Thursday, November 30, 2006

SMART: Antiretroviral Treatment Interruptions

The Kaisernetwork (November 30) in the article

Interruptions in Antiretroviral Treatment Increases Risk of Developing AIDS-Related Diseases, Can Be Fatal, Study Says

reviews the publication, in the New England Journal of Medicine of the SMART study--- Strategies for Management of Antiretroviral Therapy. Led by NIH and involving 5,472 HIV-positive people in 33 countries , it began in January 2002 but was halted at the beginning of this year after preliminary results indicated that the mortality rates among the 2,720 participants who were in the treatment-interruption group were significantly higher.

Link to .Kaisernetwork article

Link to SMART site

We looked at Poz’s and Aidsmap’s coverage of this issue in
Meds Break? (Tuesday November 7, 2006)

Gay mens' Primary Health Care

The Journal of the American Medical Association (Vol. 296 no.19) published on November 15th, was a special edition on Men’s Health. One of the articles examines ways in which the healthcare needs of gay men can be addressed in primary care. The article is reviewed by Michael Carter for Aidsmap (November 28, 2006).

For the past quarter of a century, healthcare providers working with gay men (or men who have sex with other men and do not identify as gay or bisexual) have been preoccupied with HIV. Despite the attention given to HIV, the authors of the article stress the importance of remembering that, even in cities with large gay populations and a high HIV prevalence, the overwhelming majority of gay men remain HIV-negative. They also stress that it is equally important to remember that all gay men, regardless of their HIV status, have healthcare needs that are the same as other men, and that primary healthcare services that are devoid of prejudice, judgment and homophobia are required to ensure that gay men access the care and treatment needed.

Moreover gay men are likely to have healthcare needs in addition to those of most heterosexual men. These include regular screening for sexually transmitted infections, hepatitis A and B vaccination, screening for cancerous and pre-cancerous cell changes in the anus caused by strains of the human papilloma virus, problematic drug or alcohol use, increased mental health needs, support dealing with stigma, and help forming a positive identity in the face of prejudice and discrimination, particularly during the “coming out process.”

“Straightforward, non-judgmental” should, take place in primary care regarding these issues. Practices should ensure have an environment that makes gay men feel comfortable. For example, there should be “inclusive” health information provided and questions about “next of kin” should not be restricted to blood relatives or opposite-sex partners.

The authors conclude, “much work remains to determine how to help gay men and non-gay-identified MSM engage in healthy lives that include embracing a positive image and minimizing sexual risk. Despite the complexities involved and the need for further research, clinicians can listen to these patients openly and without judgment and become better educated about current recommendations for the care of gay or other MSM.”

Link to Aidsmap article

Optimizing primary care for men who have sex with men
Makadon HJ et al.

JAMA 296: 2362 – 2365, 2006.
Link to JAMA article

Wednesday, November 29, 2006

Seattle moves to forefront in global fight to save lives

Raves from Lulu's

There was an interesting and significant article in the Seattle Times by Sandi Doughton and Kristi Heim. Yet another piece about Bill Gates the local hero. But this was no puff piece. Read it! It's an interesting analysis of how Bill and Melinda, through their foundation have made Seattle a centre of influence and progress for World Health.

We hope that its message might have some impact on the Seattle Prevention Players who rather than being supportive of this work have been small mindedly critical. The pot luck gossip that "he doesn't give enough to local organizations" was bad enough but the carping (some of it published) that the foundation was part of globalizing the issues and "de-gaying" (how that chokes!) the HIV/AIDS Pandemic was beyond. Even if the "critics" do not get the moral and ethical imperative, maybe reading this article will stimulate some enlightened self interest. What is going on in the world is impacting your small world too.

Link to Seattle Times article

The Tinky Winky Syndrome

Before you view this clip, the ultra conservatives want you to be warned that it is thinly disguised Hollywood leftist environmental propaganda.

Tuesday, November 28, 2006

HIV - Swamped by Testing?

Writing for Bloomberg News (November. 28) John Lauerman in his article
HIV Testing Plan May Triple New Cases, Swamp Clinics
reports Jim Raper and Michael Saag, who run an Alabama AIDS clinic, say their center may soon be overwhelmed by the new U.S. guidelines that everyone aged 13 to 64 who visits a doctor should be tested for HIV.

