On Alice Radio: A Conversation with Pam Barnes

“Our goal is to be sure that women can have the number of children they want, and not the number of children that their circumstances dictate.”

~ President Pamela W. Barnes

Last week, Alice Radio (97.3) in San Francisco featured Pam Barnes on its Sunday Magazine program to discuss the top reproductive health challenges facing women today and what EngenderHealth is doing to address them.

Listen to the  interview here. Or, skip to the topics that interest you:

01:30 …on advocating for national policies that promote women’s health
03:06 …on global progress in women’s health

05:25 …on the benefits of investing in women

07:17 …on engaging men to support women’s health

09:45 …on EngenderHealth’s work to address women’s health through comprehensive & integrated services

11:30 …on meeting the needs of women living with HIV, including family planning and preventing mother-to-child transmission (PMTCT) of HIV

13:12 …on Gender Matters, our teenage pregnancy prevention program that addresses gender norms among adolescents in Austin, Texas

15:45 …on why issues across the globe should matter to Americans

18:25 …on what YOU can do to support EngenderHealth’s work to improve women’s reproductive health

EngenderHealth on the Move

International conferences are always on our agenda. But this winter has been particularly busy so far, with staff attending the International Conference on Family Planning in Dakar, Senegal, and the International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA) in Addis Ababa, Ethiopia. Since our field staff cannot pack you in their suitcases and take you with them—they’re just not that strong!—we asked them to tell you a little about their experiences now that they are back home. 

 

2011 International Conference on Family Planning, Dakar: JAWEER BROWN (Technical Advisor, Family Planning)

What were some of your favorite moments from the conference, and why?

One of my personal highlights from the conference was a presentation by a young activist living with HIV. He really moved me and set the stage for my experience in Dakar. Against the backdrop of a large tent and competing with the rumblings of an enthusiastic audience, the activist reminded us of the human face behind the words family planning, HIV, systems strengthening, development, and all the jargon we use in our work. He represented the lives of so many we refer to as “client,” ”population,” or ”user.” With a palpable candor and passion, he pressed us to adhere to our commitments to make real change and embodied the purpose of our work: to meet the urgent sexual and reproductive health needs of young people like him.

Were there any takeaways from discussions surrounding the issue of HIV risk and hormonal injections?

Going into the conference, we knew the facts surrounding this important issue. An important takeaway that emerged on this topic, however, is the fact that we may never have conclusive evidence about a link between hormonal contraceptives and HIV risk. Strong leadership, therefore, is vital for proceeding within this uncertainty. This will involve investing more resources and attention to expand the contraceptive choices available to women and increase access to a wide method mix, including long-acting and permanent methods of family planning.

What other research highlights received special attention from conference participants?

I am a tech geek in disguise, and I really enjoyed a presentation on new contraceptive technologies. Two innovations in particular caught my eye: the microbicide/hormonal contraceptive ring, and the development of a topical gel contraceptive. 

What were some major contributions EngenderHealth made at the conference?

EngenderHealth contributed a great deal to the Implementing Best Practices (IBP) sessions, which were another major highlight of my experience in Dakar. The format of these sessions was unique.  Rather than Powerpoint presentations followed by a question-and-answer period, the sessions were broken up into roundtables, allowing for open dialogue in small groups of 8–10 people. It was a rare opportunity to sit down with colleagues and experts from around the world and take a bird’s eye view at what we do and how we do it.

2011 International Conference on AIDS and STIs in Africa, Addis Ababa: MARK BARONE (Senior Medical Associate)

What were some of your favorite moments from the conference, and why?

A favorite moment from the conference was a presentation that my colleague Dr. Quentin Awori delivered on our randomized controlled trial of the Shang Ring versus conventional male circumcision in Kenya and Zambia. Dr. Awori works in Homa Bay, Kenya, and is a co-investigator on the study. He is an up-and-coming young researcher, which made it even more gratifying to see our work presented by him. The presentation generated a lot of discussion and offered great hope that a device will simplify male circumcision and allow for more rapid scale-up.

I also particularly enjoyed the opportunity that the conference presented to connect with many of the people that I know who are working in the field of HIV and to meet new people. Conferences like this provide a venue to learn not only from the actual conference sessions, but also to talk with others and get a better sense of what is going on more broadly in the field  and to create opportunities for future collaborations.

What other research highlights received special attention from conference participants?

