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Friday, 27 July 2012

TUSKEGEE Part II in Africa: HIV Vaccine trials on Ugandan guinea pigs: 250 Ugandan women for vaginal ring anti-HIV study


Thus saith the Lord; Cursed be the man that trusteth in man, and maketh flesh his arm, and whose heart departeth from the Lord.
Blessed is the man that trusteth in the Lord, and whose hope the Lord is.

For he shall be as a tree planted by the waters, and that spreadeth out her roots by the river, and shall not see when heat cometh, but her leaf shall be green; and shall not be careful in the year of drought, neither shall cease from yielding fruit. (Jeremiah 17)


My Advice
The bible says that Cursed is he who trusts in man. The bible also says the heart of man is deceitful above all things and desperately wicked (Jeremiah 17:9). Therefore do not trust in carnal solutions to HIV. The only solution to avoiding the HIV virus is becoming born again. As a born again Christian, abstain from sex if you are not married and be faithful to your wife if you are married. Getting circumcised or washing your genitals after sex is all bogus advise.

Do not, I repeat DO NOT participate in HIV trials because even if the trials are successful, it is the west that will benefit. The African as always are simply being used as guinea pigs  in these trials. The purpose of these trials is to help drug companies to reap profits from HIV medicines. These so called scientists who are behind the circumcision crusade and HIV vaccine trials are working in the interests of the American New world order system and its pharmaceutical companies. 
They are not interested in you, but only want HIV spread to increase so that American and European Companies can reap profits. HIV is a creation of the USA military and the US is using it as a political weapon to control the poor of the world. They confuse African countries that they are helping out on HIV/AIDS while in reality they robbing African mineral resources.  

 

FIRST READ:

THE DRUG EPIDEMIC, VIRUSES,
EBOLA, AND AIDS
[IT'S NOT WHAT YOU THINK!]


http://www.antipasministries.com/html/file0000081.htm



UNETHICAL MEDICAL RESEARCH IN AFRICA Funded or Assisted by US-Based Institutions and/or US Government NON-CONSENSUAL RESEARCH IN AFRICA THE OUTSOURCING OF TUSKEGEE Part II






Randomized controlled trials for HIV/AIDS prevention among men and women in Africa: untraced infections, unasked questions, and unreported data




Since when did the HIV creators become passionate about HIV spread: US Embassy in Kampala says Circumcision does reduce HIV spread



MUST WATCH:


Emerging Viruses: Aids & Ebola - Nature, Accident or Intentional?


www.youtube.com/watch?v=6-VhkR9FGvA

 

Drive to End AIDS in U.S. Stalls as Epidemic Grips Blacks

http://watchmanafrica.blogspot.com/2012/07/drive-to-end-aids-in-us-stalls-as.html

 

US cannot continue funding treatment and care yet more and more Ugandans are getting infected: Oh! really

http://watchmanafrica.blogspot.com/2011/06/us-cannot-continue-funding-treatment.html

 

President Museveni makes another attack on Uganda’s Bogus Circumcision Crusade

http://watchmanafrica.blogspot.com/2012/07/president-museveni-makes-another-attack.html

 

How strange! Why is AIDS a "gay disease" in the United States, but not in Uganda, or Zaire, or Rwanda, or - for that matter - anywhere else in the world? Why only in the United States? No one in the government has ever offered a satisfactory explanation for this - until recently when a few brave researchers began to follow the path suggested by the Soviets in the late 1980s; specifically, the connection between certain HB virus studies in the United States (specifically in New York and San Francisco in the late 1970s and early 1980s) and in Africa (mainly in Zaire) shortly thereafter. The studies were carried out under the auspices of WHO (the World Health Organization) and Merck Pharmaceuticals. What brought these studies to the attention of researchers like Seale, Servin and Segal is that wherever these vaccinations were carried out, shortly thereafter an outbreak of AIDS occurred - and in the same population that the studies had targeted: gays in the United States, and heterosexuals in Africa. In the United States, AIDS has remained largely a "gay disease" because of the "closed" or "contained" nature of the gay community, while in Africa - where the experiments with the HB vaccines were carried out in the general population - AIDS became a heterosexual phenomenon.http://www.antipasministries.com/html/file0000081.htm


250 Ugandan women for anti-HIV study




Thursday, 26 July 2012 23:58

Written by KAKAIRE AYUB KIRUNDA

Uganda has started screening women to participate in a multi-country HIV prevention trial testing the use of a vaginal ring at the Johns Hopkins University Research Collaboration (MUJHU CARE LTD) clinical research site, Mulago. The project, A Study to Prevent Infection with a Ring for Extended Use (ASPIRE), is a Phase III study that seeks to determine whether the use of a vaginal ring containing the antiretroviral drug dapivirine is a safe and effective method that protects against HIV infection among sexually active women at high risk.

Speaking in Kampala on Tuesday, ahead of the formal announcement later in the evening, at the ongoing 19th International Aids Conference in Washington, DC, the site Principal Investigator, Dr Flavia Matovu Kiweewa, said about 250 Ugandan participants will be among the 3,476 women targeted across 18 sites in South Africa, Malawi, Zambia and Zimbabwe.

