Condoms and the Church, Testing for Rape Suspects, and Musings on Microbicides

Some very interesting developments in the domain of HIV/AIDS policy and research this week, as reported by my reliable news aggregator, the Kaiser Network Daily HIV/AIDS Reports.

1) An excellent summary of articles and opinions surrounding the potential relaxing of rules regarding condom use to prevent HIV/AIDS according to the Catholic Church.

Of note: mention of a book called Catholic Ethicists on HIV/AIDS Prevention, edited by Jesuit priests James Keenan and Jon Fuller which says that the church should have relaxed its ban on condoms 20 years ago." (from above link). Also mentioned: efforts of a South African bishop, Kevin Dowling, who favors condom access to prevent HIV transmission, and a speech by Pope Benedict XVI to African bishops in which he mentions the contribution of contraceptives to a "breakdown of sexual morality," with the usual conspicuous absence of references to scientific evidence to support that assertion.

Please visit the first link for discussion of the “lesser of two evils” approach, and this link regarding the forthcoming statement on condoms and AIDS from the Vatican.

Kaiser also points to a Los Angeles Times article that quotes an HIV-positive Ugandan clergy member named Gideon Byamugisha who speaks out against HIV and had this to say about his position regarding condom use: '"I've come to understand that this disease is not from God. It's not God's plan that people die at 8 years old. Or 12. Or 30," Byamugisha said, adding, "God gives us the knowledge and skills sometimes to prevent or postpone death. He's done his part. The question is, have we done ours?" (Sanders, Los Angeles Times, 4/24).'

But according to USAID-sponsored research review by David Halperin, perhaps the Church should stick to promoting circumcision and fidelity over either condoms or abstinence.

2) In the state of Alabama, the governor signed a bill permitting a judge who rules that there is probably cause to require mandatory HIV and STI testing for people charged with rape or sexual assault. Prior to this bill, survivors or their parents could only request that such testing be done on those convicted and sentenced to 30 days or more in prison.

3) I always thought that microbicides might be the magic bullet, but others disagree. I thought it would be the perfect prophylaxis for women who don’t have the self-efficacy to negotiate condom use with partners. In Kaiser’s summary of research presented at the Microbicides Conference, however, a spokesperson for the Population Council is quoted as saying that microbicides are not a silver bullet and would provide an opportunity for women to talk openly with their partners about “sex and shared responsibilties.” I am not jumping on that bandwagon till I see the numbers.

Another perspective presented in the summary is that marketing will affect how successful microbicides may be, i.e. if they are marketed as a lubricant with protective properties, they may be more acceptable than if they are explicitly marketed as prohylaxis, which is more in line with addressing the fact that it is extremely difficult for women in many cultures and circumstances to talk to their partners explicitly about disease prevention.

A Washington Post article cites the criticism by UNAIDS, WHO and other agencies of the slow progress in developing microbicides as a preventive measure against transmission of HIV/AIDS.

Africa Malaria Day

I just found out that today is Africa Malaria Day, which "The United Nations ... marked ... by highlighting the vital need to provide universal access to artemisinin-based combination therapies (ACTs) as quickly as possible on a continent where the mosquito-borne disease kills an estimated 1 million children below the age of five every year."

UNICEF promotes antimalarial efforts through distribution of bednets impregnated with mosquito repellent, primarly through clinics for maternal and child health.

Last night on NPR, I was listening to a piece that is on BBC news today, which discusses the current controversy over whether $500b that was supposed to go to Africa countries through the World Bank to fight malaria actually reached its destination, and to what extent malaria deaths have or have not been reduced thanks to these efforts:

World Bank accused over malaria





Here are several other links that I have been intending to post about malaria, and Africa Malaria Day seems like the perfect opportunity.

Earlier this month, BBC News published another article in its Health section called Hopes for cheaper malaria drug, which talks about a team of researchers at UC Berkeley that have discovered a way to produce a yeast that can easily be converted into artemisinin, the drug on which many are pinning their hopes of effectively fighting malaria, since so many other drugs are now resistant.

Artemisinin could be resistant if its use is not carefully monitored, which is why the World Health Organization called for companies to stop distributing it in a form not combined with another antimalarial drug back in January.

Thanks to Bora for pointing out this article, Genetic Strategies for Controlling Mosquito-Borne Diseases, which discusses scientific progress made toward developing an engineered gene that would inhibit mosquito-borne transmission of malaria and dengue fever.

Good, Bad, Ugly: Conviction, Meningitis, Court System

DRC: Soldiers jailed for mass rape


MONUC photo of judges

Conviction of seven former Mouvement Pour la liberation du Congo (MLC) (or Armed Forces of the DR Congo (FARDC)) soldiers of the rape of 119 women and girls and other crimes against humanity, resulting in life prison sentences, by the Military Garrison Court of Mbandakais a huge step.

It sets the precedence for further actions to be taken along these lines, which is important because a major component in establishing security and a justice system that works is accountability.

Though I certainly question whether the compensation that the court directed to be paid by the Congolese government, 'jointly responsible' for the events, to victims and families will be received in the amounts determined, at least rulings have been made.

The crimes that this ruling responds to took place in December 2003 in Equateur Province.

It will be interesting to see how the crimes perpetrated in eastern DR Congo are handled in the coming years.