Voluntary medical male circumcision received a great deal of attention during ICASA, including a number of special sessions and many oral and poster presentations. I hope that emphasis on this proven HIV prevention intervention will spur along some of the programs in Sub-Saharan Africa that have been lagging a bit.

What work did EngenderHealth present, and how did it fit into the overall conference narrative and themes?

EngenderHealth was well represented at the conference, with oral and poster presentations that highlighted our work in voluntary medical male circumcision for HIV prevention, gender, and our work with most-at-risk populations (MARPs). We also had a booth in the exhibition area highlighting our HIV-related work, with a special focus on our work with MARPs in Ethiopia.

What It Will Take to Achieve an AIDS-Free Generation

In a November 8 address, Secretary of State Hillary Rodham Clinton set forth a bold vision that the end of HIV and AIDS is finally in sight, marking the first time in history that the U.S. government has made it a policy priority to end HIV and AIDS.

Major scientific advances in the last few years offer an historic opportunity for achieving an AIDS-free generation, Secretary Clinton said. This goal is attainable through a combination of three proven interventions—prevention of mother-to-child transmission (PMTCT), voluntary medical male circumcision, and antiretroviral (ARV) treatment to prevention transmission—in addition to condoms and other prevention tools. The Obama Administration is characterizing this approach as “combination prevention.”

Here, EngenderHealth experts on HIV and AIDS offer their perspectives on the U.S. government’s new policy as well as the new 2011 Worlds AIDS Day report released by the Joint United Nations Programme on HIV and AIDS (UNAIDS).

Pamela W. Barnes, President and CEO

Bringing family planning back into the conversation…

I fully applaud the ambitious goal set forth by the Obama Administration, yet its response doesn’t measure up to the realities facing the majority of individuals living with HIV—women and girls—in Africa. Achieving an AIDS-free generation will require a broad, integrated approach that extends beyond PMTCT to include reproductive choice, which is a fundamental human right for women and girls and an indispensable component of a comprehensive solution to ending HIV and AIDS. (Photo: Pamela Barnes on the right)

Family planning is part of a four-pronged approach to achieving strong sexual and reproductive health for women living with HIV. We can all cheer when a mother gives birth to an HIV-free baby—no doubt, PMTCT is a critical tool for HIV-positive women who wish to expand their families. But the reality is that we cannot have comprehensive PMTCT without family planning.

To be effective, PMTCT services must encompass comprehensive care for pregnant women, mothers, and newborns, including family planning, primary prevention, and care and treatment for HIV-positive women and infants. Moreover, women with HIV who have just delivered a healthy baby through PMTCT must also have the means to avoid or delay future pregnancies, if that is what they wish to do.

The bigger picture of reproductive health...

In the broader context of sexual and reproductive health, we must also ask ourselves: How do we keep that same mother healthy throughout her life? She may access HIV treatment, but in these very same places, getting pregnant is one of the riskiest things she can do. For example, in places like Niger, a woman has a one in 16 chance of dying due to pregnancy in her lifetime, so meeting a woman’s broader reproductive health needs, including family planning, is imperative if we are to make measurable progress.

Paul Perchal, Director, HIV and STI
Universal access to HIV programs is the lynchpin to achieving an AIDS-free generation…

We are in a truly new era of the AIDS response, with unprecedented opportunities for realizing an AIDS-free generation, but we have a long way to go. Universal access to HIV programs is the lynchpin to achieving an AIDS-free generation. By the end of 2010, only about 47% of eligible people living with HIV were on ARV treatment, and about 48% of pregnant women living with HIV received PMTCT treatment. Moreover, after male circumcision was shown to offer protection against HIV, the United Nations set a goal for 20 million African men to be circumcised by 2015, yet to date only about 600,000 have undergone the procedure. For these numbers to change, strong referral networks are key – they help with client follow-up, and will be critical in scaling up comprehensive prevention, care, and treatment programs.

On “combination prevention” (PMTCT, MC, and care and treatment)…

Combining proven approaches must also include behavioral interventions (such as encouraging people to use condoms to reduce risks of transmission) and structural interventions (such as using microfinance loans to reduce women’s dependence on transactional sex for income). Even if HIV services are available, people may not access them or adhere to care and treatment unless they develop positive health-seeking behaviors and can do so without facing stigma and discrimination.