“They will be randomized to receive either the 25mg dapivirine vaginal ring or a placebo vaginal ring,” Kiweewa said, adding that the participants would use the product for a maximum of 24 months.

“If proven effective, vaginal rings will only need to be replaced once every month — it’s like remembering to buy sanitary pads once every month — compared to taking a pill daily or relying on your partner to wear a condom.”

Dapivirine, according to Dr Kiweewa, was chosen because it demonstrated a potential for development as a microbicide, given its potency and fast-acting properties.
ASPIRE is one of the two effective studies of a long-acting microbicide.

The International Partnership for Microbicides is conducting another study called The Ring Study, in parallel with ASPIRE, at four sites in South Africa and one in Rwanda.

The studies come at a time when there are renewed efforts by scientists to find more prevention technologies, the latest being Truvada, a drug for pre-exposure prophylaxis in high-risk groups such as discordant couples.

The US Food and Drug Administration approved Truvada on July 16 and the World Health Organisation this week responded by issuing guidelines on the usage of the drug. It must be used in combination with other existing protective methods such as condom use.

Unlike in the early years when Uganda registered substantive efforts in the prevention of HIV/Aids, the country’s efforts have recently suffered a setback. The 2011 Aids indicator survey showed that HIV prevalence has risen to 7.3 percent from 6.4 per cent in 2006.

Experts blamed the rise on complacency and government’s failure to make use of evidence-based interventions. Ending the global HIV/Aids pandemic will only be possible if a multifaceted global effort that expands testing, treatment, and prevention programmes is implemented, according to a viewpoint in the July 25 issue of JAMA, a theme issue on HIV/Aids, released ahead of the ongoing International AIDS Conference in the US.

akakaire@gmail.com

Uganda, 1989-ongoing: Study of HIV transmission and HIV-related mortality in a large rural cohort



Study Name: Rakai Community Cohort Study


US research organization: Columbia University, Johns Hopkins University


US funders: NIH, Rockefeller Foundation, USAID, John Snow Inc.


Offenses


Not protecting participants (HIV negative partners of HIV-positive men or women): Following HIV discordant couples (only one infected) not aware of their situation to observe spouse-to-spouse HIV transmission. During1994-98, the project followed 415 discordant couples, recording 90 new infections in formerly HIV-negative spouses (Quinn et al, N Eng J Med2000). In a large subsample of these couples “56% of HIV-1-positive partners…had requested and received HIV counseling, and 25% stated that they had informed their spouses” (p 1152, Gray et al, Lancet 2001).


Not protecting participants (HIV-negative babies of HIV-positive mothers): Following pregnant and breastfeeding HIV-positive women not aware they are infected and their babies. During 1994-98, the study identified 725 HIV- positive pregnant women. Only 49% of all pregnant women received their test results (Gray et al, Am J Obstet Gynecol 2001). The project followed babies to age 2 years, determining that 16% were infected before or during birth and 16% during a median 20 months of breastfeeding (Brahmbhatt et al, J Acquir Immune Defic Syndr 2006). Prevention of mother-to-child transmission was possible: In 1994, the US Public Health Service recommended Zidovudine to reduce mother-to-child transmission by two- thirds (Lurie and Wolfe, N Eng J Med 1997). Even if this intervention is deemed too difficult for Uganda, the project could have protected infants by warning HIV-positive mothers to avoid breastfeeding after 6 months.



Not protecting participants (HIV-positive adults): Following participants who are not aware they are HIV-positive and without offering prophylaxis for opportunistic infections or antiretroviral therapy to record HIV-related sickness and death. During annual home visits, the study team examined and asked participants for symptoms characteristic of opportunistic infections and recorded deaths. During 1994-98, the death rate for HIV-positive adults was 19.8 time greater than for HIV-negative adults. Survival with AIDS was often less than 1 year (Sewankambo et al, AIDS 2000). Not until the President’s Emergency Plan for AIDS Relief (PEPFAR) arrived in 2004 did the study arrange antiretroviral treatment (ART) for HIV-positive participants.




Remembering Tuskegee:  Syphilis Study Still Provokes Disbelief, Sadness


July 25, 2002 --Thirty years ago today, the Washington Evening Star newspaper ran this headline on its front page: "Syphilis Patients Died Untreated." With those words, one of America's most notorious medical studies, the Tuskegee Syphilis Study, became public.


"For 40 years, the U.S. Public Health Service has conducted a study in which human guinea pigs, not given proper treatment, have died of syphilis and its side effects," Associated Press reporter Jean Heller wrote on July 25, 1972. "The study was conducted to determine from autopsies what the disease does to the human body."


The next morning, every major U.S. newspaper was running Heller's story. For Morning Edition, NPR's Alex Chadwick reports on how the Tuskegee experiment was discovered after 40 years of silence.


The Public Health Service, working with the Tuskegee Institute, began the study in 1932. Nearly 400 poor black men with syphilis from Macon County, Ala., were enrolled in the study. They were never told they had syphilis, nor were they ever treated for it. According to the Centers for Disease Control, the men were told they were being treated for "bad blood," a local term used to describe several illnesses, including syphilis, anemia and fatigue.


