Condoms Trump Abstinence in Obama Global AIDS
posted byNov. 10 (Bloomberg) — President-elect Barack Obama will reverse U.S. family planning and AIDS prevention strategies that have long linked global funding to anti-abortion and abstinence education, a public-health adviser said.
Public health policies of President George W. Bush’s $45- billion PEPFAR program have brought AIDS drugs to almost 3 million people in poor countries such as Rwanda and Uganda, more than under any other president. Still, requirements that health workers emphasize abstinence from sex and monogamy over condom use have set back sexually transmitted disease prevention and family planning globally, said Susan F. Wood, co-chairman of Obama’s advisory committee for women’s health.
“We have been going in the wrong direction and we need to turn it around and be promoting prevention and family-planning services and strengthening public health,” said Wood, a research professor at George Washington University School of Public Health in Washington.
Bush on his first day in office in January 2001 reinstated the so-called Mexico City Policy — known as the global gag rule to critics — that bars U.S. family-planning assistance for organizations that use funding from any other source to provide counseling and referral for abortion; lobby to make abortion legal or more available in their country; or perform abortions except in certain cases. Those exceptions are a threat to the woman’s life, rape or incest.
Obama “is committed to looking at all this and changing the policies so that family-planning services — both in the U.S. and the developing world — reflect what works, what helps prevent unintended pregnancy, reduce maternal and infant mortality, prevent the spread of disease,” Wood said.
Gag Rule
Wood resigned as the top U.S. regulator for women’s health in 2005 in protest of the Food and Drug Administration’s delay in clearing over-the-counter sales of the “morning after” emergency contraceptive. Sale of the pill, called Plan B, without a prescription was held up for more than two years, after FDA staff recommended its approval in 2003.
Critics of the FDA have named Wood as among candidates they would like Obama to consider for the agency’s next commissioner.
“A lot of the family-planning associations in Africa refused the terms of the gag rule and they lost funding, they lost technical assistance and they lost contraceptives,” said Wendy Turnbull, a senior policy research analyst with Population Action International in Washington.
On the basis of that policy, Bush halted support for the United Nations Population Fund in 2002, saying it supported “coercive” abortion programs in China — an allegation the New York-based agency has denied. The directive cost UNPF more than $200 million in lost funding, said William Ryan, a Bangkok-based spokesman for the agency.
Condom Use
Restrictions on education about condom use have hamstrung effective promotion, and the U.S. Centers for Disease Control and Prevention has had some condom information pulled from its Web Site, said Gill Greer, director general of the International Planned Pregnancy Federation in London.
“The U.S. administration has certainly succeeded in demonizing condoms rather than showing that they can be part of prevention of both unplanned pregnancy and sexually transmitted infections,” she said in a telephone interview. “I’ve always joked that the whole world should vote in the U.S. election because the whole world is so affected.”
Under President Bush, the U.S. has provided more money to fight AIDS than during any other administration. Seven years ago, before the Bush program began with about $15 billion, only about 200,000 people in poor nations got treatment, and few of them were in Africa.
Abstinence Success
The emphasis on abstinence and fidelity, “has been shown to have demonstrable success in Africa,” said Valerie Huber, executive director of the National Abstinence Education Association in Washington. “It would be more than unfortunate if that policy was changed.”
Both Republicans and Democrats have indicated support for the focus on abstinence and education that goes along with PEPFAR, which has also been shown to reduce the spread of HIV in countries such as Uganda, Huber said.
“If the president-elect wants to be science-based in foreign sex-education policies, it would be wisest to continue this way because it’s shown to be effective,” she said.
Calls to the office of Mark Dybul, coordinator for the Bush AIDS treatment program, weren’t returned.
Prevention Quest
Without a vaccine, AIDS advocates are looking for ways to slow the spread of the HIV virus that currently infects about 33 million people worldwide. Treatment, even with cheaper versions of HIV drugs, is beyond the means of many patients in Africa, where about 24 million infected people live.
The U.S. has played an important role in bringing life- saving treatment to HIV patients who had been unable to get it, said Adel Mahmoud, a former head of Merck & Co. vaccines and professor in the department of molecular biology at Princeton University.
“But when the data says for every person we put on anti- retroviral therapy in Africa there are six new infections and we are doing nothing about it, it’s absolutely mind-boggling,” he said in a telephone interview. “Prevention is really the solution.”
Wood said that, in recent years, the U.S. government has influenced and “tightly vetted” international organizations to reflect its own policies.
Obama will bring “back a sense of balance and perspective and the use of good science and good medicine in these positions, and not just this narrow, political ideology,” she said.
To contact the reporter on this story: John Lauerman in Boston at jlauerman@bloomberg.net; Jason Gale in Singapore at j.gale@bloomberg.net.
