a seminar of mine called Contemporary Debates on Sexualities Research. The professor pooled questions from the class prior to Mojola’s arrival, and one of my questions regarded my intrigue with her book’s lack of discussion on Pre-Exposure Prophylaxis (PrEP) as an alternative preventative measure for the young women. Mojola expressed skepticism about the effectiveness of such an initiative, because PrEP requires the person at-risk to follow a diligent schedule, with 100% compliancy, and this is extremely difficult to achieve –especially in a setting like sub-Saharan Africa where resources are already limited and sexual education programs are insufficient. A PrEP study conducted in Kenya, South Africa, and Tanzania from 2009-2011 confirms this, as the study was halted due to female participants’ weak adherence and the poor efficacy that resulted (Damme et al. 2012). Mojola explains that in order for women to be compliant, they need to perceive themselves as ‘at-risk’ in the first place. However, these women do not think they are at risk of contracting HIV because of the perception that sex without a condom signifies the man is not having sex with other women. So, the cycle begins again and preventative measures are tainted with the conflation of trust = love = sex without a condom.

Evidently, the typical ABC programming that advocates for seemingly practical behavior changes has failed the young women of Mojola’s native country. Not all young people abstain from sexual activity, faithfulness is challenged by the concurrency and polygamy in which men and women engage, and condoms increases false suspicion that one’s partner is not faithful or trusting. Given Mojola’s findings and skepticism of alternative preventative initiatives, it is clear that eliminating the HIV epidemic among young women (particularly those in Nyanza, Kenya) would involve a complicated untangling of modern Westernized feminine beauty ideals, deconstruction of gendered economies that disadvantage young women and girls, and increasing access to menstrual products (this would keep girls in school and encourage economic autonomy). It is time to introduce and implement a redefined ABC programming that goes beyond education. It looks like this:

HIV Poster

Of course, this involves a major overhaul of the socioeconomic structures in Kenya and other sub-Saharan African countries. But, Mojola’s work provides us with the understanding that women’s current economic position in conjunction with the initial results of ABC campaigns is killing them. Such an economic overhaul is long overdue.

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By Michelle Leon

Although many may argue that women’s rights have made significant improvements and has led to a more equal society, I think people often ignore populations across the globe that are still behind in women equality. And when specifically looking at populations at risk for HIV, women are at higher risk than men. And I think the most important factor for women’s HIV risk across the globe is women subordination to men that is still seen today. And it doesn’t just occur when contracting HIV but subordination also affects women’s chance to treat HIV.

I came across a NY Times article speaking about a new vaginal ring that will reduce HIV rates in African Women. According to Denise Grady, this new vaginal ring slowly releases an antiviral drug (dapivirine) thus protecting women from HIV sexual transmission 1. Studies on African women and this vaginal ring resulted in a 27% reduction in infection rates 1. The ring can stay in the vagina for a month and it is cheap. But while I read these results I could only help but wonder why such a device is needed. In the United States, contraceptives and condoms are so prevalent and accessible that I couldn’t understand why such a device was necessary. And then I thought… women in parts of the world don’t have access to contraceptives and can’t protect themselves from sexual transmission of HIV.

Of the 37 million people who are infected with HIV, half of them are women, and most are from the sub-Saharan region of Africa 1. The reason this vaginal ring is important is because men don’t have to find out that women are using it. With this ring, women do not need to ask for permission or ask their partners to wear a condom and even when men deny women the ability to take contraceptive pills, the ring helps protect them from HIV transmission. Additionally, once placed inside, neither she nor her partner will feel it, preventing the possibility it might disturb the sexual experience 1. But such a ring would be irrelevant in a world where women were equal to men in various aspects of life. But the reality is that, women suppression is still common today and I think it is the driving force for why women are at higher risk for HIV. There are various reasons why women subordination leads to higher rates of HIV infection and decreases their rates of survival for those living with the disease.