For participating in the study, the men were given free medical exams, free meals and free burial insurance.


At the start of the study, there was no proven treatment for syphilis. But even after penicillin became a standard cure for the disease in 1947, the medicine was withheld from the men. The Tuskegee scientists wanted to continue to study how the disease spreads and kills. The experiment lasted four decades, until public health workers leaked the story to the media.


By then, dozens of the men had died, and many wives and children had been infected. In 1973, the National Association for the Advancement of Colored People (NAACP) filed a class-action lawsuit. A $9 million settlement was divided among the study's participants. Free health care was given to the men who were still living, and to infected wives, widows and children.


But it wasn't until 1997 that the government formally apologized for the unethical study. President Clinton delivered the apology, saying what the government had done was deeply, profoundly and morally wrong:


"To the survivors, to the wives and family members, the children and the grandchildren, I say what you know: No power on Earth can give you back the lives lost, the pain suffered, the years of internal torment and anguish.


"What was done cannot be undone. But we can end the silence. We can stop turning our heads away. We can look at you in the eye and finally say, on behalf of the American people: what the United States government did was shameful. "And I am sorry."


OH! Really: Ugandans highly knowledgeable about HIV vaccine and willing to participate in future trials


Education still necessary to combat vaccine misconceptions


A majority of Ugandan study participants are familiar with the benefits of vaccines and are willing to participate in future HIV-preventive vaccine trails, according to a study conducted by researchers from the Johns Hopkins Bloomberg School of Public Health and other institutions. This is one of the first studies of its kind to assess the willingness of a general population in a developing country to participate in HIV vaccine trials. The Rakai district of Uganda is a potential site for phase 3 HIV-preventive vaccine trials in the future. Researchers also found that many study participants had multiple misconceptions about the disease and vaccines. The study, "Knowledge About Vaccines and Willingness to Participate in Preventive HIV Vaccine Trials: A Population-Based Study, Rakai, Uganda" was published in the June 1, 2004, issue of the Journal of Acquired Immune Deficiency Syndrome.


Ronald H. Gray, MBBS, MSc, co-author of the study and a professor in the School's Department of Population and Family Health Sciences, said, "There is a high level of willingness to participate in HIV vaccine research in this population. However, initiation of vaccine trials will require intensive education efforts to dispel misconceptions and irrational fears about adverse effects on fertility."


The researchers completed initial and follow-up interviews with 10,312 people in Rakai, Uganda, aged 15-49 years. In between interviews, the study participants were educated on vaccines in general and potential HIV-preventive vaccines. Seventy-one percent of the study population was aware of the preventive function of vaccines and 77 percent were willing to participate in HIV-preventive vaccine trials. The researchers also learned that most of the study participants thought vaccines were only appropriate for children and women. Only 28 percent of those interviewed thought adult men could receive vaccines and 61 percent of male study participants thought men should not receive vaccines. The researchers hypothesized that this belief is typical because vaccinations in the area are mainly given to children and pregnant women. Almost 8 percent of participants thought vaccines were lethal and 2 percent thought vaccines caused fever/illness. In addition, only 12 percent of those interviewed thought HIV was a serious problem, even though Rakai has a 15 percent prevalence of the disease.


The researchers found that village-based health meetings worked in educating study participants on HIV vaccines. The researchers said they believe village meetings would be effective in the future to reinforce the seriousness of the AIDS epidemic and to educate the community on vaccines. HIV vaccine awareness increased from 68 percent at the time of the first interview to 81 percent at follow-up meetings. Even after emphasizing preventive vaccines, 60 percent of study participants still thought that HIV-infected individuals could participate in vaccine trials.


"Although vaccine knowledge and willingness to participate in trials are high in this population, there is still a need for education on the severity of the HIV/AIDS epidemic, the role of potential, preventive HIV vaccines and the importance of vaccines for men," said Dr. Gray.




The study was supported by grants from the Department of the Army, United States Army Medical Research and Material Command Cooperative Agreement, Henry M. Jackson Foundation and Fogarty Foundation.


Noah Kiwanuka, MD, ChB, MPH, Merlin Robb, MD, Godfrey Kigozi, MB, ChB, MPH, Deborah Birx, MD, MS, James Philips, MD, PhD, Fred Wabwire-Mangen, MD, MPH, PhD, Maria J. Wawer, MD, MSc, Fred Nalugoda, Bstat, MHS, Nelson K. Sewankambo and David Serwadda coauthored the study.

Also See,
US Milatary HIV study Programme for Africans : Oh! Really

Makerere University Walter Reed Project (MUWRP) Circumcises 375 Ugandan Men


Makerere University Walter Reed Project (MUWRP) Circumcises 375 Ugandan Men


HIV Prevention: Blinded by Profit or Paid Not to See?

http://hivinkenya.blogspot.com/2012/04/hiv-prevention-blinded-by-profit-or.html


We have been hearing a lot recently about various HIV treatment and prevention strategies that will significantly increase the quantities of HIV drugs produced and sold. For example, the US DHHS recommends starting antiretroviral therapy (ART) for HIV positive people at a relatively early stage of disease progression. One might think that such decisions are made on the basis of scientific evidence and concensus among medical practitioners. But Joseph Sonnabend shows that this is not necessarily so.


