5 Thus saith the Lord; Cursed be the man that trusteth in man,
and maketh flesh his arm, and whose heart departeth from the Lord. 7
Blessed is the man
that trusteth in the Lord, and whose hope the Lord is.
8 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!]
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
Drive to End AIDS in U.S. Stalls as Epidemic Grips
Blacks
US cannot continue funding treatment and care yet
more and more Ugandans are getting infected: Oh! really
President Museveni makes another
attack on Uganda’s Bogus Circumcision Crusade
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
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
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.
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
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?
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.
7. Fleiss PM, Hodges FM, van Howe
RS. Immunological functions of the human prepuce. Sex Transm Inf 1998; 74:
364-367.
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.
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).
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.
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.
