Press Association
Wednesday July 28, 2004 8:53 AM
The UK's "hidden" HIV crisis and the need to tackle it is being highlighted by England's Chief Medical Officer.
Sir Liam Donaldson's annual report on the state of public health outlines the need for earlier detection of HIV, pointing out that a third of those infected are unaware of their condition.
The report shows that, worst of all, people who are eventually diagnosed as HIV positive have had their disease for an average of six years, giving them plenty of time to pass it on.
The report, which deals with a number of other key public health issues, says that more needs to be done to ensure that people who are infected with HIV are detected at an earlier stage so that they do not go on to infect other people.
It is estimated that 50,000 people in Britain are living with HIV.
The report follows figures from the Health Protection Agency which revealed that rates of sexually transmitted infections continued to rise last year - up by 4% in 2003.
But since 1995 the rate has increased by 57% - from 449,666 to 708,083 cases.
Sexual health campaigners blamed rising rates on increasingly risky sexual behaviour, especially among young people and gay men, and long waits for treatment at genitourinary medicine (GUM) clinics.
Sir Liam's report offers a "new perspective" on five subject areas, analysing the effectiveness of current treatments and services.
It also describes Government action in these areas and identifies the action necessary to bring about improvement.
© Copyright Press Association Ltd 2004, All Rights Reserved.
Young people in America have a low level of knowledge about STDs, a survey has found. It also found that fewer use condoms for anal sex than vaginal sex.
Meanwhile, George Bush's Presidential Council on AIDS has heard an impassioned plea that if it adopts abstinence and monogamy as the main thrust of its HIV-prevention strategy, it must include gay men in it and welcome gay marriage.
The survey by the American Social Health Association was aimed at assessing sexual attitudes, behaviors and knowledge among U.S. citizens between the ages of 18 and 35. In a climate currently hostile to federally funded sexual research, the survey was funded by pharmaceutical firm GlaxoSmithKline.
The survey looked at a "snapshot" of the sex lives of 1,155 adults between March 3 and 8. It found that there was a big difference between "precautions people claim to take and their actual behavior."
Nineteen out of 20 participants said they believed their current partners did not have an STD, and 63 percent considered themselves "well informed" about them, despite the fact that 28 percent were unaware that some STDs could be asymptomatic. Nearly 85 percent of the sample said they took "necessary" steps to protect themselves against STDs, but a third had never discussed the subject with their partner.
But the most startling finding was that only just over half (53 percent) of young Americans use condoms or any other form of protection during vaginal sex, and only a third (36 percent) use condoms during anal sex when they have it. Two weeks ago -- see "Research into microbicides" -- the Microbicides conference heard that between 25 and 50 percent of young U.S. heterosexuals have unprotected anal sex.
Although most participants had heard of gonorrhea, syphilis and chlamydia, only just over half knew hepatitis B was primarily transmitted sexually.
In the meantime, spurred on by an article in the British Medical Journal that says reducing one's number of sexual partners is the key to HIV reduction (see "Fewer sexual partners should be focus of HIV fight"), the U.S. Presidential Advisory Council on HIV and AIDS (PACHA) has urged U.S. Health Secretary Tommy Thompson to assess whether the "ABC" campaign used in Africa -- Abstain, B faithful, Condom -- should be adopted by the U.S.
One presenter to the Council, Dr. Mark Thrun, head of the HIV prevention office in Denver, said that 62 percent of AIDS cases in male youth were among gay men, but that HIV prevention efforts in schools and churches "completely ignore" this group.
He "startled" some council members when he said that laws against same-sex marriage would exclude gay men from the possibility of exactly the kind of stable, monogamous relationships the president wanted to promote.
Reported in Positive Nation, April 2004
In Defense Of Bathhouses
An effort to close Los Angeles’ bathhouses blames the clubs for all the unsafe sex, and that’s not fair or right.
By WAYNE BESEN - via New York Blade
Friday, July 23, 2004
NEW ATTEMPTS TO shut down or over-regulate Los Angeles’s bathhouses are highly discriminatory, encroach on personal freedom and will do little to slow the spread of HIV.
A recent study of L.A.’s bathhouses funded by the Centers for Disease Control & Prevention shows that HIV infection rates among gay men who sought testing in bathhouses were double those of gay men tested elsewhere and seven times higher than HIV rates among the county’s general population.
Let’s be honest, bathhouses are not the healthiest environments. People who go and engage in risky behavior are either ignorant or crazy and are likely compromising their health for the pleasure of anonymous sex.
But there are a lot of other unhealthy behaviors in society that people engage in simply because they are pleasurable. Yet, no one is proposing over-regulation or an outright ban on these “vices”.
