HIVHope's International Newsletter
Vol. III, No 2 - June 27, 2012
This is an exciting and a challenging time for HIVHope and for my family. I just returned from a wonderful trip to Kenya including five seminars. I have now personally facilitated 44 seminars in 16 countries on four continents. Seminar participants around the world are making a major difference not only in the course of HIV disease, but in the lives of people in their area. Many are being introduced to Jesus Christ through their work. How wonderful!
it is also challenging. My wife, Kathy, has recently been diagnosed with breast cancer. She is scheduled for surgery on the 13th of July. They tell us that there is every reason to expect full recovery. One of our children has been struggling with addictions for more than 14 years. After participating in a program to detoxify her body, she is now recovering. We are praying that she can experience life free of the addiction.
Your prayers for us will be deeply appreciated.
This is also an exciting year on the HIV front. There have been a number of research findings that are leading some to talk about the end of the disease. While that would be wonderful, we believe that they are being overly optimistic. The International AIDS Conference in Washington next month promises to be the most interesting one I have had the opportunity to attend. You can expect to be receiving another edition of It's about people after that conference.
Know that we are praying for you and your continued effectiveness in spreading the Gospel and addressing the many issues surrounding HIV. We also pray that this newsletter will be helpful to you in your work and that God is ministering powerfully in your life and in your family.
Duane Crumb for the HIVHope Team
Your Questions
One of the participants from a seminar in Kenya emailed us a couple of questions.
Hi! How is it possible that HIV can't be transmitted by houseflies? This is a question asked by one of those I was educating.
The same reasons that explain why mosquitoes do not spread HIV hold true for other sucking and biting insects including houseflies. The "H" in HIV represents Human because this is a human virus. It lives in humans, not insects. In addition, insects do not inject blood into us when they bite. Many inject their saliva (which transmits other germs and makes us itch), but not the blood of another person who might be infected with a germ like HIV.
Can we say that it safe to use two condoms at a go.
Absolutely not! It seems logical that using two condoms would make them more effective. Sometimes doctors will put on two sets of gloves at a time to increase their protection. However, condoms are made to be used one at a time. The process of putting on a second condom could put holes in both of them. In addition, the friction of sexual intercourse rubbing two layers of latex against one another can rub a hole in both of them. Thus, if condoms are to be used, they should always be used one at a time. There are two articles below explaining some of the reasons condoms often fail and how to reduce that risk. In the end it is important to remember while sex with a possibly infected partner is LESS DANGEROUS when a condom is used every time and used correctly, it is NOT safe!
We always enjoy answering your questions.Please feel free to send them to me any time.
HIV News from Around the World
Incorrect Condom Use Is 'Common'
Australian Broadcasting Corporation News (03.09.12):: Dani Cooper - A study by international researchers finds 14 common usage errors with condoms hampers their efficacy against STDs and pregnancy. The analysis of 50 studies of sex workers, STI clinic attendees, monogamous married couples, university students, and adolescents spanning 14 countries between 1995 and 2011 revealed problems including:
*late application (17 percent to 51 percent);
*early removal (13 percent to 44.7 percent);
*failure to fully unroll the condom;
*incorrect storage;
*condom re-use;
*completely unrolling before applying to the penis (25.3 percent) rather than unrolling on the penis;
*failure to leave space for semen collection (24.3 percent to 45.7 percent);
*inside-out application that is then reversed (4 percent to 30.4 percent);
*exposure to sharp objects (like teeth) during package removal (2.1 percent to 11.2 percent); and
*not checking for damage before use (74.5 percent of men and 82.7 percent of women).
According to lead researcher, “closing the gap” between typical and perfect condom use is essential to “greatly reducing the epidemics of STIs and unintended pregnancies.”
Condom commandments
NAIROBI, 29 February 2012 (PLUSNEWS) - Condoms are widely promoted as one of the most effective ways of preventing the transmission of HIV and other sexually transmitted infections, but a recent study has found that incorrect use of condoms is common and affects their effectiveness.
Indiana University's Kinsey Institute for Research in Sex, Gender, and Reproduction conducted a review of global literature on condom errors and problems from 1995 to 2011. IRIN/PlusNews has put together a list of suggestions for condom use based on some of the common errors reported:
- Use it from beginning to end - Sometimes the condom is applied once intercourse has already started, or removed before intercourse has ended. The review found that this error was frequently reported; another common mistake was starting sex before the condom was unrolled to the base of the penis. Condoms should be fully applied before intercourse has begun and should only be removed once intercourse is finished. Do not completely unroll the condom before putting it on. The correct method involves rolling the condom on to an erect penis.
