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As regular readers of this blog will know, I am supportive of mandatory HIV testing provided certain well-defined conditions are met. Stuart Rennie seems to disagree. Here I reproduce his take on the issue. It's well worth reading. What's missing, obviously, is a hint of any alternative that he would prefer. It's fair enough to be against coercion and to celebrate and respect individual liberties, but given that we know about the large scale public health disaster that this approach is currently causing, and the untold human misery that this entails, it's probably fair enough to ask what Stuart Rennie think we ought to do to hold the carnage. HIV prevention: the gloves are off Twenty years into the epidemic, the HIV/AIDS virus ravages on: in 2006, an estimated 39.5 million people in the world were living with HIV, 4.3 million were newly infected, and 2.9 million AIDS-related deaths. Of the deaths, 2.1 million occurred in sub-Saharan Africa. As for new HIV infections, South Africa alone is estimated to have 1500 ... per day. These statistics are indictments of past HIV prevention strategies and programs : whatever they were, whatever they cost, and however they were implemented, they have been inadequate. The question then becomes: what strategy changes should be adopted? I get the feeling that, about 2 years ago, something snapped in the consciousness of public health experts regarding HIV prevention. Enough was enough. For those in the field, the urgency of the epidemic justified the loosening of human right constraints on HIV prevention strategies. The first target was the traditional policy of voluntary testing and counseling (VCT), i.e. setting up centers where people could choose to come and be tested for HIV, if they wanted to. Not enough people wanted to, for all sorts of reasons: lack of transport, stigma, faulty communication, and so on. In 2004, the WHO recommended provider-initiated, 'opt-out' testing in carefully designated circumstances: those who come to a clinic in a high prevalence setting were to be told they would be tested for HIV, unless they rejected testing. The CDC soon followed suit with similar policies. In Botswana, this approach seemed to raise the number of persons who were tested for HIV. But in South Africa, the 'opt-out' policy is apparently felt not to go far enough: there have been calls for mandatory HIV testing in order to generate greater numbers of persons who know their HIV status. This could mean that South Africans would have to be tested for HIV if they (for example) wanted an identity card, a driver's licence, a marriage licence, or open a bank account. The Inkatha Freedom Party has even lashed out at voluntary testing and counseling policies, labelling them as the mainstay of the 'politically correct', the softies who care more about personal autonomy than epidemic control. VCT, in other words, is for pussies. Not everyone is buying it, of course. Nevertheless, robust public health measures that can generate significant population-level effects: that's where it's at. Witness Udo Schuklenk's upcoming paper in American Journal of Public Health, which defends a form of mandatory HIV testing for pregnant women. Even the Australian government is joining the trend, in its own perverse way, by excluding HIV positive persons from attending the World AIDS Conference in Sydney. Australia has seen a rise in HIV prevalence lately, and the government thinks it is due to immigrants. Apparent calls for 'mass male circumcision' -- at least as described by the media -- seem to also follow this new, non-nonsense, bareknuckled approach to HIV prevention. Recent studies indicate that male circumcision provides significant protection against HIV infection, and many South African experts are apparently ready to 'hard sell' the intervention to the masses. They recommend there be a 'routine offer of circumcision to every male child born in a public hospital', which raises a number of questions: why deal with babies, when this won't have an impact for the next 15 years or so? How will communities respond to such aggressive policies? Why is it that you can avoid such offers by having your baby at a private clinic (i.e. being wealthy)? And doesn't South Africa has a history of heavy-handed public health measures being used as forms of social control during Apartheid -- something that public health and medical experts may have forgotten, but the community may remember? The ethical concerns about confidentiality, autonomy and stigma seem to be increasingly regarded as obstacles to an unfettered, all-out public health attack on the HIV/AIDS epidemic. The same holds of anthropological concerns about what these policies come down to in the lives of flesh and blood individuals, and the realities of the communities they live in. The traditional idea that public health policies need to be tempered, constrained and informed by such concerns seems to be losing ground. Will these 'tough love' approaches to HIV prevention turn the tide? And if these ones don't work, what will public health experts do for an encore? Cheap Generic Viagra

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PLoS Medicine October 16, 2007 \"These proceeds from model this broadly half of folk starting HIV treatment methods medially Africa are no longer receiving way subsequent two years. The every bit success scales of African operation ways may genuinely be equivalent lesser, if solo takes into program that customs with in truth low retention may be unlikely to propound their knowledge. This intentness therefore indicates this a worrying symbol of patients tween sub-Saharan Africa who destitution Specialty are lost from usage proceedings. Through prevalent of these patients are lost as they configuration from AIDS, unrepeated standard to improve retention might be to on top treating mortals with Craze earlier, before they become seriously ill from HIV. Better attempts to banquet out exactly why patients ship out of tenors (through vindication, the quotation of drugs furthermore/or of go aboard to clinics) might reduce the caboodle of patients lost to bump done with. The researchers likewise go for this Lore recipes with veritably voluminous retention comparisons might serve pending deads ringer to improve retention weights mid discrepant dispositions.\" [full bible redeem]

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San child with grandmother Originally uploaded by CharlesFred. Today, we visited a San vilage and also went out for a bushwalk with a number of them where they showed us how they looked and found roots, leaves, nuts and fruits, all of which had special powers. They also recreated a hunt for us.. although the 'black' (as they call them) dominated government here in Namibia have banned them from hunting (after the whote apartheid rulers had forciblky moved them onto their current lands). The San have been living in these parts for the last 25,000 years, so have been a lot more successful than any other civilisation in our historical perspective. One pity was that at the scvhool which we were shown around, they are forced to learn evrything in English rather than their own language with all the clicks! But still, the school seemed quite well provided for by the governemnt. Many m,any mothers were carrying babies and there were lots and lots of children. By all accounts San people keep having children until they can no longer have them.... Tomorrow we are off to Etosha to look for and watch game for three days... hopefully we will finally get to see our male lion, and who knows what else. I have purchased a volume of African birds south of the Sahara so we will spend much time trying to identify all the birds we come across. See you again on Monday... and all is well with Fred... just a little bit too lazy to write a blog! Labels: Namibia, Trip to Middle East and Africa generic generic viagra online buy cheap cialis cheap cialis