Dr Sonnabend finds that 'expert opinion' in this instance refers to that of DHHS panel members, most of whom have a financial interest in selling more drugs. There are many experts who would not agree that starting ART early has a net benefit, but they don't sit on the panel. There is scientific evidence for the benefits of starting later, but none for those of starting earlier. Basing such decisions on the expert opinion of a few people is bad enough; expert opinion should never trump scientific evidence. But when most of the experts can also benefit financially from the recommendation as well, there is a clear conflict of interest.


ART must be taken for life and has side-effects, only some of which are currently recognized. It is also expensive and life changing. And there is the issue of the virus developing resistance to the cheaper drugs that people usually take at first. Resistant strains of HIV can be transmitted, so there could be a snowball effect here. We already know what can happen when drugs are overprescribed and adherence is poor from the case of antibiotics and perhaps malaria medication. So this is not a minor issue about precription recommendations. In contexts where HIV is common, it could profoundly affect the course of the epidemic.


It's fashionable enough these days to claim that 'treatment is prevention', but as Dr Sonnabend points out, it is those who have reached a later stage of disease progression who are most likely to transmit HIV. Therefore, the preventive value of ART will only be high for partners of people who start treatment at a later stage. Treatment at an earlier stage will be less relevant, perhaps irrelevant, and the benefits have not been shown to outweigh the risks. While it may be empowering to provide people with the drugs they demand, it is only so if they are also informed about the known effects of those drugs, in addition to the hypothesized ones.


WHO has also made a recommendation that similarly serves the interests of Big Pharma. As the English Guardian reports, "Aids drugs should be given immediately to anyone with HIV who has an uninfected partner, to stop transmission and slow the epidemic". As mentioned above, this is unlikely to slow the epidemic much and could have many drawbacks which have, as yet, not been investigated. Resistance rates are steady enough to guarantee that people taking relatively cheap (but still grossly overpriced) first line drugs will gradually need outrageously overpriced second line, and even third line drugs. And resistance will eventually develop in second and third line drugs too, as they have found in Uganda. Quite a virtuous cycle for Big Pharma!


Far from just being used to treat HIV positive people and to prevent transmission to HIV negative people, ART programs appear to have the effect of drawing attention away from possible HIV risks. How has a virus that is difficult to transmit heterosexually infected, for example, 43% of adult women in Mozambique and nearly 38% of adult men? There are clearly non-sexual risk factors involved, but what are they? If diseases such as malaria, TB, intestinal parasites and the like are involved, for example, they urgently need to be treated and prevented, which can be done cheaply and relatively safely. But if the virus is being transmitted through unsafe healthcare practices, showering people with drugs is a misdirected effort and may not even reduce transmission.


The relative contributions of all risks need to be identified, whether they relate to sexual or non-sexual transmission. But putting more and more people on drugs while ignoring possible risks is not the way to eradicate the virus. Two things that are blind to the causes of HIV transmission and to appropriate prevention strategies are drugs and high profits. Of course, Big Pharma make drugs and big industries, especially the HIV industry, make profits. But the problem is when profit is seen as the only goal and treatment is seen as a mere step to be taken in the pursuit of profit. As for prevention, the industry seems to be looking for ways of making money out of it rather than for how best to achieve it.




Makerere University Walter Reed Project (MUWRP) Circumcises 375 Ugandan Men

Ugandan Speaker of Parliament Rt. Hon. Rebecca Kadaga launched Parliament Health Week on December 5 with a call to rejuvenate the national fight against HIV and cancer. As part of its programming, Parliament invited the U.S. Mission-supported Makerere University Walter Reed Project (MUWRP) to provide Safe Male Circumcision (SMC) services to Members of Parliament and staff during the health fair, held on Parliament grounds from December 5-8, 2011.

During Health Week, the MUWRP surgical team circumcised 375 men, including three Members of Parliament. As the week progressed, so did demand for services; the team circumcised 63 males on Tuesday, 83 on Wednesday, 91 on Thursday, and 88 on Friday. The SMC package included a physical exam, voluntary HIV counseling and testing, education about SMC, screening and treatment of sexually transmitted infections, and clear post-surgical instructions. After the health fair, MUWRP staff followed up with participants to ensure they had no adverse effects from the procedure.

MUWRP is a non-profit partnership between Makerere University and the U.S. Military HIV Research Program (MHRP), which is part of the greater effort to advance HIV research, prevention, care, and treatment in Uganda. MHRP has been conducting HIV research in Uganda since 1998. In 2005, MHRP expanded its portfolio to include prevention, care and treatment activities under the President’s Emergency Plan for AIDS Relief (PEPFAR).