A shared responsibility…

An effective global response to HIV and AIDS involves a shared responsibility and ongoing moral and financial commitment from both developed and developing countries, communities, and donors. We also need to help support and strengthen local governments and civil society organizations by building their institutional capacity to increase transparency and accountability and ensuring that donor resources actually reach the people they are meant to support in a timely and cost-efficient way.

On the new global framework described in the 2011 UNAIDS World AIDS Day Report…

The comprehensive global framework for HIV and AIDS should deliver significant results if countries, donors, and multiple development sectors can commit to it. The framework underscores the need to promote “social enablers,” such as human rights and the capacity of community-based organizations, as well as “program enablers,” such as community-centered program design and delivery, integration, management and incentives, and research and innovation.

Achieving universal access to HIV prevention, treatment, care, and support by 2015 through the framework will require scaling up funding, including moving closer to spending 15% of government revenue on health (as per the Abuja Declaration for Africa), as well as using existing resources more cost-efficiently. It will also require leveraging synergies with other sectors such as gender, education, social protection and welfare, and economic development.

Finally, maximizing critical enablers requires program efforts and new innovations that function together and include a combination of biomedical, behavioral, and structural components.

Insights from 2011 Int’l AIDS Society Conference

Back from Rome where they participated in this year’s International AIDS Society (IAS) Conference, Mark Barone and Jared Nyanchoka, Technical Advisors at EngenderHealth, took time to share highlights from the annual meeting:

Q: What were some research highlights from the conference?

A: Two major research advancements drew much attention at the conference: 1) treatment as prevention and 2) pre-exposure prophylaxis, known as PrEP. In the first case, a large, randomized study showed that when people living with HIV begin antiretroviral (ARV) treatment before they normally would, their chances of transmitting the virus are reduced by an astounding 96%. The second breakthrough involved two randomized studies among heterosexual couples in Botswana, Kenya, and Uganda, which showed that a daily dose of ARV drugs for HIV-negative men and women reduced the risk of contracting HIV by 60-70%.

Another interesting study addressed male circumcision for HIV prevention, one of EngenderHealth’s HIV focus areas. A study from South Africa showed for the first time that male circumcision reduced the number of new HIV infections within a population. Among 15- to 34-year-old men, there was a 76% reduction in new HIV infections between 2007 and 2010 in the Orange Farm area outside of Johannesburg.

Q: What are the key issues emerging in light of the recent findings involving HIV treatment for prevention?

A: Treatment as prevention took center stage at this year’s IAS conference in Rome. While everyone seems very excited about these amazing results, many debates have surfaced about the practical issues that must be addressed before this approach can become a reality.

Currently, in Africa, as in other parts of the world, many people need treatment now, yet are unable to get it because of lack of availability and resources. How can we begin giving anti-HIV drugs to people who do not need them yet clinically, even though we know that doing so will decrease the chances of passing HIV to others? Treatment-as-prevention approaches are extremely expensive, and stigma is an obstacle to getting tested and accessing treatment. There are also concerns about human rights issues surrounding drug distribution in limited resource settings. These are only a few of the many issues that complicate this discovery.

It is also important for people to keep in mind that treatment as prevention and PrEP have a major behavioral component. People actually need to take the drugs. With past prevention measures (condom use, reduction in sexual partners, safe drug injection practices), we have seen that behavior change is not easy. We must not be lulled into thinking that these prevention approaches using ARV drugs will be any more likely to succeed without significant efforts.

The ethics of using placebos in future HIV research were also debated at the conference, particularly with regard to developing an HIV vaccine. How ethical will it be to give placebo medication in place of other near effective biomedical approaches such as treatment as prevention and PrEP when researching effectiveness?

Q: What new HIV-related research did EngenderHealth present at the conference?

A: EngenderHealth gave two poster presentations on our male circumcision work in Kenya, both of which were very well-received. One demonstrated that male circumcision provided by non-physicians (nurses and clinical officers) is safe, effective, and acceptable, when the providers are well trained and facilities have the required equipment and supplies. The second confirmed the safety and acceptability of the Shang Ring, a novel device for adult male circumcision that EngenderHealth is researching in Africa. Participants were eager to use the findings as a lobbying tool to push their governments to support male circumcision.

Q: What role do you think this and similar conferences play in knowledge sharing and advancement?

A: Scientific conferences are crucial for knowledge sharing. They provide a forum for presenting the latest developments and advances in the field, for exchanging ideas about projects, and for immersing oneself in the latest work in many different subfields of HIV research. Conferences allow researchers to present their data and solicit input from others, as well as provide input on others’ work. They allow for critical discourse, discussion and debate that help to move the field forward and provide an opportunity to network with colleagues and to develop new collaborations with people from around the world.

