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Medical Forum / Diseases and Disorders / AIDS / July 2005HIV - a thread from the past
From: "Moira de Swardt" <firstnam...@wol.co.za> Newsgroups: alt.politics.usa,alt.religion.christian,aus.politics,soc.culture.israel,soc.culture.jewish,soc.culture.south-africa,soc.culture.african,sci.anthropology Subject: Re: circumcision Date: Fri, 2 Jul 2004 09:00:34 +0200 "Danian" <dani...@jordi.net> wrote in message > What would be the underlying motivation of these people? No scientific > rebuttal so what can it be then? I posted the urls early in the thread. The jury is out. I'm convinced that circumcision is not adequate protection against HIV. I've now *really* lost interest in this thread. Moira, the Faerie Godmother ============================================== OK Moira so a year on we have the following for your comment: Study Says Circumcision Reduces AIDS Risk by 70% Findings From South Africa May Offer Powerful Way To Cut HIV Transmission By MARK SCHOOFS, SARAH LUECK and MICHAEL M. PHILLIPS Staff Reporters of THE WALL STREET JOURNAL July 5, 2005; Page A1 In a potentially major breakthrough in the campaign against AIDS, French and South African researchers have apparently found that male circumcision reduces by about 70% the risk that men will contract HIV through intercourse with infected women. Other than abstinence and safer sex, almost nothing has been proved to reduce the sexual spread of HIV, the virus that causes AIDS. World-wide, the major route of HIV transmission for many years has been heterosexual sex. Vaccine developers have said they would consider an AIDS vaccine with just 30% efficacy useful. But so far, no effective vaccine against the disease has been developed, leaving AIDS workers desperate for another tool to help them stem the tide of new infections, estimated at almost five million last year. The circumcision findings were so dramatic that the data and safety monitoring board overseeing the research halted the study in February, about nine months before it would have been completed, on the grounds that it would be immoral to proceed without offering the uncircumcised control group the opportunity to undergo the procedure. While men were directly protected from infection by circumcision, women could benefit indirectly because circumcision would reduce the chances their partners would be HIV-positive. Researchers in the field have been aware of the study's basic findings, but they haven't been published, so most experts haven't evaluated them. The British medical journal the Lancet decided against publishing the study, but for reasons unrelated to the data and scientific content, according to people familiar with the matter. Lancet officials, following standard policy at the journal, refused to comment on why the study was turned down. The fact that an independent board ordered the study halted is considered a strong sign that the science is sound. Bertran Auvert, the French researcher who headed the trial, declined to discuss the findings but is expected to present them later this month at an International AIDS Society conference in Brazil. Still, the fact that the research hasn't yet been published makes experts in the field wary about commenting. "Confirm, confirm, confirm," said Seth Berkley, a veteran HIV researcher and president of the International AIDS Vaccine Initiative. But if the study holds up, said Dr. Berkley, who wasn't involved with the research, it would be "quite important" because circumcision would be "an intervention that works over a person's lifetime and could reduce HIV in a community setting." Assuming circumcision is as effective as the new study shows, it would still require careful implementation. In particular, health experts are concerned that men understand that circumcision can't fully protect them and that they maintain other preventive measures, such as safer sex. "These preliminary results are quite interesting and we look forward to examining the data more closely, to looking at the technical aspects of the study and public-health implications if these results are confirmed by other trials," said Cate Hankins, chief scientific adviser to the United Nations AIDS agency, UNAIDS. More than 30 previous studies have suggested a relationship between circumcision and lower rates of HIV infection. In Kenya, for example, HIV prevalence is much higher among the Luo people, who don't practice circumcision, than among the Kikuyu, who do. And there are strong biological theories as to why. For example, a type of cell that HIV targets, called the Langerhans cell, lies close to the delicate underside of the foreskin, whereas the head of a circumcised penis tends to develop a thick layer of outer skin that may armor it against HIV. Another theory: Rather than acting against HIV itself, circumcision may help prevent other sexually transmitted diseases that are known to facilitate the acquisition of HIV. Despite these theories, no study until now has been able to prove that circumcision reduces the chances of contracting HIV. Longtime advocates of the benefits of circumcision note that performing such a study has always faced resistance because of the sensitive cultural issues involved as well as the challenge of persuading a significant number of men to undergo the procedure. The new research was designed to test the hypothesis by the most rigorous possible method: a randomized, controlled clinical trial. It was conducted with more than 3,000 HIV-negative men ages 18 to 24 in a South African township called Orange Farm. Half of the men were randomly assigned to be circumcised and the other half to remain uncircumcised as controls. The study, headed by Dr. Auvert, a researcher at the French National Institute of Health and Medical Research and at the University of Versailles Saint-Quentin, originally planned to follow the men for 21 months. But after all the men had been followed for a year -- and about half of them for the full 21 months -- the data showed the circumcised group fared far better. For every 10 uncircumcised men in the study who contracted HIV, only about three circumcised men did so, according to two people familiar with the research and a draft of the study reviewed by The Wall Street Journal. Stopping trials is common when an intervention is clearly shown to be effective. Indeed, the result of the South African trial is likely to spark discussion of whether to halt or modify two other major studies of circumcision and HIV under way in Kenya and Uganda, funded by the National Institutes of Health. Ronald Gray, lead researcher on the Uganda trial, said, "It would be extremely unwise" to stop the Kenya and Uganda trials at this stage because "medicine has been burned in the past when policy is based on a single trial." It isn't clear how the new study, if confirmed, would influence U.S. policy. Circumcision wouldn't affect IV drug users who get infected by sharing syringes, a group that accounts for a large proportion of American HIV cases. Also, the South Africa study didn't evaluate whether circumcision would offer any protection to gay men, who make up another large proportion of American cases. Any direct benefit to gay men would almost certainly be restricted to the insertive partner in anal intercourse, not the receptive partner. In countries where male circumcision is uncommon and heterosexual HIV rates are high or rising rapidly, the procedure could be a powerful way of reducing the spread of the disease, the new study shows. Even so, researchers warn of potential pitfalls in trying to put the findings into practice. First, circumcision doesn't make a person immune to infection. Indeed, if men abandon safer sex practices because they think the surgery completely protects them, then HIV transmission could rise. "It will not take very much of an increase in risk behavior to overcome the benefit from circumcision," said Carolyn Williams, an American researcher involved in the Kenya circumcision study. AIDS experts insist that circumcision will have to be accompanied by intensive counseling. Secondly, AIDS researchers worry that circumcisions performed in unsanitary conditions could lead to dangerous complications. And while many Africans come from cultures that practice circumcision, many others don't. Would large numbers of men in noncircumcising cultures consent to go under the knife simply to reduce their risk of acquiring HIV? "It's a surgical procedure on an organ that, you know, conjures up a lot of feelings in people," said Robert Bailey, the principal investigator in the Kenya study. "It's not just a shot in the arm." Write to Mark Schoofs at mark.schoofs@wsj.com1, Sarah Lueck at sarah.lueck@wsj.com2 and Michael M. Phillips at michael.phillips@wsj.com3 URL for this article: http://online.wsj.com/article/0,,SB112052891400077032,00.html "Jordi" <Jordace@happy.org> wrote in message > OK Moira so a year on we have the following for your comment: > Study Says Circumcision Reduces AIDS Risk by 70% I still wouldn't gamble my life on a 30% of the original chance. But as I pointed out a year ago, I have a personal preference for circumcised men as sexual partners (that reads as if I make a habit of having multiple sexual partners, which isn't the case), so if people want to be circumcised, don't let me be the one to discourage them from this course. But as to using it as the sole prevention of the transmission of HIV ... YMMV but then you may also play Russian Roulette for all I know. -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. > "Jordi" <Jordace@happy.org> wrote in message > [quoted text clipped - 11 lines] > > YMMV but then you may also play Russian Roulette for all I know. Well if it comes to that would you rather have 70% of the chambers containing a bullet of just 30%? Now whoever said that "it" was the sole method of prevention? "Jordi" <Jordace@happy.org> wrote in message > > "Jordi" <Jordace@happy.org> wrote in message > >>OK Moira so a year on we have the following for your comment: > >>Study Says