The bible says that Cursed is he who trusts in man. The bible also says the heart of man is deceitful above all things and desperately wicked. Therefore do not trust in carnal solutions to HIV. The only solution to avoiding the HIV virus is becoming born again. As a born again Christian, abstain from sex if you are not married and be faithful to your wife if you are married. Getting circumcised or washing your genitals after sex is all bogus advise. Do not, I repeat DO NOT participate in HIV trials because even if the trials are successful, it is the west that will benefit. The African as always are simply being used as guinea pigs  in these trials. The purpose of these trials is to help drug companies to reap profits from HIV medicines. These so called scientists who are behind the circumcision crusade and HIV vaccine trials are working in the interests of the American New world order system and its pharmaceutical companies. They are not interested in you, but only want HIV spread to increase so that American and European Companies can reap profits. HIV is a creation of the USA military and the US is using it as a political weapon to control the poor of the world. They confuse African countries that they are helping out on HIV/AIDS while in reality they robbing African mineral resources.  

Scientists hunting for an AIDS vaccine may be getting close: oh! really



By Alyssa A. Botelho,

Scientists compare the hunt for an AIDS vaccine to the search for the Holy Grail. And for three decades, it has proved to be about as difficult to find.

Since Robert Gallo and Luc Montagnier identified HIV — the virus that causes AIDS — in 1983, only three vaccine trials have been completed. The first failed to prevent or control infection. The second also failed, mysteriously increasing infection. The third, completed in 2009, provided protection to only about a third of the people receiving it — but how it did that is still unknown.

Yet, leaders in AIDS vaccine research say they may finally be on the cusp of a period of major discovery leading to a vaccine.

“The past few years have been a turning point,” said Gary Nabel, director of the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases. “I’m more optimistic than I’ve probably ever been in my career.”

The optimism stems from recent strides in understanding antibodies — the first weapons the human immune system deploys to fight an infection.

When a person is exposed to the AIDS virus, the immune system churns out millions of antibodies to fight it. HIV shakes off the vast majority of them, so researchers are focused on the remaining minority. These “broadly neutralizing” antibodies bind powerfully to HIV’s outer shell and prevent the virus from invading cells.

Until recently, scientists had been able to identify only four such antibodies. But in the past three years, they have worked out the structures of nearly two dozen, and they have developed the technology to find more.

If they can trigger these antibodies in healthy people, researchers suspect, they can create an effective AIDS vaccine.

A master of disguise
HIV is a master at replicating quickly — and during that process, it acquires many small mutations that create subtle changes to the contour of its shell. As a result, the immune system must play a constant game of cat-and-mouse: As soon as the body makes a new antibody to attack HIV’s outer coat, the virus has crafted a new one.

“When you’re fighting a war like this, especially with a very clever virus, it’s not going to just roll over and die when the first responder comes in. It will just put on a new mask and go on,” Nabel said.

Because the virus can mutate so easily, people with AIDS have millions of slightly different copies of HIV in their bloodstreams. With 35 million people currently infected with HIV globally, this amounts to a staggering number of viral disguises — and a successful AIDS vaccine would have to train the immune system to recognize all of them.

Nonetheless, there are vulnerable regions in HIV’s shape-shifting armor that persist across all strains, scientists say. The one garnering most interest is called “Env,” short for “envelope glycoprotein.” Resembling spikes on the virus’s surface, each Env can bind to a white blood cell called the CD4 T cell and then pull the whole virus inside. There, HIV begins its cycle of invasion, replication and escape to other white blood cells, which ravages the immune system and leads to AIDS.

HISTORY OF HIV/AIDS IN RAKAI



By NBS TELEVISION · July 19, 2012


HIV/AIDS is generally believed to have entered Uganda through Rakai district from parts of Northern Tanzania in the early 1980s.

Various interventions have been instituted to fight the disease in the district, including using the population in scientific research by NGOs and Uganda’s development partners. A new research by Rakai Health Services Program, an NGO funded by the Johns Hopkins University in America has showed that the prevalence has increased to 13%, almost double the national average at 7.3%.

According to Dr. Robert Mayanja the district Health Officer, the sudden increase in the HIV/AIDS prevalence rates have been brought about by complacence within the population and fewer deaths due to the disease.

Rakai district is home to Kasensero Landing site where the first HIV patient was diagnosed in 1982. The same area still has the highest prevalence of HIV/AIDS in Uganda at 40%.

Authorities and Non Governmental Organizations have now embarked on a Safe Male Circumcision campaign, after it was reported to reduce infections by 60%. The ground breaking research was carried out in Kenya, South Africa and by Rakai Health Services Program in Rakai, Uganda.

The Alliance of Mayors and Municipal Leaders on HIV/AIDS in Africa (AMICAALL) have partnered with the district authorities to extend Safe Male Circumcision to the population. So far, 20,000 surgeries have been performed in the past one year. The campaign is funded by the World Health Organization, UNAIDS and the Uganda Aids Commission.

Rakai Health Services Program, a research leaning NGO has pioneered the introduction of the Shang ring circumcision method, first studied by Chinese researchers. Over 500 volunteer males have registered to take part in the trials.

The main challenge facing the HIV/AIDS fight in the district is the authorities’ failure to harmonize all data from the numerous researches conducted by NGOs and other partners for effective implementation.


