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AFRO-NETS> Kaiser Daily HIV/AIDS Report
Kaiser Daily HIV/AIDS Report
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NIGERIA: CLINTON VISIT WILL PROMOTE DEMOCRACY, AID AWARENESS AND
TREATMENT
President Clinton leaves today for a weekend visit to Nigeria to con-
vey support for the country's democratic transition and to announce
more financial support from the United States for the prevention and
treatment of infectious diseases, particularly AIDS (White House re-
lease, 8/24). The main agenda items are related, White House Chief of
Staff John Podesta implies: "[T]here are critical issues that go be-
yond political reform and even economic reform towards the issues
that are confronting Nigeria and the continent," such as AIDS and
other infectious diseases (Gearan, Associated Press, 8/24). A Wash-
ington Post editorial concurs, stating, "The stronger Nigeria's de-
mocracy- and the better its people are able to cope with looming
health crises such as HIV/AIDS-the more secure [the country] will be"
(Washington Post, 8/25). The Associated Press reports that "Clinton
may also approve a write-off of some of Nigeria's foreign debt but he
would need congressional approval for any U.S. debt forgiveness" (As-
sociated Press, 8/24). The AIDS pandemic has taken a "staggering
toll" on Africa, with recent estimates that 25% of the continent's
more than 700 million people are projected to die of AIDS by 2010,
"leaving behind 35 million orphans and slashing the region's economy
by a quarter." AIDS and other infectious diseases, such as cholera,
malaria and E. coli, have decreased the average life expectancy in
Africa to 48 years. A senior U.S. official who monitors Africa said,
"Africa has not yet fallen off the edge of the world. But the gap be-
tween it and the rest of the developing world is getting wider and
wider by the day" (Wright, Los Angeles Times, 8/25).
AIDS IN AFRICA: ZIMBABWE SPURNS DRUG LOAN OFFER
Zimbabwe has rejected loan offers for the purchase of anti-AIDS drugs
from the U.S. Export-Import Bank, the Harare-based Financial Gazette
reports. The country joins South Africa and Namibia in denouncing the
loans, saying the offer "would enrich American and Western drug manu-
facturers while creating an extra debt burden" for African nations.
Health experts doubted if any nation of the 14-member Southern Africa
Development Community would accept the Ex-Im Bank offer. Dr. Thuthula
Balfour, director of the SADC's health unit, said that "it was better
for the developed world to make anti-AIDS drugs freely available in
Africa than to talk of loans that created interest." The loans, part
of President Clinton's initiative to combat HIV/AIDS in Africa, of-
fered interest rates of about 7%. Pharmacists in Harare say prices
for antiretrovirals have actually increased, despite claims from
manufacturers that prices would be reduced for African nations. The
cost of a month's supply of Combivir has increased from $11,000 in
June to $14,782 currently. But five big pharmaceutical companies, in-
cluding Glaxo Wellcome, the manufacturer of Combivir, are currently
negotiating cheaper rates with the World Bank, the United Nations and
African governments (Financial Gazette, 8/24).
CIRCUMCISION: UNIVERSITY OF ILLINOIS PROFESSOR DISCUSSES LINK WITH
HIV
In an interview with the Nairobi, Kenya, newspaper The Nation, Pro-
fessor Robert Bailey of the University of Illinois at Chicago ex-
plained his plans for an upcoming study examining the role of male
circumcision in the spread of HIV. The proposed randomized controlled
study, which will take place in Nyanza, Kenya, will recruit young
men, 50% of whom will be voluntarily circumcised. Both the uncircum-
cised and the circumcised groups will be followed for two years, with
each man receiving HIV counseling and testing every six months, and
the final analysis will compare HIV incidence between the two groups.
Bailey discussed the rationale behind his upcoming study on male cir-
cumcision in the following comments:
* Bailey noted that over 35 studies have shown that uncircumcised
men are 2-8 times more likely to become infected with HIV than cir-
cumcised men. He added that the areas of highest HIV prevalence-
Uganda, Zimbabwe, Zambia, and western Kenya-are areas where male cir-
cumcision is not practiced. He also contested that in areas where men
are not circumcised, up to 55 percent of HIV infections are attribut-
able to the lack of circumcision.
* Concerning the number of circumcised men in Africa, Bailey said
that in western Africa and in Muslim societies, circumcision is
largely routine. He estimated that 65%-70% of the males are circum-
cised, but added that the practice varies largely by region. In com-
paring Cameroon, where most men are circumcised, and Zimbabwe, where
most are not, Bailey reported that in both countries men and women
"have multiple sexual partners, low condom use, high numbers of sexu-
ally transmitted infections, and yet the HIV rate in Cameroon is just
5% while in Zimbabwe ... the HIV rate is 28%."
* Bailey stated that the skepticism shown by some experts toward
his study stemmed from several concerns, one being that the promotion
of circumcision as an HIV prevention method might lead some men to
believe that once circumcised, they cannot contract the disease. Bai-
ley said that "circumcision is not fully protective; it only reduces
one's risk of infection. Circumcision will work best if it is inte-
grated jointly with the other anti-HIV prevention interventions."
* Noting that only observational studies on circumcision have
been completed to date, Bailey stated that "only a randomized control
trial will allow us to know for sure whether circumcision is help-
ful."
* Explaining that the costs of traditional African circumcision
ceremonies were high, Bailey said that circumcisions performed in
clinics would be more economically feasible for most of the popula-
tion. "I think there is no question it costs money to train medics
and procure supplies, but we have to remember that there are already
high costs being paid for traditional circumcision."
* Addressing the politics surrounding circumcision in Africa,
Bailey said that he anticipated resistance to his study, as most peo-
ple in the region are traditionally non-circumcising, but that most
young men "'want to start [in the study] right away.'" Bailey added
that the study has been reviewed by the Nyanza provincial medical of-
ficer and the Nyanza Ethical Review Board, but is waiting approval by
other government officials.
* Bailey concluded by stressing the importance of the trial and
its possible worldwide impact. "It is the very first controlled trial
ever trying to prove scientifically the link between circumcision and
the HIV/AIDS pandemic. ... [I]f it is proved to be effective it will
affect hundreds of thousands of infections in Africa ... Circumcision
has very far-reaching implications for HIV reduction worldwide"
(Otieno, The Nation, 8/22).
AIDS DISSIDENTS: PLAN UGANDAN CONFERENCE
"Dissident scientists" who doubt the link between HIV and AIDS will
hold an international health conference in Uganda later this month to
discuss their views on what has caused the pandemic, Sapa reports.
These scientists, whose views have been supported South African
President Thabo Mbeki, "question the validity of methods used in HIV
testing and the usefulness of [antiretroviral drugs] in treating vic-
tims." The conference, to be held at the Roman Catholic Uganda Mar-
tyrs University, will be called, "Making Sense: Alternative Views on
the Origins and Causes of AIDS in Africa." The Uganda AIDS Commission
has criticized the conference, but it has not indicated it would try
to prevent it from proceeding. UAC Commissioner General Kihumuro Apu-
uli cautioned that contrarian activities like these hurt the fight
against AIDS and ultimately lead to more deaths. "This is a serious
matter and we have a problem here. It can be proved in the laboratory
that HIV causes AIDS, but these people are saying it is caused by
something else," he said. Along with the commission, the Ugandan gov-
ernment favors awareness efforts and voluntary testing to fight the
spread of HIV (Sapa, 8/20).
--
Cecilia Snyder
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