By Amy Lieberman
Zambian public health clinics performing adult male circumcisions.
It was a bold move, says Doug Call, Senior Regional Director of Southern Africa at PSI, despite support from local government and evidence from recent randomized controlled trials that showed a 60 percent reduced chance of HIV transmission for HIV-negative circumcised men.
“It was risky on a number of fronts,” Call remembers. “The randomized controlled trials were published but there was and continues to be a backlash against male circumcision. We didn’t know whether or not the donor environment in the U.S. would really get behind the idea to fund this.”
PSI also did not want to make an investment and have it fall apart, Call says, over a project that was culturally loaded.
By the end of 2008, PSI, through its partnership with the Zambian government, performed nearly 2,500 circumcisions. The next year, the program expanded to Zimbabwe – with more than $1 million in private funding for the start-up initiative – and by 2011, the project received its first funding award from the U.S. Agency for International Development and then by the Bill & Melinda Gates Foundation in 2010.
Now, PSI’s voluntary medical male circumcision program has performed the surgical operation on more than 400,000 teenage boys and adult men in Southern Africa. The United Nations Children’s Fund, the Gates Foundation, USAID and the U.K. Department for International Development are backing is Zimbabwe project with an approximate collective $57 million, and the Zambia initiative is receiving roughly $39 million from USAID, the Gates Foundation and the U.S. Department of Defense.
By Ambreen Saleh, Deputy General Manager, Communications, Greenstar Social Marketing Pakistan
Mukhtar lives in a semi-urban part of Mohalla Gharib Abad, Multan. He lives in a community of 3000 to 4000 people, mostly uneducated laborers from a low-income background, who earn a meager income of Rs. 400 ($4) a day. He is an honest and hard working man who cares for the welfare of his family, but worries about how to keep them well-fed, healthy and educated. Mukhtar has four young children since both he and his wife were unaware on how to space births. His dream is sending his children to school some day.
Recently, Mukhtar met with Zahid, a health worker, at an awareness session held for men in the community. Zahid encourages men to play a responsible role in planning their families by preventing unintended pregnancies. Zahid directed Mukhtar to a nearby general store, where a range of condoms is supplied by Greenstar at affordable prices. The owner of the general store also manages a small tea corner for the men of the community. His advice is valued and he educates men on healthy birth spacing as a means to lead a better quality life within their meager income. He encourages Mukhtar and other men in the community to visit him regularly and comfortably, to obtain a supply of condoms.
May 22, 2013
A new UN report finds that AIDS-related deaths are declining in Africa and the number of people receiving AIDS treatment is going up. From VOA:
The report from the Joint United Nations Program on HIV/AIDS says the number of people in Africa who receive anti-retroviral drugs increased from less than 1 million in 2005 to more than 7 million last year.
It says AIDS-related deaths fell by nearly a third during that same period, and that new HIV infections are also falling.
Many African countries have taken steps over the past decade to ensure that at least some of their HIV patients have access to treatment.
The report, released Tuesday, notes that Africa continues to be affected by HIV more than any other region in the world. It says the continent accounts for nearly 70 percent of people living with the virus worldwide.
It also notes that in 2011, there were still 1.8 million new HIV infections in Africa, and 1.2 million people died of AIDS-related illnesses.
By Lung Vu, Research Advisor, HIV & TB and Rena Greifinger, Technical Advisor, Sexual Reproductive Health and TB
HIV has a devastating impact on men who have sex with men (MSM) in Nigeria.
“[B]ecause of stigma, discrimination, homophobia, and criminalization that MSM face in the course of their lives in many African countries, many are reluctant to access health care services and participate in research thus heightening their vulnerability to HIV infection,” says an article from the June 1 issue of the Journal of Acquired Immonudeficiency Syndromes (JSAIDS).
Led by PSI’s Lung Vu, the researchers found MSM to practice very high-risk behavior: having more than one sexual partner and high rates of unprotected sex, as well as many who have sex with both men and women. Many of these men suffer with internalized homophobia and are therefore less likely to access HIV prevention and treatment services. The researchers call for a combination prevention approach which includes biomedical (such as HIV counseling and testing and condoms), behavioral (such as mass media campaigns and education programs), and structural (such as advocacy to change discriminating policies) interventions.
May 21, 2013
A new study from the Guttmacher Institute finds that modern contraceptives are lagging in developing countries. From VOA:
Guttmacher says between 2003 and 2012 the number of women wanting to avoid pregnancy – and in need of modern contraception – rose from 716 million to 867 million. The sharpest increase was seen, it says, in the 69 poorest countries “where modern method use was already very low.”
Senior fellow Jacqueline Darroch co-authored the study with Susheela Singh and published their findings in a special edition of The Lancet medical journal. Darroch said that the figures are based on household surveys.
“The Guttmacher Institute for a long time has focused on issues of reproductive health and especially the high rates of unplanned child bearing and unplanned pregnancies across the world – the United States, as well as other countries. And part of the answer to both why we have such high rates of unintended pregnancy – and part of the solution – has to do with contraceptive use.”
She said between 2003 and 2012, overall modern contraceptive use in the developing world increased from 71 to 74 percent among women wanting to avoid pregnancy.
“Methods ranging from condoms to pills, implants, injections, IUD’s, sterilization,” Darroch said.
However, rates can vary across sub-regions. For example, Eastern Africa rose from 31 to 46 percent; Southern Africa from 75 to 83 percent; Southeast Asia increased from 64 to 72 percent; and South America from 73 to 79 percent.