Without extra money to add doctors, nurses and other staff at HIV clinics like the one in Alabama, which treats low-income and uninsured patients, the plan may hamper quality of care for AIDS patients, says Saag, a doctor and the clinic's director. His center is running a $1.1 million deficit, and he says the guidelines may add more than a 1,000 clients within 18 months, a 75 percent increase. He will join dozens of health professionals meeting with U.S. officials in Washington tomorrow to discuss how to implement the guidelines.

John Lauerman also writes about the CDC’s February(2007) Push, which will begin promoting its testing suggestions during a series of HIV-testing workshops set for high- volume emergency departments and urgent care centers nationwide, says Bernard Branson, a CDC associate director. The agency will then move to hospitals and primary care clinics.

Branson says the financial impact of the guidelines will be minimal and that newly identified infections will rise by only about 50,000 in 2007 from the 40,000 estimated for this year. “I have a little difficulty with the perception that it's going to create costs,'' he says. The increase will be gradual, “not a geometric increase.''

John Bartlett, a Johns Hopkins University infectious disease expert disagrees. He says the testing will add twice as many new cases of the virus that causes AIDS, or acquired immune deficiency syndrome, as the CDC estimates, bringing the total to 140,000. In such a scenario, U.S. costs alone may increase by $1.5 billion, he said. “The saying is pay now and save money later,'' says Bartlett. “The problem is, we don't have the money now.''

Emergency rooms at hospitals may also be hobbled by testing, says Andrew Bern, an emergency doctor at the Delray Medical Center in Delray Beach, Florida. Emergency departments will need many more of the HIV tests. While insurance covers some testing, the number of people without coverage is on the rise and hospitals are already facing financial pressures as the government seeks to cut overall health-care costs.”You have to create time for testing, counseling, and follow up to get patients into care,'' Bern says. “Can it tie up an emergency room? Absolutely.''

Link to article

AIDS will be one of top 3 causes of death by 2030

Colin D. Mathers, and Dejan Loncar, the authors of a WHO report (published on line in Public Library of Sciences Medicine Journal) explained the project ---- Global and regional projections of mortality and disease for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, new projections to 2030 starting from WHO estimates for 2002.

The researchers used projections of socio-economic development to model future patterns of mortality and illness for:

  • a baseline scenario.
  • a pessimistic scenario that assumed a slower rate of socio-economic development.
  • and an optimistic scenario that assumed a faster rate of growth.

Their analysis predicts that between 2002 and 2030 for all three scenarios:

  • life expectancy will increase around the world,
  • fewer children younger than 5 years will die,
  • the proportion of people dying from non-communicable diseases such as heart disease and cancer will increase.
  • Although deaths from infectious diseases will decrease overall, HIV/AIDS deaths will continue to increase; the exact magnitude will depend on how many people have access to antiretroviral drugs and the efficacy of prevention programs.
  • But, even given the rise in HIV/AIDS deaths, the new projections predict that more people will die of tobacco-related disease than of HIV/AIDS in 2015.

The researchers predict that by 2030, the three leading causes of illness will be

  • Depression,
  • Ischaemic heart disease (problems caused by a poor blood supply to the heart)

[in the optimistic scenario, road-traffic accidents will replace heart disease as the third leading cause (there will be more traffic accidents with faster economic growth)].

Projections of Global Mortality and Burden of Disease from 2002 to 2030
Colin D. Mathers, Dejan Loncar
Public Library of Sciences Medicine journal
Link to PLOS Journal article

Monday, November 27, 2006

UK HIV experts criticize 'damaging' HIV transmission prosecution policy

Edwin J. Bernard, writing for Aidsmap (November 24, 2006) draws attention to the issue of legal systems being used to counter reckless transmission of HIV. Specifically referring to the UK he suggests that the Crown Prosecution Service's (CPS) current policy of prosecuting reckless HIV transmission “lacks a real understanding of the very different concerns, circumstances and vulnerabilities of people living with HIV,” according to the Expert Advisory Group on AIDS (EAGA), which published their response to the CPS public consultation this week. EAGA also asserts that “the damage to the public health is such as to outweigh any benefit from prosecuting reckless transmission, except in the most extreme and unusual cases.”

