Saturday, July 24, 2010

Male circumcision, a proven HIV prevention strategy, overshadowed by another one years from fruition

VIENNA, Austria – Much of the buzz at the XVIII International AIDS Conference that just finished here was around the encouraging news of a microbicidal gel that trials have shown to be almost 40% effective, although we are still years away from having a product on the market. Meanwhile, male circumcision (MC), a proven and effective HIV strategy that reduces transmission by nearly 60% and is already available, got much less attention, though it finally got some, and for that we can be grateful.

Two years ago in Mexico City, nary a word was said about male circumcision — and certainly not in a plenary meeting — despite its proven effectiveness. I organized a press conference on male circumcision for PSI, which was successful in generating some media buzz and attention, including The Economist, which called it the one bright spot in prevention at the conference. In fact, I think that press conference resulted in an improved environment for MC. However, donors and governments, for the most part, continued to do nothing to scale up an intervention that could have saved millions of lives with one notable exception.

In December 2008, the Gates Foundation became the first donor to scale up MC, quietly providing funding for PSI to expand its male circumcision pilot project in Zambia to two other countries (a third country was added later). There was no fanfare, no announcement, as everyone was concerned about provoking a negative reaction for an intervention that addressed long-standing cultural practices.

However, there was no significant negative reaction and now the environment seems to have changed. MC seems to be going mainstream. Both Bill Clinton and Bill Gates mentioned MC in their speeches in Vienna. In particular, Bill Gates could hardly stop talking about the wonders of MC, calling it and prevention of mother-to-child transmission two of the interventions that “are so effective that in endemic countries it is more expensive not to pursue them.” While more than 41 million men in sub-Saharan Africa could benefit from the procedure, he said, just 150,000 have been circumcised in the past few years.

“I have to admit: When it comes to circumcision, I used to be one of the sceptics,” he said in his speech. “I thought: ‘Sure, it reduces transmission by nearly 60%. But there’s no way that large numbers of men will sign up for it. I’m glad to say I was wrong. Wherever there are clinics available, men are volunteering to be circumcised in far greater numbers than I ever expected.”

The Council attempted to monitor the major media coverage of this conference, and our unscientific analysis showed male circumcision to be the second most covered story on the first two days of the conference (after the microbicidal study, of course), with stories in Agence France Presse, Bloomberg News, Los Angeles Times, The Guardian, die Presse, Frankfurter Rundschau, Le Point, Le Figaro, Prensa Latina, Radio Canada, Radio France Internationale and Reuters, among others.

It wasn’t quite that high profile at the conference itself but it was certainly more evident than in Mexico City, with a number of oral and poster presentations on different aspects of MC. This has not come a day too soon. For every man we reach with male circumcision services that he already wants, the fewer new HIV infections will be produced in the future. It is an intervention whose time seems to have come.

Tuesday, July 20, 2010

AIDS activists need new communications strategies

VIENNA, Austria — In the history of AIDS, activists certainly deserve a place of honor for their persistence in pushing governments and donors to do more than they would have done on their own or, at least, not done as fast. But the new generation of AIDS activists sure don’t seem to be winning over the rest of non-activists here at the XVIII International AIDS Conference. And they could use some communications training.

At the opening ceremony on Sunday, they annoyed the vast majority of the audience — many of whom had arrived early to secure good seats — by disrupting the screening of a film produced by the Global Fund to shout for more funding. Ironically, the whole point of the Global Fund film was to raise awareness about the need for more funding in this, the third round of Global Fund replenishment. The Global Fund film makes this point more eloquently and convincingly than the protestors. But I know that only because I had seen the film previously, without disruptions; the audience could not hear the film because of the continuous chanting.

Another irony was that the official speakers at the podium continually agreed with the protestors, and agreed with great patience and politeness. And even some of these speakers were shouted down by much less articulate and more impolite activists. When the protestors finally left the state after an interminable period of time, the audience applauded, not in support but for gratitude that they were finally leaving.

Today, in the Media Centre, I witnessed another disruption, this one even more strident. A couple dozen demonstrators were allowed into the Media Centre — I’m not quite sure how the super alert security staff allowed them in when they don’t normally anyone, however inoffensive, to enter without media credentials — to disrupt a PSI press conference on male circumcision.

Now the demonstrators had no beef with PSI, nor with male circumcision. They were offended by the presence of U.S. Global AIDS Coordinator Eric Goosby, who was on the panel and who they blame for “the ongoing harm of PEPFAR’s anti-prostitution pledge requirement.”

Their indignation over the requirement is justified; their tactics are not. They were aggressive, they were rude. One or two of them sounded hysterical, screaming at Goosby, for 10-15 minutes.

This is the same Eric Goosby to whom former President Bill Clinton gave a huge shout-out in the opening plenary on Monday: “This man is your friend. He’s been working on AIDS since before the youngest people in this room were born. He is a good man.” Apparently, the demonstrators did not get that message, or chose to ignore it. The journalists working in the Media Centre were not impressed and mainly just ignored them, and deservedly so.

They need to find a more effective way of making their point, which is actually a point Clinton made in his speech: “You have two options here. You can demonstrate and call the President names or we can go get some more votes in Congress to get some money. My experience is that the second choice is a better one with a far better payoff.”

Yesterday, in the Media Center, the activists won no friends; they might have lost a few.