EngenderHealth joins the global health community in celebrating proof-of-concept of microbicides

At the International AIDS Conference in Vienna, there was standing ovation in a packed conference hall for the Caprisa 004 microbicide study. As the New York Times reports:

After two decades in which researchers searched fruitlessly for an effective vaginal microbicide to block H.I.V., South African scientists working in two AIDS-devastated communities of South Africa, one rural and one urban, say they have finally found something that shows real promise.

Women who used a vaginal microbicidal gel containing an antiretroviral medication widely used to treat AIDS, tenofovir, were 39 percent less likely over all to contract H.I.V. than those who used a placebo. Those who used the gel most regularly reduced their chances of infection 54 percent, according to a two-and-a-half year study of 889 women by Caprisa, a Durban-based AIDS research center.

Download the official press release (PDF, 168KB).

EngenderHealth at the International AIDS Conference: Highlights

PEPFAR Gender Symposium: Practical Approaches for Integration with HIV and AIDS, featuring Dunstan Bishanga of EngenderHealth’s CHAMPION Project, and new (as of 1 September 2010) EngenderHealth President Pamela W. Barnes

Sunday, July 18
Mini Room 8, 1:30–3:30 pm

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EngenderHealth co-launches the new Global HIV Stigma Reduction Network

Wednesday, July 21
Mini Room 3, 6:30–8:30 pm

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Leadership & Accountability Development Workshop: Scaling Up Key Programmes to Protect Human Rights, led by Paul Perchal, Director, HIV and STI program, EngenderHealth

Monday, July 19
Mini Room 1, 2:30–6:00 pm

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The Language of Love: Tanzanian Women Define Intimacy, Sexuality, and Violence in the 21st Century, M. Leslie-Rule, EngenderHealth CHAMPION Project

Wednesday, July 21
Session Room 9, 2:30–4:00 pm

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EngenderHealth will be featured in more than 25 sessions at the International AIDS Conference. Download our complete schedule of activities (PDF, 376KB).

EngenderHealth at the International AIDS Conference 2010

Beginning on Sunday, July 18, policymakers, scientists, program experts, persons living with HIV, and others committed to ending the AIDS pandemic will gather in Vienna, Austria, for AIDS 2010, the 18th International AIDS Conference. Visit us at Booth #418!

Paul Perchal, director of EngenderHealth’s HIV/STI Program, will be among the conference participants. Paul’s commitment to this field is in part the legacy of losing two of his closest friends to AIDS during the mid-1990s. Gearing up for the conference, the theme of which is “Rights Here, Right Now,” Paul offers his perspective on the upcoming week in this brief Q&A:

As we head into the conference, what do you see as the most vital issues facing the field?
Universal access to prevention, care and treatment for people living with HIV and AIDS, regardless of where they live, remains paramount. The economic crisis means that donors are rethinking their priorities, and that some of the gains we’ve made in recent years could be undermined. There’s also renewed focus on human rights, and increased recognition that in places where HIV stigma persists, people just aren’t getting tested. Likewise, pregnant women are not accessing care and treatment to prevent transmitting the virus to their newborns. We really need more effective strategies to reduce stigma and its effects.

Male circumcision is also receiving wide attention. It has been proven to reduce the risk of HIV transmission in men by up to 60%, and many governments are now introducing large-scale programs to make the procedure widely available. In Kenya, for example, the government is rapidly expanding services so that 1.1 million men can opt for the procedure by 2015. While not a panacea, male circumcision is an essential tool for HIV prevention that is currently not available to millions of men who want it.

How will EngenderHealth be represented at the conference?
EngenderHealth’s expertise in reducing HIV-related stigma, engaging men to prevent HIV in their relationships and communities, and preventing mother-to-child transmission, along with what we’re learning in our large-scale male circumcision program in Kenya, will be showcased through special satellite sessions, oral presentations, and more than 20 posters. I’m especially excited that we’ll be sharing the results of our safety study of the Shang Ring, an innovative male circumcision device.

What are you most looking forward to?
The International AIDS Conference is always an opportunity to be part of the conversation about the direction the field is going in. It’s also inspiring to learn the latest in technical and clinical breakthroughs, and to engage with young and emerging leaders. Of course, it’s also great to catch up with colleagues. The opportunity for an exchange of ideas around our innovative work and for collective problem-solving is really incomparable.