He reports that since 2001, eleven prosecutions have taken place in the United Kingdom (one in Scotland; ten in England and Wales, with just one acquittal) for the sexual transmission of HIV. In addition, several more cases are due to go to trial. Although relatively few in number, the impact of these prosecutions has been widespread, resulting in a public discussion and consultation regarding confidentiality from the (UK) Department of Health, and, especially, a public consultation on the CPS policy itself. [eds. Note: Aidsmap have been reviewing these issues for some time and the article contains links to previously published pieces]

Bernard highlights the point:

Public interest includes more than convicting alleged criminals

So, EAGA only “supports the use of criminal sanctions for transmission of HIV under certain circumstances where there is a recognized threat to public health” and where “the benefits of prosecution outweigh the negative impacts on individual and public health.” These include deliberate, intentional infection and “deception about infection status/deliberate attempt to mislead, in the absence of extenuating circumstances”.

EAGA suggests that “where a person's reckless sexual behavior has resulted in the infection of more than one sexual partner, and that behavior is continuing, there will be a stronger public health argument for prosecution than when there is a single victim” although “prosecution should be a last resort, having exhausted all other less punitive measures.”

They also deal with the ‘negative impact on public health' that prosecutions may have. They notes that “health professionals [are] modifying the advice given to HIV-infected patients” because they “are conflicted between building trust with their patients and knowing that information provided by patients about their sexual partners and recorded in the patient's notes could be subpoenaed and used against them in a court of law”. There is also “the risk of criminal prosecution may be leading to" HIV-positive individuals not disclosing the full details of their sexual practices, "to the detriment of partner notification and public health.”

EAGA stresses that “as a general principle it is important that the CPS policy supports the public health messages that sexual health is a shared responsibility and that assumptions about infection status should not be relied upon as a means of protection.

Attention is also drawn to the need to understand the science of HIV. “There seems to be an assumption that the science of HIV transmission is sufficiently robust to provide definitive evidence of the timing and route of transmission. The limitations of the scientific evidence are not addressed. The position as regards bacterial infections is even more uncertain.”

Link to EAGA's consultation response

Link to Aidsmap article

HIV and the Law: the US situation

It seems that the rest of the world is way ahead in coming to terms with some of the legal implications evolving from HIV --- particularly the issue of “reckless transmission”. We have specifically referred the UK situation as well as to the legal happenings in Australia - Doubts on HIV’s existence ‘insane’ (October 26, 2006).

So what is the US situation? We have reported some of the implications of the wish to view HIV as a “civil liberties issue” rather than a “Public Health “ issue. We reminded you of the California Supreme Court ruling on Constructivist Knowledge (July 13, 2006). Many publications, including POZ magazine, reviewed the implications of that ruling. In the July 2006 edition POZ also published an article Barely Legal by Kai Wright (still available on the POZ site) which “navigates the tangles sheets of HIV criminalization” in the US. We won’t quote from it because we feel strongly that everyone should read all of it.

Meanwhile the underlying implication remains that there are people who are “deliberately” putting their sex partners at risk. Will they take responsibility? Should they be held accountable? Will the community take hold of this issue (as other countries appear to be doing) or will we leave it to the legal/political system (notice we didn’t say “justice” system)? We are reminded of the comment by Russell Crowe in a recent interview, “Your justice system is a bit open to exploitation, mate.”

We repeat ourselves but this still applies:

When Don’t Smoke Means Do

An editorial in the New York Times (November 27, 2006) evaluates the Philip Morris “role of good citizen” as it mounts a campaign of television spots that urge parents to warn their children against smoking. That follows an earlier $100 million campaign warning young people to “Think. Don’t Smoke,” analogous to the “just say no” admonitions against drugs.