First off, marital violence and gender-based violence prevent women from protecting themselves from sexual transmission 2. In a study conducted in South Africa, women who experienced partner violence were 50% more likely to get infected with HIV than those who do not experience such violence 3. Secondly, women in countries with high rates of HIV (e.g. sub-Sahara Africa) have less access to healthcare services or have none 2. Lack of access to sexual health services indicates that women have less ability to look out for their health and even when women have access to some services, stigma against women can result in refusal. Consequently, when pregnant, women infected with HIV may not receive the appropriate care to reduce transmission to her child. And lastly, girls’ lack of access to education also drives their higher rates of HIV infection. According to UN’s 2004 publication on women and HIV/AIDS, one study of 32 countries found that women who had some secondary education were five times more likely than illiterate women to have knowledge of HIV 4. Additionally, illiterate women were four times more likely to believe that HIV could not be prevented.

So as you can tell by now, most of these factors that increase women’s risk for HIV infection, are intertwined with women suppression. And I think that is what needs to be addressed and be top priority in developing countries and regions of the world that continue to have high rates of HIV. Women suppression needs to be dealt with through education and spread of knowledge. Women in countries known to have women subordination need better HIV testing, better antiretroviral treatment for pregnant women, better school-based interventions to reduce stigma against women and help change cultural norms about the role of women.

 

 

 

References

 

1 Grady, D. (2016, February 22). Vaginal Ring With Drug Lowers H.I.V. Rates in African Women. Retrieved February 26, 2016, from http://www.nytimes.com/2016/02/23/health/vaginal-ring-hiv-aids-drug-dapivirine.html

 

2 Women and HIV/AIDS | AVERT. (n.d.). Retrieved February 26, 2016, from http://www.avert.org/professionals/hiv-social-issues/key-affected-populations/women

 

3 Jewkes, R. et al (2010) ‘Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study‘ The Lancet 376(9734):41-48

 

4 United Nations Population Fund (UNFPA) (2004) ‘Women and HIV/AIDS: Confronting the Crisis

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By Michael  Manni

HIV, even with the advanced ARV treatments and medical care available in the United States, is one of the greatest fears of any sexually active man who has sex with other men. The perceived risk of negative side-effect from sexual behaviors or actions among MSMs (men who have sex with men) is a very complex issue. In my experience as a gay man, I know that not all men fulfill the stereotypical role of a sexually immoral deviant featured in many instances of popular culture involving a mix of alcohol, drugs, and unprotected sex. That being said, the gay hookup scene is very real, and there are many outlets to facilitate high risk sexual behaviors between MSMs, including phone applications like Grindr and Tinder; lots of men have sex in loosely planned encounters, often involving drugs and alcohol, and very often involving misuse or lack of protective measures.

As most people know, condoms (the most popular form of protection) do not typically enhance the pleasure of sex for those wearing them, so having an option that provides protection as well as pleasure would be amazing, especially if this protection is shown in studies to be extremely effective in the prevention of HIV. A highly promising new option for protection against HIV did become available in 2012 in the form of Truvada, a pre-exposure prophylaxis (PrEP for short) effective in preventing contraction of HIV. PrEP is a daily medication regiment intended for those who are at risk of contracting HIV, a population which in the United States consists mainly of MSMs and specifically self-identified gay and bisexual men. Truvada as PrEP has been shown to be extremely effective, virtually eliminating the risk of contracting HIV in a sexual encounter, even when other forms of protection are not used. This is exciting news for men who engage in sex with other men, as well as national and global public health organizations who are trying to fight the spread of HIV.