South Africa ramps up its response to HIV and AIDS

In a move that United Nations officials say is the biggest and fastest expansion of AIDS services ever attempted, South Africa is opening up a new front in its response to HIV. In the past month, some 500 hospitals and clinics have begun dispensing antiretroviral drugs, and the government has trained hundreds of nurses to prescribe the drugs, work that was formerly the domain of doctors, the New York Times reported yesterday. The plan is to train enough nurses so that all of South Africa’s 4,333 health clinics will be able to dispense antiretroviral medicines.

South Africa is home to an estimated 5.7 million HIV-positive people, the largest number in the world. More than half of South Africans living with HIV are women, and 20 percent of pregnant women accessing public health services in 2008 tested positive for HIV. South Africa also has a high rate of sexual and domestic violence toward women, which increases women’s vulnerability to HIV infection.

Since 1998, EngenderHealth has worked in South Africa to transform men’s attitudes and behaviors to reduce gender-based violence and HIV infection rates. We have also introduced innovative approaches for improving men’s access to HIV counseling and testing and care and treatment services. We applaud South Africa’s increased efforts to respond to HIV and the campaign that was kicked off on Sunday to test 15 million of the country’s 49 million citizens for the virus by next June. We also know from our experiences in places where doctors are scarce that properly trained nurses and midwives can offer high-quality health care.

Read more about EngenderHealth’s work to train nonphysicians to perform male circumcision in Kenya.

New Series of HIV and AIDS Program Briefs

This World AIDS Day, EngenderHealth announces a new series of HIV and AIDS program briefs highlighting promising practices and lessons learned from our work. The briefs explore hallmarks of our programs, including strengthening health systems, developing human resources, engaging communities, and advocating for supportive policies. In nine countries, EngenderHealth partners with local clinics and community-based organizations to provide comprehensive HIV and AIDS prevention, care, and treatment services.

The first in the series is a set of five briefs on the AIDS, Population, and Health Integrated Assistance (APHIA II) Nyanza Project, which is based in Nyanza, Kenya. APHIA II is a holistic project to improve and expand HIV prevention, treatment, care, and support services, along with integrated reproductive health, maternal health, family planning, malaria, tuberculosis, and child health services.

The briefs in this series are:

• Implementation Strategy of the APHIA II Nyanza Project (PDF, 416KB)
  
• Improving Health Facility–Based Services in Nyanza Province, Kenya: The APHIA II Nyanza Project (PDF, 372KB)
• Implementing a Community Strategy within the APHIA II Nyanza Project (PDF, 328KB)
• Community-Based Care and Support within the APHIA II Nyanza Project (PDF, 380KB)
• Strengthening the Kenya Health Management Information System (HMIS) for Monitoring and Evaluation of the APHIA II Nyanza Project (PDF, 372KB)

APHIA II Nyanza is supported by the U.S. Agency for International Development and is managed by EngenderHealth, in collaboration with Kenya’s Ministry of Health. Other partners include: the Academy for Educational Development (AED), the Christian Health Association of Kenya, Inter Diocesan Christian Community Services, and PATH.

For more information about the APHIA II Nyanza Project and EngenderHealth’s HIV and AIDS programs, please visit www.engenderhealth.org/aphia or contact Sharone Beatty at: sbeatty@engenderhealth.org.

World AIDS Day Community Statement

EngenderHealth is among the organizations signing the World AIDS Day Community Statement, which recognizes the advances that have been made in the response to HIV and AIDS, as well as the challenges ahead. Download the full statement. (PDF, 3.0mb)

First Lady of Tanzania Visits EngenderHealth-Supported Clinic

In November 2009, the First Lady of Tanzania, Mama Salma Kikwete, visited Madaba Health Centre, a facility in the Ruvuma Region in southwestern Tanzania that is supported by EngenderHealth and that serves 50,000 people. The First Lady was there as part of a national campaign to reduce maternal and neonatal mortality, and she spoke about the importance of avoiding early pregnancy, improving maternal health care, and openly discussing HIV and preventing its spread.