For example, Gov. Arnold Schwarzenegger is regularly photographed smoking cancer-causing cigars. Hollywood produces movies with glamorous stars smoking cigarettes, even though the CDC estimates that 400,000 people die prematurely each year from smoking.
More than 60 percent of Americans aged 20 years and older are overweight, with illnesses linked to obesity killing approximately 280,000 people a year. Yet, fast food chains are on nearly every corner.
The World Almanac says auto accidents killed 44,000 motorists in 2002, yet nearly everyone has a car.
IF THE HEALTH department is closing down bathhouses without taking drastic measures to eliminate these other risky behaviors, it is only fair to conclude that the crackdown is based on discrimination.
This discrimination is not of the traditional anti-gay variety, and even many gay-friendly politicians and gay leaders find bathhouses objectionable.
Still, bathhouses make for an easy political target to attack because gay men enjoying anonymous sex is not a popular pastime, such as ordering an artery clogging Happy Meal at McDonalds for the kids.
Even mainstream gay activists are loath to defend the baths knowing that right wing groups will distort what they say and falsely claim that gay civil rights groups endorse sex clubs.
But if you allow that there is no fundamental right to go to bathhouses, you must also allow that there is no fundamental right to smoke at cigar bars or pig out at Burger King.
THOSE IN SUPPORT of closing the baths like to point out that San Francisco closed its bathhouses in 1984. There is a strong argument to be made that this might have been the right move in 1984 because AIDS was a relatively new disease and a temporary state of emergency had to be declared to improve awareness.
I liken what San Francisco did to recalls of beef when a Mad Cow Disease scare occurs.
But times have changed and such drastic action is no longer needed. What we need is more education in these places. Every bathhouse should be equipped with condoms and lubrication, as well as a person from the health department offering anonymous HIV testing.
One bathhouse in Chicago goes a step further and sometimes offers the services of a mental health worker who can talk to people and help them make healthy, smart choices.
Instead of taking the wise route, the L.A. Department of Health is proposing new rules that appear to be intended to drive bathhouses out of business. The proposed restrictions allow the health department to close a club if patrons have unprotected sex.
Though well intended, this rule is as absurd as shutting down General Motors because a driver of a GM vehicle gets a DUI. Individuals, not clubs, can only be responsible for personal behavior. This rule is unfair to bathhouse owners, arbitrary toward patrons and wholly unenforceable.
Another proposed rule would allow health inspectors to regularly visit unannounced during peak hours. But that’s like L.A. sending a monitor into Wendy’s to tell overweight patrons, “You sure look fat, would you consider not getting a shake with your fries?”
In an editorial urging the closing of the baths the L.A. Times admits that the Internet makes containing HIV a more difficult challenge. Closing the baths will only result in a redistribution of the disease, not a reduction, as bathhouse patrons take their risky behavior to parks and the Internet.URBAN, South Africa, July 23 - At S Cemetery in Umlazi Township, Innocent Gasa's handiwork is everywhere: endless mounds of fresh red earth topped with headstones, unpainted wooden crosses, or, for the most miserable, bricks bearing a painted identifying number. Mr. Gasa has dug graves on this lumpy, unkempt, Halloween-spooky hilltop for two years now, five holes a week, 52 weeks a year, well over 500 holes in all.
Which may seem peculiar, seeing as S Cemetery exhausted its last space for new graves five years ago. City records sum up its status succinctly, even dismissively: "Full."But in Durban, "full'' is a term of art. This city is being battered by an AIDS pandemic so sweeping that people are dying faster than the city can find space to bury them. And so gravediggers like Mr. Gasa are reopening existing graves - the city calls it "recycling'' - and interring fresh bones atop the old ones.
The job gives Mr. Gasa nightmares. "I think it is not a good thing, to take out the bones'' for reburial, he said during a break in his spadework. "But we have no choice."
Every time southern Africa's AIDS epidemic threatens to exhaust its store of superlatives, some new, sobering extreme rises to the fore. The latest is Durban, where 51 of the 53 municipal cemeteries are officially filled to capacity, and a surging death rate threatens to overwhelm the remaining two within a couple of years.
"Five years ago, we used to have about 120 funerals a weekend, but this number has now jumped to 600," Thembinkosi Ngcobo, who heads the municipal department of parks and cemeteries, said in an interview this week. "In order to cope with the current rate of mortality - we hope it is not going to increase - we will need to have 12.1 hectares every year of new gravesites."
That is nearly 30 acres. "That would obviously turn Durban and the whole country into one big graveyard if we continue," he said.
The statistics offer little encouragement. Roughly one in eight South Africans is H.I.V.-positive, and in Durban, South Africa's third-largest city with about 3.5 million people, a survey two years ago of women at pregnancy clinics found about 35 percent were infected with H.I.V.
