Angelo Bottone ci suggerisce due letture da fare, sono in inglese, ma Angelo ci aiuta. Grazie ancora. Cliccando i due titoli si va ai rispettivi siti da cui sono stati tratti i due articoli.
UNAids and myth of condoms efficacy against Aids
Sempre sulla questione condom e Africa, molto interessante e' questo articolo apparso su The East African il 7 febbraio, ossia prima delle polemiche legate alle parole del Papa. Si parla dell'UNAids, l'agenzia delle Nazioni Unite che dovrebbe prevenire e curare la malattia, e di come questa abbia nascosto e manipolato studi scientifici che mostrano come le politiche basate sulla promozione del condom si siano rivelate sbagliate.
Vi traduco il paragrafo piu' importante, che conferma quanto dicevo nei giorni scorsi:
I critici dell'organizzazione credono che i fatti messi in luce da Maxine Ankrah, Norman Hearst, Tom Barton ed altri erano semplicemente troppo duri da digerire per l'UNAids in quanto contraddicevano il sistema di credenze dell'organizzazione - che i condom e non il cambiamento di comportamente fossero la soluzione definitiva per prevenire il diffondersi della pandemia nell'Africa subsahariana e in altre regioni in sviluppo. In breve, era un chiaro caso nel quale l'ideologia prende sopravvento sui fatti epidemiologici.
UNAids and myth of condoms efficacy against Aids
By CURTIS ABRAHAM
Saturday, February 7 2009
The recent appointment of Michael Sidibe of Mali as the new director of the United Nations Programme on HIV/Aids (UNAids), the main advocacy body in the global fight against HIV, the deadly virus that causes Aids, could mark a significant turning point in the way the organisation handles its mandate in the political and scientific spheres of the deadly disease.
However, two recent books criticising the way the organisation is putting political correctness above scientific evidence as well as recent calls in some quarters for the organisation to be disbanded altogether have thrown the usefulness of the global body into serious question.
Experts now know that unprotected sex involving high rates of long-term concurrent sexual relationships coupled with low rates of male circumcision has led to national prevalence rates in East and Southern Africa ranging from six per cent to 24 per cent, according to the 2007 report, Why is HIV prevalence so severe in Southern Africa?: The role of multiple concurrent partnerships and lack of male circumcision, written by Daniel T. Halperin of the Department of Population and International Health at the Harvard School of Public Health and Aids expert and author Helen Epstein.
However, UNAids and other Aids organisations fail to recognise fully the role of long-term multiple concurrent relationships in the spread of HIV and instead appear to favour the use of condoms, abstinence and other less effective methods.
Take the case of Dr Norman Hearst, an epidemiologist at the University of California, San Francisco.
In 2003 Dr Hearst and his research assistant Sanny Chen, then of San Francisco’s Department of Public Health, carried out an extensive literature review commissioned by UNAids on the effectiveness of condoms in preventing the spread of HIV virus in sub Saharan Africa and other developing regions.
The initial report, titled: Condoms for Aids prevention in the developing world: A review of the scientific literature, concluded that although condoms were about 80 per cent to 90 per cent effective as a public health strategy in halting the spread of Aids in some concentrated epidemics (epidemics affecting men who have sex with men, injecting drug users and commercial sex workers) in places like Thailand and Cambodia, condoms were seen as ineffective in preventing the spread of HIV/Aids in generalised epidemics like those taking place in Eastern and Southern Africa.
“These findings surprised us and were not what UNAids wanted to hear at all,” recalls Dr. Hearst who says that his report provoked serious debate within UNAids.
Efforts were made by UNAids to edit the Hearst/Chen report into something that might be more politically palatable to the organisation. In fact, Dr Hearst was shown various drafts of the heavily edited document, which UNAids was expected to publish but in the end never did.
Instead they released their own separate statement about how wonderful and effective condoms are. This did not have our names on it, nor would I have wanted it to,” says Hearst. “It made no reference to our review or our report. I was never given any explanation for this decision.”
But the conclusions reached by the Hearst/Chen study would have been of major importance to policy makers in Africa, the West and elsewhere in the developing world; Aids agencies; Aids activists; and the general public at large in terms of policies formulation and programme implementation to combat the spread of Aids.
However, this crucial report was not made public by UNAids. According to UNAids insiders, the organisation rewrote the entire report — even removing the names of the researchers — and published something quite different from what they had submitted. Taken aback by this blatant action, Hearst and Chen published their original findings in 2004 in Studies in Family Planning, a major peer-review journal.
Per ragioni di copyright non posso citare l'intero articolo ma lo trovate qui.
Vi traduco il paragrafo piu' importante, che conferma quanto dicevo nei giorni scorsi:
I critici dell'organizzazione credono che i fatti messi in luce da Maxine Ankrah, Norman Hearst, Tom Barton ed altri erano semplicemente troppo duri da digerire per l'UNAids in quanto contraddicevano il sistema di credenze dell'organizzazione - che i condom e non il cambiamento di comportamente fossero la soluzione definitiva per prevenire il diffondersi della pandemia nell'Africa subsahariana e in altre regioni in sviluppo. In breve, era un chiaro caso nel quale l'ideologia prende sopravvento sui fatti epidemiologici.