EngenderHealth, through a U.S. Agency for International Development–supported ACQUIRE Project Associate Award, is helping to equip facilities in the Ruvuma Region with obstetric wards and is improving the quality and use of family planning services by training health care staff, strengthening supervisors’ skills, and raising awareness in communities. Over the past year, more than 400 clients received long-acting or permanent methods of contraception at Madaba, and nearly 9,000 clients received these methods in the region overall. EngenderHealth, through funding from the President’s Emergency Plan for AIDS Relief (PEPFAR), also trains health care professionals to provide counseling and testing for HIV and AIDS, other reproductive health services, and life-skills coaching to youth.

Last year, EngenderHealth assisted 38 facilities throughout Tanzania in improving the quality of their maternal health and family planning services.

Learn more about EngenderHealth’s work in Tanzania.

EngenderHealth Leads HIV Project to Reach At-Risk Urban Population in Ethiopia

EngenderHealth has been awarded a three-year, $6 million project from the U.S. Agency for International Development to expand HIV prevention services among Ethiopian adults and young people involved in or at risk of transactional sex—those who exchange sex for money or goods. Activities will be focused in select urban areas and reach both those engaged in sex work and informal transactional sex, as well as their clients and partners.

EngenderHealth will launch a comprehensive package of HIV prevention services, including: peer education, condom distribution and promotion, stigma reduction, mobile testing and counseling, and drop-in centers for vulnerable women and girls. Recognizing that many women and girls rely on transactional sex because they have few alternatives for making a living, the project will also incorporate income-generation activities.

“By bringing HIV prevention services to venues associated with transactional sex, we can reach the women and men most at risk—and address the underlying factors, like alcohol abuse and limited access to condoms and other information and services, that go hand-in-hand with HIV transmission,” said Paul Perchal, director of EngenderHealth’s HIV program.

EngenderHealth will lead a team of partners to implement this project, including the local organizations: Timret Le Hiwot, Integrated Services for AIDS Prevention and Support Organization, and Addis Continental Institute of Public Health.

Through this award, EngenderHealth will also receive additional funds to continue the Male Norms Initiative in Ethiopia, which began in 2007. This work will complement the project, addressing the significant role that gender socialization plays in HIV transmission. The new funding will expand activities that challenge men’s attitudes and behaviors that contribute to higher risk for acquiring or spreading HIV, while engaging men and young people in prevention efforts.

About EngenderHealth
EngenderHealth is a leading international reproductive health organization working to improve the quality of health care in the world’s poorest communities. EngenderHealth empowers people to make informed choices about contraception, trains health providers to make motherhood safer, promotes gender equity, enhances the quality of HIV and AIDS services, and advocates for positive policy change. The nonprofit organization works in partnership with governments, institutions, communities, and health care professionals in 25 countries around the world. For 65 years, EngenderHealth has reached more than 100 million people to help them realize a better life. For more information, visit www.engenderhealth.org.

For more information, contact: Paul Perchal at pperchal@engenderhealth.org or (212) 561-9831, or Sharone Beatty at sbeatty@engenderhealth.org or (212) 561-8022.

Preparing for HPV vaccination in South Africa: Key challenges and opinions.

Mark Barone, Senior Medical Associate, co-authored a paper in the journal Vaccine on preparing for human papillomavirus vaccination in South Africa. The abstract is below.

This article reports on qualitative research investigating key challenges and barriers towards human papillomavirus (HPV) vaccine introduction in the Western Cape Province, South Africa. A total of 50 in-depth interviews and 6 focus groups were conducted at policy, health service and community levels of enquiry. Respondents expressed overall support for the HPV vaccine, underscored by difficulties associated with the current cervical screening programmes and the burgeoning HIV/AIDS epidemic in South Africa. Overall poor community knowledge of cervical cancer and the causal relationship between HPV and cervical cancer suggests the need for continued education around the importance of regular cervical screening. The optimal target populations for HPV vaccination was influenced by the perceived median age of sexual activity in South African girls (9-15 years), with an underlying concern that high levels of sexual abuse had significantly decreased the age of sexual exposure suggesting vaccination should commence as early as 9 years. Vaccination through schools with the involvement of other stakeholders such as sexual and reproductive health and the advanced programme on immunization (EPI) were suggested. Opposition to the HPV vaccine was not anticipated if the vaccine was marketed as preventing cervical cancer rather than a sexually transmitted infection. The findings assist in identifying potential barriers and facilitating factors towards HPV vaccines and will inform the development of policy and programs to support HPV vaccination introduction in South Africa and other African countries.