New research shows that the ads aimed at youths had no discernible effect in discouraging smoking and that the ads currently aimed at parents may be counterproductive. This comes a study just published in The American Journal of Public Health by respected academic researchers who were supported by the National Cancer Institute, the National Institute on Drug Abuse and the Robert Wood Johnson Foundation. Using sophisticated analytical techniques, the researchers concluded that the ads aimed directly at young people had no beneficial effect, while those aimed at parents were actually harmful to young people apt to see them, especially older teenagers. The greater the teenagers’ potential exposure to the ads, the stronger their intention to smoke and the greater their likelihood of having smoked in the past 30 days.

The editorial notes the theme — that adults should tell young people not to smoke mostly because they are young people — is exactly the sort of message that would make many teenagers feel like lighting up. (Trial testimony has made it clear that the goal of Philip Morris’s youth smoking prevention programs is to delay smoking until adulthood, not to discourage it for a lifetime.)

The most exhaustive judicial analysis of the industry’s tactics, by Judge Gladys Kessler of the Federal District Court for the District of Columbia, concluded that the youth smoking prevention programs were not really designed to effectively prevent youth smoking but rather to head off a government crackdown. They are minimally financed compared with the vast sums spent on cigarette marketing and promotion; they are understaffed and run by people with no expertise; and they ignore the strategies that have proved effective in preventing adolescent smoking Philip Morris, the industry’s biggest and most influential company, is renowned for its marketing savvy. If it really wanted to prevent youth smoking — and cut off new recruits to its death-dealing products — it could surely mount a more effective campaign to do so.

One postscript thought (from us) --- are there some lessons here that might be applied to the safe sex – risk reduction campaigns?

Saturday, November 25, 2006


At least the Abstinence crowd will be pleased --- condoms were not mentioned!

Friday, November 24, 2006

UK now one of fastest growing HIV epidemics in Europe

Aidsmap (November 24, 2006) warns that the U.K. had one of the highest rates of new HIV diagnoses in Europe last year, outstripped only by Portugal, Ukraine, Estonia and Russia, according to a report from the European Centre for Disease Prevention and Control. published this week in Eurosurveillance Weekly.

HIV/AIDS in Europe: trends and EU-wide priorities
FF Hamers, Eurosurveillance 11 (11), 2006.

Link to Aidsmap article and its link to ECDPC report

Over 66,000 living with HIV in the UK

Writing for Aidsmap (November 22, 2006) Edwin J. Bernard, reports the number of adults living with HIV in the United Kingdom at end of 2005 has increased by 9% from the previous year to 63,500, according to the Health Protection Agency's (HPA) annual report on HIV/AIDS and sexually transmitted infections (STIs). Of these, a third – an estimated 20,100 – were unaware of their infection. The report also reveals that more gay men and other men who have sex with men (MSM) than ever were diagnosed with HIV in 2005, whereas there were fewer new diagnoses amongst heterosexual women and men who acquired their HIV in Africa.

Link to Aidsmap article

The UK Collaborative Group for HIV and STI Surveillance.
A Complex Picture. HIV and other Sexually Transmitted Infections in the United Kingdom: 2006.
Health Protection Agency, Centre for Infections. London, November 2006.

Link to HPA Report

Wednesday, November 22, 2006

Condom Communications

[Sorry this is the only recording we could find]

There's a hole in my condom

There’s a hole in my condom, dear Lisa, dear Lisa,
There’s a hole in my condom, dear Lisa a hole.

Well, get another, dear Henry, dear Henry, dear Henry,
Get another, dear Henry, dear Henry, another one.

How shall I open it, dear Lisa, dear Lisa?
How shall I open it, dear Lisa, open it.

Tear it, dear Henry, dear Henry, dear Henry,
Tear it, dear Henry, dear Henry, rip it!

How shall I tear it, dear Lisa, dear Lisa?
How shall I tear it, dear Lisa, tear it.

With your teeth, dear Henry, dear Henry,
With your teeth ,dear Henry, dear Henry, bite it!

Oh, there's a hole in my condom, dear Lisa, dear Lisa,
There's a hole in my condom ,dear Lisa, a hole.