UNAids and myth of condoms efficacy against Aids
By CURTIS ABRAHAM
Saturday, February 7 2009
The recent appointment of Michael Sidibe of Mali as the new director of the United Nations Programme on HIV/Aids (UNAids), the main advocacy body in the global fight against HIV, the deadly virus that causes Aids, could mark a significant turning point in the way the organisation handles its mandate in the political and scientific spheres of the deadly disease.
However, two recent books criticising the way the organisation is putting political correctness above scientific evidence as well as recent calls in some quarters for the organisation to be disbanded altogether have thrown the usefulness of the global body into serious question.
Experts now know that unprotected sex involving high rates of long-term concurrent sexual relationships coupled with low rates of male circumcision has led to national prevalence rates in East and Southern Africa ranging from six per cent to 24 per cent, according to the 2007 report, Why is HIV prevalence so severe in Southern Africa?: The role of multiple concurrent partnerships and lack of male circumcision, written by Daniel T. Halperin of the Department of Population and International Health at the Harvard School of Public Health and Aids expert and author Helen Epstein.
However, UNAids and other Aids organisations fail to recognise fully the role of long-term multiple concurrent relationships in the spread of HIV and instead appear to favour the use of condoms, abstinence and other less effective methods.
Take the case of Dr Norman Hearst, an epidemiologist at the University of California, San Francisco.
In 2003 Dr Hearst and his research assistant Sanny Chen, then of San Francisco’s Department of Public Health, carried out an extensive literature review commissioned by UNAids on the effectiveness of condoms in preventing the spread of HIV virus in sub Saharan Africa and other developing regions.
The initial report, titled: Condoms for Aids prevention in the developing world: A review of the scientific literature, concluded that although condoms were about 80 per cent to 90 per cent effective as a public health strategy in halting the spread of Aids in some concentrated epidemics (epidemics affecting men who have sex with men, injecting drug users and commercial sex workers) in places like Thailand and Cambodia, condoms were seen as ineffective in preventing the spread of HIV/Aids in generalised epidemics like those taking place in Eastern and Southern Africa.
“These findings surprised us and were not what UNAids wanted to hear at all,” recalls Dr. Hearst who says that his report provoked serious debate within UNAids.
Efforts were made by UNAids to edit the Hearst/Chen report into something that might be more politically palatable to the organisation. In fact, Dr Hearst was shown various drafts of the heavily edited document, which UNAids was expected to publish but in the end never did.
Instead they released their own separate statement about how wonderful and effective condoms are. This did not have our names on it, nor would I have wanted it to,” says Hearst. “It made no reference to our review or our report. I was never given any explanation for this decision.”
But the conclusions reached by the Hearst/Chen study would have been of major importance to policy makers in Africa, the West and elsewhere in the developing world; Aids agencies; Aids activists; and the general public at large in terms of policies formulation and programme implementation to combat the spread of Aids.
However, this crucial report was not made public by UNAids. According to UNAids insiders, the organisation rewrote the entire report — even removing the names of the researchers — and published something quite different from what they had submitted. Taken aback by this blatant action, Hearst and Chen published their original findings in 2004 in Studies in Family Planning, a major peer-review journal.
Per ragioni di copyright non posso citare l'intero articolo ma lo trovate qui.
The Pope and the condoms
THE POPE AND CONDOMS
March 23, 2009
On March 17, a reporter asked Pope Benedict XVI, while en route to Cameroon, to defend the Church’s promotion of monogamy and opposition to condoms in the fight against AIDS, especially since such positions are “frequently considered unrealistic and ineffective.” He responded in part by saying that “the scourge cannot be resolved by distributing condoms; quite the contrary, we risk worsening the problem.” This prompted a fresh, if predictable, round of scorn from the western press. France went so far as to say his statements represent a threat to public health. Yet it might surprise the casual observer to learn that empirical record supports the Pope’s assertions.
First, every instance in which HIV rates have fallen in Africa is most attributable to fundamental changes in sexual behavior, most importantly an increase in faithfulness. In contrast, HIV transmission rates have remained high and even grown in other African countries where widespread behavior change has not occurred, despite considerable increases in condom use. An influential article in Science last year lamented that international HIV prevention priorities had not yet shifted to reflect this epidemiological profile.
In recent years, researchers have paid greater attention to the specific issue Benedict raised: the possibility that condom promotion even risks “worsening the problem.” The theory that people may take greater risks in exposing themselves to harm because they feel a new technology grants them a measure of protection in doing so, goes by the names of “risk compensation” or “behavioral disinhibition” in public health circles. A series of recently published articles (including in the Lancet) have concluded that this phenomenon – that condom promotion can lead to greater risk taking - is quite real indeed.