Circumcision Reduces AIDS Risk by 70% > > I still wouldn't gamble my life on a 30% of the original chance. > > But as I pointed out a year ago, I have a personal preference for [quoted text clipped - 3 lines] > > them from this course. But as to using it as the sole prevention of > > the transmission of HIV ... > > YMMV but then you may also play Russian Roulette for all I know. > Well if it comes to that would you rather have 70% of the chambers > containing a bullet of just 30%? It's irrelevant if one doesn't play Russian Roulette. > Now whoever said that "it" was the sole method of prevention? Well, if "it" isn't, then condoms on penises where the HIV positive person on either side of the condom is also on ARVs seem to work just fine and correctly and consistently used have a success rate in the prevention of transmission of HIV (and many other STI's) is 100%. One should know one's own HIV status, the HIV status of one's partner, and then one should practice safer sex every time, which includes the use of condoms. -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. > "Jordi" <Jordace@happy.org> wrote in message >>Well if it comes to that would you rather have 70% of the chambers >>containing a bullet of just 30%? > > It's irrelevant if one doesn't play Russian Roulette. You mean they abstain? In whose perfect world does that happen Moira? If I remember last time you also failed to understand the difference between personal protection and a protective effect across a population. One more time then. Personal protection is what individuals do and probably extends (not exclusively) from abstinence to "every-time" condom use. Yes, in the end unless becoming infected through rape or infected blood it is generally a self inflicted wound. When these self inflicted wounds were found mainly among the gay community it was possible for mainstream society to justify their lack of action and compassion by saying "serves the sodomites right". This in Africa is not anywhere near the main issue as we have no doubt that there is indeed a heterosexual epidemic and when infection rates rise above the 20% of the adult population one would think that people would not be able to laugh it off. But they do. They come up with inane comments like you have. When infection across different populations is compared where circumcision practice is a factor all kinds of other factors, the main one being religion (Islam) as to why a biological infection mechanism should not be taken seriously, are introduced. At this time last year we were in the position where despite in excess of 20 studies finding a significant protective effect accruing through male circumcision RCT's were needed to confirm the findings before male circumcision could begin to be promoted as *one* means of reducing HIV infection rates. We spoke of protective effect across a given population. We read as far back as 1999 from Bailey and Halperin in their paper: Male circumcision and HIV infection: 10 years and counting http://www.circumcisioninfo.com/halperin_bailey.html that: "Male circumcision, were it to be adopted by a substantial proportion of men within customarily non-circumcising societies, could have a huge impact on the HIV pandemic in developing countries. If the relative risk of HIV-1 infection for uncircumcised men is 2·5 (near the low end of the risks found in the prospective studies) in a country where 20% of men are not circumcised, which is roughly the situation in countries such as Nigeria and Indonesia, the proportion of heterosexual HIV-1 infections in men attributable to lack of circumcision is 23%.10,11 On the other hand, if 80% of men are not circumcised, as is roughly the case in Zambia and Thailand, an estimated 55% of HIV-1 infections in men are attributable to lack of circumcision. In populous regions such as South Asia where a large population of men are uncircumcised, the number of infections attributable to lack of male circumcision could soon reach into the millions." And no one listened and the number has reached into the millions. In fact it was not that no one listened we had people like you Moira who actively talked the evidence down (and are still doing so). Bailey and h\Halperin: "In the face of such compelling evidence, we would expect the international health community to at least consider some form of action. However, the association between lack of male circumcision and HIV transmission has met with fierce resistance,12 cautious scepticism,13 or, more typically, utter silence, which is evidenced by a dearth of public-health information on the issue. For example, the Johns Hopkins Media/Materials Clearinghouse has been unable to identify among its comprehensive collection of over 30000 health communication materials a single pamphlet, poster, or flyer that mentions lack of male circumcision in relation to HIV/AIDS (as at 1999)." "And the Band Played On" and while the same hypocrites who nodded sagely when Shilts made this comment about Reagan: "Already, some said Ronald Reagan would be remembered in history books for one thing beyond all else: He was the man who had let AIDS rage through America, the leader of the government that when challenged to action had placed politics above the health of the American people" they sat on their hands when evidence of the biological mechanism of HIV infection in males would described. Moira, as much as Reagan had "blood on his hands" for his deliberate lack of action so do you and those who support your view. I would go as far as to say that it makes a mockery of your odd visit to a hospice to hold hands with the dying when you are deliberately assisting millions of other young people become unnecessarily infected. What about as an act of Christian contrition from you Moira? I can suggest something but it would be better coming from your heart. >>Now whoever said that "it" was the sole method of prevention? > [quoted text clipped - 3 lines] > the prevention of transmission of HIV (and many other STI's) is > 100%. Oh I see. So instead of trying to prevent HIV infection you now try to sell HIV as a manageable condition. Your theory is bullshit of course because it implies that the infected partner must be sick enough to be on ARV's. God you are pathetic Moira. > One should know one's own HIV status, the HIV status of one's > partner, and then one should practice safer sex every time, which > includes the use of condoms. What should happen and what does happen are two different things unless you live in cloud cuckoo land. You obviously do as we know in "South Africa" that "Fear of testing positive for HIV and the potential consequences, particularly stigmatization, disease and death, were the major identified barriers to VCT".(1.) So dream on Moira ... and oh yes, let the band play on. (1.) Attitudes to HIV voluntary counselling and testing among mineworkers in South Africa: will availability of antiretroviral therapy encourage testing? http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1 2959817&dopt=Abstract "Jordi" <Jordace@happy.org> wrote in message > "And the Band Played On" and while the same hypocrites who nodded sagely > when Shilts made this comment about Reagan: "Already, some said Ronald [quoted text clipped - 5 lines] > described. Moira, as much as Reagan had "blood on his hands" for his > deliberate lack of action so do you and those who support your view. What? I support circumcision in infancy (mostly because I prefer having sex with circumcised men, and can't understand why this might not be a general feeling, but also because I abhor the infliction of wounds to the penis of a teenager in unsterile conditions in circumcision schools), the use of ARVs which reduce the risk of transmission of HIV together with the correct and consistent use of condoms. > I would go as far as to say that it makes a mockery of your odd visit to > a hospice to hold hands with the dying when you are deliberately > assisting millions of other young people become unnecessarily infected. How am I deliberately assisting millions of people to become infected? Get real. > What about as an act of Christian contrition from you Moira? I can > suggest something but it would be better coming from your heart. > > Well, if "it" isn't, then condoms on penises where the HIV positive > > person on either side of the condom is also on ARVs seem to work > > just fine and correctly and consistently used have a success rate in > > the prevention of transmission of HIV (and many other STI's) is > > 100%. > Oh I see. So instead of trying to prevent HIV infection you now try to > sell HIV as a manageable condition. Your theory is bullshit of course > because it implies that the infected partner must be sick enough to be > on ARV's. God you are pathetic Moira. Where am I not trying to prevent HIV infection? Remember *I'm* the one that says circumcision alone is inadequate. One needs correct and consistent condom use, and now that ARVs are available, ARVs as well. I have explained at length how ARVs reduce the risk of transmission and why condoms are still necessary. Preventing transmission and managing HIV are not mutually exclusive. > > One should know one's own HIV status, the HIV status of one's > > partner, and then one should practice safer sex every time, which > > includes the use of condoms. > What should happen and what does happen are two different things unless > you live in cloud cuckoo land. You obviously do as we know in "South > Africa" that "Fear of testing positive for HIV and the potential > consequences, particularly stigmatization, disease and death, were the > major identified barriers to VCT".