Tuesday, November 21, 2006

The Lessons of Vietnam, Mr. Bush

HIV/AIDS: Milestones

The current issue of the New Scientist (18 November 2006)celebrates its 50 Year Anniversary with a section 50 Years of New Scientist: The Best Articles. Included is an article by Richard Fisher, originally published in New Scientist on 16 December 1982

AIDS: The gay epidemic

To us looking back, it includes some amazing statements:

Between spring 1981 and August 1982, physicians in the US diagnosed 500 Americans with an "acquired immunodeficiency syndrome" (AIDS) and consequently notified the Center for Disease Control in Atlanta, Georgia. At least 175 of these people have since died. Of those who had developed AIDS in 1980, 70 per cent are now dead. Two cases were reported in England in 1982 and both died. Six similar instances occurred in Denmark. Two died and two are still in hospital. The outcome of two French cases and one in Spain is not known. All 11 European patients were male homosexuals. Of the vastly greater number of Americans, 95 per cent are men and 85 per cent are either homosexual or bisexual.

The earliest American reports described cases of a fatal pneumonia in male homosexuals caused by a mycobacterium, Pneumocystis carinii (Nature, vol 299, p 103). Then a rare skin malignancy, Kaposi's sarcoma (KS), appeared in the same group. Perhaps because it is a cancer and therefore more frightening, reports of KS victims multiplied quickly in the US. None has been reported in the UK, but seven European AIDS patients have had KS.

Why should the Center for Disease Control link a fatal pneumonia and a rare cancer, and why should both attack primarily male homosexuals?

British psychiatrist Dr Alex Comfort wrote that "one of the ingredients in the dissemination of the disease must be something which homosexuals do that heterosexuals do not" (British Journal of Sexual Medicine, September 1982, p 4). He suggests two: anal intercourse and the use of certain drugs. Promiscuity could be a third factor.

Link to New Scientist article

Where are we NOW?

According to a report AIDS Epidemic Update: December 2006 issued today (Tuesday November 21) by the UNAIDS and the World Health Organization the number of people living with HIV/AIDS over the past two years has increased and the worldwide total now stands at nearly 40 million.

The report estimates that 4.3 million new HIV infections occurred worldwide this year and that about 2.9 million people died of AIDS-related illnesses

40% of new infections among people age 15 and older occurred among young people ages 15 to 24.

There were 2.8 million new HIV infections in Africa in 2006, and 2.1 million people on the continent died of AIDS-related illnesses.

The most evident increases in HIV incidence occurred in Eastern Europe and Central Asia, with a nearly 70% increase in new infections over the past two years..

The number of HIV-positive women worldwide has reached 17.7 million, an increase of more than one million over the past two years. In sub-Saharan Africa, women account for 59% of people living with HIV/AIDS.

Hope = Prevention Programs

According to the report, HIV prevention programs are effective when they are focused, sustained and adapted to address the most vulnerable groups.

The report cites examples in China of programs aimed at sex workers that have led to significant increases in condom use and declines in sexually transmitted infections.

In addition, Botswana, Burundi, Côte d'Ivoire, Kenya, Malawi, Rwanda, Tanzania and Zimbabwe have seen increased condom use, delay in beginning sexual activity and decreased number of sexual partners among young people.

Link to BBC story on the Report

UNAIDS/WHO AIDS Epidemic Update: December 2006
Link to UNAIDS report

Clothes Maketh the Doctor?

Writing in the Health section of today's New York Times (November 21, 2006) Dr. Erin N. Marcus, explores an issue raised by the behavior of one of her former residents --- "There was just one problem.
"As she delivered her thoughtful patient presentations to me and the other attending doctors, it was hard not to notice her low-cut dress."
The title sums it up When Young Doctors Strut Too Much of Their Stuff and her final question raises a good point
"Do patients and colleagues underestimate her abilities? Ultimately, we didn’t do her a favor by pretending to ignore her clothes."
But some might think that this focus could only come from a doctor. The patient's main focus remains: Will the Doc really communicate with me?