Finally, the track record for condoms – by far the most emphasized approach over the years – has been rather poor in Africa. An exhaustive review of the impact of condom promotion on actual HIV transmission in the developing world concluded that condoms have not been responsible for turning around any of the severe African epidemics. This rigorous study was originally commissioned by UNAIDS, and conducted by researchers at the University of California at San Francisco. Instead of welcoming the findings, and adapting HIV prevention strategies accordingly, UNAIDS first tried to alter the findings, and ultimately refused to publish them. The findings were so threatening to UNAIDS that the researchers were finally forced to publish them on their own in another, peer-reviewed journal.
This episode provides a disturbing glimpse into the priorities of the lead United Nations’ AIDS agency. Though normally quick to insist on the right to “accurate information” about condoms, in this case they placed their own ideological convictions above the welfare of those they are charged with protecting. Still, the New York Times claims, mere hours after the Pope’s remarks, that he “deserves no credence when he distorts scientific findings about the value of condoms in slowing the spread of the AIDS virus.” The informed observer might well conclude that the outrage aimed at the Pope over the fight against AIDS is poorly directed.
Matthew Hanley
PS.
Per chi non capisce l'inglese, traduco il paragrafo piu' importante.
Negli anni recenti i ricercatori hanno prestato piu' attenzione alla questione specifica sollevata da Benedetto: la possibilita' che la promozione del condom rischia di "peggiorare il problema". La teoria secondo la quale le persone possono incorrere in rischi maggiori esponendosi al danno perche' hanno la sensazione che una nuova tecnologia assicuri loro una misura di protezione nel farlo viene chiamata nei circoli che si occupano di salute pubblica "compensazione del rischio" o "disibizione comportamentale". Una serie di articoli pubblicati recentemente (su The Lancet incluso) hanno concluso che questo fenomeno, ossia che il la promozione del condom puo' portare a rischiare maggiormente, e' certamente reale.
March 23, 2009
On March 17, a reporter asked Pope Benedict XVI, while en route to Cameroon, to defend the Church’s promotion of monogamy and opposition to condoms in the fight against AIDS, especially since such positions are “frequently considered unrealistic and ineffective.” He responded in part by saying that “the scourge cannot be resolved by distributing condoms; quite the contrary, we risk worsening the problem.” This prompted a fresh, if predictable, round of scorn from the western press. France went so far as to say his statements represent a threat to public health. Yet it might surprise the casual observer to learn that empirical record supports the Pope’s assertions.
First, every instance in which HIV rates have fallen in Africa is most attributable to fundamental changes in sexual behavior, most importantly an increase in faithfulness. In contrast, HIV transmission rates have remained high and even grown in other African countries where widespread behavior change has not occurred, despite considerable increases in condom use. An influential article in Science last year lamented that international HIV prevention priorities had not yet shifted to reflect this epidemiological profile.
In recent years, researchers have paid greater attention to the specific issue Benedict raised: the possibility that condom promotion even risks “worsening the problem.” The theory that people may take greater risks in exposing themselves to harm because they feel a new technology grants them a measure of protection in doing so, goes by the names of “risk compensation” or “behavioral disinhibition” in public health circles. A series of recently published articles (including in the Lancet) have concluded that this phenomenon – that condom promotion can lead to greater risk taking - is quite real indeed.
Finally, the track record for condoms – by far the most emphasized approach over the years – has been rather poor in Africa. An exhaustive review of the impact of condom promotion on actual HIV transmission in the developing world concluded that condoms have not been responsible for turning around any of the severe African epidemics. This rigorous study was originally commissioned by UNAIDS, and conducted by researchers at the University of California at San Francisco. Instead of welcoming the findings, and adapting HIV prevention strategies accordingly, UNAIDS first tried to alter the findings, and ultimately refused to publish them. The findings were so threatening to UNAIDS that the researchers were finally forced to publish them on their own in another, peer-reviewed journal.
This episode provides a disturbing glimpse into the priorities of the lead United Nations’ AIDS agency. Though normally quick to insist on the right to “accurate information” about condoms, in this case they placed their own ideological convictions above the welfare of those they are charged with protecting. Still, the New York Times claims, mere hours after the Pope’s remarks, that he “deserves no credence when he distorts scientific findings about the value of condoms in slowing the spread of the AIDS virus.” The informed observer might well conclude that the outrage aimed at the Pope over the fight against AIDS is poorly directed.
Matthew Hanley
PS.
Per chi non capisce l'inglese, traduco il paragrafo piu' importante.
Negli anni recenti i ricercatori hanno prestato piu' attenzione alla questione specifica sollevata da Benedetto: la possibilita' che la promozione del condom rischia di "peggiorare il problema". La teoria secondo la quale le persone possono incorrere in rischi maggiori esponendosi al danno perche' hanno la sensazione che una nuova tecnologia assicuri loro una misura di protezione nel farlo viene chiamata nei circoli che si occupano di salute pubblica "compensazione del rischio" o "disibizione comportamentale". Una serie di articoli pubblicati recentemente (su The Lancet incluso) hanno concluso che questo fenomeno, ossia che il la promozione del condom puo' portare a rischiare maggiormente, e' certamente reale.
Angelo Bottone
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