Last Updated: November 10, 2008 10:07 EST
Comment (1)NCAVP Releases 2006 Report on Domestic Violence
posted byReport provides unique snapshot of intimate partner violence experienced by lesbian, gay, bisexual, and transgender (LGBT) people
July 12, 2007
New York – The National Coalition of Anti-Violence Programs (NCAVP), an LGBT-specific network of community-based organizations, released its Annual Report on Domestic Violence within Lesbian, Gay, Bisexual and Transgender Communities in the United States. The 43 page report compiled by the New York -based coalition includes data regarding over 3,000 individuals who experienced domestic violence. Fourteen of 33 NCAVP member programs contributed to this year’s report. Participating regions include Tucson, AZ, Los Angeles, CA, San Francisco, CA, Colorado, Chicago, IL, Massachusetts, Minnesota; Kansas City, MO, New York, NY, Columbus, OH, Pennsylvania, and Houston, TX.
There were 3,534 reported incidents of domestic violence affecting LGBT individuals in 2006, a decrease of 15% over incidents recorded in the 2005 report. However, this decrease does not necessarily indicate that LGBT domestic violence is declining. Numerous factors influence whether or not a victim of domestic violence will seek help through an organization or a hotline, including visibility of the local organization, fears on the part of the victim of being “outed,” and fear of bringing shame to ones family or community. Additionally, individual organizational capacity and ability to participate in this report shift somewhat from year to year which could also account for the numerical difference.
Demographically, the report found that most organizations receive about equal numbers of reports from gay male and lesbian victims of domestic violence. Reports from people of transgender experience typically hover around 5-10% of the total. Race or ethnic identity of victims was also documented in the report. Of the victims for whom race and ethnic information was know, white victims accounted for 43%, followed by Latino/a victims (27%) and African American victims (15%). Multi-racial identified victims accounted for 7%, Asian/Pacific Islanders accounted for 3%. Indigenous people, and those of Middle-Eastern descent accounted for 2% each.
NCAVP members compiled additional statisticl information, such as rates of weapons use in a domestic violence incident, police involvement, and police misconduct. Police were involved in about 26% of all reported cases for 2006. Of those, about 8% reported police misconduct (defined as verbal or physical abuse, and/or the use of anti-LGBT slurs).
In addition to the quantitative information, the NCAVP report also includes personal narratives from LGBT survivors reporting from various regions, as well as a directory of local NCAVP member programs, an overview of academic studies conducted on LGBT domestic violence, and recommendations for changes to end discrimination and re-victimization of LGBT people who experience domestic violence.
Clarence Patton, Executive Director of the New York City Anti-Violence Project emphasized the importance of this report, “In a changing political climate where issues like hate violence legislation and the gay marriage debate are routinely making headlines, we must ensure that the voices of survivors and victims of violence within our communities are heard. Pressure to keep silent about violence within ones relationship can be overwhelming and LGBT inclusive services are still hard to come by.”
“This report is an important step in breaking that silence and contributing to a world where LGBT communities and our allies support each other, not only in eliminating discrimination against our communities in domestic violence services, but in eliminating domestic violence itself,” concluded Patton.
Comment (1)Frequent Sexual Activity by Brooklyn Teens Infected With HIV at Birth
posted by48th ICAAC, October 25-28, 2008, Washington, DC
Mark Mascolini
A small chart study of US teens infected with HIV at birth found that more than half had sexual experience, often with multiple partners [1]. Nearly one third of the girls studied got pregnant once or twice, but none of their children had HIV.
Although small, the study underlines gaps in how much is known about a growing population of teens infected with HIV since birth. Results in this small group suggest that HIV education and prevention efforts for these adolescents are failing, even though all these children received consistent care from the same clinicians for 14 years or more.
Researchers in Brooklyn, New York, analyzed records of 15 boys and 14 girls with perinatal HIV infection; 4 had died by the time of the study. Of the remaining 25 teenagers, median age stood at 17 years. The group’s age averaged 11.6 years when they learned they had HIV infection, and an average 5.8 years passed between diagnosis and this study.
When diagnosed with HIV, 16 children (55%) did not have or no longer lived with a biological parent. Three children (10%) were not being cared for by parents, relatives, foster families, or adoptive families. Five of 29 children had graduated from high school by the time of the study, and 21 of 25 living children were still in school. Three of 25 teens were working toward a Graduate Equivalent Degree. Twenty-four of 29 youth (83%) had one or more problems reported from school.
Of the 25 surviving children, 5 (20%) smoked cigarettes, 7 (28%) smoked marijuana, 3 (12%) drank alcohol, and 2 (8%) used other drugs. These proportions may not be unusual among Brooklyn teens in general, or they may be lower than in the general population. The researchers did not report population-based rates.