- Leave a space at the tip of the condom - Generally, it is recommended that a space of about 1cm be left at the top of the condom to collect semen; if no space is left, there is a risk that the semen may run down the sides of the condom and leak out before the penis is withdrawn.
- Squeeze air from the tip before use - Excess air should be removed from a condom before use, as it can cause breakage.
- Put the condom on right way up - Another common condom error was putting the condom on inside out and then flipping it over and using it the right way round; this poses risks because it potentially exposes the sexual partner to pre-ejaculate once the condom is flipped to the correct side. If the condom is put on inside out, it is best to discard it and use a fresh one.
- Be careful not to damage the condom - The study reported the use of sharp objects to open the packet, knowingly using a damaged condom or not checking for physical damage. Condom packets should not be opened with fingernails, scissors or other sharp objects.
- Use the right lubricant - Some common lubrication issues include the use of un-lubricated condoms, which increases the risk of breakage. Oil-based lubricants break down the latex and make it more likely to break. If lubricant is required, water-based lubricants are preferable to reduce the risk of breakage.
- Withdraw correctly - Not holding the base of the condom during withdrawal can lead to leakage.
- Store safely and check expiration dates - Ideally, condoms should be kept in a cool, dry place; condoms in wallets or in back pockets for long periods are not a good idea, as body heat can weaken them.
- Do not re-use - Condoms are intended for single use, and should be disposed of after intercourse. In Kenya, at least one community reported washing and re-using condoms due to the long distance between villages and health centres providing free condoms.
Ethiopians Trade Holy Water for AIDS Drugs
Wall Street Journal (03.05.12):: Miriam Jordan - Ethiopia is slowly embracing antiretrovirals (ARVs) to treat HIV/AIDS, following years in which superstitious views of the disease dominated, and affected people often shunned drugs in favor of holy water as a curative. In Ethiopia, Orthodox Christians represent the largest religious group. To them, holy water has the power to heal, and it is bathed in as well as ingested.
Johns Hopkins University in 2007 began supporting an HIV clinic near Entoto, where a spring produces water that church writings say can exorcise demons. When the clinic started integrating ARVs into holy water treatments, locals began accepting the pills. By the middle of 2007, the archbishop of the Ethiopian Orthodox Church called for concurrent use of ARVs and holy water. Standing next to the archbishop at that announcement was then-US Ambassador Donald Yamamoto, who said that religion and science could complement each other in Ethiopia.
The latest Ministry of Health data available show that in 2010, nearly 250,000 Ethiopians had started ARV therapy, up from 72,000 in February 2007. In 2010, the total number of AIDS-related deaths was 28,100, down from 71,900 three years earlier.
Religious leaders regret stigmatising people with HIV
SATURDAY NATION By ARTHUR OKWEMBA - Faith-based organisations vow to discard their strong-stance approach and adopt a new way of fighting HIV prevalence after a joint meeting with government representatives. Kenyan religious leaders have often viewed matters to do with HIV and AIDS through a sexual and moral lens. Often taking a strong stance, the religious leaders have been known to reprimand people living with HIV. Not any more.
A recent meeting bringing together Christian and Muslim religious leaders acknowledged that this approach to fighting HIV prevalence in the country had been wrong and that it had inflicted harm on the infected people. The meeting, at a Nairobi hotel, agreed that the strong-stance approach had only helped to alienate people living with HIV from the society.
In a 2012 report by National AIDS Control Council (NACC), a copy of which Saturday Nation has, the leaders admit that they need to do more to help reduce the spread of HIV. "We are concerned that for the last 27 years, we as religious leaders, have perceived HIV and AIDS as a sexual and moral issue leading to unintended stigma towards individuals, families and communities in Kenya," they say.
In the communiqué titled Declaration of Commitment by Religious Leaders on HIV Prevention: Doing More and Doing Better Towards Zero New Infections, the leaders add:
"This has contributed to stigma, shame, silence, denial, discrimination, inaction, and mis-action that continue to undermine the national HIV prevention, treatment and care efforts."
Right move by faiths in fight against HIV
Jesus would give the youth suitable options, argues one pastor.
The leaders were drawn from the National Council of Churches of Kenya, the Supreme Council of Kenya Muslims, the Anglican Church, the African Inland Church, the Salvation Army, the Deliverance Church, the Evangelical Lutheran Church, the Seventh Day Adventist church, the Friends Church and the Presbyterian Church, among others.
