Forced Sterilisation in Namibia

The BBC reported this week that three women in Namibia are suing the state for performing a sterilisation without consent. There appears to be some uncertainty about the degree of force because of difficulties during consultation. A legal representative remarked that procedures are not always discussed clearly and the eleven indigenous languages create, at times, a language barrier. The women have been protesting and carrying placards which state “My body, my womb, my right”. 

Now, for the next crucial point: these women were sterilised following a positive diagnosis of HIV. Coming from a society (UK) that promotes individual autonomy and truth-telling to patients to its greatest extent, it is easy to jump on the bandwagon and start pointing the finger at the accused doctors for their wrong-doing. Forced sterilisation has been reported in other countries, particularly post-Communist countries such as Albania and the Czech Republic. It has been difficult to carve out the image of autonomy from a history that denied individuality. But Namibia has a different twist. I can only surmise that the goal for preventing future pregnancies of these women is to halt this method of potential transmission of the HIV virus.

In a country where HIV/ AIDs is the leading cause of death, and the National Demographic Health Survey (2006) estimated close to 17% of children under the age of 18 have been orphaned by at least one parent, the medical community – as well as society – must be close to despair. Does this make a doctor’s action to perform a sterilization on a HIV+ woman who may have not consented with capacity and competence, or not consented at all, any easier to understand?

Is it a utilitarian ethic to prevent the potential future suffering – medical and social – of a family – and is a doctor the right person to instigate such practices? First of all, HIV is a manageable chronic condition in Western countries, but with the lack of accessibility and availability of medication along with other factors specific to a country, HIV is a death-sentence.

Is managing birth a way of managing disease? Truth and trust often go hand-in-hand. What are the implications for Namibian women and the countries medical system? It appears that the sterilization of these three women, forced or not forced, is raising questions about how must medicine respond to dire threats to human life, and moreover, cutting the cord of trust between a doctor and a patient terminates a part of the system of society.

Bone Marrow Transplant Cured AIDS?

BBC News reports that a patient suffering from AIDS and leukemia shows no signs of AIDS infection after receiving a bone marrow transplant from an AIDS-resistant donor.

He had been infected with the human immunodeficiency virus, that causes Aids, for more than a decade and also had leukaemia.

The clinic said since the transplant was carried out 20 months ago, tests on the patient's bone marrow, blood and other organ tissues have all been clear.

In a statement, Professor Rodolf Tauber from the Charite clinic said: "This is an interesting case for research.

"But to promise to millions of people infected with HIV that there is hope of a cure would not be right."

Like many of you, I am skeptical about the long-term efficacy of this treatment and am concerned about the social justice challenges presented should this be determined to be a cure. But this story is valuable for the new direction it offers to medical research; while many researchers focus on preventing the virus from propagating, introducing genetics and possibly retroviruses opens up more possibilities. By pursuing all available angles of this crisis, we increase our chances of finding that elusive cure to this global epidemic.

(Still) Wanted: A Female-Controlled Method to Prevent HIV

Twenty-seven years after AIDS was first diagnosed among gay men in California and New York, HIV/AIDS has become a health threat borne disproportionately by women in the developing world. Globally, there are twelve HIV-positive women for every ten HIV-positive men. In the hardest hit countries in sub-Saharan Africa, young women are three times more likely than their male peers to become infected.

The disproportionate impact of HIV on women is due to a variety of biological and socioeconomic factors. Many of those factors make today’s HIV prevention options – condoms, mutual monogamy, and male circumcision – inaccessible to women at greatest risk of infection. Many women do not have the social or economic power necessary to insist on condom use and fidelity or to abandon partnerships that put them at risk, and a recent study from Uganda shows that circumcision does not protect female receptive sex partners. There thus is a desperate need to develop new tools to enable women to protect themselves, including microbicides.

This morning, the Population Council posted the results of a phase III effectiveness study of a candidate microbicide called Carraguard, an odorless, clear gel made from carrageenan. Over 6,000 women in South Africa volunteered to be part of this clinical trial, in which participants were randomly assigned to either receive Carraguard or a comparator gel. Trial participants were instructed to use the gel plus condoms every time they had sex, and asked to return to the study clinic repeatedly over a two-year period. During this time, they were provided with condoms and received comprehensive risk reduction counseling, HIV testing, and screening and treatment for STIs.

Unfortunately, trial results showed that the product was safe and acceptable to women, but did not reduce their risk of acquiring HIV.

Twelve other candidate microbicides are currently in human trials, and a new generation of antiretroviral-based products is entering the development pipeline. But developing and testing these compounds is a time- and resource-intensive process, and many policymakers have begun to question whether or not limited public health resources are better used to promote proven prevention technologies like condoms.

This, I believe, is short sighted. For the reasons mentioned above, proven HIV prevention technologies will not protect at-risk women. Furthermore, drug development is always a long term struggle, with dozens of failed products for every one that makes it to market.

As disappointing as these results are, the fact that the trial reached completion is itself a breakthrough. Successful completion of the Carraguard trial is a testament not only to the commitment of the study investigators but also to the dedication of the trial participants themselves.