Other studies of penis cleaning vs. HIV
            At least four studies of risks for prevalent HIV infection in Africa have reported various data on intact men’s penile hygiene vs. HIV infection. In a 1999 survey in South Africa, intact men who reported washing their penis less than once a day were 2.7 times more likely to be HIV-positive compared to men who washed at least once a day.[9] Another study in South Africa among intact men attending a sexually transmitted infections clinic reported that men with “subpreputial penile wetness” were 2.3 times more likely to be HIV-positive compared to men without wetness; wetness was in turn less common among men who reported washing after sex (with no information on time between coitus and washing).[10]

In a case control study among intact men recruited for the 2002-06 trial of circumcision to protect men in Kisumu, Kenya, men who reported “wash[ing] genitals immediately after last sexual intercourse” (without specifying the number of minutes between coitus and washing) were 0.2 times as likely to be HIV-positive as men who reported not doing so.[11] A 1999 survey in Kenya found that intact men without “adequate” genital hygiene were 1.3 times more likely to be HIV-positive compared to intact men with “adequate” hygiene (men reporting fully retracting their foreskins when washing and with no smegma on the glans penis during examination).[12]
None of these studies reported information on the timing of post-coital cleaning or on wiping vs. washing. Furthermore, in studies of risks for HIV prevalence, reverse causation could explain some of the findings; eg, men with HIV and weakened immune symptoms are more likely to get genital infections causing subpreputial wetness.


Did post-coital penile cleaning influence HIV incidence among intact men in the South African and Kenyan studies of male circumcision to protect men?
            Two other trials of circumcision to protect men – in Orange Farm, South Africa, 2002-05, and in Kisumu, Kenya, 2002-06 – reported that HIV incidence in intact men was more than double HIV incidence in circumcised men.[13,14] The study team for the South African trial has not reported post-coital cleaning practices for intact men. In 2010, the study team for the Kisumu trial reported that 21% of men in the control (intact) group “washed” their penis within one hour after coitus; but the study team has not reported if or how penile cleaning was related to HIV incidence.[15] Neither team has said what information they collected about post-coital cleaning (and have not reported). The study teams have also not reported what if any advice they gave to intact men about post-coital cleansing.


Has post-coital cleaning contributed to high HIV incidence among intact men in later and continuing studies?
            Post-trial studies in Orange Farm, South Africa, and in Rakai, Uganda, reported higher rates of HIV incidence in intact men compared to rates observed during the trial. In Orange Farm, a cross-sectional survey in 2007-08 reported a rate of HIV incidence in intact men of 5.6% per year (using the BED assay to identify incident infections).[16] A follow-up study in Rakai among men in the two (NIH- and Gates-funded) circumcision trials found that men who remained intact after the trials acquired HIV over the following two years at the rate of 1.93% per year compared to 1.14% per year during the trial.[17] Neither of these studies reported any information about post-coital cleansing. Similarly, neither has reported what if any advice the study team gave to intact men on when and how to clean their penises after coitus.

Some other recent studies in Africa have reported HIV incidence in intact vs. circumcised men but without any information about post-coital cleaning practices. For example, a study of HIV transmission among discordant couples with or without anti-retroviral therapy[18] asked about circumcision but not post-coital cleaning (in this reference,[19] click on “agree,” then on “individual CRFs: international sites,” then on “partner circumcision assessment” and “partner sexual history assessment”).


Recommendations
Data from Rakai, Uganda, discussed in this note have multiple implications for HIV prevention and research in Africa.
            First, all interested parties should mobilize all available channels (newspapers, NGOs, churches, etc) to get two public messages to intact African men:
(a) Don’t go for circumcision. If a partner is HIV infected, you are safe with condoms. If for some reason you are exposed, according to available evidence you are safer if you are intact and wait at least 10 minutes to clean your penis than if you have been circumcised.
(b) Wait at least 10 minutes after coitus to clean your penis, and then do so by wiping with a cloth, without water or other fluid.
Second, programs to circumcise men and babies in Africa should be suspended pending further evidence on the impact of post-coital penile cleaning on HIV incidence.
Third, researchers should urgently report and/or collect and report information on HIV incidence among intact men according to post-coital cleaning practices. All relevant collected but unreported information should be disclosed (including information on post-coital cleaning, incidence of sexually transmitted disease, and injections and other blood exposures). Questions about post-coital cleaning can be added to ongoing studies of risks


The bible says that Cursed is he who trusts in man. The bible also says the heart of man is deceitful above all things and desperately wicked. Therefore do not trust in carnal solutions to HIV. The only solution to avoiding the HIV virus is becoming born again. As a born again Christian, abstain from sex if you are not married and be faithful to your wife if you are married. Getting circumcised or washing your genitals after sex is all bogus advise. Do not, I repeat DO NOT participate in HIV trials because even if the trials are successful, it is the west that will benefit. The African as always are simply being used as guinea pigs  in these trials. The purpose of these trials is to help drug companies to reap profits from HIV medicines. These so called scientists who are behind the circumcision crusade and HIV vaccine trials are working in the interests of the American New world order system and its pharmaceutical companies. They are not interested in you, but only want HIV spread to increase so that American and European Companies can reap profits. HIV is a creation of the USA military and the US is using it as a political weapon to control the poor of the world. They confuse African countries that they are helping out on HIV/AIDS while in reality they robbing African mineral resources.  