They further acknowledged that matters of faith have sometimes led to non-adherence to HIV treatment by those infected. In their candid declaration, they recognised the existence of serious gender imbalances and injustices, which were making women and girls bear the greatest burden of HIV.
While faith-based organisations are implementing some HIV activities around treatment and prevention, especially focused on abstinence, this is the first time they have made, as group, an official and unequivocal declaration about their actions in the fight against the disease. It was also a defining moment as they have declared their strong commitment to take part in broad programmes in the management of HIV and AIDS.
An Action Plan for 2011-2012 details the various strategies the religious leaders will use to roll out their activities. They want to ensure that they are fully engaged in the prevention, treatment, and care of people living with the virus and their families. Among the activities will be integrating HIV in theological studies; training religious leaders on sexuality issues; incorporating HIV information in their sermons; and development of a policy that will protect worshippers from mis-informed religious leaders.
Other strategies to be implemented this year include reviewing the theology expressed in prayer, song, sermons and testimonies to promote what they call "safer practices", access to treatment and nutrition, voluntary, routine and stigma-free counselling and testing and empowerment.
Religious leaders will also be expected to re-interpret the scriptures liberally; to use spiritual and medical doctors to clarify facts; and to speak openly about sexual and gender-based violence.
The government, on its part, wants religious leaders to speak with one voice on HIV and AIDS matters. In this regard, the National AIDS Control Council is in the process of signing a memorandum of understanding with the religious leaders about their specific actions on managing the disease.
The need to engage the faith-based organisations was prompted by recent survey findings which showed that more new HIV infections were occurring in married couples than in any other grouping. The religious organisations, which advocate sex only in marriage and are in contact with a majority of the married couples, were identified as key in helping reduce HIV infections in this group. Religious leaders will be key in the anti-HIV fight. For many years, the leaders have taken a stand that those who are found to be HIV positive were reaping the sins of promiscuity. Most of the infected people within the church and other religious groupings were, therefore, stigmatised. They refused to go public about their HIV status for fear of being disgraced.
This position by church leaders also made many people shun HIV testing, fearing the backlash they might experience if they tested positive. The use of condoms was also condemned; they were seen as encouraging immorality among young people and in marriages.
Abstinence received plenty of attention, with sexually active young people being asked to wait until they were married to engage in sex. However, recent statistics that show that HIV infection is higher among married people than in other groups seem to have thrown the church off balance. Marriage, an institution that was advocated for by the church as the best assurance against infection, is now the leading driver of the disease, with 44 per cent of new infections being reported among married couples.
This rate is higher than the one reported among commercial sex workers (14.1 per cent), men who have sex with men (15.2 per cent), and drug users (3.8 per cent), who, when put together, are responsible for 33 per cent of new HIV infections.
In addition to HIV infections being high in marriages and among steady partners, the church has been forced to reassess itself, especially after some religious leaders and its followers declared publicly that they were HIV positive. The Anglican Church, for instance, found out in a 2004 survey that 65,000 of their adherents were living with HIV/AIDS. The church says in its ACK Mandate on HIV/AIDS: "
The change of heart by religious leaders is good news for HIV advocates, who have constantly implored faith-based organisations to support all interventions against the disease, including condom use. Many of the advocates have argued that HIV is not about morality and that there were other cultural, gender, environmental and religious factors that predispose people to infection. Religious leaders, the advocates argued, should see the disease from this perspective.
Spreading the message
It is also acknowledged that the faith-based organisations have a major influence on the behaviour, decisions and actions of its followers. Having them as partners in the fight against the disease is a guarantee that the message is going to reach many people. "Religious leaders are very instrumental in offering effective HIV education."
Experts on HIV have for a long time argued that having religious organisations on board would significantly reduce stigma, which is the main factor why people fail to go for HIV testing, disclose their status, seek treatment or adhere to their therapy, and engage in risky sexual behaviour.
In their declaration, religious organisations identified five key commitments.
- Work with people living with HIV and AIDS to eliminate mother-to-child transmission of HIV by 2015.
- Adopt a faith and evidence-based non-stigmatising approach in their fight against the spread of HIV.
- Encourage their members to go for HIV testing as a starting point for HIV prevention, care and treatment.
- Enhance their advocacy for local financing of the anti-HIV war.
