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UNAids and myth of condoms efficacy against Aids

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By CURTIS ABRAHAM

Posted  Saturday, February 7   2009 at  11:56

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.

“It is true that the way that UNAids dealt with my report says a lot about the culture of UNAids and how they operate — and that much of what it says is not very good,” laments Dr Hearst. “On the other hand, I have refrained until now from trying to make this a bigger issue than it should be. And I don’t have a great desire to participate in any unnecessary UNAids bashing.”

Prior to the commissioning of the UNAids condom review study, Norman Hearst had actively participated in the organisation’s affairs spanning the course of several years. But since that time he feels that he has been blacklisted by UNAids.

In fact, some UNAids officials are said to have denied they had ever funded the study.

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