Why Do HIV Rates Go Up After Graduation?

I'm in Limpopo Province with the travelling Kaiser Foundation HIV/AIDS seminar. This afternoon, our group visited the Lenyenye Youth-Center (or Y-Center), one of the benefactors of Kaiser funding. We learned that HIV rates seem to be declining among youngsters 15 to 17 but then they start climbing again, after age 18.

Several young people from Center explained it this way: once you're out of school, you're not as closely supervised as before. So the temptation to go a little wild, be a little irresponsible is great.

"When teenagers leave school, they say 'I am on my own,' " says 20-year old Itumeleng Hlokwe, a young man who has served as the Center's deejay and hopes to go to university to become a biochemist. " 'It's me against the world. My parents don't see me. My teacher doesn't see me.' " (That's Itu on the right in the photo above.)

Representing the girls' point of view is 19-year-old Katlego (pictured on the left in the photo, with me in the middle). "After school, many girls think, I have to do this," she says. They know what they must do to protect themselves against HIV and may have done so successfully throughout high school. But then, to many, it seems they have lost whatever power they had to negotiate sexual relations or safer-sex practices.

Listening to Itumeleng and Katlego it was easy to imagine that they won't be caught in the same trap. Their plans for the future--Katlego wants eventually to go into agriculture, either animal or plant production--sound so promising.

Next question: why did the Global Fund stopped giving money to loveLife, the South African NGO that sponsors the Lenyene Y-Center? The CEO of loveLife, David Harrison, mentioned that in brief remarks this afternoon. But that's a question for another day. I can feel the jet lag catching up with me.

Read the Fine Print on Diaphragm HIV Study

Is it true that a diaphragm plus a condom is no better than a condom alone at preventing HIV transmission? That's what a study in the July 13 issue of the Lancet concluded. But there's an interesting detail that makes me wonder just what the study really shows.

Scidev.net reports that "The authors note that the proportion of women using condoms was significantly lower in the diaphragm group than in the control group (54 per cent as opposed to 85 per cent), possibly because of a perceived irrelevance of a second barrier method."

So is it possible a diaphragm alone offers similar protection to a condom? Or better protection than no condom at all? Alas, the study was NOT designed to answer that question but it makes you wonder.

On the Road

There's going to be little or no posting for most of the rest of July. I'm heading off to South Africa in a few days, courtesy of the Kaiser Family Foundation, for a traveling seminar on HIV/AIDS. After that, I'll do some of my own reporting and traveling. I'll try, if I can, to post while on the road, but no promises.

So, in the meantime, add your vote to the pandemic poll at right. And check out some of my favorite blogs:

Aetiology Just where do pathogens come from anyway?
Crof's H5N1 blog All bird flu, all the time
Effect Measure Angry, anonymous and well-informed
Global Health Policy (Center for Global Development) Claiming the middle road for development
Google's own global health blog Beyond Larry Brilliant
My Heart's in Accra (Ethan Zuckerman) An eclectic mix
THD Blog Global health techno-trends
Perspectives Global health meets A Higher Power

And for something completely different:
Rootless Cosmopolitan The Middle East from a South African perspective, plus the latest football (soccer) scores

Global Call to Stop Cervical Cancer

What do AIDS and cervical cancer have in common? Both are caused by viruses, transmitted sexually and disproportionately affect poor women and women of color. But AIDS still cannot be prevented by a vaccine while cervical cancer can.

So perhaps it is only natural to hear a global call to stop cervical cancer being issued in Nairobi, Kenya today at what is billed as the first international conference on women and AIDS. You can join the call, which has been initiated by 13 organizations, including the World YWCA and the Rockefeller Foundation, until October 12.

The product behind the call is a vaccine against human papilloma virus (HPV), the major cause of cervical cancer. Still unclear to me is how much the vaccine formulation that's being marketed in the richer parts of the world will have to be retooled for other countries.

After all, there are a number of different subtypes of HPV that cause cancer--HPV-16 and HPV-18 being the most common culprits in the U.S. But other subtypes, like HPV-35, may be more troublesome in other parts of the world, as I wrote last May in A Geographical Puzzle on HPV.

Can there be a truly global vaccine against cervical cancer? What sort of testing, reformulation will be required? Will the incentive to do so disappear if the same vaccine that has already been developed for women in the richest part of the world can't be used everywhere?

Update: See also the Center for Global Development's concerns that the advocacy cart is getting ahead of the cost-analysis horse on HPV vaccines.

Atlanta Lawyer Reclassified with MDR-TB

Oops. Atlanta lawyer Andrew Speaker doesn't have extensively drug-resistant tuberculosis (XDR-TB), after all. Press reports indicate his diagnosis is being changed to multi-drug-resistant TB (MDR-TB). Still means he's likely in for a couple of years of treatment but his chances of survival are better than if he had XDR-TB.

While others will take jabs at the Centers for Disease Control for allegedly overblowing the whole affair, a smarter view is to focus on the state of TB diagnostic tests--which haven't really been updated in decades. Even the new TB tests coming down the pike are not terribly effective, according to Real Health News.