Truvada Pill Bottle

While it is true that Truvada is helping many gay communities (such as San Francisco) stop the spread of HIV, these communities are also noticing unexpected health impacts of a barrier-less form of HIV prevention. PrEP only prevents HIV and not other sexually transmitted infections, so individuals on PrEP are still instructed to use condoms to protect against other STIs, like syphilis and gonorrhea. However, the perceived risk of these STIs is not as great as the perceived risk of HIV; gonorrhea, syphilis, and chlamydia are rarely fatal conditions and typically consist of a run to the clinic and a course of medication if contracted. Of course, no one wants any of these diseases and the costs of treatment can be a great burden on the healthcare system, but the possible risk on an individual level (in terms of experiencing discomfort and being prescribed some antibiotics) is not great enough for inhibiting great condomless sex for many men. This is why in communities where PrEP has extremely widespread use, the rates of HIV transmission are dramatically falling while the rates of STIs are skyrocketing. An article from Towleroad.com featured a study completed in San Francisco that tracked the behaviors and effectiveness of PrEP in a group of PrEP users showed no new cases of HIV, which is encouraging news for both health professionals and patients. However, among participants of this study, condom use had declined drastically, with 41% of participants claiming to use condoms less frequently. Another study , featured on the SF’ist, revealed that among PrEP users in San Francisco, the instance of STI’s increased by 30% over the first year, and then an additional 50% over the following 6 months.

Graph MSM

This all brings up fears of a new “PrEP culture,” as described in an article by Slate online; will the relaxed fears of HIV and the commonality of PrEP cause a new epidemic of STIs in America? Evidence shows that this is not an unrealistic fear. We need to start educating PrEP users not only about the risk of HIV, but the risk of STIs and the importance of continued protected sex during sexual encounters. Gay men and other MSMs are quite used to altering sexual behaviors, due to sexual risks that other groups do not face, and I predict that they would be highly receptive to educational programs and public health policies re-emphasizing the risks of other STIs and the importance of condom use. The fight for truly safe sex is not over, and it will not be solved with PrEP alone, but instead with a universal adoption of healthy sexual practices and behaviors.

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-By Brandi Brittain

HIV/AIDS is an epidemic that has rapidly swarmed the world and infected almost 70 million people since its inception. As of 2012, there are about 35.3 million people living with HIV/AIDS worldwide. There have been many programs implemented in order to spread the awareness of various preventative measures to take in order to protect and limit the risk against the transmission of HIV. Some preventative measures include using clean needles when partaking in intravenous drugs, using a condom during vaginal, anal, and oral sex, and knowing the HIV status of your sexual partner. Many people are encouraged to take an HIV test if they are at risk of being exposed to these factors in order to determine their status and to figure out which steps to take from there. The sooner a person’s HIV status is determined, the better the results of the treatment or preventative measure will be. (more…)

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-By Elinor Dyer

It has been over thirty years since the start of one of the largest challenges for international public health, and it is still rare that we hear about successful interventions that have been in place since the start of the problem…until now. As a society, we are accustomed reading about the various issues that have exploded from the 1981 AIDS epidemic, which is why it was surprising to see which nation has continued to have the best response. One would think that the leading country would be among those in the first world, but shockingly, the country that has had the most beneficial intervention strategies with this epidemic from the get-go was, and continues to be, Brazil. Since the start of the outbreak in 1982, Brazil’s government has dedicated itself to preventing and treating this disease. By using a multi-step approach of intervention and education programs combined with providing access to free medication, Brazil’s infection rate has significantly declined over the past thirty years while those in countries such as the United States have remained elevated (Gomez). (more…)

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By Harry Griffin

            The role stigma plays in the spread of HIV/AIDS has long been discussed as a key hurdle to overcome in the battle against the disease. The discussion of HIV/AIDS has always been centered on uncomfortable topics such as sex, intravenous (IV) drug use and homosexuality, which effectively put a hamper on many of the initial attempts to engage in a discussion about how to best combat the spread of the virus. As more and more data about the potential threat of the virus came in during the 1980s, health officials from many developed nations began to realize that they could no longer avoid talking about such uncomfortable topics if they wanted to prevent the spread of the deadly virus. (more…)

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