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Posted at 1:56 PM ET, 01/25/2011

Shared Norms -- What to Expect from Davos

By Kate Roberts

There’s been a lot of talk about “donor fatigue” around HIV and whether the uncertainty and unreliability of donor funding will stall – or worse, reverse – global HIV prevention and treatment efforts. Unfortunately, in recent years, that fatigue has spread beyond just donors.

When I started working at PSI more than a decade ago, HIV/AIDS was the cause du jour, with celebrities such as Elizabeth Taylor and Magic Johnson leading the way on raising awareness, building dialogue and promoting positive behavior change. But since then, HIV has slowly stopped receiving the attention it deserves. A recent study by the Kaiser Foundation found that HIV/AIDS news coverage has dropped more than 70 percent in developed countries over the past two decades. That’s an astonishing decrease – and highly troublesome, considering that 40 million people are living with HIV or AIDS and 7,000 young people are becoming newly infected each day.

With this in mind, you can imagine how pleased I was when the forum decided to put the examination of the progression of HIV/AIDS prevention on the agenda for Davos this year. That kind of leadership is incredibly important in the current climate. While we continue to struggle to control the spread of HIV, we have had some very tangible successes. More lives are being saved from HIV and AIDS than ever before, and eight developing countries (Botswana, Cambodia, Croatia, Cuba, Guyana, Oman, Romania and Rwanda) now provide universal access to antiretroviral treatments. In terms of prevention, PSI is leading the way on one of the most innovative and effective prevention interventions, male circumcision. Voluntary male circumcision can reduce the risk of female to male HIV transmission by 60 percent, and PSI is the largest NGO male circumcision implementer, leading a team of partners and governments in scaling up service delivery across Southern Africa.

What we’ve learned from these examples isn’t only important in the context of HIV, but also in the context of other diseases, such as malaria, pneumonia, tuberculosis and the non-communicable diseases I wrote about last time on this blog.

Over the course of Davos, we’ll hear from Peter Piot, director of the London School of Hygiene & Tropical Medicine, as well as the crown princess of Norway, Mette-Marit, who serves as a UNAIDS special representative. The objective of the sessions will be to provide a venue for global leaders to share experiences, engage in cross-cultural dialogue and learn about what works and what doesn’t from an international group of peers. Perhaps more importantly, it will give us the opportunity to celebrate our successes and to turn the spotlight back on the work that is being done and that still needs to be done to control the spread of HIV and other diseases.

It’s a tough but important task the folks at Davos have ahead of them. I’m sorry I’ll be missing those discussions this year. Normally right now I’d be madly sorting through a pile of shoes trying to convince myself that three-inch heels are indeed a reasonable choice for the snowy streets of Davos. But I’m literally days away from giving birth, so this time around, I’ve happily passed along the desperate task of finding fashionable footwear that can survive the snow to my boss, PSI’s president and chief executive, Karl Hofmann. He’ll be blogging directly from Davos once he arrives. Keep checking this blog for ongoing updates.

Kate Roberts leads the Corporate Marketing and Communications Departments of PSI. Kate is the founder and executive director of YouthAIDS and Five & Alive, two marketing programs of PSI. Prior to her role at PSI, Roberts worked with Bates, Saatchi & Saatchi Advertising.

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By Kate Roberts  | January 25, 2011; 1:56 PM ET
Categories:  Kate Roberts  
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Comments

Having lived with HIV for over 28 years, I am stunned how, indeed, the more things change, the more they stay the same. Successes in prevention and treatment of HIV disease are met with indifference from the Western masses and global elites, while the economic and human toll of the virus increases every day. In that light, Davos is an ideal venus for raising the awareness of the costs of HIV and other diseases, the impact of lost productivity on both developing and developed economies, and the potential political de-stabilization created by disease. I hope that Piot and others have greater success in speaking truth to business and government leaders and in securing their commitment to sharing responsibility for eradicating HIV and other pathogens within this half century.

Posted by: bigolpoofter | January 26, 2011 2:38 PM | Report abuse

It is very interesting how "60% lowering of HIV transmission" is attributed to cutting parts of a man's penis. In two of the three Africa studies the "60%" lowering was not found (it was always lower than that). Also the % lowering is actually a 1.8% difference in infection rates in hard numbers (or a small risk change).

Beyond the curiosity of the continuous misquote and the spin via % lowering as opposed to risk change it is interesting that the real world data absolutely contradicts the 3 Africa studies. Many have pointed to the high circ rate and high HIV rate in the US compared to the low circ rate and LOW HIV rate in EU and JP. However, few mention that within the US, there is no HIV (nor HPV , STD) advantage to missing parts of the penis. What has gotten my attention is that in many of the countries that have started a circumcision campaign, the % of cut men with HIV is much higher than natural penis men with HIV. In Swaziland the infection rate for circumcised males is at 22 per cent while for those with a natural penis it is 20 per cent. IN Kenya they just did a study of a group and circumcision status was not associated with HIV or HSV-2 seroprevalence or current genital ulceration. How do these studies and the US, EU and JP data not match the Africa studies data? The 60% lowering that was really about 53%) and that is really a 1.6% risk change of the three often cited Africa studies has not been detected in the industrialized world and has also not been detected in places in Africa as noted. Further, another Africa study clearly showed that circumcised men were passing HIV to women at a rate more than 50% higher than natural penis men.

I think there is a need to reconsider male circumcision as an HIV prevention method. The WHO and many in Africa will take the US money that is being thrown at them by circumcision proponents eager to keep the practice going in the US. However, as this has not been shown to be effective in the real world, the money is most likely wasted. This shows desperation on the part of Africans to try anything (to do something)as to the HIV crisis. However, it also shows that American circumcision pushers and possibly the American public are eager to justify the mutilation practice even though the real data indicates that keeping all of ones penis does not put one at risk.

Posted by: jackno1 | January 26, 2011 5:51 PM | Report abuse

"...one of the most innovative and effective prevention interventions, male circumcision. Voluntary male circumcision can reduce the risk of female to male HIV transmission by 60 percent" Talk about counting your chickens before they've hatched! In the three trials, they circumcised 5,400 men and left a similiar number for later. After less than two years, 64 of the circumcised men had HIV, and 137 of the non-circumcised. The difference, 73 circumcised men who didn't have HIV (how many of them have it by now, I wonder?) is the sum total of the "protection" conferred by circumcision to date.

A study from USAIDS, (http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf) found "There appears to be no clear pattern of association between male circumcision and HIV prevalence. In 8 of 18 countries with data, as expected, HIV prevalence is lower among circumcised men, while in the remaining 10 countries HIV prevalence is higher among circumcised men"

There was on the other hand a clear correlation between HIV infection and medical injections in the previous year. Did the circumcision studies control for that? And what is being done to ensure African medical centres use a fresh needle every time?

Posted by: hugh7 | January 27, 2011 5:07 PM | Report abuse

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