HIVHope - These two articles demonstrate some of the importance of the involvement of the church (both the organization and the people who make up the church) in HIV. There are still far too many churches and believers whose words and attitudes are moving in the wrong direction. We hope that, especially for those of you in Kenya, you will be able to participate in and take advantage of the new initiatives that have come out of this meeting. If you are not in Kenya, please pray about how you can help a similar initiative start in your area.
KENYA: Better training needed for counsellors of HIV-discordant couples
NAKURU/NAIROBI, 5 April 2012 (PLUSNEWS) - The Kenyan government has issued guidelines on counselling for HIV-discordant couples, but many counselors in smaller, rural health centres remain untrained. "HIV infection among discordant couples will increase without adequate counselling because... it is only through counselling that they learn to live with each other, and use preventive measures such as condoms consistently," said Churchill Alumasa, the coordinator at the local NGO, Discordant Couples of Kenya (DISCOK).
According to the government, six out of every 10 HIV-positive couples are discordant, amounting to an estimated 350,000 couples.
When Rose Njeri, 31, a mother of one, tested HIV-positive two years ago during a routine antenatal visit, she was advised to bring her husband along for her next visit. When he tested negative, he became hostile towards her. "Trouble started immediately. He insulted me as we headed home, saying I knew my status and wanted to infect him intentionally."
Couples counselling
The couple was given a counselling session on safe sex, but Njeri said her husband sometimes insists on unprotected sex when he comes home drunk.
"It is also important to note that couples counselling cannot be done once. It needs to be continuous, especially if there is a case of discordance." "Challenges associated with discordance can be reduced if counsellors test couples together and they benefit from knowing each other's status at the same time, and in the presence of a counselor." "[Counsellors] should also dedicate more time to these couples because their cases are normally different," and mistrust and engaging in risky sexual behaviour can be diminished by ensuring that couples are tested together, rather than separately.
Many couples preferred to test individually rather than together, thereby missing out on the opportunity for couples counselling. "If you insist on testing them together, some disappear
forever."
Children
The unmet reproductive health needs of HIV-discordant couples are a key issue and needs to be addressed. "Discordant couples who are not counseled together are likely to engage in unprotected sex in search of a child, and [if] one partner doesn't know the status of the other, they find it hard to discuss condom use." "For discordant couples, condoms remain the most effective contraceptive, but their use can only improve in a situation where there is vibrant couples counselling."
A number of reproductive options exist for HIV-discordant couples, including artificial insemination after 'sperm washing', and the infected partner starting antiretroviral therapy (ART) to decrease the chances of transmission to the HIV-negative partner. However, counsellors are often not equipped to provide couples with this information.
Health workers are awaiting guidelines on HIV-discordant couples from the UN World Health Organization. These were due to be released in 2011 but were delayed by findings on the impact of early treatment on reducing HIV infection within stable sexual relationships. Experts say home-based counselling and testing and psychosocial support groups are also helpful tools in reaching out to discordant couples.
HIVHope - Some research suggests that in as many as half of the couples in which at least one partner is living with HIV, the other is not infected. In every HIVHope seminar people ask about discordant couples and how that is possible. This article gives some important thought about how to minister to and help these couples. Let us know what you think.
Rising ARV resistance threatens HIV fight
KAMPALA, 22 May 2012 (PLUSNEWS) - The prevalence of drug-resistant HIV strains in Uganda has risen from 8.6 percent to 12 percent in the last five years, one of the highest rates in Sub-Saharan Africa, according to a recent study. The report for 2008-2012 found that the prevalence of transmitted drug resistance among people who have never taken life-prolonging antiretroviral (ARV) medication was substantially higher in Uganda.
ARVs were available at least five years earlier in Uganda than in the five other countries studied - Kenya, Nigeria, South Africa, Zambia and Zimbabwe -where drug resistance was estimated at 5 percent in selected areas of those countries.
HIV drug resistance occurs when patients do not respond to prescribed ARVs, and their health deteriorates despite taking the drugs correctly and consistently. Patients who have become resistant must start taking a more expensive second-line regimen of medication. HIV-positive people with drug-resistant strains can transmit them to others.
"Drug-resistant HIV variants selected during ART [antiretroviral treatment] failure have the potential to limit the response to subsequent lines of treatment, and constitute a reservoir for onward transmission [of drug resistance] to newly infected individuals," the authors said. "Drug-resistant HIV may severely restrict therapeutic options, and treatment costs will greatly increase when more people need second- and third-line ART regimens."