Have WHO and UNAIDS gotten the wrong message from studies of circumcision to reduce men’s risk for HIV?

https://sites.google.com/site/davidgisselquist/have-who-and-unaids-gotten-the-wrong-message-from-studies-of-circumcision-to-reduce-mens-risk-for-hiv


16 April 2012

In 2003-06, a study team funded by the US National Institutes of Health (NIH) recruited HIV-negative intact (uncircumcised) men in Rakai, Uganda, circumcised some, and then followed and retested both circumcised and intact men to see who got HIV.[1] The most widely reported data from this study say that men in the intervention (circumcised) group got HIV at the rate of 0.66% per year vs. 1.33% per year for men in the control (intact) group. These data have been used to motivate efforts to circumcise 20 million African adults by 2015 as well as to introduce routine infant circumcision.

Circumcise vs. wait and wipe
However, other data from the same study show a more effective, less dangerous, less culturally intrusive, and less expensive option for intact men to protect themselves from HIV after sexual contact – simply waiting at least 10 minutes after coitus before doing anything to clean one’s penis, and then just wiping it with a dry cloth, without water (Table). (Condom use reliably protects men from acquiring HIV from sexual partners; this note discusses waiting and wiping as an alternative to circumcision, not as an alternative to condom use.)
While all intact men in the NIH-funded Rakai trial got HIV at the rate of 1.33% per year, HIV infections in intact men concentrated in men who cleaned their penises within 3 minutes after coitus (2.32% per year) and men who used water alone to do so at any time after coitus (2.26% per year). On the other hand, intact men who cleaned their penises after coitus but waited at least 10 minutes to do so got HIV at the rate of 0.39% per year. Intact men who cleaned their penises after coitus by wiping with a dry cloth (within 3 minutes or later) got HIV at the rate of 0.55% per year. Notably, intact men who waited at least 10 minutes to clean and/or cleaned with a dry cloth were at less risk for HIV than circumcised men; and intact men who waited at least 10 minutes to clean were even at less risk than men who reported no sex partners (see Table).
According to Ronald Gray, the head of the Rakai study team, one message from the study is “there ought to be a little time left for postcoital cuddling before you go and wash. Don’t just finish and jump out of bed.”[5]

Why did intact men who cleaned later without water have lower risk for HIV?
Frederick Makumbi and other members of the Rakai study team, as well as other AIDS experts, speculated that washing could remove enzymes in vaginal fluid that neutralize HIV, that “the acidity of vaginal secretions may impair the ability of the AIDS virus to survive,” and that water with its neutral pH may facilitate viral survival.[5,6]
The study team did not consider that men’s prepuce and its secretions as well as semen – like women’s sexual organs and secretions – might also have viral defenses that are damaged by washing immediately after coitus. Years before the Rakai circumcision trial, Fleiss and colleagues’ 1998 review of the “hygienic and immunological properties of the prepuce and intact penis” noted commensal bacteria and secretions with anti-bacterial and anti-viral activity associated with the foreskin.[7]
Another possibility is that reported post-coital cleaning had little or no impact on HIV risk but was linked to other behaviors that accounted for a lot of the infections. Sixteen of the 67 incident infections recorded during the NIH-funded Rakai trial occurred in men who reported no sex partners (6 infections) or 100% condom use (10 infections),[1] which suggests that many infections came from blood exposures.[8] If men who were most worried about HIV from sex both washed immediately after sex and went for injections for (suspected) sexual infections, their greater risk for HIV may have been from unsafe injections rather than sex. for HIV incidence to get information within 6-12 months. Considering the urgency of this information, it would be unwise to wait for findings from a new trial, which could take years. Moreover, considering the observed high risk for HIV associated with early cleaning and cleaning with water, it is arguably not ethical to follow men without warning them to avoid such practices.
            Fourth, individuals and groups that have been opposing circumcision in Africa should independently collect information on:
(a) post-coital cleaning practices in Africa and elsewhere;
(b) official advice about post-coital cleaning in Africa; and
(c) scientific evidence about the effect of various post-coital cleaning practices on the microbiological defenses of the foreskin.
            These four recommendations are not intended to be complete or decisive. This is a preliminary note. Hopefully people with relevant information and expertise will help to resolve questions raised by Rakai data on post-coital cleaning and will suggest additional questions and steps.

References
1. Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomized trial. Lancet 2007; 369: 657-666.
2. Makumbi FE, Gray RH, Wawer, M, et al. Male post-coital penile cleansing and the risk of HIV-acquisition in rural Rakai district, Uganda. Fourth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, abstract WEAC1LB, Sydney, 2007. Available at: http://www.ias2007.org/pag/Abstracts.aspx?SID=55&AID=5536.
3. Collins S. IAS feedback: news drugs and prevention studies. 20 September 2007, i-Base. Available at: http://www.powershow.com/view/82522-ZjE3O/IAS_feedback_news_drugs_and_prevention_studies_African_Treatment_Advocacy_Training_flash_ppt_presentation (accessed 14 April 2012).

