Hurrah for Needle Exchange

As a wonderful Christmas/Chanukah/Kwanzaa/Saturnalia present, Congress has finally passed the national budget that also removes the ban on federal funding for needle exchange.

As I've said before needle exchange is an effective tool to improve the lives of people who inject drugs.

Here is more: needle exchange has been thoroughly reviewed for (1) impact on HIV among injecting drug users, (2) uptake by injecting drug users of drug treatment programs, (3) impact on initiation of others to drugs and injecting, (4) impact on the neighborhood where the needle exchange point is placed.

What have the studies shown? Needle and Syringe Exchange Points: (1) reduce HIV incidence among injecting drug users- which also reduces the potential for HIV to be passed on to non-injectors through unprotected sex, (2) increase uptake of drug treatment programs, (3) DO NOT increase initiation among non-injectors and non-users to injecting drugs,(4)DO NOT hurt the neighborhoods around the points.

Needle and Syringe Exchange points are one of the few interventions that have been proven to effectively reduce HIV transmission rates among injecting drug users. There are really not many to choose from for this group. Finally, public health professionals funded by the US federal government can use these effective tools to address HIV among vulnerable groups.

HIV and Income

Hans Rosling, of Gapminder, did a great
presentation of the complicated picture of HIV.


Some key points:

(1) The poorest countries/poorest population quintiles aren't necessarily the ones with the highest HIV prevalence.
(2) Africa is a diverse continent, home to countries with different HIV epidemic stories. We see different epidemiological stories even within those countries.
(3) We need to think about and test other explanations of different HIV/STI epidemic stories e.g. number of partners and concurrency (vs serial monogamy).


Please see the presentation in full at the Hans Rosling TED presentation

The Lancet Strikes a Major Blow to the Pope's Flawed Argument Against Condom Use for prevention of HIV transmission

The Lancet, one of the most respected medical journals in the world joins the many public health professionals to call the Pope out for his irresponsible statement on condom use with regard to the HIV epidemic.

The Lancet states in an editorial, "When any influential person, be it a religious or political figure, makes a false scientific statement that could be devastating to the health of millions of people, they should retract or correct the public record."


AFP "Pope 'publicly distorted' condom science: Lancet"

See my previous posts on the Pope's comments here and here .

The Lancet

Picture via Flickr

What interventions can reduce HIV among IDUs

Way back when I was working in Central Asia, I served as a "country expert" in a joint WHO-UNODC process to set some sort of global standard targets in HIV prevention with injecting drug users (IDUs).

For those interested in HIV prevention interventions for IDUs, I recommend reading it. Not just because I was a part of this process. You get a basic idea of a comprehensive "package" to reduce incidence of HIV among IDUs and some of the definitions of standards indicators for coverage and quality- down to a definition of who should be considered an IDU. If your site does not include one of the elements of the "package"- perhaps that is the gap you should try to fill.

I found that other "HIV prevention comprehensive packages" are a bit of tripe and bs, but this is something that has potential (if only folks pay attention).

So read it!

WHO and UNODC
Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users

Picture via Flickr

Pope Benedict dicts around with human lives in the face of the HIV epidemic, 359 years until the apology comes?

As a child of a lapsed Catholic, I do care about what the Pope says. As an epidemiologist, I am disappointed with the Pope's recent statements in Africa against the utility of condom use in reducing the spread of HIV. "You can't resolve with the distribution of condoms,"... "On the contrary, it increases the problem." Source: Yahoo News article on the Pope's stance.

In doing so, he ignores the immense body of evidence that condoms used effectively and consistently are very effective in preventing the sexual transmission of HIV and other sexually transmitted infections and that promoting condom use and increasing access to condom do not increase frequency of sex or number of sex partners. (Smoak et al, Sexual Risk Reduction Interventions Do Not Inadvertently Increase the Overall Frequency of Sexual Behavior: A Meta-analysis of 174 Studies With 116,735 Participants J Acquir Immune Defic Syndr 2006;41:374Y384).

He also sets back the progress that has been made to increase condom use in Africa and countries with large Catholic populations.

This is especially sad because in 2006, the current Pope was considering softening the Catholic Church's stance on condoms. Cardinal Carlo Maria Martini, a moderate in the Vatican said in April 2006, "We need to do everything possible to combat AIDS. Under certain conditions, the use of condoms is necessary. Those who are afflicted have an obligation to protect the other partner," and the Vatican's equivalent of health minister, Cardinal Javier Lozano Barragan, said that the Pope had taken the initiative on taking another look at the condom issue. Source: Deutsche Welle.

It does seem that the Catholic Church does have people who are a bit more sensible on life in the times of HIV. Cardinal Godfried Daneels of Belgium, who was once considered a candidate to suceed John Paul II, had a more sensible position to condom use. In 2004, he stated that someone had HIV could use a condom to protect life. Source: WorldNet Daily.

It took more than 300 years for the Catholic Church to apologize for persecuting Galileo and 60 years to apologize for its inactivity against the Holocaust. Perhaps with another 2 million deaths from AIDS-related complications (annual mortality rate is just over 2 million- source UNAIDS), including sero-negative spouses of people living with HIV, the apology and change from the Catholic Church will come sooner?

Radioactive IEC Materials

I've also come across an IEC materials in Vietnamese to warn people against the dangers of Avian Flu. In it you see a radioactive man with green muck on his face who is being menanced by an angry looking rooster carrying a bloody scythe and a figure who seems to be a mix of the Grim Reaper and the Tuxedo Mask character from Sailor Moon.

This poster is laughably bad. It also serves as a sad memory of the media to build HIV awareness that continues to be produced in developing country with donor funds. I've seen way too many grim reapers/grinning skulls, blood, and other evil looking characters carrying a syringe. This approach simply doesn't work! It translates HIV into some fantastical evil out of a comic book and makes it seem less like a real risk. We all know to avoid roosters with scythes, but how many of us know how we can reduce our risk of Avian flu in areas at risk?

It reminds me also of a forward passed around a few years ago. This is a fake Tajik Airways safety card. It features glowing bad guys hijacking a plane and suggests ways passengers can protect themselves like offering hijackers a cigarette and flirting with them.

Link to the larger picture of Tajik Air's "Safety Card

Condoms for Kids?

I'm of the mind that all sites and literature promoting safer sex should provide guidance based on real situations.

I'm sick of materials designed for high risk groups such as Men who have sex with Men (MSM), sex workers, and injecting drug users that uses child-like cartoons like little condom-men with smiling faces. I've seen more projects that I'd like to admit that have responded to the challenges of trying to reach a young or low-literate target group by making their communications too childlike. Sex is a very adult issue. Treating your target group with a modicum of respect makes for more effective interventions.

Example from: http://www.thethreeamigos.org/

There is hope. I am a big fan of the work at Hard Cell, a website targeting Men who have Sex with Men who address questions of protection with a heavy dose of sexual content. Only those 18 and over should visit.