The report revealed that poor treatment adherence to ARVs, shortage of health professionals, limited training, deficient adherence counselling, inconsistent drug supply and weak enforcement of quality standards were among the causes of HIV drug resistance.
HIVHope - This research brings home how vital it is for people on ARVs to follow their doctors' instructions exactly.
African HIV Activists Want a New Model for Prevention
Christian Science Monitor (06.08.12):: Fredrick Nzwili - The “ABC” message (Abstinence, Be faithful, and Condomize) that has been used worldwide to prevent the spread of HIV is being criticized in parts of Africa as ineffective. African faith leaders have designed a new strategy called “SAVE” (Safer practices, Access to Treatment, Voluntary Counseling and testing, and Empowerment) to replace ABC. Fifteen African countries have adopted SAVE, and Malawi is expected to adopt it soon.
A 2011 UNAIDS report said the highest HIV infection rates remain in sub-Saharan Africa, even as infections have dropped by 20 percent. This decline has been linked to changes in behavior and increased knowledge of HIV, both attributable to ABC.
For many groups in Africa, including faith groups, ABC is seen as not effective enough because it fails to curb the stigma of AIDS, which pushes the epidemic underground and hinders universal access to HIV diagnosis and treatment. In addition, AIDS activists say scientific advances as well as cultural changes in Africa make it necessary to redesign AIDS messages. Mother-to-child HIV transmission still exists, and levels of infection among people in relationships has increased.
ABC's problem is that it takes a moral and sexual approach only which does not work in African cultures, according to Canon Gideon Byagumisha, a Ugandan cleric. He believes a comprehensive strategy is needed that addresses HIV in its entirety.
ABC also does not teach people other strategies to help prevent the spread of HIV. “Abstinence, for example, [also] needs condom use, safe blood, safe circumcision, microbicide, vaccines and so forth,” said Byagumisha. “ABC is somehow inaccurate because it seems to portray that once you are faithful you don't get HIV,” he said. “Yet we know there are very faithful people, there are people who are virgins at marriage, who end up being positive. This means that faithfulness is not safeness.”
HIVHope - is a new model for HIV prevention. It works! We trust you are putting it into action in many ways and sharing it with others so that they can see how important and effective your tools for HIV education are.
Device to Test HIV Immunity Unveiled
BY JOHN MUCHANGI AND JOEL MAGU, 21 JUNE 2012 - A new device that determines the immunity levels of people with HIV within 20 minutes is now in Kenya. The portable device that provides an absolute CD4count within such a short duration was launched by researchers from the Kenya Medical Research Institute (Kemri) in Nairobi.
The new device will help break the HIV infection cycle earlier. CD4 cells are a type of white blood cells that fight infection and the lower they are the more progressive HIV is in the patient's body. Currently, it can take several weeks to test the CD4count in Kenya, delaying treatment for thousands of people. The point- of-care test is important because individuals who are unaware of their infection are nearly four times more likely to infect others.
People can only be put on life-prolonging antiretroviral drugs once their CD4count and viral load have been established. The device is designed for remote places. This enables more patients to access a CD4result, and reduces both the number of patients lost to follow-up and the time to initiate antiretroviral therapy.
HIVHope - This new device can make a big difference. However, we are concerned about the headline to the article. Does it suggest to you that some people are immune to HIV and this device can test for that? If so, it can lead to some very dangerous interpretations.
Heart Trouble Early and Often in HIV Patients
New York Times (06.18.12):: Donald G. McNeil Jr. - People with HIV, even those whose virus is well-suppressed by treatment, have a greater risk of heart attack than their uninfected peers, and at an earlier age, new research shows. A cardiologist's findings confirm a link that some AIDS experts have long suspected, in the Journal of the American College of Cardiology.
“I think most cardiologists and most HIV specialists are not really aware of this.” said the study author. “Most of the people I see are referred to me after they’ve had a heart attack, a bypass, a stent. To me, that’s too late. We should be screening people for coronary disease, aggressively treating blood pressure, aggressively treating cholesterol.” Both HIV and the drugs to treat it cause chronic inflammation that likely increases the risk of heart attack. HIV medicines cause the liver to make more cholesterol. In addition, HIV can cause “leaky gut syndrome,” in which inflammatory microbes enter the blood.
HIVHope - This is a complication of HIV infection that is rarely talked about. People living with the virus and those who care for them need to be aware of this so that they can be looking for indicators of heart disease and taking appropriate steps to reduce the risk and respond if there is any evidence of the problem.
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