Showing posts with label Johannesburg. Show all posts
Showing posts with label Johannesburg. Show all posts

Wednesday, February 29, 2012

The West's Influence on the Spread of AIDS

viaNPRbooks

A woman walks past a banner placed around the perimeter of the Rand Afrikaans University in Johannesburg on World AIDS Day. The university used the banner to raise public awareness about AIDS and the devastating toll the disease has had in South Africa. HIV is a slow-moving time bomb.

Unlike Ebola, which infects and kills people quickly — and then disappears just as quickly — the HIV epidemic has become so good at killing people in part because it moves so very slowly, says journalist Craig Timberg.

"In vaginal sex, you can have sex with hundreds of people and not transmit [HIV], it turns out," he says. "And that's part of the reason it's still with us today. It has spread very slowly. It makes people ill very slowly. ... And that's one of the reasons why it's been so difficult for the world to understand it. ... It's been hard to make sense of this epidemic because of the way it moves. It's not obvious."

Timberg, the former Johannesburg bureau chief for The Washington Post, with his co-author Daniel Halperin, an AIDS expert currently at the University of North Carolina, explores the history of the HIV virus and efforts to fight the AIDS epidemic in his book Tinderbox: How the West Sparked the AIDS Epidemic and How the World Can Finally Overcome It.

The History Of HIV

Timberg tells Fresh Air's Dave Davies that the simian version of HIV — which is called SIV — has been around for thousands of years. It was only when colonial powers migrated across parts of Africa — where the SIV virus existed among the chimps — that the virus started to spread among humans.

"It was only with the introduction of these new transport routes, of these human movements, that HIV popped out of the chimpanzee population and starts an epidemic among the human population and became what we see today," he says.

In the past 100 years, 99 percent of all of the world's deaths from AIDS have come from a strain of the virus called HIV-1 group M, which first appeared in remote parts of Cameroon, where African porters worked a century ago cutting paths across dense brush in places where humans had never before traveled.

"The best theory is that a human caught a chimp, was butchering a chimp — which is a very bloody business — and in the process of that cut his hand, and the virus mutated as it went into the human bloodstream," says Timberg. "... [There was] human movement in areas where humans didn't live in great density before colonialism arrived — you had the arrival of the rubber trade and the ivory trade, and suddenly you had to go into these very deep parts of the forest that were not hospitable to humans before and since."

From Cameroon, strains of HIV migrated down into other parts of central Africa and then into Leopoldville, which is now called Kinshasa. Leopoldville was a Belgian territory and by 1920 had become the capital of the Belgian Congo — complete with factories, shipyards, railways and single-sex dormitories for the workers, who were thrust into urban living conditions.

"You had the kind of human movement that could really get an epidemic moving," says Timberg.

In 1960, the Belgians gave up Congo, which then became an independent country again. At that point, 1,000 to 2,000 people likely had HIV, says Timberg.

"But you have to bear in mind, when HIV progresses into AIDS, it looks like a lot of other diseases," he says. "You have diarrhea, you have fevers, you have wasting. So there's not much evidence that anybody at the time had any evidence that there was a new sickness."

The unknowingly infected inhabitants of Kinshasa mingled with U.N. aid workers who were flown over from Haiti to work as physicians and civil servants. It is almost certainly the case, says Timberg, that one of the Haitian aid workers caught HIV in Leopoldville and then flew back to Haiti.

Fighting AIDS In Africa

In the 1980s in the United States, there was a large resistance to the idea that HIV and AIDS could spread widely among a heterosexual population — in part, says Timberg, because it didn't happen in many places. But across Africa, he says, it was a different story.

"The first researchers who began to look into the HIV epidemic in Africa found these unbelievable rates of infection that frankly horrified them and terrified them," he says. "When they began to write their papers about this, the peer-reviewed medical journals were like, 'You're crazy. You can't have HIV spreading like this.' But in Africa, it did."

