VOLUNTARY COUNSELING AND TESTING [VCT] EFFICACY VIZ OTHER PREVENTATIVE STRATEGIES: LESSONS FOR POLICY- FROM A SYSTEMS APPROACH BY MARISEN MWALE- FELLOW- COM/CDC/PEPFAR

VCT EFFICACY VIZ OTHER PREVENTATIVE STRATEGIES:

LESSONS FOR POLICY-

FROM A SYSTEMS APPROACH

Most high prevalence sub-Saharan African countries- Malawi inclusive- tend to over-emphasize abstinence, fidelity and condom use as major preventative measures vis-à-vis the AIDS pandemic. Studies of behavior change that focus exclusively on the two measures of most interest to the prevention community- condom use and fidelity [faithfulness] or chastity [abstinence]- however bias examinations of behaviour change downward by ignoring other effective ways of limiting the epidemic. The prevailing debate over provider initiated testing in Malawi may depict a shift toward HIV testing and counseling in AIDS prevention. Not only that, the rejection of the National AIDS Commission’s proposal over counterproductive policy emphasis and neglect of efficacious strategies may depict the need for stringency in our AIDS prevention bid. The object of this short analysis is not to taut VCT as superior to other preventative strategies but rather to depict its central role in AIDS prevention. If we were to construe AIDS prevention from the systems approach with each preventative strategy considered as interconnected to other dissimilar strategies, I beg to vouchsafe how VCT could be perceived as the hub of the preventative system.

Based on empirically validated findings first, VCT has been shown to lead to safe sexual behaviors and increased condom use, thus preventing further spread of the disease [Vidanapathirana et. al, 2007]. Systematic review on the impact of VCT on risk behavior in developing countries reflects increased condom use. Second, VCT has been shown to be useful in targeting persons at high risk because risky behaviors are positively associated with the decision to take the HIV test [Miller, 1996]. A small Qualitative study conducted at MACRO empirically validates the observation. In focus group discussions conducted with three women groups with the objective of delineating facilitators and barriers to female uptake of VCT, it was universally alluded to that the VCT uptake rate among men may be higher because most men patronize HTC services to vilify themselves in face of their risky sexual debuts.

Third, research findings have documented how couple counseling could result in trust  and faithfulness between partners reinforcing intimacy and fidelity thus preventing the overall spread of HIV/AIDS and curtailing multiple and concurrent partnerships. The FGD referenced above also validated how couple counseling and testing could be a precursor to positive living as well as a means of limiting transmission of HIV to one’s partner in cases of sero-discordancy but only when all partners were aware of their serostatus since ignorance was shown to exponentially perpetrate the opposite trend. Forth, among the youth VCT has been proven to reinforce not only primary but above all else secondary abstinence. Youth tend to limit the number of their sexual partners and further indulge in safer sexual behaviors. Philosophies that are being promoted in AIDS prevention and whose efficacy has been verified in the name of ‘Zero Grazing’ in Uganda- adopted as ‘One Love’ in Malawi- have been reinforced where the youth know their sero-status through VCT.

From a systems approach, it is thus evident that condom use, fidelity [faithfulness], as well as abstinence [chastity] could be expedited and rendered more efficacious by scaling up and promoting VCT. The challenge however remains how programmes could be integrative in approach and emphasize the connectedness of the preventative strategies. In the absence of an efficacious vaccine and cure for HIV and AIDS, emphasizing on stringent mitigative strategies remains the window of hope in our desperate war against the HIV/AIDS pandemic not only in Malawi but sub-Saharan Africa in general.

BY MARISEN MWALE- FELLOW/MACRO

ORIGINS OF HIV: THE MAKING AND UNMAKING OF UNORTHODOX CONSPIRACY THEORIES- BY MARISEN MWALE

ORIGINS OF HIV:

THE MAKING AND UNMAKING

OF

UNORTHODOX CONSPIRACY THEORIES

The Human Immunodeficiency Virus [virus that causes AIDS] belongs to the large family of RNA viruses. The exact origins of HIV will never be completely elicited. There are however certain facts that have led to more or less general agreement among scientists as to the source of this epidemic. It is plausible to conclude that HIV is a pathogen new to the human race, the first documented cases of what is now known to have been HIV-1 infection in humans occurring in Central Africa in 1959. According to Robert Gallo and other theorists in what has come to be known as the Green Monkey Theory HIV infection of humans probably resulted from a non-pathogenic, sub-human primate retrovirus, which made a species jump from African monkeys and chimpanzees to humans. There is widespread evidence that many old world primates in sub-Saharan Africa, e.g., chimpanzees, mandrills, sooty mangabeys and African green monkeys, have been infected with retroviruses similar to HIV for thousands of years, although they are non-pathogenic and do not cause disease in these animals. The viruses are referred to as simian immunodeficiency viruses [SIV]. They have the same complex genomic structure as HIV, share 40-50% homology [genomic similarity] with HIV and infect T-lymphocytes through the CD4+ cell-surface receptor, just as HIV does.

It is probable that these retroviruses are the progenitor viruses from which HIV either mutated or recombined into the human population. Humans may have been exposed to these viruses as a result of killing and butchering monkeys. In doing so, blood from an SIV-infected non-human primate could have infected human through non-intact skin on the hands. Once SIV had gained entry to the human body, it found it could thrive in what was, after all, simply a closely related primate species. The concept of cross-species transmission, i.e., a zoonosis, refers to any disease or infection that may be transmitted between animals and humans under natural conditions. Several other infectious diseases of humans have a zoonotic origin, e.g., tuberculosis, rabies, brucellosis, Lassa fever and various tropical hemorrhagic fevers. The species leap may have occurred, from time to time, for many hundreds of years. However, HIV infection [and subsequent disease] remained episodic. Because of the rural [village] lifestyle, short life span and restriction of the number of different sexual partners in the past, the infection was not widely transmitted to other humans and remained localized to the village. Several factors conspired to change this episodic infection, first to an epidemic and then to a pandemic infection, including; the migration of rural populations into cities, changes in sexual behavior leading to more frequent changes in sexual partners, improved road, rail as well as air travel routes and international travel. In addition, increasing reliance on non-barrier forms of contraception, i.e., ‘the pill’, and injecting drug use also hastened the spread of HIV infection.

There is no evidence to support the theory painstakingly elaborated by journalist Edward Hooper that oral polio vaccines used in Africa during the 1960s and 1970s had been accidentally contaminated during manufacture with the chimpanzee strain of SIV and other simian tissues used as culture medium and may have contributed to the rapid spread of human HIV infection in Africa. There is also no evidence for other conspiracy theories as that HIV was accidentally cultured as part of other clinical research in other words ‘chance’ occurrence possibly in cancer research. There is neither evidence that HIV was deliberately cultured as a biological warfare experimental virus at the US Army’s bio-warfare department at Ft Detrick, Maryland or by the German biological warfare all the way back to the Nazi dominance or in the Russian secret service’s deliberate use of destructive viruses.

Other bizarre theories for the origins of HIV/AIDS as hypothesized by Edward Hooper allude to ex caelo origins [from the skies]. The tail of the comet theory elucidates that the viral material responsible for AIDS was carried in the tail gases of a comet passing close to the earth and that this material was deposited, subsequently infecting nearby people. Another such orthodox based theory stipulates that God’s wrath is responsible for the plague due to the sins of this generation. Wherever the virus emanated from, the bottom-line however remains that AIDS is here with us and we need to delve into mechanisms of not only containing the pandemic but researching a cure and possibly a vaccine all of which still remain a toll order.

BY MARISEN MWALE: FELLOW/MACRO