(1.) So dream on Moira ... and oh yes, > let the band play on. VCT mostly happens in communities where there is no drivel about HIV being fed to people, but rather *all* the available facts and unconditional support. In the corporate environment of BMW, for example, more than 99% of their workforce has been tested and those who are HIV positive (and have declared their status to their employers) are either receiving free ARVs or are chosing to manage their HIV in some other way. Studies show that people who know their status, whatever it is, generally manage it better than those who don't know their status. -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. > What? I support circumcision in infancy (mostly because I prefer > having sex with circumcised men, and can't understand why this might [quoted text clipped - 3 lines] > transmission of HIV together with the correct and consistent use of > condoms. What you said on 2 July 2004 was as follows: "The jury is out. I'm convinced that circumcision is not adequate protection against HIV." My response was: "The jury is still out on what? Whether there is a protective effect from circumcision or whether the protective effect is proven to the extent that circumcision as a public health intervention can be promoted?" You never responded. I further stated: "In any event male circumcision could never be a stand alone intervention but would need to be incorporated into a broad multi-faceted intervention covering all the bases from abstinence through to safe sex." I would ask you to indicate where you have raised the issue of traditional circumcision schools schools before? Now their is a new angle about using ARV's to reduce HIV transmission. Are you suggesting that they be used by HIV- people? "Jordi" <Jordace@happy.org> wrote in message > > What? I support circumcision in infancy (mostly because I prefer > > having sex with circumcised men, and can't understand why this might [quoted text clipped - 3 lines] > > transmission of HIV together with the correct and consistent use of > > condoms. > What you said on 2 July 2004 was as follows: > "The jury is out. I'm convinced that circumcision is not adequate > protection against HIV." I'm still convinced that circumcision is not adequate protection against HIV. Your posting of the 70% reduction confirms my conviction. > My response was: > "The jury is still out on what? Whether there is a protective effect > from circumcision or whether the protective effect is proven to the > extent that circumcision as a public health intervention can be promoted?" > You never responded. I thought and still think this discussion is rubbish. What are you saying? That you're circumcised? That universal circumcision is desirable? That HIV will die if circumcision is universal? That there is some indication that circumcision is likely to make one a little less vulnerable to HIV? > I further stated: > "In any event male circumcision could never be a stand alone > intervention but would need to be incorporated into a broad > multi-faceted intervention covering all the bases from abstinence > through to safe sex." > I would ask you to indicate where you have raised the issue of > traditional circumcision schools schools before? Now their is a new > angle about using ARV's to reduce HIV transmission. Are you suggesting > that they be used by HIV- people? Why would I have to have raised the issue of tradtional circumcision schools before? The angle about ARVs is not purely to reduce HIV transmission, but to manage HIV, but a positive side effect is the reduction of transmission. And no, I am not suggesting that ARVs be used by HIV negative people. That's completely ridiculous and doesn't address the method of the reduction at all. Now I'm once again bored with this thread, so ask your questions and phrase your statements carefully and then we can once again drop it. I'm only replying once more. -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. > "Jordi" <Jordace@happy.org> wrote in message > [quoted text clipped - 33 lines] > there is some indication that circumcision is likely to make one a > little less vulnerable to HIV? This is more about the prevention of HIV infection and thereby the slowing down of the epidemic than a pissing contest over who is or isn't circumcised. Bailey and Halperin did the math based on what the protective effect of circumcision was found to be at the time. The scientific community stated that RCT's were necessary before circumcision could be considered as an intervention. They are taking place as we speak and the the previous findings are being confirmed. Yet the bullshit remains. This study was stopped after 9 months because the authors believed it to be unethical not to offer the uncircumcised men the option being circumcised. I quote: "The circumcision findings were so dramatic that the data and safety monitoring board overseeing the research halted the study in February, about nine months before it would have been completed, on the grounds that it would be immoral to proceed without offering the uncircumcised control group the opportunity to undergo the procedure." So your "a little less vulnerable" indicates that you are not willing to accept this research so there must surely be something else floating your boat. A reasonable interpretation to make, no? "Jordi" <Jordace@happy.org> wrote in message > So your "a little less vulnerable" indicates that you are not willing to > accept this research so there must surely be something else floating > your boat. A reasonable interpretation to make, no? Safer sex (read using a condom correctly and consistently) every time floats my boat. I acknowledge that there are probably a few relationships where fidelity also counts as safer sex, but I wouldn't want to risk my life on someone else's fidelity after discovering that my ex-husband was unfaithful. -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. > "Jordi" <Jordace@happy.org> wrote in message > [quoted text clipped - 6 lines] > Safer sex (read using a condom correctly and consistently) every > time floats my boat. How would you place yourself on the sexual activity stakes, Moira? Once a day, once a week, once a month, once a year? It is important to place your risk in some sort of context. Also are you purely vanilla or do you get into the naughty sh.t? You see Moira your comment comes across that of the failed "Just Say No" anti-drugs campaign. > I acknowledge that there are probably a few relationships where > fidelity also counts as safer sex, but I wouldn't want to risk my > life on someone else's fidelity after discovering that my ex-husband > was unfaithful. Wise move. Is this all hypothetical or are you actually active? "Jordi" <Jordace@happy.org> wrote in message > How would you place yourself on the sexual activity stakes, Moira? Once > a day, once a week, once a month, once a year? It is important to place > your risk in some sort of context. Also are you purely vanilla or do you > get into the naughty sh.t? > You see Moira your comment comes across that of the failed "Just Say No" > anti-drugs campaign. Well, I "Just Say No" to drugs *and* I subscribe to safer sex every time. Actually I'm unmarried and celibate. -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. > "Jordi" <Jordace@happy.org> wrote in message > [quoted text clipped - 12 lines] > Well, I "Just Say No" to drugs *and* I subscribe to safer sex every > time. Actually I'm unmarried and celibate. Celibate? Well that suggests why it is so easy for you to make pious statements about "restrained" sexual activity. > VCT mostly happens in communities where there is no drivel about HIV > being fed to people, but rather *all* the available facts and [quoted text clipped - 5 lines] > their status, whatever it is, generally manage it better than those > who don't know their status. Yes Moira, if wishes were horses and pigs had wings. What percentage of people in South Africa actively and willingly seek VCT? Sadly as the problem approaches the stage of becoming overwhelming we see the do gooders withdrawing into little comfort zones where they site best practice which only occur on a pathetic minority scale. OK but let us agree that the majority of these BMW employees are men and they have been helped. How is this initiative helping the core spreader group who happen to be young women who are vulnerable to sexual predation and are mostly not able to negotiate safe sex practice and would not dream of disclosing their status if it could alienate their male partner regardless of who infected who? You may have noticed how all bent out of shape people in the US get over HIV/AIDS which affects less than one percent of their population and how nonchalant you and others are where the adult infection rates exceed 20%. As they say Moira, and the band played on. "Jordi" <Jordace@happy.org> wrote in message > > VCT mostly happens in communities where there is no drivel about HIV > > being fed to people, but rather *all* the available facts and [quoted text clipped - 5 lines] > > their status, whatever it is, generally manage it better than those > > who don't know their status. > Yes Moira, if wishes were horses and pigs had wings. What percentage of > people in South Africa actively and willingly seek VCT? No idea. What's your estimate? However, the fact that I have no idea how many are seeking VCT this is not stopping me from advocating that people should seek VCT and proclaiming why I think they should. > Sadly as the problem approaches the stage of becoming overwhelming we > see the do gooders withdrawing into little comfort zones where they site > best practice which only occur on a pathetic minority scale. Ah, because I/the do gooders/companies/goverment can't reach everyone no-one should benefit? > OK but let us agree that the majority of these BMW employees are men and > they have been helped. How is this initiative helping the core spreader > group who happen to be young women who are vulnerable to sexual > predation and are mostly not able to negotiate safe sex practice and > would not dream of disclosing their status if it could alienate their > male partner regardless of who infected who? Well, I suppose those people are advocating VCT and safer sex in their community. Just because one can't reach everyong doesn't mean that one shouldn't do what one can do. > You may have noticed how all bent out of shape people in the US get over > HIV/AIDS which affects less than one