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March 30, 2007
De Kock: Less Cock
The World Health Organization formally endorsed circumcision as an HIV prevention method, clearing the way for governments and NGOs to pay for the procedure. Read a news summary or The Boston Globe.
All along, some questions have dogged this idea and they're not going away quickly. (See this strategy paper.) Several recent studies show that circumcision can reduce transmission by 65 percent. But before we start waving this extraordinary number around, consider that it's comparing cut men with uncut men in heterosexual situations. It doesn't (necessarily) change a woman's chances of getting HIV from an infected man, so it doesn't mean that infected, cut men can be irresponsible. Poz summarizes.
The theory is that foreskin cells allow HIV easy entry into the body, and that the virus can live longer underneath the foreskin. So the procedure must be done under proper medical care to avoid bacterial infections. And men must wait until they are healed before having sex or else their risk may actually increase.
There is also worry that a wrongheaded belief of the protection this conveys could actually lead to an increase in risky behavior. As an opinion piece in a medical journal argues: "It is difficult to imagine a convincing public health message that effectively influences men to undergo circumcision and continue to consistently use condoms."
Also the not-insignificant cultural barriers to this practice all over the world. As one doctor told me last week, "Perhaps I'm naive but I just can't imagine a 20-year-old walking in and saying, 'Doc I'd like to have the end of my dick cut off.'"
Posted by Adam Graham-Silverman at 11:10 PM | Comments (0)
Uganda: Guinea is in West Africa
Because of its apparent early success at fighting HIV, Uganda has long been held up as an example of what countries can do if they confront the problem early, and head-on. But their policies haven't been consistent over the years, as the Washington Post points out. Much of the success came from politicians all the way up to the president encouraging "zero grazing," fidelity to one partner. The policy toward condoms has flip-flopped, and some critics say Uganda's more recent promotion of religion-based abstinence programs reflects the government's desire to cozy up to the Bush administration. Now HIV rates may be backsliding...
Posted by Adam Graham-Silverman at 12:31 PM | Comments (0)
March 18, 2007
Straight Talk Express... Whoops!
Sen. John McCain got stumped by a question about federal funding for distributing condoms overseas while campaigning in Iowa. Watching McCain squirm amused the New York Times's Adam Nagourney, who then notes that McCain "relied on the advice of Senator Tom Coburn, a physician and Republican from Oklahoma." Coburn may be a doctor, but he's also somewhere to the right of Rick Santorum on family planning and gay and women's issues. Not the guy who's going to bring America together.
Posted by Adam Graham-Silverman at 2:29 AM | Comments (1)
March 13, 2007
Snooke(RED)?
Ever wonder how much of the dollars you spent at the Gap or on a red iPod or Razr through Product:(RED) actually goes to its intended recipient, the Global Fund? The answer is that it's extremely hard to tell, according to the Christian Science Monitor.
This story is in part a response to this piece in AdAge last week that claimed the program had produced $18 million, but at a marketing cost of $100 million. CSM debunks the $100 million number but can't offer its own. The left pounced quickly, but this is $18 million (or $25 million, according to CSM) that wasn't around before. Plus, as the story points out, the marketing included 10 miles of Gap storefronts with AIDS awareness messages.
Then again, NYT media columnist David Carr paints a "cheeky" picture of Bono working with Graydon Carter on Bono's guest-editing gig at Vanity Fair. The pictures that accompany the story are by Annie Liebovitz -- is that necessary?
Posted by Adam Graham-Silverman at 2:22 AM | Comments (0)
March 9, 2007
The Numbers Are In
PEPFAR has released its third annual report to Congress. One highlight: The program is providing ARVs to more than 800,000 people.
Rob Weissman, who runs Essential Action and its access to medicines project, writes:
"The treatment chapter also contains important and useful information on Pepfar's use of generics and pricing data, starting on page 67. Key points:
- Fourteen of 15 focus countries are said to be using some generics.
- Overall expenditure in FY 2006 for ARVs was just under $110 million,
with about 27 percent of that spent on generics."
He points out the comparison of brand-name and generic prices for ARVs (page 72). Price differences for various three-drug combinations run from $165 for the generic and $594 for the name-brand (3.6 times as much) to $487 for the generic and $606 for the name-brand (20 percent more).
UPDATE, March 22: The ever-critical Center for Health and Gender Equity argues that the 800,000 number is inflated, and that abstinence programs are causing problems disproportionate to their share of the PEPFAR budget.
Shirttail: In the South African Business Day, Nobel economist Joseph Stiglitz makes the case that drug prices are disproportionate to the costs their makers incur.
Posted by Adam Graham-Silverman at 11:38 PM | Comments (0)