Raise Your Voice : End the Global Gag Rule

The Global Gag Rule has had terrible consequences for the health and lives of poor women and their families, in ways that have nothing to do with abortion. The Global Gag Rule has forced clinics to cut back on all sorts of health services, such as family planning, obstetric care, HIV testing, and malaria treatment.

Urge President-elect Obama to overturn the Global Gag Rule during his first 100 days. Watch the video, sign the petition, then spread the word.

Learn more about the Global Gag Rule.

HIV and circumcision

An op-ed by Paul Perchal, the director of EngenderHealth's HIV/STI program, appeared in the Los Angeles Times today:

“My downstairs neighbor, eight months pregnant, recently stopped me in the elevator to share her dilemma about whether to have her baby boy circumcised. For a growing number of American parents today -- particularly in urban centers like Los Angeles and New York -- the decision to cut or not to cut is not the foregone conclusion it used to be.

“Forty years ago, the circumcision rate for newborn boys in the United States was 85%; today, according to the Agency for Healthcare Research and Quality, it's about 56%, as more parents rethink whether circumcision is--or ever was--necessary.

“In sub-Saharan Africa, attitudes are moving in the other direction. There, circumcision is gaining a hold in communities where historically it has not been practiced, and there is good reason for the shift.”

Read the rest of the article.

Video: HIV is Real and It's Around

Mogomotsi "Supreme" Mfalapitsa, a senior transformation agent at EngenderHealth in South Africa, works in our Men As Partners® program to reduce both HIV and gender inequality. He performed this original song about HIV and safe sex at the Mexico YouthForce pre-conference just before the 2008 International AIDS Conference. The video was filmed by Marius Juel Hovland. As Supreme says, “I am passionate about music being used to send positive messages and creating change in people's lives.”

Download a free MP3 version of Supreme's song.

Turning the Corner for People Living with HIV

EngenderHealth's president, Dr. Ana Langer, appears in the Huffington Post as a guest columnist.

“Today, people across the globe will rally around World AIDS Day. An AIDS awareness bike marathon will wind its way through the streets of Cairo. Zagreb will host a massive rock concert. And hundreds of activists will gather for a candlelight memorial on Gorée Island in Senegal.... A lot has changed since the World Health Organization designated the first World AIDS Day 20 years ago. Back then, 5 to 10 million people were thought to be infected with HIV worldwide. Today that number is estimated at 33 million.”

Read the rest of the article.

Champions Speak: Voices from Uganda

The theme of the 2008 World AIDS Day is leadership, and we are reminded of the leaders we encounter every day who take bold steps to address HIV and transform their communities. In this photo essay, “Champions Speak: Voices from Uganda,” meet individuals like Alice Kiyonga, who helped change attitudes toward people living with HIV.

Advancing Male Circumcision to Prevent HIV in Kenya

“Expanding male circumcision services is a great opportunity to engage men to take greater responsibility for HIV prevention. Reaching a population that does not usually access health services, we can maximize chances to educate men about behavior change and the importance of shared sexual decision-making, which would improve health outcomes for both men and women.”
—Feddis Mumba, Country Director, EngenderHealth-Kenya, and Project Director, EngenderHealth–Male Circumcision Consortium

EngenderHealth is pleased to announce that it is partnering with Family Health International and the University of Illinois at Chicago on the Male Circumcision Consortium, which launched November 24 in Kenya. The Consortium will improve and expand access to voluntary medical circumcision services in Kenya as part of an overall strategy to reduce HIV infections in men.

Male circumcision is gaining recognition as an important practice for limiting the spread of HIV across Sub-Saharan Africa. Several studies have shown that being circumcised dramatically reduces a man’s chances of acquiring HIV during sex with a female partner who has the virus. The challenge now is to transform this clinical knowledge into a public health strategy that can save millions of lives.

Working closely with the Kenyan government, the Consortium will focus on Nyanza Province—which has the country’s highest HIV prevalence and low rates of male circumcision. The experience and knowledge the Consortium gains in Kenya will offer positive lessons for similar programs in other countries.

Given the large number of men who are expected to want circumcision and the shortage of skilled health care professionals, EngenderHealth will develop a national training plan to increase the number of medical staff able to provide safe male circumcision services. EngenderHealth will also conduct research to assess the safety, efficacy, and cost of having nonphysicians (e.g., nurses) provide male circumcision, as well as study community outreach models.

The Consortium’s activities complement EngenderHealth’s other work in Nyanza to improve male circumcision services, supported by the APHIA II project.

Read more about the Male Circumcision Consortium.