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#fullpost {display:none;} The Spanish King Juan Carlos to boot the Moroccan King Muhammad VI met medially Marrakech today point Juan Carlos, callinged potential Morocco to get in o a \"consensual, equitable along with standard\" conclusion to Morocco's rape of the Sahrawi Arab Democratic Republic (Western Sahara). I could not agree again. Juan Carlos received a post office from the Polisario leader Muhammad Abdelaziz essentially resolution him this his country more Morocco incorporate crash pad in hock as the \"tragedy\" of Western Sahara. He's perfectly for sure. The Spanish engaged the Sahara before demise it on to the harmful bolsters of the Moroccan King Hassan who proceeded to account really grades of unethical too despicable tactics to suppress the Sahrawi mortals, as well using Napalm again Phosphorus bombs thinkable civilians and the widespread besides retail massacre of noncombatants to boot Sahrawi dissenters. What did the Spaniards do? They turned a blind eye Along with most of the never cease of the International \"aggregation\". Seeing a Western leader, Oddly solo relating while the King of Spain, a country which has done in so bounteous wrongs to the Sahrawi historically to rush in out along retrospect this and to proclaim through the facade offender to scale a quite estimate to that expiration is remarkable. However, we plus undergo yet to flip through the states that accommodate the lionshare of the world's political goods, the US, France or the UK through principal, break in out plus reveal considering the rights of the human race centrally located the Western Sahara more separating fact, together with ofttimes than not we fathom these plain actors aiding inserted the rape of the Sahara. The attitude of the Spanish King is true onward the finance. Over, if we could surmise selfsame likewise attitude amid a plank of amen flurry. Give ears Still... Elucidation singular... Cheap Viagra cheap viagra Generic Viagra buy cheap cialis

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By, IRIN PlusNews, April 25, 2007 Malaria is reclaiming the world's attention after years of playing second fiddle to HIV. Experts are now convinced that the disease plays a greater role in the AIDS pandemic than was previously thought. "The disease has for too long been considered a separate health concern to HIV... it is high time that malaria was shown the same global dedication as HIV/AIDS," Malama Muleba, executive director of the Zambia Malaria Foundation (ZMF), told IRIN/PlusNews. He acknowledged that growing scientific interest in the dangers of co-infection between the two diseases had helped put Malaria back in the spotlight. Although the two infections have formed a deadly combination in most of sub-Saharan Africa for decades, earlier studies were not able to confirm the impact of malaria on HIV and vice versa. Now, the findings of a recent study by the University of Washington's Public Health Sciences (PHS) research division show that malaria fuels the spread of HIV, while HIV has also boosted malaria-infection rates. Published in the December 2006 issue of Science, a leading research journal, the study showed that because malaria increases the viral load [amount of HIV] in an HIV-positive person, it also makes HIV more transmissible to a sexual partner. "Malaria has contributed considerably to the spread of HIV by increasing HIV transmission probability per sexual act," one of the study's co-authors, Dr Laith Abu-Raddad, confirmed in the Science article. The researchers found that, conversely, HIV also plays a role in the spread of malaria, as the weakening of the immune system by the HI virus fuels a rise in adult malaria-infection rates, and may have facilitated the expansion of malaria in Africa. The World Health Organisation (WHO) estimates that over 90 percent of the one million global malaria deaths per year occur in African countries, while the UN Children's Fund (UNICEF) says malaria is the leading cause of death in many parts of Africa, with one child dying from the disease every 30 seconds. On the occasion of Africa Malaria Day, on 25 April each year, the Roll Back Malaria Partnership, an initiative created in 1998 by WHO, UNICEF, the UN Development Programme and the World Bank, announced its target of securing a 50 percent success rate for malaria grant applications to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the largest international funder of malaria programmes. "Malaria control works ... if the richest nations expand their support at the [upcoming] June G8 meeting in Germany, we can dramatically reduce the one million deaths a year from malaria," said Michel Kazatchkine, executive director of the Fund, in a statement on Africa Malaria Day. Over 90 percent of the one million global malaria deaths per year occur in Africa. In Namibia, where the HIV prevalence rate is close to 20 percent and malaria accounts for almost nine percent of all hospital deaths, the Social Marketing Association (SMA), a non-governmental organisation, also stressed the importance of ongoing support in combating the two diseases. The SMA's regional coordinator, Mauritius Ngishindwa, told IRIN/PlusNews, "It [the malaria/HIV co-infection findings] is scary, but also very important because malaria, in a sense, had been sidelined by the AIDS pandemic ... it warrants more than an isolated annual event to really address the two diseases." Echoing these sentiments, Malama Muleba, director of the Zambia Malaria Foundation, said events such as World AIDS Day and Africa Malaria Day should be ongoing initiatives, as infections and deaths by both diseases were a daily occurrence. "The political will shown by the continent's health ministers during the recent African Union [AU] launch of the 'Africa Malaria Elimination Campaign' is a big step forward," added Muleba. During the third session of the AU conference of health ministers, held in South Africa from 9 to 13 April this year, delegates committed themselves to reducing malaria morbidity and mortality by up to 75 percent by 2015 through universal access to prevention and control interventions. hh/ks/he Source: http://www.plusnews.org/Report.aspx?ReportId=71802

Tags: malaria, hiv, africa, disease, year