Regardless of the results, this trial will yield important information about microbicide effectiveness, safety, use, and acceptability, and will help researchers design and test new HIV prevention technologies.

Deadly (Mis)Diagnosis

After nine years Audrey Serrano is a "free" woman.
A jury has awarded her $2.5 million in damages for HIV treatment she received over those nine years--powerful drugs she was given to treat an illness she does not have.

Serrano filed suit against the doctor who treated her, following a second diagnosis that revealed no presence of HIV in her blood. The misdiagnosis was based, according to Serrano's attorney, on presumptions by her former doctor about Serrano's lifestyle that tend to be associated with patients more likely to have HIV and AIDS.

See details of what's being called an "astonishing" case in this article from the Washington Post.

spray on condoms

Do you ever find yourself watching a television show, or movie, and having to hit pause to Google something you saw, because you just can't quite believe it? In this particular instance, I'm catching up on episodes of CSI: NY, and in the first episode of season four, they begin talking about (and demonstrating) spray on condoms.

"No way!" I thought, sure that this was something I could laugh off as improbable. Liquid latex in a spray can, spray application, 5 second drying time? Pause, Firefox, Google. See! Complete fict- what? Real? Oh. ...oh?

It would seem I slept through this particular bit of 2006 science innovation.

In reality, it's not necessarily what CSI: NY showed; it's more of a slide on device that coats the penis evenly with spray nozzles (most news coverage refers to it as "car wash like", a description I'm just going to leave alone) that a latex condom version of hairspray, and marketing is targeted towards a custom fit that will help prevent slippage and breaking.

You can watch a video clip showing the prototype, how the latex dries, and a short interview at this link, but please be aware that the link is not necessarily safe for work, and contains references to other videos and stories of sexual activity that certainly runs the risk of offending.

Of course, assuming this makes it to market (some time in 2008, according to the manufacturing company), you've got to wonder if anyone would really use it. And is it actually a better "fit"? Is the lack of reservoir tip going to create problems? How is it different from liquid latex? What safety mechanisms are built in to ensure that it's an even coat, and not patchy, thin, or missing a spot here and there? Is it cost effective?

I can certainly see having a can of aerosolized liquid latex being fun - I'm the type of person who would promptly run around and try coating everything I could with it, just to see what would happen (especially if it could at all be used in practical jokes, like covering someone's sandwich unnoticed), but I'm having a hard time seeing its actual benefit for protection during sexual activity. It seems like it would be a type of bragging ("oh, I can't wear regular condom sizes...") or a gadget-y purpose of (in)conspicuous consumption.

Thoughts?
-Kelly

World AIDS Day

Along the lines of the post below, the following youtube video illustrates the vast number of individuals affected by lighting a candle for each person living with HIV/AIDS.

HIV/AIDS In Light of Numbers

Yesterday, December 1st, was World AIDS Day, and in conjunction with that two new studies have been released. The first is a worldwide "oops", as the United Nations has acknowledged that it has overestimated the cases of HIV/AIDS by approximately 6 million people. (That's more than the population of New Zealand, and only slightly less than the population of Switzerland.) New infection rates are also down, to 2.5 million a year, and India's infection rate has been estimated at half its previous numbers.

But while the new numbers suggest both that the UN needs to revise how it's running its numbers, and that prevention strategies have been effective, the numbers for the United States are more grim.

The CDC has moved from an informal tracking of HIV/AIDS infections to a more accurate assessment, and in the process, discovered that infection rates in the States is much higher than previously thought. How much higher is up for debate, since the CDC has not yet released the figures from their new study; the official word is patience until their papers have been peer reviewed.

According to the NYTimes, the new assessment involves

two different blood tests of H.I.V. antibodies — the first indication of an infection. One test is highly sensitive and is able to spot an infection even in its earliest months. The other test is cruder, and patients must nurse an infection for many months before it can be identified with this test.

When a blood sample receives a positive result on the first test and a negative result on the second, officials have decided that this person was probably infected recently. By adding up these mixed results and projecting them across the country, the agency is able to come up with an estimate for new infections.

And while the numbers haven't been released, everyone seems to agree on one thing - the numbers will go up. Of course, the question then becomes why have the numbers increased - are there actually more cases of infection, or are the more sensitive tests combined with reporting both HIV and AIDS cases (when previously not all states reported positive HIV tests, only active AIDS cases) showing a more accurate picture?

Either way, one thing is certain - prevention efforts are not proving as effective as they could be in the United States. Unfortunately for us, HIV/AIDS prevention is a highly political issue, not just in finances, but in what's taught. We know that the best prevention education focuses on a combination of increasing condom use, decreasing sexual partners, and general education both about sex and infectious disease. In light of the numbers, showing decrease due to education, or increase because of a reinterpretation of numbers, we owe it to ourselves, to everyone, to accurately educate and contribute to preventing the spread of this infectious disease.

Just because HIV can be treated as a chronic condition - wonderful news for those already infected - does not mean we should decrease our efforts at prevention.