Many African countries initially ignored the AIDS crisis, but some nations — like Uganda and Zimbabwe — were successful in providing public health information and slowing the spread of the disease. Timberg says when Western countries later became serious about fighting the African AIDS epidemic, international AIDS groups didn't follow Uganda's model — and overlooked some relatively simple and inexpensive approaches proven to stem the spread of HIV.

One of their errors, he says, was overlooking the effectiveness of male circumcision. Circumcised men are at a much lower risk of becoming infected with HIV through sexual transmission.

"When you look at the parts of not just Africa but the world where HIV is worse, it is almost inevitably societies that don't circumcise," he says. "The science on this began emerging in the 1980s and it became terribly politicized. People were uncomfortable with the subject, and the whole discussion became incredibly controversial. It took almost 20 years for the scientific community and the community of policymakers to really do enough science and enough research to realize how important this was."

Read the Rest.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Friday, July 8, 2011

Risk factors for HIV vary between African cities, need tailored responses

Via AIDSMap, by Carole Leach-Lemens.



A comparative study in three large cities in southern Africa has found big differences in risk factors for acquisition of HIV infection, emphasising the importance of locally tailored HIV prevention strategies and up-to-date information on local risk factors.

The study looked at behavioural risk factors associated with acquiring HIV infection in 5000 sexually active women in Harare, Durban and Johannesburg who took part in a large trial of an HIV prevention method based on use of the diaphgram.

Sue Napierala Mavedsnege and colleagues report the findings of their prospective cohort analysis in the advance online edition of the Journal of Acquired Immune Deficiency Syndromes.

A total of 309 incident HIV infections were identified. Durban reported the highest incidence rate, followed by Johannesburg and then Harare (6.75 per 100 person years, 95% CI: 5.74-7.93; 3.33 per 100 person years, 95% CI: 2.51-4.44; 2.72 per 100 person years CI: 2.26-3.26, respectively).

Having more than one partner in the last three months was the only common factor associated with HIV incidence.

The majority of the estimated 35 million people living with HIV live in sub-Saharan Africa where 70% of all new infections occur. Women represent over 60% of all infections. Southern Africa, with the highest regional prevalence, reflects different phases of the epidemic.

In Zimbabwe, with an estimated prevalence of 14.3%, the epidemic began early, peaked in 1998 with a subsequent decline in incidence and prevalence.

From 1990-1998 South Africa had an exponential increase followed by a moderate increase until 2004 when apparent stabilisation began. In 2008 estimated provincial prevalence rates ranged from 5.3% to 25.8%.

In Gauteng province, with Johannesburg its largest city, prevalence appears to have peaked in 2002 at 20.3% and declined to 15.2% in 2008. In contrast, Kwa Zulu Natal province where Durban is the largest city, estimated prevalence rose from 15.7% in 2002 to 25.8% in 2008.

While cross-sectional studies looking at risk factors associated with HIV have taken place in Zimbabwe and South Africa, few have looked at risk factors for HIV incidence in women. A better understanding of these factors within local contexts will help develop targeted interventions so reducing transmission.

The authors looked at factors associated with differences of HIV incidence among women in Harare, Johannesburg and Durban enrolled between September 2003 and September 2005 in the Methods for Improvement of Reproductive Health (MIRA) study, a randomised clinical trial to look at the effect of the diaphragm plus lubricant gel for the prevention of HIV. The intervention did not reduce HIV incidence.

The authors undertook a prospective cohort analysis of trial participants who were followed for a median of 21 months (12-24 months).

Socio-demographic, biological and behavioural data were collected at baseline and at quarterly visits. Testing for HIV and STIs were conducted at each quarterly visit.

Each location had distinct characteristics as well as different patterns of individual risk factors.

In Harare women were more likely to live with their partner, be employed and not use alcohol or drugs but more likely to wipe inside their vagina. While they had a later sexual debut and fewer partners than in Durban or Johannesburg there was more transactional sex (for money, food, drugs or shelter) within the last three months.

Early sexual debut was more common in Durban, while in Johannesburg consumption of alcohol within the last three months, multiple sexual partners and sex under the influence of drugs or alcohol were more likely.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]
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