percent of their population and how > nonchalant you and others are where the adult infection rates exceed 20%. Why do you think I'm nonchalant? What is it that you think I'm doing or not doing? What is it that you would have me do? And in what way are you setting a better example? > As they say Moira, and the band played on. I think you're attacking the wrong person. -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. > I think you're attacking the wrong person. Moira don't take it personally, the people you help & comfort know & appreciate the good that you do. jordan only believes in destructive criticism, the person he lashes out at or cause he attempts to destroy are irrelevant to him. Norman >jordan only believes in destructive >criticism, the person he lashes out at or cause he attempts to destroy >are irrelevant to him. I think "jordi" is a fredshaw sock puppet! lol..... Moira! I'm enjoying your meticulous shredding of these ridiculous arguments. Indeed, older data show that circumcision after a certain age is no longer of benefit. I think tho the data are accumulating that it can be one piece of the risk reduction strategy--and indeed, assuring that those who WISH to undergo the procedure are able to do so under as sterile as possible conditions is another aspect (given that many may not access at-birth circumcision options and some cultures still circumicise boys around puberty). So these are all issues that can be addressed intelligently, not something we'll ever get out of the likes of "jordi." George M. Carter >>jordan only believes in destructive >>criticism, the person he lashes out at or cause he attempts to destroy >>are irrelevant to him. > > I think "jordi" is a fredshaw sock puppet! lol..... Hi George. Not Fred Shaw anyway lol > Moira! I'm enjoying your meticulous shredding of these ridiculous > arguments. Indeed, older data show that circumcision after a certain > age is no longer of benefit. Of course you are free to interpret what is posted in anyway you feel. But having watched you attack the denialists relentlessly on the basis of their misuse/twisting/misrepresentation of facts I thing your chain should be jerked on this. I assume you refer to the Kelly study (see below). Lets see exactly what they found. If circumcised before the age of 12 the risk is 0.39 of the uncircumcised. If circumcised between the ages of 13-20 risk is 0.46 of the uncircumcised. If circumcised after the age of 20 the risk is 0.78 of the uncircumcised. Or course there is a benefit at 0.78, in fact if there was a means of reducing the risk of Malaria by 22% we would jump at it. We don't have that means so here in South Africa we are spraying with DDT again (much to the chagrin of the international environmental bodies). Now let us look at the reasons why men in Uganda would be circumcised after the age of 20. Does not fit the religious reasons as Muslims fit the first group. Does not fit the second group because traditional circumcisions are in mid to late teens. So what would you say George? The answer is most likely medical circumcisions where there is a prevailing medical condition (like gonorrhea). Further that this group who experience such SDT problems have obviously been sexually active _before_ being circumcised and therefore would have the possibility of being infected _prior_ to being circumcised. What is the rough odds of infection of a 20 year old male in South Africa? I have it at around 7% across the general male population but nothing specific about 20 year old males who have been circumcised for medical reason after the age of 20. I could speculate on how much less the risk is of those circumcised after the age if 20 if they have not _required_ a medical circumcision. So George in the interests of accuracy please do try to stick to the facts and not to make "Paul King" deliberately inaccurate statements. When I see the responses from you and others I admit to a wry smile when I remember how thrilled the scientific world was when a malaria vaccine proved to provide 30% protection. And maybe you would remember back to gp120 in 2000 when Dr. Donald Francis said of a 30% protection level: "Thirty percent protection for a 100 percent fatal disease is that 30 percent of those people don't die." ========================= Age of male circumcision and risk of prevalent HIV infection in rural Uganda. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=10199231&query_hl=1 OBJECTIVE: To assess whether circumcision performed on postpubertal men affords the same level of protection from HIV-1 acquisition as circumcisions earlier in childhood. DESIGN: Cross-sectional study of a population-based cohort. SETTING: Rakai district, rural Uganda. METHODS: A total of 6821 men aged 15-59 years were surveyed and venous blood samples were tested for HIV-1 and syphilis. Age at circumcision was dichotomized into men who were circumcised before or at age 12 years (prepubertal) and men circumcised after age 12 years (postpubertal). Postpubertal circumcised men were also subdivided into those reporting circumcision at ages 13-20 years and > or = 21 years. RESULTS: HIV-1 prevalence was 14.1% in uncircumcised men, compared with 16.2% for men circumcised at age > or = 21 years, 10.0% for men circumcised at age 13-20 years, and 6.9% in men circumcised at age < or = 12 years. On bivariate analysis, lower prevalence of HIV-1 associated with prepubertal circumcision was observed in all age, education, ethnic and religious groups. Multivariate adjusted odds ratio of prevalent HIV-1 infection associated with prepubertal circumcision was 0.39 [95% confidence interval (CI), 0.29-0.53]. In the postpubertal group, the adjusted odds ratio for men circumcised at ages 13-20 years was 0.46 (95% CI, 0.28-0.77), and 0.78 (95% CI, 0.43-1.43) for men circumcised after age 20 years. CONCLUSIONS: Prepubertal circumcision is associated with reduced HIV risk, whereas circumcision after age 20 years is not significantly protective against HIV-1 infection. Age at circumcision and reasons for circumcision need to be considered in future studies of circumcision and HIV risk. ========================= snip >If circumcised after the age of 20 the risk is 0.78 of the uncircumcised. > >Or course there is a benefit at 0.78, in fact if there was a means of >reducing the risk of Malaria by 22% we would jump at it. snip... >"Thirty percent protection for a 100 percent fatal disease is that 30 >percent of those people don't die." 22 does not equal 30 which is somewhat of a "Paul King" type approach. STD treatment and management is a good idea. Condoms are a good idea. Circumcision under appropriate circumstances can be a good idea. George M. Carter > snip > [quoted text clipped - 14 lines] > > George M. Carter Don't be deliberately obtuse George. But then if one _combines_ all the interventions into a single strategy then we have the potential to apply the brakes to the epidemic. > I think tho the data are accumulating that it can be one piece of the > risk reduction strategy--and indeed, assuring that those who WISH to [quoted text clipped - 3 lines] > puberty). So these are all issues that can be addressed intelligently, > not something we'll ever get out of the likes of "jordi." It would be interesting to know - really know - what prompted the custom of circumcision in the first place and how many cultures require it to be performed. Perhaps there was an event, going way back in time, which stimulated it. It is certainly does not seem to be a necessity under normal conditions. The first recorded (or portrayed) evidence comes from ancient Egypt, but the practice was spread all over the World and in ancient times too. Mark Richardson >>I think you're attacking the wrong person. > [quoted text clipped - 4 lines] > > Norman Norman of course Moira may choose where and with whom she gets involved. She is also free to place any value she chooses on that input. She has a right to feel good about her contribution no matter what nor how much. >>I think you're attacking the wrong person. > > Moira don't take it personally, the people you help & comfort know & > appreciate the good that you do. jordan only believes in destructive > criticism, the person he lashes out at or cause he attempts to destroy > are irrelevant to him. A deeply unhappy chap from what one can tell. I don't know why anybody bothers responding though, it is such transparent Elizabeth Bott style foot stamping. -- The creed which accepts as the foundation of morals, Utility, or the Greatest Happiness Principle, holds that actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness. -- J.S.Mill Chapter II, Utilitarianism * TagZilla 0.057 * http://tagzilla.mozdev.org Moira ode Swardt wrote: > "Jordi" <Jordace@happy.org> wrote in message > [quoted text clipped - 6 lines] > advocating that people should seek VCT and proclaiming why I think > they should. What is regrettable about it is that you offer no other strategies to cover people in environments where such an approach will not work. The tree of dealing with the threat of HIV/AIDS should comprise many branches, no? >>Sadly as the problem approaches the stage of becoming overwhelming >>we [quoted text clipped - 4 lines] > Ah, because I/the do gooders/companies/goverment can't reach > everyone no-one should benefit? My question is about the vast majority who are not benefiting through CT interventions for one reason or another? f.ck em, right? >>OK but let us agree that the majority of these BMW employees are >>men and [quoted text clipped - 10 lines] > their community. Just because one can't reach everyong doesn't mean > that one shouldn't do what one can do. One strategy, take it or leave it, is hardly an intelligent approach to a pandemic. For instance how does this approach help AIDS orphans on in rural kwaZulu where young girls need to service men in the area in order to earn a crust to feed their younger brothers and sisters at great risk of HIV infection. I understand that the workers are easy to get to and through some degree of education are able to understand