The city held a conference on the cemetery problem this month and discovered that a host of other South African graveyards - in Cape Town, Bloemfontein, Pretoria, Port Elizabeth - are also filling up at alarming rates.
Durban's space crunch, says Mr. Ngcobo, defies a quick or simple solution.
Cremation, cheaper and space-saving, is an obvious option - and an untenable one for many of the ethnic Zulus who make up seven in 10 Durbanites. "It is not good to burn the bones in Zulu culture," Mr. Gasa, the gravedigger, explained. "Your ancestors are unhappy."
Mr. Ngcobo's office is campaigning to change the cultural bias against cremation, even visiting schools to argue that it can coexist with the Zulus' complex funeral rituals and their deep reverence for the dead. But success so far is limited; in five years, the share of Zulu burials by cremation has doubled - to 2 percent.
Recycling is but a temporary solution: many apartheid-era graveyards once set aside for blacks are in poor or boggy soil and are unsuited for their existing burials, much less additions. No grave can be recycled for at least 10 years, the span needed to reduce a corpse to bones, and survivors can prevent a grave from being reused at all by renewing their lease on the burial site.
In practice, Mr. Ngcobo said, most families consent to recycling only under financial duress: using someone else's grave costs 320 rand, or about $53, while acquiring a new gravesite at Red Hill Cemetery, one of the two still open, costs about $250. Families also resist interring a loved one with anyone except a close relative.
Even then, he said, there are problems: some survivors claim that the departed speak to them in dreams, complaining, for instance, that their bunkmates have pushed them so close to the surface that they get wet when it rains.
Durban could also build new cemeteries, and, indeed, the city is negotiating to buy a 100-acre site to do just that. But it costs at least $1.25 million to build a graveyard, and more to maintain it in perpetuity, money the city does not have. And those 100 acres will last only three and a half years.
A deliberate man, Mr. Ngcobo says that simple economics will eventually lead families to the logical solution, cremation. "It's not uncommon in a family to bury, say, three people a year, and it is becoming very expensive,'' he said. "On average a funeral costs 15,000 rand" - close to a year's average income. Cremation costs 375 rand.
He could be a highways official contemplating the effect of toll roads on traffic density. But when he talks about how the rising death toll has affected his own life, it is clear that he is anything but detached.
"You are now required to go to funerals every weekend," he said. "At times, you go to funerals for eight weekends nonstop. At times, you have two a day, so you have to divide the family up so that one can go to one funeral, and one to the other. If you live in a neighborhood, you are sure to feel it."
Facts and figures do not do justice to Durban's plight. For that, only visits to S Cemetery, which serves one of Durban's most destitute neighborhoods, and Red Hill Cemetery, one of the two municipal graveyards still open, will do.
Opened in 1996, Red Hill was supposed to last 15 years. Mr. Ngcobo now estimates that it will be full in 10. No one who walks Red Hill's rows of recent burials, heap after heap of dirt blowing slowly away in the Indian Ocean breeze, can fail to be sobered by the havoc AIDS is wreaking here.
Yet it is not the number of graves that stops a visitor cold, but their markers. Some of the dead are remembered with only a sheet of paper, shielded from the elements by plastic wrap, listing names, dates of birth and dates of death. For many more, the only record is a few strips of plastic tape, imprinted by a mortuary's label-maker and glued to a tiny plate.
At S Cemetery, the 37-year-old caretaker, Anton Khumalo, bends over a succession of markers and ticks off the ages of the dead: 31; 20; 38; 39; 26; 29;35; 31. "Most of the people - maybe this one - are 18 to 30," he says, peering at one marker. "You hear from the relatives that they died of AIDS. They're not ashamed. They say: 'Our kids don't listen. That's why they died.' ''
Mr. Gasa, the gravedigger, nods when asked whether any of his friends have died from AIDS-related diseases. "Too many," he says. "I can't count them. Too many."
Cemeteries here are all but deserted on weekdays. But as the sun peaks overhead at S Cemetery, Judith Dlamoni and her granddaughter, 4-year-old Phmelele, pass through the rusted gate to visit the grave of Phmelele's mother and Ms. Dlamoni's daughter, Gutulethu Dlamoni.
Gutulethu Dlamoni died last October at 25 after traditional healers failed to cure her. Her husband, an ex-convict, does not live nearby. Judith Dlamoni, 73, unemployed, divorced and broke, is now the sole support of a 4-year-old.
At Red Hill, the only visitor is Siyada Tlatla, 22, who is building a block wall around the grave of his uncle, Phumalani Mkhwanaze. Mr. Mkhwanaze, he says, "was into sport, very into sport.''
"Cross country,'' he adds. "He ran marathons."
Mr. Mkhwanaze left a wife and a 1-year-old son. "He got sick," the nephew says, not needing to say more.
He was 28