4. Tobian AAR, Ssempijja V, Kigozi G, et al. Incidence HIV and herpes simplex virus type 2 infection among men in Rakai, Uganda. AIDS 2009; 23: 1589-1594. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2715553/pdf/nihms121760.pdf (accessed 11 May 2012).
5. Altman LK. Washing after sex may raise HIV risk. New York Times 21 August 2007. Available at: http://www.nytimes.com/2007/08/21/health/21hiv.html (accessed 10 April 2012).
6. Bainemigisha H. Washing the penis after sex may increase HIV infection. New Vision, 12 August 2007. Available at: http://www.newvision.co.ug/D/9/34/580913 (accessed 10 April 2012).
7. Fleiss PM, Hodges FM, van Howe RS. Immunological functions of the human prepuce. Sex Transm Inf 1998; 74: 364-367.
8. Gisselquist D. Points to Consider: responses to HIV/AIDS in Africa, Asia, and the Caribbean. London: Adonis & Abbey, 2008. Available at: http://sites.google.com/site/davidgisselquist/pointstoconsider (accessed 15 April 2012).
9. Auvert B, Ballard R, Campbell C, et al. HIV infection among youth in a South African mining town is associated with herpes simplex virus-2 seropositivity and sexual behavior. AIDS 2001; 15: 885-898.
10. O’Farrell N, Morison L, Moodley P, et al. Association between HIV and subpreputial penile wetness in uncircumcised men in South Africa. J Acquir Immune Defic Syndr 2006; 43: 69-77.
11. Mattson CL, Bailey RC, Agot K, et al. A nested case-control study of sexual practices and risk factors for prevalent HIV-1 infection among young men in Kisumu, Kenya. Sex Transm Dis 2007; 34: 731-736. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2562680/pdf/nihms55078.pdf (accessed 15 April 2012).
12. Agot KE, Ndinya-Achola JO, Kreiss jk, et al. Risk of HIV-1 in rural Kenya. Epidemiology 2004; 15: 157-163.
13. Auvert B, Taljaard D, Lagarde E, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 trial. PLoS Med 2005; 2: e298.
14. Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 2007; 369: 643-56.

15. Mehta SD, Krieger JN, Agot K, et al. Circumcision and reduced risk of self-reported penile coital injuries: results from a randomized controlled trial in Kisumu, Kenya. J Urol 2010; 184:203-9. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3090633/pdf/nihms287145.pdf (accessed 15 April 2012).

16. Lissouba P, Taljaard D, Rech D, et al. Adult male circumcision as an intervention against HIV: An operational study of uptake in a South African community (ANRS 12126). BMC Infect Dis 2011; 11: 253. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192707/pdf/1471-2334-11-253.pdf (accessed 15 April 2012).
17. Gray R, Kigozi G, Kong X, et al. The effectiveness of male circumcision for HIV prevention and effects on risk behaviors in a post-trial follow up study in Rakai, Uganda. AIDS 2012; 26: 609-615.
18. Cohen M, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Eng J Med 2011; 365: 493-505.

19. Statistical Center for HIV/AIDS Research & Prevention. HPTN 052 CRFs. Available at: https://atlas.scharp.org/cpas/login/HPTN/052/agreeToTerms.view?returnUrl=%2Fcpas%2Fproject%2FHPTN%2F052%2Fbegin.view%3F (accessed 16 April 2012).


2007 Rakai Trial Found Genital Hygiene More Effective Than Circumcision

Some time ago, I wondered out loud if penile hygiene could be more effective than mass male circumcision when it comes to reducing HIV transmission. It's certainly cheaper, more appropriate and should carry fewer risks. Even men who are circumcised still need to practice genital hygiene and use condoms. A research project to find out if penile hygiene would be acceptable, convenient, practicable and if adherence would be high, received funding a few years ago. As far as I know the findings have not yet been reported.

But it turns out that the Rakai circumcision trial, which made its findings public in 2007, also found that penile hygiene is a lot more effective than mass male circumcision. The findings for the relative effectiveness of penile hygiene were reported. But those who continue to urge for circumcision, many of whom would have been involved in the Rakai study (or one of the other studies), have chosen to ignore the more effective, safer and cheaper option. Yet men who remained uncircumcised and waited at least 10 minutes after coitus faced a far lower risk of being infected with HIV than men who were circumcised.

Men are advised to use a dry cloth rather than water. Coupled with the advice to wait a while this could be seen as complicated. But circumcision doesn't obviate the need to take this advice. Therefore circumcision is not just very expensive and has potential risks in countries where health services can be very unsafe, it also gives less protection than something that could already be second nature to most men. The biggest mystery, though, is why there is so much pressure to spend what would probably amount to several billion dollars to circumcise tens of millions of men when those advocating for the campaigns had access to this information at least five years ago.

Dr David Gisselquist has written extensively on this subject on the Don't Get Stuck With HIV website. He has also created a table showing that, according to the Rakai trial data, the biggest reduction in HIV transmission is among those who remained uncircumcised but waited at least 10 minutes after coitus to clean their penis. Hundreds of thousands of circumcisions, perhaps millions, have already been carried out, ostensibly to reduce HIV transmission; tens of millions are planned in adults, children and infants. It is vital that those being persuaded to have the operation have access to all available information in order for them to give informed consent. So far, they only appear to have been given information calculated to bias their decision towards circumcision.