However, there was virtually no increase reported in mid and western African countries. Darroch said that has consequences.
“Couples are having children more than they want to. They are having what we call unintended births – births, that they tells us in surveys, that they either wanted later or they didn’t want to have at all. So there’s difficulty controlling fertility.”
Some couples, she said, are turning to induced abortions in unsafe conditions that can lead to maiming or death.
“The timing and the number of children and how you control that affects women’s health by preventing pregnancies when they’re most risky – when women are very young or older – by preventing the deaths and disability from pregnancy itself, as well as for newborns. In today’s societies, smaller families tend to do better off economically in terms of the resources that families are able to use for their children.”
A part of our goal is to keep you up to date on the latest happenings around the global health world. Here are a few quick stories and happenings from the PSI Laos office.
PSI Finds 136 TB Cases in 2012
With support from the National Tuberculosis Center and Ministry of Health, PSI Laos detected 136 new TB cases in 2012 thorough its Sun Quality Health network of franchised private sector clinics, mobile education activities, and peer education. PSI also mobilizes pharmacists to refer clients presenting with key TB symptoms to SQH for TB screening, which contributed close to a third of new cases last year. These achievements support the Lao government’s aim to detect more TB cases and achieve MDG 6.
In efforts to increase TB case detection, PSI Laos also worked with the NTC to train 97 private sector providers. The training were held at the provincial level with the goal of strengthening the private sector to detect and treat TB in 12 target provinces.
May 20, 2013
More than 20 boys in South Africa have died during coming-of-age rituals in the past week. Police say botched circumcisions are the probable cause. From Reuters:
More than 20 South African boys have died over the past week during coming of age rituals, police said on Thursday, and they blamed botched circumcisions as the likely cause of death.
Northern Mpumalanga province’s police department has opened 22 murder cases but no arrests have been made so far, spokesman Colonel Leonard Hlathi said.
Every year in South Africa, boys aged 10 to 15 years from several of the country’s tribal groups are circumcised in traditional “initiation rituals”. The ceremonies usually take place over a number of weeks in remote rural areas.
Deaths are often caused by blood loss or infection when circumcisions are poorly performed by traditional practitioners.
Minister in the Presidency Collins Chabane this week called the recent deaths “regrettable”.
“This has happened to young people who were still at their prime, looking forward to a brighter future where they could still reach their potential,” he said in a statement.
In June 2012, along with a team from IPC, I visited a client in Sector 5 F, Karachi. A young mother of five children, she had been contacted by an outreach worker from Greenstar, and encouraged to seek family planning support from a nearby Greenstar clinic. With encouragement and information from the outreach worker and the health service provider at the Greenstar clinic, she had adopted the PPIUCD method. Although this young client was facing serious financial difficulties in life, and working as a cleaning lady at the same time as looking after her children, her defiance, resilience – and desire to make life better for herself and her family – caught the attention of the outreach worker Tasleem. This client became “Sitara”- the “star”, and symbolic of many women in Pakistan. Her story featured in the second issue of “Voice of Sitara”.
May 17, 2013
An estimated 14,000 villagers from 20 communities in Niger participated in a public vow to end Female Genital Mutilation and forced underage marriage. From Reuters:
Though Niger outlawed the practice in 2003, FGM and other violent treatment of young women remain prevalent among some ethnic groups in the impoverished Sahel nation, which ranks bottom of the United Nations’ world development index.
At a ceremony in Makalondi, about 85 km (53 miles) west of the capital Niamey, villagers threw scissors, knives and blades into a pit in the village square which was then filled in.
Participants in the ceremony, sponsored by Niger’s government and non-governmental groups including U.N. child agency UNICEF, also vowed to end forced early marriages and the removal of young girls from schools.
About 38 percent of girls in Niger are married off before the age of 15, according to official statistics.
Niger’s minister for population, women and child protection, said the government was determined to end such practices.
“The government is aware of its responsibilities,” Maikibi Kadidiatou Dan Dobi said during the ceremony on Wednesday.
FGM is the partial or total removal of external female genitalia and leads to physical and psychological problems including painful sex and childbirth, infections, infertility and incontinence.
It is done for religious and cultural reasons and is prevalent in 28 African nations and parts of the Middle East and Asia, notably Yemen, Iraqi Kurdistan and Indonesia.
The United Nations General Assembly adopted a resolution in December urging countries to ban the practice, calling it an “irreparable, irreversible abuse” that threatens about three million girls annually.
The World Health Organization estimates 140 million girls and women have undergone FGM.
In Niger, the practice is still common among certain ethnic groups such as the Gourmantche where about 65 percent of girls have undergone FGM. The rate is around 13 percent among the Peuls and about 3 percent among Nigerien Arab girls.
By Ambreen Saleh, Deputy General Manager, Communications, Greenstar Social Marketing Pakistan
Sitara lives in Suraj Miani, near Multan, Punjab. She lives in a village of about 4000 to 5000 people who are Siraiki speaking. Most people in her village are from a low socio-economic background. Her husband is a mason and earns around Rs 8000 to Rs 9000 ($81- $91) a month. They have five children and they all live together in a two bedroom house.
Sitara’s life is representative of the lives of many women in Pakistan.
The couple is frequently under the financial, mental and emotional pressure of surviving and looking after their many children. She was approached by a community educator from Greenstar, who explained the various methods available for her to look after her health and plan the size of her family.