the value of VCT to themselves and their families but it is really a soft option when the hard work (and the huge social tragedies) gets to be ignored don't you think? >>You may have noticed how all bent out of shape people in the US >>get over [quoted text clipped - 6 lines] > doing or not doing? What is it that you would have me do? And in > what way are you setting a better example? Moira you give the distinct impression that you are merely going through the motions. >>As they say Moira, and the band played on. > > I think you're attacking the wrong person. Maybe but nothing over the past few years that you have posted in this regard has indicated that to be the case. "Jordi" <Jordace@happy.org> wrote in message > > "Jordi" <Jordace@happy.org> wrote in message > >>Yes Moira, if wishes were horses and pigs had wings. What > >>percentage of > >>people in South Africa actively and willingly seek VCT? > > No idea. What's your estimate? However, the fact that I have no > > idea how many are seeking VCT this is not stopping me from > > advocating that people should seek VCT and proclaiming why I think > > they should. > What is regrettable about it is that you offer no other strategies to > cover people in environments where such an approach will not work. The > tree of dealing with the threat of HIV/AIDS should comprise many > branches, no? You haven't answered the question. I presume that means you have no answer. Here's another question in view of the fact that I agree that all HIV interventions should be as multifaceted as possible. What strategies are you aware of that have been tried in order to facilitate prevention other than VCT for people who will not engage in VCT? What have their success rates been? > >>Sadly as the problem approaches the stage of becoming overwhelming > >>we > >>see the do gooders withdrawing into little comfort zones where > >>they site > >>best practice which only occur on a pathetic minority scale. > > Ah, because I/the do gooders/companies/goverment can't reach > > everyone no-one should benefit? > My question is about the vast majority who are not benefiting through CT > interventions for one reason or another? f.ck em, right? No, I am most certainly not planning to. I only practice safer sex. Let's hear what ideas you have for dealing with the vast majority who are not being counselled and tested. > >>OK but let us agree that the majority of these BMW employees are > >>men and [quoted text clipped - 6 lines] > >>their > >>male partner regardless of who infected who? > > Well, I suppose those people are advocating VCT and safer sex in > > their community. Just because one can't reach everyong doesn't mean > > that one shouldn't do what one can do. > One strategy, take it or leave it, is hardly an intelligent approach to > a pandemic. For instance how does this approach help AIDS orphans on in [quoted text clipped - 5 lines] > hard work (and the huge social tragedies) gets to be ignored don't you > think? AIDS orphans have a large number of resources that they can tap. Perhaps not nearly enough. But they're not the ones at greatest risk in the pandemic. Rural women, particularly illiterate rural women, are at greater risk, for example. You are right in saying that education is key in promoting VCT and that HIV is largely a social issue. > >>You may have noticed how all bent out of shape people in the US > >>get over > >>HIV/AIDS which affects less than one percent of their population > >>and how > >>nonchalant you and others are where the adult infection rates > >>exceed 20%. > > Why do you think I'm nonchalant? What is it that you think I'm > > doing or not doing? What is it that you would have me do? And in > > what way are you setting a better example? > Moira you give the distinct impression that you are merely going through > the motions. I've been doing this at least as part of my work since 1984. Do you want me to bleed every time I'm in contact with someone that is HIV positive? Or cry? Or scream and shout? There comes a time when it is no longer an issue, but merely something that people live with. The trick is then to exercise fairness and compassion, to be understanding of the stresses, to be aware of the issues, but to continue to live with hope and healing. The advent of ARVs has made this easier to deal with on a human level. HIV is no longer a death warrant, a scourge, a blot. It has become a disease which can be managed and which can be fought. There is hope that AIDS can be wiped out in our lifetimes. In the past the only way that AIDS could be handled was for HIV positive people to die. That was a time of great frustration and invalidation for HIV positive people. Now HIV and AIDS are two different concepts, though obviously still linked. > >>As they say Moira, and the band played on. > > I think you're attacking the wrong person. > Maybe but nothing over the past few years that you have posted in this > regard has indicated that to be the case. Maybe you have comprehension problems. -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. > "Jordi" <Jordace@happy.org> wrote in message > [quoted text clipped - 32 lines] > facilitate prevention other than VCT for people who will not engage > in VCT? What have their success rates been? Old trick that Moira, high school level really, you respond to a question with a question. Been around a little too long to be led around by the nose. Sorry. > No, I am most certainly not planning to. I only practice safer sex. > Let's hear what ideas you have for dealing with the vast majority > who are not being counselled and tested. I'm surprised you seek information on this or anything at all Moira. You always present yourself as omnipotent. But I suspect that you have not concerned yourself with matters beyond your little comfort zone. > AIDS orphans have a large number of resources that they can tap. > Perhaps not nearly enough. But they're not the ones at greatest risk > in the pandemic. Rural women, particularly illiterate rural women, > are at greater risk, for example. You are right in saying that > education is key in promoting VCT and that HIV is largely a social > issue. Well this is a very disturbing statement. I was hoping that you would see the broader social aspects of the pandemic and not just simply on the issue of infection. Do try a little lateral thinking Moira. > I've been doing this at least as part of my work since 1984. How much of this "work" was paid? > Do you > want me to bleed every time I'm in contact with someone that is HIV [quoted text clipped - 3 lines] > understanding of the stresses, to be aware of the issues, but to > continue to live with hope and healing. I see the trick is to harden ones heart then Moira. It is only something people live with as long as their world and that of their families does not implode. The social impact Moira the social impact. > The advent of ARVs has made > this easier to deal with on a human level. Remind me who has access to ARV's (in South Africa) again? > HIV is no longer a death > warrant, a scourge, a blot. To whom Moira? > It has become a disease which can be > managed and which can be fought. By whom, Moira, and with what resources? > There is hope that AIDS can be > wiped out in our lifetimes. Put a time line on that and explain how the next generation deals with the social tragedy arising from the pandemic? > In the past the only way that AIDS > could be handled was for HIV positive people to die. Hellooooooo ... that is how it is for the majority of people Moira. What planet are you living on? > That was a > time of great frustration and invalidation for HIV positive people. Still is Moira, still is. "Jordi" <Jordace@happy.org> wrote in message > > "Jordi" <Jordace@happy.org> wrote in message > >>>"Jordi" <Jordace@happy.org> wrote in message > > You haven't answered the question. I presume that means you have no > > answer. Here's another question in view of the fact that I agree > > that all HIV interventions should be as multifaceted as possible. > > What strategies are you aware of that have been tried in order to > > facilitate prevention other than VCT for people who will not engage > > in VCT? What have their success rates been? > Old trick that Moira, high school level really, you respond to a > question with a question. Been around a little too long to be led around > by the nose. Sorry. You simply haven't answered the question whereas I have answered your question. The fact that you continue to pose it again and again, doesn't mean that I haven't answered it. > > No, I am most certainly not planning to. I only practice safer sex. > > Let's hear what ideas you have for dealing with the vast majority > > who are not being counselled and tested. > I'm surprised you seek information on this or anything at all Moira. You > always present yourself as omnipotent. But I suspect that you have not > concerned yourself with matters beyond your little comfort zone. I present myself as omnipotent? Where? It may well be true that I have not concerned myself with matters beyong my comfort zone. Over the past twenty years I have only been involved with society's marginalised people for about sixteen of them. > > AIDS orphans have a large number of resources that they can tap. > > Perhaps not nearly enough. But they're not the ones at greatest risk > > in the pandemic. Rural women, particularly illiterate rural women, > > are at greater risk, for example. You are right in saying that > > education is key in promoting VCT and that HIV is largely a social > > issue. > Well this is a very disturbing statement. I was hoping that you would > see the broader social aspects of the pandemic and not just simply on > the issue of infection. Do try a little lateral thinking Moira. What lateral thinking would you like me to try? Direct my thinking a little. > > I've been doing this at least as part of my work since 1984. > How much of this "work" was paid? Well, I was in the Salvation Army full time from September 1986 to January 2002, during which time I started an AIDS "hospice" in