As an added irony, there was another small item in the same Health Section. Under the title Safer Scrubs, C. Clairborne Ray also deals with providers clothing.
Q. I always thought wearing hospital scrubs was intended to protect patients from the spread of infection. Doesn’t the fashion of wearing hospital scrubs on the street threaten patient health?
She notes that a study published in The Journal of Clinical Microbiology in 2000 found that MRSA survived for long periods on commonly used hospital fabrics like scrub suits, lab coats and hospital privacy drapes, underscoring the need for careful disinfection of such fabrics.

The increase in regulations to prevent this are typified by the example she cites of the rules for surgical residents at the College of Medicine at the University of Illinois at Urbana-Champaign state: “Scrubs are not to be worn outside the hospital or taken home. This rule will be strictly enforced without exception. Taking soiled surgical attire from the operating room into the home can result in the spread of potential contamination to the home environment.”

Monday, November 20, 2006

Recreational Drugs & Barebacking

An Aidsmap article (November 17, 2006) reports that a California Study of recently HIV-infected men who have sex with men (MSM) found that they were more likely to have unprotected anal sex when they used recreational drugs - especially crystal meth - and erectile dysfunction drugs like Viagra.

The researchers divided the men into groups, according to whether they had had unprotected intercourse with all (24%), some (60%), or none (16%) of their last three partners. Recreational drug use was lowest in those who had not barebacked at all, and highest in those who had barebacked with all of their most recent partners. Erectile dysfunction drug use, however, was nearly the same in all groups.

The most unique component of the study was an analysis of the men who had only barebacked some of the time, to see the differences between their ‘safe’ and ‘unsafe’ sexual encounters. Recreational drugs were much more commonly used during the ‘barebacking’ encounters – especially crystal meth (5.3 times more common), marijuana (5.7 times), multiple drugs (3.8 times), and poppers (2.6 times).

The researchers stated that, “In all analyses, the most important predictor of UAI [‘barebacking’] among the last three sexual partners was methamphetamine use, suggesting that methamphetamine is an independent predictor of HIV transmission. To our knowledge, our study is the first to demonstrate that methamphetamine is associated with UAI among recently HIV-infected MSM, while controlling for individual factors. Considering the high transmissibility of HIV during early infection, these analyses suggest that methamphetamine may contribute significantly to HIV transmission from newly infected MSM to others.”

The researchers concluded that their study “contributes to the overall understanding of drug use and UAI by (1) providing support to prior studies that demonstrate associations between methamphetamine or [erectile dysfunction drugs] and sexual risk behavior, (2) clarifying that a direct association is likely to exist between specific drugs and UAI, and (3) providing evidence that the use of methamphetamine, [erectile dysfunction drugs], and possibly other illicit substances may contribute to HIV transmission.”

[eds. note: It seems that the hip Prevention Players new term is using UAI as a substitute for barebacking']

Unprotected anal intercourse and substance use among men who have sex with men with recent HIV infection. Drumright, Lydia N PhD et al
Journal of Acquired Immune Deficiency Syndromes. 43(3): 344-350, Nov 1 2006.

Link to Aidsmap article

Link to JAIDS article abstract

Sunday, November 19, 2006

Ooh, Vicar

This interesting viewpoint on the issue of Religious Education ("Faith Based" don't you like to call it?) is from the London Sunday Times (October 29) but its implications are universal. Take into account AA Gill's style. If you are in any doubt what that mean look at the next piece It’s all a bit hard to swallow.

Why do we put our faith in these schools? They just corrupt us

I went to a Church of England junior school when nothing in the world was multi-anything, including culture, and it was built, to last a lifetime. English life was filmed in black and white and had a harmonica soundtrack. We all looked like Just William and walked the two miles to the Victorian brick school, happily throwing stones at the limbless ex-servicemen selling matches and touching chimney sweeps for luck.

There were two Jewish children at the school; we knew they were Jewish because they weren't allowed into assembly where we sang All Things Bright and Beautiful - the rich man in his castle, the poor man at his gate, the few charging interest and foreclosing his estate.

If the headmaster had said, "Okay, someone killed baby Jesus and we're all going to sit here until I find out why,' we'd have handed them in. "It was the Jews, sir.They've got the nails in their pockets. One of them's hiding in the attic.”