EDIT: Fleur d'Afrique has some words about this event as well.

DRC: Meningitis suspected in the death of 20 in Bandundu



No confirmation has been published that I am aware of as to whether these 20 people, plus another 16 who were still living, were suffering from meningitis. The article states that "If not treated, the disease may progress to delirium and coma. With early diagnosis and antibiotic treatment, however, the fatality rate is low."

Hopefully the fact that the Ministry of Health and WHO officials are aware of the illness and are testing for the disease in Kinshasa means that the survivors will receive proper treatment.


DRC: Interview with Pierre Akele Adua, president of the Congolese military high court

In sum: the judicial system needs reform, recommendations have been made but not implemented. Officials abuse the stature that their stations afford, and employees in the system are underpaid. Prisons are overcrowded and underfunded (food is provided by charities if at all). Impunity is the norm.

M. Akele states that under Laurent Kabila's regime, the situation was worse: "[His military court] did not respect the necessary rules and procedures for the death penalty. It even allowed extrajudicial killings."

When asked whether the new constitution will help improve the situation, his answer was not hopeful, which brings me back to my argument that some structure is better than no structure. At least there will be something upon which to improve.

Changes in the Church: Approaches to addressing HIV in Africa

I saved these articles and then never posted the post. We'll start with the bad news, and then progress to the good. My thoughts, in brief:

Re: this article: Burundi's Roman Catholic Church To Conduct Wedding Ceremonies Only For Couples Who Receive HIV Tests

Generally requiring tests prior to marriage is not 100% successful, although I am sure it may help some people. People pay for mock-ups of negative test results, whether they have tested positive or not tested at all. This technique does not engender trust in relationships, because both parties will want to prove that they are HIV- through whatever means possible.

Being negative prior to marriage is not a guarantee that one will remain negative, but with that slip of paper and that marriage certificate, one has all the 'proof' one needs to never address the subject again. A better approach to me would be one that encourages couples discussion, regarding a range of issues - trust, fidelity, HIV and STIs, children, marriage - the whole gamut of tough topics that are easily brushed aside because they are difficult to broach.

Unfortunately, the Catholic clergy assumes that because people say they believe, and 'beliefs' are a specific set of rules and commitments, that people follow these rules. (I just deleted a typo, 'fules,' which may be more accurate?)

Re: this article: African Religious Group Announces New Strategy To Fight HIV/AIDS, Meant To Replace ABC

This approach is a large step in the right direction. Here, we have a group that represents the population in question (African Network of Religious Leaders Living With or Personally Affected by HIV and AIDS, or ANERELA+) coming up with its own methods for fighting HIV/AIDS. Let's dispense with all the experts, technical assistance, and specific approaches required by acceptance of certain types of bilateral funding.

According to the article, "the strategy uses the acronym SAVE -- which stands for safer practices, available medications, voluntary counseling and testing and empowerment through education..."

Non-profit Christian Aid's objection to the ABC strategy (Abstinence, Be Faithful, use Condoms - which I find tricky simply because of lack of grammatical consistency) is that it "'is not well suited to the complexities of human life' and 'fuels stigma and precludes safer sexual practices' by placing people in one of the three categories. Christian Aid says that being faithful to one sexual partner does not automatically protect a person against HIV transmission and that condom users are not necessarily people who do not wish to abstain or be faithful."

Finally, a published recognition of the limitations of ABC.

During work in DR Congo, I was given a booklet that served as an HIV teaching tool, in which each of the three, A, B, and C, were portrayed as lifeboats. One chose the option that best served one's situation. In the newer edition which has come out in the past year, the image was updated to show two life rafts and a smaller dinghy.

You can guess which one was relegated to dinghy status.

Updates on Kinshasa streetkids and Zuma's rape trial

Following up on an entry that I wrote recently (found here), I am posting a link from the BBC highlighting a Human Rights Watch report that indicates that up to 70% of streetkids in Kinshasa are abused and thrown out as a result of accusations of sorcery.

And to follow up on my initial entry about the rape trial of Zuma (potential successor to President Thabo Mbeki) in South Africa, boy, BBC is really churning out the news on this one.

Zuma apparently thinks that there is no risk associated with his unprotected sex habits, even with a woman publicly known to be HIV+.

Oh, did I mention that he is the former head of the National Aids Council??

Also, this case has reportedly "reveal[ed the] SA rape problem.

Because we didn't know that rape was a problem before.

At any rate, it tells us that "A woman is raped in South Africa every 26 seconds, according to Powa's estimate. Only one in nine rapes that takes place in South Africa is ever reported - out of the reported cases, only 7% lead to a conviction, Powa says." Though the definition of rape is not provided here, the article states that it is narrow, and that the trial will likely focus on the woman's sexual history.

In the link above, it also states that Zuma's accuser has been in hiding for three months (now over 4 months) and is in a witness protection program. No wonder, since Zuma has a lot of supporters.

Here we go, election chaos is building

According to the BBC, Union for Democracy and Social Progress (UDPS) (also recall: Etienne Tshisekedi's party) is boycotting the elections after all, which are now supposedly postponed past June. Also noted: at least 70 presidential candidates have entered the race and paid their $50,000 fee, and 4,000 candidates have registered for 500 Parliamentary seats; before the registration deadline was extended, only 100 candidates had registered.