Port Elizabeth in one of the en-suite rooms at an Old Age Home and worked with HIV positive mothers and their children, where I started an OASIS drop-in centre in Kimberley, and was part of the founding of the OASIS drop-in centre in Johannesburg and where I ran the OASIS "Caring for the Carers" for five years. I worked as a missionary at the AIDS section of the Msunduza Clinic in Mbabane, Swaziland for a year. If one considers the pittance they give Salvation Army officers as pay, then I was paid for all that. In addition, I worked for ANERELA+ (African Network of Religious Leaders Living with HIV and AIDS) on a contract basis during 2002 and 2004, for which I was paid. As a volunteer I have continued to run the OASIS "Caring for the Carers" since February 2002, and I have been involved in teaching and training home based care through St. John Ambulance Brigade since 1984. I was actively involved in the HIV vaccine trials at Chris Hani Baragwanath during 2003 and 2004. > > Do you > > want me to bleed every time I'm in contact with someone that is HIV [quoted text clipped - 3 lines] > > understanding of the stresses, to be aware of the issues, but to > > continue to live with hope and healing. > I see the trick is to harden ones heart then Moira. It is only something > people live with as long as their world and that of their families does > not implode. The social impact Moira the social impact. The carers don't do anyone any good if they're out there bleeding in the streets. But for what it's worth, it is not necessarily a "hardening of the heart" but a toughening of the psyche. > > The advent of ARVs has made > > this easier to deal with on a human level. > Remind me who has access to ARV's (in South Africa) again? Theoretically anyone. But even the Health Department admits that rural people don't have effective access. And the costs are dropping and the access is increasing. This is what we should be aiming for when dealing with people who are already HIV positive. > > HIV is no longer a death > > warrant, a scourge, a blot. > To whom Moira? To those who are fortunate enough to be able to afford computers and access to ARVs. > > It has become a disease which can be > > managed and which can be fought. > By whom, Moira, and with what resources? It can be managed and fought by anyone. It is the duty of all voters, in fact all citizens, to ensure that the government of the Republic of South Africa is accountable for providing decent health services. And these health services include ARVs. > > There is hope that AIDS can be > > wiped out in our lifetimes. > Put a time line on that and explain how the next generation deals with > the social tragedy arising from the pandemic? I sign myself a "the Faerie Godmother" not "God". I wish I were omnipotent. > > In the past the only way that AIDS > > could be handled was for HIV positive people to die. > Hellooooooo ... that is how it is for the majority of people Moira. What > planet are you living on? Perhaps for the majority of people in South Africa at the moment, but there is hope that this situation will change. Already those of us in the field are working towards getting long term strategies in place where professional nurses in PHC clinics can be trained to do the necessary work to ensure that people get ARVs. This is far more of a problem than the actual current cost of the ARVs. > > That was a > > time of great frustration and invalidation for HIV positive people. > Still is Moira, still is. Not if they don't know their status. Perhaps that's another reason why people don't want to be tested? -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. > "Jordi" <Jordace@happy.org> wrote in message > > My question is about the vast majority who are not benefiting [quoted text clipped - 4 lines] > Let's hear what ideas you have for dealing with the vast majority > who are not being counselled and tested. This is an interesting point. Forty years ago, those who are now considered to be most at risk would never have been counselled and tested because the need for counselling and testing would not have existed. There was a cultural basis of responsible behaviour - I know that the subject of migrant workers would need to be considered, but they would be easy subjects for counselling and testing. What has happened since then has been an erosion of basic cultural values in this area (and one or two others). The real need, from the point of view of stopping the spread of the infection, is to try to achieve a return to the previous situation and given the fact that so many cultural practices remain in place, this should not be an impossible task. >The advent of ARVs has made > this easier to deal with on a human level. HIV is no longer a death [quoted text clipped - 5 lines] > Now HIV and AIDS are two different concepts, though obviously still > linked. There is a tsunami that will hit at some, not too distant time in the future - bird flu transmitted from humans to humans - and the ARVs will not be a reliable preventative for those who will be most at risk. There is also the problem of getting the ARVs to where they are most needed and on a regular basis. Mark Richardson "Mark Richardson" <mwmarho@iafrica.com> wrote in message > This is an interesting point. Forty years ago, those who are now considered > to be most at risk would never have been counselled and tested because the [quoted text clipped - 6 lines] > achieve a return to the previous situation and given the fact that so many > cultural practices remain in place, this should not be an impossible task. STD's were rife forty years ago. > There is a tsunami that will hit at some, not too distant time in the > future - bird flu transmitted from humans to humans - and the ARVs will not > be a reliable preventative for those who will be most at risk. There is also > the problem of getting the ARVs to where they are most needed and on a > regular basis. Our Minister of Health estimates that 70-80% of South Africans have little or no access to medical care. Scary in view of the new estimate of 6 million HIV positive South Africans. And the fact that only about 30% of the HIV positive people *in* the best government health systems (e.g. Johannesburg Hospital) are receiving ARVs. -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. > Our Minister of Health estimates that 70-80% of South Africans have > little or no access to medical care. Scary in view of the new > estimate of 6 million HIV positive South Africans. And the fact > that only about 30% of the HIV positive people *in* the best > government health systems (e.g. Johannesburg Hospital) are receiving > ARVs. Our minister is not serious about HIV either. All we hear is piss poor excuses why they can't roll out health care to all South Africans while the two bitches and that drunken dwarf of a president jet around the world doing "interesting" stuff. > Preventing transmission and managing HIV are not mutually exclusive. Yes and no. Preventing transmission of HIV by known HIV+ people to uninfected people is on the other end of the spectrum from preventing infection of HIV- people. Transmission by people who know their status should be potentially a criminal offense. Now you can use smoke and mirrors and talk about ARV's and condoms but it is nothing but an attempt to legitimize the risk their partners are placed at. "Jordi" <Jordace@happy.org> wrote in message > > Preventing transmission and managing HIV are not mutually exclusive. > Yes and no. The answer is not "Yes and no". Either they are not mutually exclusive or they are. I state that they're not. Why do you think they are. > Preventing transmission of HIV by known HIV+ people to uninfected people > is on the other end of the spectrum from preventing infection of HIV- > people. No. HIV is spread from HIV positive people to HIV negative people. HIV negative people *all* have a duty to know their status and to stay HIV negative. There is *no*, repeat *NO* excuse for anyone to become HIV positive though their own careless sexual behaviour in the year 2005. > Transmission by people who know their status should be potentially a > criminal offense. Now you can use smoke and mirrors and talk about ARV's > and condoms but it is nothing but an attempt to legitimize the risk > their partners are placed at. There is no, or at least, very little risk of an HIV negative partner of an HIV positive person becoming HIV positive when safer sex is practiced every time. The only difference, in fact, between an HIV negative person having sex with an HIV positive partner and an HIV negative person having sex with an HIV negative person is that the HIV negative person with the HIV positive partner is likely to have safer sex every time. This thread is starting to bore me. There is only one way of ensuring that one does not become HIV positive and that is to have safer sex every time one has sex. This is not negotiable in either theory or in my personal practice. -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. > "Jordi" <Jordace@happy.org> wrote in message > [quoted text clipped - 6 lines] > exclusive or they are. I state that they're not. Why do you think > they are. I said "Yes and No" and not just no. Do try to maintain some degree of honesty Moira. I see it rather as approaching the issue from two different angles. One is how to prevent people getting infected in the first place and the second preventing those infected to infect other people. Your comments about the use of ARV's relates to the second group. >>Preventing transmission of HIV by known HIV+ people to uninfected >>people [quoted text clipped - 6 lines] > become HIV positive though their own careless sexual behaviour in > the year 2005. Where does the no come in? There are clearly different approaches needed to help negative people stay that way and to prevent positive people from infecting others. The obverse of your coin is that there is *no* repeat *NO* excuse for an HIV+ person to infect another through sexual behaviour (careless or otherwise) in 2005 or any other