Sixteen of 29 teens (55%) had sex at least once, and 12 (41%) had 5 or more sex partners. Four of the 15 girls (27%) had been pregnant, 2 of them (13%) twice. Two pregnancies ended in abortion. None of the 4 children born had HIV. Most of the HIV-infected teens reported using some form of protection during sex.
Again, the researchers did not report sex or pregnancy rates for a general population of Brooklyn teens. A citywide study found a pregnancy rate of 10% among 15-to 19-year-olds in the year 2000 [2], considerably lower than the 27% in this small study of HIV-infected teens. Regardless of comparative statistics, however, the high frequency of sexual intercourse in these HIV-infected teens clearly places them and their sex partners at risk of pregnancy and complicating sexually transmitted diseases, while posing a risk of HIV transmission to uninfected sex mates.
The investigators proposed that “innovative modalities need to be used to enhance sexual responsibility and substance use counseling to this group.” They called for ´mental health support and behavior monitoring and modification.”
References
1. Desai N, Abraham M, Cambridge-Phillip R. Long-term follow-up of teens with perinatal HIV infection after disclosure of diagnosis. 48th Annual International Conference on Antimicrobial Agents and Chemotherapy (ICAAC). October 25-28, 2008. Washington, DC. Abstract H-461.
2. New York City Department of Health and Mental Hygiene. Who is at risk? Teen pregnancy in New York City. December 2002 (http://home2.nyc.gov/html/doh/downloads/pdf/fhs/tpreport.pdf).
Add CommentsHalf of Black US Women Switch HIV Clinicians Because of Communication Problems
posted by48th ICAAC, October 25-28, 2008, Washington, DC
Mark Mascolini
Half of black women in a study of 700 antiretroviral-treated women changed their physician because they believed communication problems hampered their treatment, a rate significantly higher than among Hispanic or white women [1]. Black and Hispanic women in the survey were more likely than white women to feel that race or ethnicity affected their overall care. The findings must be interpreted cautiously, however, because of the methods used to sign up women for this study.
Researchers recruited HIV-infected women from a US national network of AIDS counseling centers through flyers left at the centers. Participants called a toll-free number and answered questions during a 15-minute structured interview. They got $25 for their effort.
Blacks and Hispanics account for almost 80% of newly diagnosed HIV infection in US women today. The 700 survey respondents included 300 blacks, 200 Hispanics, and 200 whites. They averaged 42.5 years in age, and 42% were at least 45 years old. More women came from the South (33%) and Northeast (30%) than from the Midwest (21%) or West (16%). Women knew they had HIV infection for an average 10.6 years and had taken combination antiretroviral therapy for an average 8.1 years. All had taken antiretrovirals for at least 3 years. Significantly more black women (41%) and Hispanic women (40%) had children than did white women (30%) (P < 0.05).
Black and Hispanic women were significantly more likely than whites to believe their culture, ethnicity, or language affected the care they received “a lot”: 38% of blacks, 40% of Hispanics, and 27% of whites (P < 0.05). Compared with whites, more blacks and Hispanics also felt these factors affected their care “a little”: 21% of blacks, 32% of Hispanics, and 10% of whites (P < 0.05). Women in the South were significantly more likely than women in the West or Northeast to believe culture, ethnicity, or language affected their care “a lot” (44% versus 25% and 33%, P < 0.05).
Women seeing a family physician or general practitioner were significantly more likely than those seeing an infectious disease specialist or a nurse practitioner or physician’s assistant (PA) to feel that culture, ethnicity, or language affected their care “a lot” or “a little” (76% versus 53% and 49%, P < 0.05). In contrast, 51% of women seeing a nurse or PA switched providers because of perceived communication problems, compared with 45% seeing a family physician or generalist and 38% seeing an infectious disease physician.
The survey found that 433 women (60%) switched clinicians during treatment for HIV, and 292 of these 433 (43%) switched because of poor communication with their provider. While 33% of white women and 37% of Hispanic women changed clinicians because of communication problems with their provider, 47% of black women did (P < 0.05).
The researchers believe their findings highlight “a need for heightened awareness of ethnic and cultural issues that influence a patient’s interaction with health care providers and satisfaction with her medical care.”
Women who responded to this survey may not represent all US women with HIV, first, because they attended an AIDS counseling center and, second, because they self-selected themselves by picking up the survey flyer and calling the toll-free number. Because of these factors, respondents may be more involved in their health care or more dissatisfied with their care than the general US population of women with HIV.
Reference
1. Hodder S, Aberg J, Feinberg J, et al. Perceptions of care by HIV-infected women in the United States. 48th Annual International Conference on Antimicrobial Agents and Chemotherapy (ICAAC). October 25-28, 2008. Washington, DC. Abstract H-445.