Even then, as I said my prayers at the end of the day that finished with "God bless the little boys and girls not as lucky as me”, I knew there was something not quite kosher about this exclusion. Religious education is an oxymoron, it's a wicked thing. Not simply in the laughable sense of denying Darwin or the hours devoted to rote-learning holy books, but it's the belief that there is one set of facts for us and another for the rest of you.

Seeing the pusillanimous Alan Johnson cave in to Catholic bishops wasn't just cringingly depressing, it was a derogation of the business of government to create and maintain an equitable open state for everyone.

What is it that Catholic kids need to get taught that the rest of us can't be told? What’s so delicate about their faith that it can't go to school with everyone else? And anyway, we seem to be missing the real victims here. It isn't the secular community that's being barred (unless of course they're special needs and can be charitably picky), it's the poor kids who get accepted for the full benefit of the weird cruelty, fear, guilt and twisted sensuality that are the defining characteristics of a really thorough Christian education.

It's not a coincidence that your local [bookstore chain] has sections devoted to the memoirs of people abused in religious schools. I expect the church would say that there are so many best-selling books of Catholic misery was proof of the soundness of their education. The Catholic Church’s record on care for children is worse than any Pakistani madras or, indeed, most borstals.

I know that the children who were most corrupted by my mild C of E junior school were not the Jewish lads who were made to feel different but the rest of us who were shown that they really were different.

It’s all a bit hard to swallow

It's a bird-eat-bird world. The pelicans in St. James's Park are swallowing the pigeons and the usual swooning battalion of critter lovers is reaching for the smelling salts and the green ink. Pelicans should breakfast on fish.

Though I can't for the life of me see the qualitative difference between the life of a haddock and a feral pigeon. We go to watch pelicans being fed fish in the zoo; how much more amusing to chuck them a flying rat. I think urban pigeon coursing would be an exciting day out. and fun for all the family.

We'd start with a mad woman throwing breadcrumbs, as bait while we sit behind trees with our trained pelicans at the ready. Maybe packs of them would go for foxes - riding after a squadron of killer pelicans coming out of the sun would be brilliant.

The pelican is the ancient symbol of selfless charity. They were thought to feed their young with the blood from their breast (they don't) and the pigeon of course is cousin to the dove, harbinger of peace. Some might think that charity eating peace was an augury of some imminent catastrophe or perhaps it's just an elegant bestiary metaphor for the end of the Tony Blair years?


Saturday, November 18, 2006

The Madonna Saga continues

The Malawi newspaper The Nation reports that the Malawi Human Rights Commission (MHRC) applied to the High Court in the Capital Lilongwe to allow it to join the Madonna adoption case because "there is a human rights dimension in the case which it needs to advance". The MHRC Director of Legal Services said, "We have seen that the case concerns child rights. Where a child is getting new parents, his or her rights should not be ignored."

One might be tempted to think that a child without parents or languishing in an orphanage can be quite safely ignored!

On the other hand, Titus Mvalo the lawyer who was representing "civil organizations challenging the procedures" withdrew from the case because he did not want to be seen as blocking the adoption of David Banda.

Meanwhile the Sunday New York Times (November 12) last week in its travel section, looked at another positive impact.

While the legal right of Madonna, above, to adopt an African boy may be a matter of some debate, no one is disputing that she has raised the profile of Malawi, and given a boost to the efforts of groups running charitable volunteer trips to that impoverished country.

“Madonna has attracted attention to a country that does not get in the press often, which helps them enormously,” said Mike Lamb, of Quest Overseas, a British company that organizes four-week trips of volunteers to an orphan care center in Malawi, as well as other expeditions throughout Africa and South America. “She has made people think about food distribution, poverty and H.I.V./AIDS education, which has generated a lot of interest in our programs.”

“What ends up in the news, such as this Madonna story, helps bring these issues into people’s consciousness and often leads them to volunteer,” said Amy Bannon, a placement officer for Volunteers for Peace, a nonprofit group in Vermont .Her organization offers more than 3,000 short-term voluntary service projects in over 100 countries — 10 a year in Malawi.

