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Nov. 9, 2007
A snip of prevention
Circumcision may help reduce AIDS transmission.
BAILA LAZARUS
It may be a surprise to many, but circumcision may be one of the best means of preventing AIDS transmission for males participating in unprotected sex.
The topic was referred to as the "hottest" area of HIV prevention research at a recent panel discussion that included four of the foremost AIDS researchers in the world.
Learning by Example in the Fight Against AIDS: A Dialogue on the Ethiopian-Israeli Experience brought together Dr. Mark Wainberg of Montreal, Dr. Dawit Wolday of Addis Ababa, Ethiopia, Dr. Shlomo Ma'ayan of Jerusalem and Dr. Dan Turner of Tel-Aviv. Held at the Gordon and Leslie Diamond Health Care Centre at Vancouver General Hospital, the event was just one in a busy week that saw the four guests meeting with health experts and government representatives. Prior to the discussion, the doctors had visited Vancouver's controversial Insite safe injection site – an initiative heralded by Wainberg as "one of the most evaluated" safe injection sites in the world. It is one, he said, that is supported by the science.
Introducing the guests was Louise Binder, a Canadian HIV-positive lawyer, diagnosed in 1993.
"I'm your neighbor ... in Forest Hill," Binder said, opening up the discussion. "The Jewish woman lawyer who lives next door." Binder's husband, who Binder believes infected her, died from the disease. Binder herself had been given only two years to live. "I determined I needed to see if there were any lives I could save," and so she became an activist, founding and chairing numerous committees supporting women and girls with HIV/AIDS.
The four speakers that followed Binder presented a global picture of the AIDS epidemic, the progress that has been made in fighting the disease and the role Israel has been playing, particularly in its research relationships with Ethiopia.
In sheer numbers, the effect is staggering: 25 million have died from the disease; 45 million are infected in Africa alone.
"We've made enormous progress with drugs that are largely taken for granted," said Wainberg, the director of research at the Jewish General Hospital in Montreal and professor of medicine and microbiology and immunology at McGill University. "Maybe that's how it should be, but, in contrast, those in developing countries are bereft of hope. [Those affected in Africa] have no recourse but to die because their countries don't have the economic means to supply the drugs."
Though some drugs to combat the disease are available, a vaccine is "still very far away," Wainberg said. "Science has not helped us in the protection for at risk individuals." Unlike polio or measles, for which vaccines were developed, the HIV virus mutates, making a vaccine elusive.
The one ray of hope in Africa has been research done on men who have been circumcised. Studies done in South Africa, Kenya and Uganda, looked at men who had circumcision done when they turned 20 and who were having unprotected sex. Scientists asked one group to wait two years before becoming circumcised, and those individuals were 60 per cent more likely to contract AIDS. The foreskin has cells prone to infection, Wainberg said, which explains the higher incidence rate. And the findings are applicable everywhere in the world.
"This is unassailable evidence," he said.
Israel has long been at the forefront in AIDS research and, due to its proximity with Africa, as well as large immigration numbers from Ethiopia, the two countries have been collaborating for more than a decade. Thus, Israeli doctors have been conducting research alongside African colleagues and holding "train the trainers" workshops in Africa to teach doctors there how to perform circumcision.
"It became obvious that it was necessary to work in Ethiopia," said Ma'ayan, the director of Hadassah Medical Centre's AIDS centre in Jerusalem. "Most of the AIDS cases in Israel are from Ethiopia."
In addition to the approximately 40,000 Ethiopian immigrants, there are also about 200,000 worker immigrants, as well as refugees coming from Darfur, added Turner, an infectious diseases specialist at Tel-Aviv Sourasky Medical Centre. Collaboration with Africa in other areas, such as agriculture and construction, its high level of expertise in clinical and laboratory aspects of HIV care and its ability to develop health care in stressful conditions means Israel has a lot to offer Ethiopia.
Among the collaborative efforts is one between the Hadassah AIDS centre and Medical Biotech Laboratories in Addis Ababa, of which Wolday is the executive director. Wolday's research focuses on sex trade workers, who, he said, carry the highest rate of HIV transmission. In urban areas in Ethiopia, the infection rate is as high as 10.5 per cent, Wolday said. With Israel's help, he is trying to identify the pathogens responsible for certain syndromes in the infected population, in order to create a vaccine or treatment.
While most of the panel's presentation focused on efforts between Israel and Ethiopia, Wainberg urged the audience not to forget what's going on in Canada, as well. Passionately referring to the homeless on Robson Street and members of the aboriginal community, he said Canadians have "done a terrible job" at addressing those at enormous risk. "We absolutely must do better to ensure people who suffer from HIV in Canada can confront the disease."
In this regard, he told a small group after the lecture, that the Conservative government should be supporting Insite.
"None of us are in favor of people using drugs, but we can't put our heads in the sand. There are vulnerable people who will be prone to using drugs. We want to bring that to a minimum.
"I think the prevention of HIV is the most conservative of all values."
Baila Lazarus is a freelance writer, photographer and illustrator living in Vancouver. Her work can be seen at www.orchiddesigns.net.
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