HIV News Digest - April, 2009

The following is a selected list of several notable HIV-related articles and news stories for April.

(1) Sooner is better: A New England Journal of Medicine article suggests we should start ARVs sooner. In the authors own words, "[there is strong] evidence that patients would live longer if antiretroviral treatment was begun when their CD4+ count was above 500." (Sax/Baden, New England Journal of Medicine, 4/30).

(2) We can do better: An accompanying editorial notes that, "[While] the battle to start providing antiretroviral therapy in the developing world has been won, the battle to provide the best care we can is just beginning" (Ford et al., New England Journal of Medicine, 4/30). Most African treatment programs start ARVs at a CD4 of 200 or, at best, 350.

(3) HIV no better (or worse) than diabetes? According to a study in South Africa, the Ivory Coast, Zimbabwe, and Malawi, for adult patients who start ART with a high CD4 lymphocyte count and no signs of advanced HIV disease, mortality is similar to that associated with diabetes. (Brinkhof MWG, et al. E, Mathers C, et al. (2009) PLoS Med 6(4))

(4) Is transmitting HIV worse (or as bad) as killing? The Ugandan Government is considering criminalizing HIV transmission a move that is believed by many advocates of prevention efforts to invokes stigma, discrimination and a disincentive for voluntary testing, and access to care and treatment."

(5) Does it not follow that HIV prevention is good? An Iranian appeals court recently upheld the sentence for two Iranian physicians brothers who implemented Iran's first HIV/AIDS prevention program. Arash and Kamiar Alaei received prison sentences of six and three years, respectively, The charge was plotting to overthrow the Iranian government.

(6) Before hitting the sack: An analysis of three recent studies (South Africa, Uganda and Kenya) found that heterosexual African men reduced their risk of HIV infection by half after undergoing circumcision. From an evolutionary perspective, one author said, “There are no more competitive advantages to keeping your penis in a sack.” (The Cochrane Library)

(7) China’s No.1: China announced in February that HIV/AIDS was the country's No. 1 deadly infectious disease in 2008 (UNAIDS)

(8) USA’s number is up: One person in the U.S. contracts HIV every nine-and-a-half minutes, and new infection rates are climbing among many groups. This and other messages will be dissiminated during a five-year, $45 million campaign to increase HIV/AIDS awareness in the States, where for many at-risk the epidemic has fallen off the radar screen.

(9) 1,200,000: HIV/AIDS-related mortality and prevalence among residents of 12 PEPFAR-funded countries (Botswana, Cote d'Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia), when compared with residents of 29 other sub-Saharan African countries that did not receive PEPFAR funds, was lower, with estimated lives saved in the seven-digit range, or around 1.2 million.

Search terms - A cultural encounter, Part 2 (of 4)

This is Part 2, continued from previous posting. (See below.)

...The search terms “Africa” and “Bible” had several billion hits.

I first browsed a site on “The Africans Who Wrote The Bible”, where the author of the so-titled book passionately explained that black ancient Egyptians were primarily responsible for the book. A bible history site pointed out that only part of Africa—again, Egypt—was known by the Hebrews, and perhaps those countries now known as Libya. Next, in “Reading the Bible from an African Perspective”, the author explained matter-of-factly that “a literal reading of the Bible is the most acceptable reading in churches in Africa.” I imagined a few word substitutions: “A [monolithic] reading of the [African sub-continent] is the most acceptable reading in [libraries] in [the West],” and this made me grin.

But, it was time to get serious. I tried again, typing “Botswana and religion.” Wikipedia popped up and taught me that an estimated 70 percent of Batswana identify themselves as Christians, with Anglicans, Methodists, and the United Congregational Church of Southern Africa making up the majority of these. About 5,000 of Botswana’s 1.7 million inhabitants are Muslim, primarily from South Asia. (I drive by a large mosque every day on the way into clinic. In front, a sign reads “Islam Welcomes You.” Botswana’s CDC office neighbors an impressive minaret and dome.) Botswana is also home to ~3,000 Hindus and ~700 Bahá'ís. Six percent of citizens are practitioners of an indigenous religion called Badimo, and approximately 20 percent of citizens espouse no religion.

I found this breakdown of affiliations interesting, but it worsened my confusion.

No matter where one lives, the rules of cultural engagement guide almost everything. Failure to learn and obey them risks much (relationships, professional effectiveness, etc). But, no matter where we live, sometimes the rules are hard to predict, especially if religion is involved. For example, during a staff meeting in Swaziland, the meeting chair once insisted that the opening prayer be repeated after a colleague of mine, a US pediatrician, read a beautiful Buddhist prayer (the Metta Karuna Prayer, I believe).

Talking about God in any context is of course complicated. In university, I briefly considered 'the ministry' as a profession, but in the end, preferred clinical science, a vocation with tangibility and rules/methods that enjoy near universal acceptance. Simply put, at the time, science seemed safer. Now I can say with confidence: Still does.

I half-heartedly googled “safe bible versus”. This was not helpful. So, having no other choice, I decided to use common sense.

This concludes Part 2. To be continued...