year. >>Transmission by people who know their status should be potentially >>a [quoted text clipped - 11 lines] > that the HIV negative person with the HIV positive partner is likely > to have safer sex every time. Why do you skirt the legal issue? Why should it not be mandatory for HIV+ people to disclose their status to potential sex partners? Why should it not be an offense to place an unknowing partner at risk? Why do you place the onus upon the negative partner for not becoming infected? Do positive people not have a responsibility for not infecting other people? This is a significant human rights issue. "Jordi" <Jordace@happy.org> wrote in message > The obverse of your coin is that there is *no* repeat *NO* excuse for an > HIV+ person to infect another through sexual behaviour (careless or > otherwise) in 2005 or any other year. What if the HIV positive person does not know his or her status? Even believes him or herself to be HIV negative? > Why do you skirt the legal issue? Why should it not be mandatory for > HIV+ people to disclose their status to potential sex partners? Why > should it not be an offense to place an unknowing partner at risk? Unknowing partners should always have safer sex. In fact evey sex act that is not *specifically* performed with the intention of creating a baby should be done with a condom. > Why do you place the onus upon the negative partner for not becoming > infected? Do positive people not have a responsibility for not infecting > other people? This is a significant human rights issue. All the HIV positive people I've ever discussed this with say they own a very strong motivation for not passing the virus on to other people. But every one of them acknowledges that if they had practiced safer sex every time, they'd be HIV negative today. There might be a few exceptions to this, but not many. -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. > "Jordi" <Jordace@happy.org> wrote in message >>The obverse of your coin is that there is *no* repeat *NO* excuse > for an [quoted text clipped - 4 lines] > What if the HIV positive person does not know his or her status? > Even believes him or herself to be HIV negative? That seems to be one of the reason why there is resistance to testing. If you don't know then you can't be to blame for knowingly infecting someone. They don't want to know. They should be made to know. >>Why do you skirt the legal issue? Why should it not be mandatory > for [quoted text clipped - 5 lines] > act that is not *specifically* performed with the intention of > creating a baby should be done with a condom. There is more to sex than just the penis penetrating and thus there are other means of exposure to body fluids. It is import to have some idea. It is important that HIV+ people are made to make their potential partners aware of the risk. >>Why do you place the onus upon the negative partner for not > becoming [quoted text clipped - 7 lines] > practiced safer sex every time, they'd be HIV negative today. There > might be a few exceptions to this, but not many. What about a clue as to sample size and demographics? I would have thought that a hardened campaigner like you would also realize that there is a grand canyon between what people say they feel and do and what the actual case is. >> "Jordi" <Jordace@happy.org> wrote in message > That seems to be one of the reason why there is resistance to testing. If > you don't know then you can't be to blame for knowingly infecting someone. > They don't want to know. They should be made to know. That is a good point, I know that would infringe on their civil liberties, blah, blah. If the law was changed that it was a reportable disease then there would be far more information available, the infected people could be made responsible and accountable for infecting people. If an HIV+ person has knowingly performed unsafe sex should he be made accountable for endangering his partners life ? "sportsfan" <bignose@telkomsa.net> wrote in message > "Jordi" <Jordace@happy.org> wrote in message > > That seems to be one of the reason why there is resistance to testing. If > > you don't know then you can't be to blame for knowingly infecting someone. > > They don't want to know. They should be made to know. > That is a good point, I know that would infringe on their civil liberties, > blah, blah. If the law was changed that it was a reportable disease > then there would be far more information available, the infected > people could be made responsible and accountable for infecting > people. If an HIV+ person has knowingly performed unsafe sex > should he be made accountable for endangering his partners life ? The resistance to testing is multi-faceted. Why don't people get tested for cancer? Who really knows? Certainly if one catches certain cancers, such as breast cancer or testicular cancer, early on the prognosis for a long life thereafter is excellent while if one does not catch them early the prognosis is extremely poor. That thinking permeates HIV testing as well. Add to that a huge stigma problem with HIV, the fact that there is a lot more misinformation about HIV than about cancer, and the general scare tactics employed by bullies, and it is scarcely any wonder that a large number of black people, for whom there is no real discernable benefit to knowing their HIV status, do not want to be tested? There is a myth "out there" that there are many people who are knowingly having unprotected sex while they are fully aware of their HIV status. There can, of course, be no way of determining these things, but let me share with you what we see in counselling. When people are told that they are HIV positive there is usually a grave concern for their sexual partners and their children. This indicates to me that most of the people are as concerned about passing HIV on to others as they are for their own well-being. People are usually far more willing to use condoms after they discover that they are HIV positive than they were before they discovered they were HIV positive. People taking ARVs responsibly nearly always couple this behaviour with correct and consistent use of condoms. There is a feeling amongst people working in the field of HIV and AIDS that those who are spreading the virus are usually the ones that *don't* know for sure that they have HIV because they've never been tested. Some of these people must know, or at least suspect, that they are HIV positive because of their own clinical symptoms, however they refuse to take ownership of their status. Now sex, at least the kind from which one can contract HIV, requires two people. Thus in any case where the virus is going to be transmitted from one person to the other, it can be assumed that there are two people involved, one of whom is HIV positive (because regardless of whether sex is safe or unsafe the virus can only be transmitted from an HIV positive person to an HIV negative person). We *all* have a responsibility for our own sex lives, unless one is mentally deficient. Thus it is that there is an equal onus on both the HIV positive person and the HIV negative person not to have unsafe sex. This is a problem in cases where a disempowered HIV negative wife is forced to have unsafe sex with her HIV positive husband which is technically rape, I suppose. It should not be a problem in any other situation where the sex act is voluntary. In other words, where the sex act is voluntary, there is an equal onus on both partners to prevent the transmission of HIV, thus there can be no imposition of an onus one only one of these people at the time of the sex act. Where the sex act is forced on one of the partners this obviously does not apply and the question of whether an HIV positive status of the perpetrator means that he (or rarely, she) should be charged with attempted murder in addition to rape can at least be discussed. I don't believe that HIV, while not a pleasant prospect, is a "death sentence" therefore I think any charge of attempted murder is legally doomed to failure. Of course, "accountability for endangering a partner's life" is not anything that the law recognises, otherwise bad driving, drunkenness, drug abuse (and sometimes use) and slovenly food preparation would all be criminal offenses in ways that they are not currently, mostly because it's too difficult to prove. -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. > "sportsfan" <bignose@telkomsa.net> wrote in message > [quoted text clipped - 4 lines] > on the prognosis for a long life thereafter is excellent while if > one does not catch them early the prognosis is extremely poor. This may not be entirely germane, but the matter of screening is interesting. It is important for cancers particularly and possibly for other diseases too, to realise that there are negative consequences to being tested for a disease. One of the largest, for cancer, is the cost of false positives. All tests have a proportion of false positives and false negatives (including tests for death). A false positive for cancer can lead to dangerously invasive treatments which pose a significant risk. Thus somebody, who does not have the condition, is going to be healthier, statistically, if there he doesn't have a test. It is also worth considering that, though it is far fewer than before, a number of cancers are not curable and the treatment can lead to a lower quality of life than no treatment at all - all doctors that I've spoken to on this matter would refuse all treatment for cancer apart from morphine for the pain. If you are going to refuse treatment then there isn't much point in having the test - you'll know when you need morphine soon enough! There is also, as you've mentioned, the important matter of probability. If somebody has been celibate and not in the habit of using the hairbrushes in the House of Commons, then his chances of having AIDS are slim, if you excuse the old pun. Thus the expense and risk of the test is unnecessary. There is no point in being tested for something if you are not likely to be in an 'at-risk' population. -- The