UN Panel on HIV/AIDS and female Genital Mutilation

Who: IHEU -- Appignani Center for Bioethics, Population Communications International and Femmes Afrique Solidarite

What: UN Panel on Health and Empowerment: The Impact of HIV/AIDS and FGM

Where: 777 UN Plaza, New York City

When: Wednesday, Feb. 28, 2007 12:00 PM-1:45 PM

Contact: 212-687-3324 (tel) | 212-661-4188 (fax) | www.iheu.org/bioethics | E-mail: AnaLita@iheu.org

On Wed, Feb. 28, 2007 a panel of bioethicists, physicians and activists will discuss "Health and Empowerment: The impact of HIV/AIDS Epidemic Worldwide and Female Genital Mutilation in African Diaspora Communities" at the United Nations under the auspices of the Division for the Advancement of Women, Commission on the Status of Women.
The panel will discuss the health and empowerment of women, focusing on the international HIV/AIDS epidemic, female genital mutilation (FGM) in Africa and immigrant communities living in Western nations.

Although the practice of FGM is viewed by many within the international community as a human rights violation, FGM is reportedly still performed on three million women annually. It is estimated that 130 million girls alive today have undergone FGM.

The U.N. has challenged the world to fulfill eight Millennium Development Goals by 2015 that would drastically improve living standards around the world. The panel will address FGM within the context of these goals, FGM's relationship to the HIV-AIDS epidemic and directions for the future.

Speakers include:

Wayne R. Cohen, M.D., Ph.D is chairman of Obstetrics and Gynecology at Jamaica Hospital NY, visiting professor Dept. of Ob--Gyn and Women's Health at Albert Einstein Bronx, NY. He was the Obstetrician and Gynecology-in-Chief Sinai hospital of Baltimore Maryland. He wrote an important book entitled Complications in Pregnancy, published by Lippincott Williams&Wilkins 2000 (the 5th edition).

Adrian Sângeorzan, M.D., a specialist obstetrician and gynecologist and a full-time attending and faculty adviser at Jamaica Hospital, New York. A graduate of the Medical School at the University of Cluj, Transylvania, Sângeorzan worked as a doctor in Romania until immigrating to the United States in 1990. His prizewinning, best-selling volume of memoirs and fiction, ,Between Two Worlds-- Tales of a Women's Doctor, is published in Romanian and English.

Zeinab Eyega, M.Sc, executive director and founder of Sauti Yetu, an organization seeking to empower women to exercise, advocate and protect their rights based in New York City. Previously she was a program director for the African Immigrant Program at Research, Action and Information Network for the Bodily Integrity of Women (RAINBO), a program that examined the needs of circumcised women and girls in New York City. In addition to teaching and public speaking, she has facilitated numerous cross-cultural competency workshops for health care providers and reproductive health promotion seminars for African immigrant and refugee communities throughout the U.S.

Tata Traore, director of intervention for the Bondala Department of the Harlem United Community AIDS Center, a community-based organization providing a unique continuum of care for over 2,300 clients per year. She works to integrate socially and economically disenfranchised people into a healthy and healing community, offering clients access to a full range of medical, social, and supportive services.

Ana Lita, Ph.D., director of the IHEU-Appignani Center for Bioethics in New York City. She holds a Ph.D. in Applied Ethics and Social Philosophy from Bowling Green State University. The author of numerous conference presentations and publications in the fields of education, ethics and bioethics, Ana Lita is a Women's Bioethics Project Scholar and
the recipient of a Soros Foundation Fellowship and a National Association Fellowship for International Scholars.

Michael Castlen, executive director of PCI --Telling Stories, Saving Lives in New York City. He has an extensive background building organizational capacity in non-profit organizations, specifically those involved in international development. He served as Chief Operating Officer at the Foundation for a Civil Society and worked with NGOs in the Czech Republic and Slovakia to strengthen civil society organizations and nurture local corporate philanthropy. At Holt International he worked in Romania on strengthening child-welfare.

The IHEU-Appignani Center for Bioethics focuses on raising awareness of bioethical issues confronting the international. The Center is a new initiative of the International Humanist and Ethical Union (IHEU), an international umbrella organization for humanist, ethical culture, rationalist, secularist and free-thought groups. IHEU holds a special consultative status with the U.N., a general consultative status with UNICEF and the Council of Europe as well as operational relations with UNESCO in Paris.

PCI -- Telling Stories, Saving Lives (Population Communications International) is dedicated to the promotion of education and health, including reproductive health and informed choice; sensitivity to national and local cultures; and the principles put forth by the U.N. Millennium Development Goals. PCI develops entertainment-education programs and social marketing strategies that support targeted health and poverty alleviation initiatives. For more than 20 years, PCI has worked in over 27 countries, producing more than 75 radio and television programs, training hundreds of individuals, providing technical assistance to more than 100 international organizations. Central to PCI's long-running Kenyan radio drama Ushiwapo Shikamana was a storyline about the health consequences of female genital mutilation (FGM).

In the fall of 2006, PCI and the IHEU-Appignani Center for Bioethics launched a new program, the Women's Health Center, aimed at supporting grassroots women's health organizations develop their own resources to address the global status of women's health. The Women's Health Center enables these organizations to merge their resources and develop new, innovative strategies to improve the lives of the world's most vulnerable women.