Male Circumcision for prevention of HIV transmission

What the new data mean for HIV prevention in the United States

By: Sullivan PS, Kilmarx PH, Peterman TA et al.
Published in: PLoS Med 4(7): e233, 2007
Via: Docuticker

Circumcision may have a role for the prevention of HIV transmission in the US. However, because of the many differences between the underlying HIV epidemics in Africa and the US, differences in the prevalence of male circumcision in Africa and the US, and the considerable gaps in knowledge that exist regarding the potential impact of circumcision on HIV transmission by male–male sex, the extent of this role on a population basis is unknown. Further, the already high prevalence of circumcision among US men suggests some limitations in the potential impact of circumcision at a population level.

(http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2
Fjournal.pmed.0040223&ct=1)

New data on male circumcision and HIV prevention: policy and programme implications

Male circumcision: a new strategy for HIV prevention?

Published by: World Health Organization, 2007
Via: Eldis

This technical consultation paper from the World Health Organisation (WHO) and UNAIDS reports that male circumcision has been proven to effectively reduce the transmission of HIV from women to men. However, male circumcision does not provide complete protection against HIV, and it has not been proven to reduce the transmission of the virus from men to women. Circumcision for HIV positive men is not recommended. The paper emphasises that it is important to deliver accurate information about the implications of male circumcision in relation to HIV and that programmes promoting circumcision as a HIV prevention measure should be culturally aware, respectful of human rights and aware of gender issues.

The paper recommends that programmes promoting male circumcision should now be included in the range of HIV prevention strategies but that such programmes should not be seen as a replacement for these existing strategies. These programmes should deliver clear information, aimed at both men and women, emphasising that male circumcision only offers partial protection against HIV. It also recommends that such programmes be targeted to maximise their public health benefit, and in particular programmes should be directed at regions with very high HIV prevalence and low levels of male circumcision.
(http://www.who.int/hiv/mediacentre/MCrecommendations_en.pdf)

Gender and Trade: impacts and implications for financial resources for gender equality

Financing gender equality

By: Williams, M
Published by: International Gender and Trade Network, 2007
Via: Eldis

To what extend can the multilateral trading system help to support the financing of gender equality and women’s economic and social empowerment in Commonwealth developing countries? This paper provides an overall framework for understanding how the multilateral trade system, working in tandem with the International Financial Institutions can contribute to the financing of gender equality and women’s economic empowerment. The authors look at how trade liberalisation and trade reform impact on the resources available for financing gender equality, and seek to identity the likely direct and indirect gendered impacts of trade on resource availability.

The paper offers a tentative overview of how trade impacts on the three domains of gender equality and explores the financial impacts of the World Trade Organisation and other trade arrangements on financing and gender equality. Its main focus is on the area of trade reform, in addition to looking at aid for trade and trade related capacity building and technical assistance. Specific recommendations made in the paper are:

• each count should develop a framework for engendering its trade related capacity building and Aid for trade programmes
• it is important to ensure that trade diagnostic studies focusing on promoting trade readiness and market entry include gender analysis and pay specific attention to the needs of women-owned small and medium enterprises as well as to the sectors in the economy most likely to be adversely affected by changing trade policies
• trade negotiations mandates should proactively include a gender sensitive framework for each of the sectoral areas under negotiations
• gender sensitive measures are needed to deal with the negative outcomes of trade reform underlying the implementation of trade agreements.

(http://www.igtn.org/pdfs//Gender%20and%20Trade%20and%20financing%20gender%
20equality%20-%202007.pdf)

Male circumcision and HIV prevention

Ethical, medical and public health tradeoffs in low-income countries

By: Rennie S, Muula AS and Westreich D
Published in: Journal of Medical Ethics. 33:357-361, 2007
Via: Docuticker

If male circumcision is to be promoted in regions of high HIV prevalence, the following basic ethical conditions must be put in place: sufficient material and human resources to perform circumcisions safely; careful monitoring of the quality of follow-up care; international and national committments to low-cost circumcisions to facilitate equitable access; flexible policies informed by concerns of local communities regarding if, when, where and how circumcisions should be performed; careful attention to the consent process and sustained condom promotion to minimise the risk of behavioural disinhibition; monitoring of circumcision promotion messages to ensure that prospective clients are aware of potential benefits and limits; education of women and girls about male circumcision initiatives to combat potentially tragic misconceptions; and conformity of circumcision policies with international norms (such as the Siracusa principles) limiting the extent to which individual rights can be infringed to promote the public good.

Future initiatives to promote male circumcision as part of comprehensive HIV prevention policies are likely to lose public trust and effectiveness if they are not grounded in respect for persons, social justice, human rights and community values. Without an open-minded dialogue on these ethical challenges between the Western medical establishments and international organisations promoting male circumcision, and the people and governments for whom the intervention may be most appropriate, a potentially vital contribution to the fight against HIV/AIDS could be squandered.
(http://jme.bmj.com/cgi/content/full/33/6/357)

Change, choice and power: young women, livelihoods and HIV prevention

Important interventions supporting the livelihoods of young women and adolescents

By: Urdang, S
Published by: United Nations Population Fund (UNFPA), 2007
Via: Eldis

The urgency of addressing the vulnerability of young women and adolescent girls of all backgrounds, but particularly the poor, cannot be over stated. Innovative, far-reaching and rapid responses are needed to impact whole generations so that the Millennium Development Goals to reduce poverty can be within reach. This paper sets out to explore the relationship between economic independence, vulnerability to HIV infection, the level of sexual and reproductive health among women and adolescent girls, and gender-based violence. It focuses in particular on southern and eastern Africa and looks at the role of microfinance, as this is often the only potential source of income for poor young women and adolescent girls. Vocational training is also reviewed. The authors make recommendations in five main areas that are important for interventions supporting livelihoods directed at young women and adolescents:

• a situational analysis and base line survey that includes a full assessment of the gendered social, cultural, economic and political contexts for the intervention is essential in order to identify as fully as possible the challenges and opportunities for young women and link these directly to their vulnerability to HIV infection; programmes need to go beyond satisfying the practical, short term survival needs to addressing the strategic (empowerment) interests of the young women and adolescent girls
• a participatory monitoring and evaluation tool needs to be introduced from early stages of the intervention
• thorough documentation of the process will provide important lessons for replication and upscaling
• microfinance interventions for young women and adolescent girls need to take into account the differences between providing such services for older women, and for young women/adolescent girls
• macro level: policy at the state level needs to be reviewed and revised, with the provision of resources, a re-examination of attitudes towards young women as small scale (and bigger scale) entrepreneurs
  

(http://www.unfpa.org/upload/lib_pub_file/674_filename_change.pdf)

Parliaments, politics and HIV/AIDS: a comparative study of five African countries

Can parliament play a role in the HIV and AIDS pandemic?

By: Caesar-Katsenga M & Myburg M
Published by: Institute for Democracy in South Africa (IDASA), 2006
Via: Eldis

This paper provides an assessment on the national parliaments of Botswana, Ghana, Kenya, Mozambique and South Africa use of their oversight function to inform and monitor national HIV and AIDS responses. More specifically, the primary goal is to improve the overall effectiveness of the HIV and AIDS responses in the participating countries. Research findings from all the country-specific reports indicate that the pandemic has had some impact on parliaments in all of the countries. Placing any limitation on the role of parliaments in determining HIV and AIDS priorities undermines an effective response to the pandemic and the power of democratic governance. The paper confirms that oversight of HIV/AIDS is largely confined to specific parliamentary committees, in particular those with a broad social welfare mandate. A number of recommendations are made. These include:

• it is imperative that all parliaments ensure effective and consistent engagement with citizens
• there needs to be more parliamentary committees that integrate HIV and AIDS into their work
• there needs to be a more systematic framework for HIV and AIDS oversight
• there is a need for a more generalised, mainstreamed approach to HIV/AIDS within parliament, which requires more committees to be involved in HIV and AIDS oversight
• it is important that parliaments consider not only the policy and legislative implications of the effect of HIV and AIDS but also the institutional implications.
  

(http://www.idasa.org.za/gbOutputFiles.asp?WriteContent=Y&RID=1711)

Off the map

How HIV/AIDS programming is failing Same-Sex practicing people in Africa

By: Cary Alan Johnson
Published by: International Gay and Lesbian Human Rights Commission, 2007
Via: Docuticker

This report exposes and analyses the unacceptable climate of silence that confronts men who have sex with men and women who have sex with women in the epidemic. By focusing on the effects of discrimination, the report demonstrates that access to prevention, care and treatment must be equal for all. The ravages of AIDS fall hardest on those most marginalized in our societies: women, the poor, LGBTs. We must insist that access to HIV prevention, treatment, and care do not follow discrimination’s path.
(http://www.iglhrc.org/files/iglhrc/otm/Off%20The%20Map.pdf)

Action on gender based violence and HIV/AIDS: bringing together research, policy, programming and advocacy

What are the link between gender-based violence and HIV?

Published by: Center for Women’s Global Leadership (CWGL); Program on International Health and Human Rights (PIHHR), 2007
Via: Eldis

At the 2006 International Aids Conference a meeting was convened to explore the linkages between gender based violence (GBV) and HIV. Its objective was to understand common challenges and to inform research, advocacy, policy and practice. This report summarises discussions, outcomes, and recommendations from the consultation. Issues requiring further attention were identified, in particular those necessary to improve future advocacy and research on the topic. Participants recognised the need:

• for an evidence base proving the causal linkages between GBV and HIV
• to carry out this work within the framework of gender-based equality and non-discrimination
• to help government and other partners better understand and address the realities of women’s lives with the objective to inform gender sensitive programming policy
• to challenge elite understandings of what is commonly considered “valuable knowledge” by policy makers

Suggestions for moving the work on linking HIV and GBV forward include:

• developing an overarching strategy
• tracking funding of work at the intersection of HIV and GBV
• developing criteria and minimum standards for donors’ work on the subject

(http://www.cwgl.rutgers.edu/globalcenter/policy/HIVAIDS/toronto.pdf)

Understanding positive women's realities

Making the sexual rights of women living with HIV count

By: Bell E & Orza L
Published in:Exchange on HIV/AIDS, Sexuality and Gender, Autum 2006
Via: Eldis

This issue of Exchange, produced in association with the International Community of Women Living with HIV/AIDS (ICW), focuses on the experience of women living with HIV. The issue focuses particularly on sexual and reproductive rights. It shows how the ABC (Abstain; Be Faithful; Use Condoms) approach, currently favoured by funding bodies such as USAID, ignores the complexity of human needs and desires. There is also a report from India on women who have lost their land due to their HIV status, and a report from Uganda on the ’memory work’ project in which mothers living with HIV and their children have been involved. Despite a growing recognition of the rights of women living with HIV to healthy and fulfilling sexual lives and reproductive choices, there remain many obstacles to women exercising those rights. Women living with HIV have to balance their fears of rejection, abandonment and violence from partners with their need for intimacy and their desire to have children. They also frequently face harsh judgements from health workers about their rights to have sex and children. This includes examples of access to antiretroviral therapy (ART) for women being tied into the use of certain types of contraception. The authors recommend that testing, and other HIV services, be carried out in a sexual rights framework that provides women with the support to deal with these complex issues. They also urge that the voices of women living with HIV be meaningfully included in all HIV policy and programme development.