creed which accepts as the foundation of morals, Utility, or the Greatest Happiness Principle, holds that actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness. -- J.S.Mill Chapter II, Utilitarianism * TagZilla 0.057 * http://tagzilla.mozdev.org "Peter H.M. Brooks" <peter@new.co.za> wrote in message > > "sportsfan" <bignose@telkomsa.net> wrote in message > > The resistance to testing is multi-faceted. Why don't people get > > tested for cancer? Who really knows? Certainly if one catches > > certain cancers, such as breast cancer or testicular cancer, early > > on the prognosis for a long life thereafter is excellent while if > > one does not catch them early the prognosis is extremely poor. > This may not be entirely germane, but the matter of screening is > interesting. It is important for cancers particularly and possibly for > other diseases too, to realise that there are negative consequences to > being tested for a disease. Agreed. But weigh these against the negative consequences of not being tested. > One of the largest, for cancer, is the cost of false positives. All > tests have a proportion of false positives and false negatives > (including tests for death). A false positive for cancer can lead to > dangerously invasive treatments which pose a significant risk. Much of the testing for cancer actually involves invasive treatments. This is not true of HIV. > Thus somebody, who does not have the condition, is going to be > healthier, statistically, if there he doesn't have a test. It is also [quoted text clipped - 4 lines] > pain. If you are going to refuse treatment then there isn't much point > in having the test - you'll know when you need morphine soon enough! Depends which cancer, actually. Testicular cancer caught early has few negative consequences. A close friend had testicular cancer. He tells me the reconstruction, which was done at the same time as the surgery has left no visual impact. My mother, a nurse, received treatment for breast and uterine cancer, but always claimed that she would refuse it for cancer of the mouth and throat. The prognosis for nearly all cancers is improved by early detection. In the case of HIV there are definite health benefits to knowing and ARVs greatly increase quality of life. There are debates as to when to start the ARVs, but they undoubtedly increase both length and quality of life. > There is also, as you've mentioned, the important matter of probability. > If somebody has been celibate and not in the habit of using the > hairbrushes in the House of Commons, then his chances of having AIDS are > slim, if you excuse the old pun. Thus the expense and risk of the test > is unnecessary. There is no point in being tested for something if you > are not likely to be in an 'at-risk' population. Well, I have a test every two weeks or every month. Platelet donor. :-) -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. > "Peter H.M. Brooks" <peter@new.co.za> wrote in message > [quoted text clipped - 11 lines] > Agreed. But weigh these against the negative consequences of not > being tested. Absolutely. The matter is the weighing - some people are not properly aware of either set of consequences. >>Thus somebody, who does not have the condition, is going to be >>healthier, statistically, if there he doesn't have a test. It is [quoted text clipped - 32 lines] > would refuse it for cancer of the mouth and throat. The prognosis > for nearly all cancers is improved by early detection. Yes, that's true. I don't think anybody would refuse treatment involving having some minor bits, or even fairly major bits, lopped off - it is the radio and chemo therapy that is so dreadfully unpleasant. > In the case of HIV there are definite health benefits to knowing and > ARVs greatly increase quality of life. There are debates as to when > to start the ARVs, but they undoubtedly increase both length and > quality of life. I agree, no doubt at all. For people in the West it is now an unpleasant (because of all the drugs) chronic disease, not a killer as it was a decade or so ago. >>is unnecessary. There is no point in being tested for something if > [quoted text clipped - 4 lines] > Well, I have a test every two weeks or every month. Platelet donor. > :-) Naturally, but it is the recipients who are the potential 'at-risk' group there. -- I am never satisfied that I have handled a subject properly until I have contradicted myself at least three times - John Ruskin * TagZilla 0.057 * http://tagzilla.mozdev.org > "Peter H.M. Brooks" <peter@new.co.za> wrote in message >> > "sportsfan" <bignose@telkomsa.net> wrote in message [quoted text clipped - 3 lines] > to start the ARVs, but they undoubtedly increase both length and > quality of life. I find the above interesting as a senior British medical scientist who has been involved with AIDs research for many years said ARV's when taken immediately for suspected infection as may happen in a laboratory, have a 98% success rate of preventing contracting HIV. Your statement would seem to question this opinion. "sportsfan" <bignose@telkomsa.net> wrote in message > "Moira de Swardt" <moira.deswardt@wol.co.za> wrote in message > > In the case of HIV there are definite health benefits to knowing and > > ARVs greatly increase quality of life. There are debates as to when > > to start the ARVs, but they undoubtedly increase both length and > > quality of life. > I find the above interesting as a senior British medical scientist who > has been involved with AIDs research for many years said ARV's > when taken immediately for suspected infection as may happen in > a laboratory, have a 98% success rate of preventing contracting HIV. > Your statement would seem to question this opinion. Not at all. The prophylactic use of ARVs is something else altogether. Ideal to start within an hour of suspected or possible infection. I think the recommendation is to take ARVs for thirty days or until possible infection source definitely eliminated. This is the treatment for all exposure, including needlestick injury and rape or even a case of carelessness. There are problems associated with this so it is not something one wants to do for every pin prick, so one must be cautious about episodes of "carelessness". When one has already acquired the virus and one is testing positive, there are two schools of thought. The one is "hit early and hit hard" while the other is to delay the start of ARVs until the CD4 count drops. South Africa's public health services are employing the latter and they've set the mark at a CD4 count of 200 or less. There are pros and cons of both routes. My gut feeling is that I would follow the latter principle, but let the ARV's kick in when my body told me that I was no longer coping with fighting off minor infections. -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. > "sportsfan" <bignose@telkomsa.net> wrote in message >> "Moira de Swardt" <moira.deswardt@wol.co.za> wrote in message [quoted text clipped - 22 lines] > with this so it is not something one wants to do for every pin > prick, so one must be cautious about episodes of "carelessness". Thank you, I now understand where the difference comes in, my daughter has never had a mishap in years of working with infected blood. But many years ago a girl she was training with broke a glass vial containing infected blood and she died within two years, very tragic but today with ARV's the chances are that would not happen. > When one has already acquired the virus and one is testing positive, > there are two schools of thought. The one is "hit early and hit [quoted text clipped - 10 lines] > I hope my standard of living doesn't go up. I can't afford the one > I have now. "sportsfan" <bignose@telkomsa.net> wrote in message > Thank you, I now understand where the difference comes in, my > daughter has never had a mishap in years of working with infected > blood. But many years ago a girl she was training with broke a glass > vial containing infected blood and she died within two years, very > tragic but today with ARV's the chances are that would not happen. Probably not. Even without ARVs the chances are not all that high. For a cut it would be a lot higher, but for a needlestick injury (I think with HIV positive blood) the chances are something like 323:1 against getting HIV. Not much comfort for the person who the one in three hundred and twenty three. (I don't remember the exact figure, but it was something similar). When I was in Swaziland one of our nurses had a needlestick injury - her own fault even though she was one of our better professional nurses - but we put her on ARVs for the month and all was fine and negative. It was a worrying time for her. I expect she was a better nurse after that. She'd be so much more empathetic of counselling, testing and dealing with HIV positive as well as HIV negative patients. -- Moira, the Faerie Godmother I hope my standard of living doesn't go up. I can't afford the one I have now. >>"Peter H.M. Brooks" <peter@new.co.za> wrote in message >> [quoted text clipped - 10 lines] > a laboratory, have a 98% success rate of preventing contracting HIV. > Your statement would seem to question this opinion. Well what you speak of is using ARV as a PEP (post exposure prophylaxis). As far as I remember Combivir(?) is one such drug combo used for this purpose. Start taking the drugs within 72 hours and keep going until you are clear (13 weeks). If you can't wait a HIV PCR viral activity test can be undergone. As to when to start ARV treatment this is the National Antiretroviral Treatment Guideline: http://www.kznhealth.gov.za/arv/arv5.pdf "• CD4 < 200 cells/ mm - irrespective of stage, or • WHO stage IV AIDS defining illness, irrespective of CD4 count, and • Patient expresses willingness and readiness to take ARVs adherently" There will always be different opinions on this matter. > "sportsfan" <bignose@telkomsa.net> wrote in message >> "Jordi" <Jordace@happy.org> wrote in message [quoted text clipped - 27 li |
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