Link to

Link to

For those who are still asking this shows the location of Malawi:

Welcome Back Chloroquine

The drug chloroquine was for many years the standard for treating malaria because it is cheap, effective and safe. In 1993 doctors stopped using it in the African nation of Malawi because the malarial parasites carried by the mosquito developed resistance.

In recent years, researchers from the University of Maryland School of Medicine saw signs of genetic shifts in the parasite that suggested it might, once again, be vulnerable to chloroquine. They tested 105 malaria-infected children at a Malawian clinic and 99% were cured.Researcher Christopher Plowe said "We didn't expect to see this. I'm not aware of any case where a drug wasn't working clinically and was withdrawn and now is 100 percent effective again".

Link to New England Journal of Medicine

Friday, November 17, 2006

Doctors Often Don't Talk Cost

Doctors Often Don't Talk Cost
or is it just --- Doctors don't often talk?

A research team led by Derjung Tarn of the University of California at Los Angeles looked at patient and doctor surveys and transcripts of 185 audio taped patent visits at two California health care systems.

The study published in he American Journal of Managed Care reports that doctors only discuss the cost of drugs about one-third of the time when they prescribe them to patients. They also failed to discuss refill, generic options and insurance coverage.

Link to American Journal of Managed Care

Are we prescribing HIV drugs properly?

This is the question raised by the New Scientist.(11 November 2006).

In cash-starved regions of the world, deciding who should get anti-retroviral drugs for HIV is a tough call. Now it seems that one of the main tools for making that decision may be less reliable than it appeared.

World Health Organization guidelines recommend starting anti-retroviral drugs when someone's CD4 cell count has fallen below 350 cells per microlitre, an indicator of HIV infection, or for people with symptoms of AIDS whose CD4 count has dropped to below 200.

Brian Williams of the WHO and his colleagues studied HIV-positive and HIV-negative populations in eight African countries including Ethiopia, South Africa, Uganda and Zambia. They found that between 3 and 5 per cent of HIV-negative people had CD4 counts below 350.

What's more, when people with low pre-infection cell counts did contract HIV, and received anti-retrovirals, they survived for about nine years - the same as people with high counts (Journal of Infectious Diseases, vol 194, p 1450).

The new findings call into question just how much we understand about CD4 cells and their interaction with HIV, says Williams. "Generally, if you have high CD4 counts you can be considered to be doing pretty well and if you have very low counts, you're in trouble," says Williams.

But CD4 counts can vary a lot naturally so if you follow the WHO guidelines to the letter, then some people started on anti-retrovirals would not even be infected with HIV, he concludes.

Link to InfectoNews with links to abstract and full test of WHO study

Link to New Scientist article

Thursday, November 16, 2006


Has Crix Belly gone away?

Lipodystrophy-related differences in waist size not seen in HIV-positive men

Derek Thaczuk writing for Aidsmap (15 November 2006) was one of the many who reviewed a study published in the 1st November issue of the Journal of Acquired Immune Deficiency Syndromes.

The study (with the daunting title: Longitudinal anthropometric changes in HIV-infected and HIV-uninfected men), took body measurements (with a tape measure = 'anthropometry') and compared the changes over a four-year period. Waist and hip sizes increased as men aged -- as expected. However, HIV-positive men on potent anti-HIV treatment had slower increases in hip size. Changes in waist size were the same regardless of drug treatment or HIV status.

The results seem to contradict earlier observations that anti-retroviral medication sometimes causes increases in belly size -- Crix Belly or Protease Paunch. (Crix was first associated with the effect found in patients using crixivan). As Derek Thaczuk warns, belly size increase continues to be seen around us in many people with HIV and is reported anecdotally by physicians.

Oh, and what is Lipodystrophy, you ask?

Lipodystrophy is the blanket term for HIV-associated changes in body fat distribution.
Past studies have shown that fat loss in the face and extremities --lipoatrophy--- and fat gain in the trunk and belly --- lipohypertrophy --- are separate processes.

Link to Aidsmap article

Longitudinal anthropometric changes in HIV-infected and HIV-uninfected men. By T Brown et al.
Journal Acquired Immune Deficiency Syndromes. 43(3): 356-362, 2006.

Link to JAIDS article abstract