Inter Press Service (Johannesburg) - July 28, 2005
Mario Osava, Rio De Janeiro

A prime example is the impact made by a recent study which recommends male circumcision as a means of preventing HIV infection, presented at the Third International AIDS Society (IAS) Conference on HIV Pathogenesis and Treatment, which took place Sunday through Wednesday in Rio de Janeiro.

Using circumcision to prevent the spread of HIV, the virus that causes AIDS, "does not correspond to Latin American realities, in terms of sexual behaviour and culture," Dalva Pereira Lopes, a member of the International Community of Women Living With HIV/AIDS (ICW), told IPS.

The study, carried out by French researchers in South Africa between 2002 and 2005, involved 3,274 men between the ages of 18 and 24 in the province of Gauteng, where 32 percent of the population is HIV-positive.

Half of the men were circumcised while the other half were not, and after a 21-month period, only 18 of the circumcised men had contracted the virus, as compared with 51 in the control group.

This 65 percent reduction in the infection rate can be attributed to various factors. Removing the foreskin decreases the surface area of penis, lessening the possibilities of open wounds and reducing healing time. The scientists who conducted the study also said that cells on the foreskin of the penis are more susceptible to HIV infection.

But Lopes believes that the effectiveness of this measure was not adequately confirmed. The observation period was very short, and the lower rate of infection among the circumcised men could have been the result of a period of sexual abstinence and greater preventive efforts following the surgery, she argued.

Circumcision has already been used for a considerable time to prevent the spread of other sexually transmitted diseases, but more evidence is needed to draw conclusions on its effectiveness with regard to AIDS. Besides, "this is important for Africa, but not for Latin America," said Katia Braga Edmundo, a coordinator with the Centre for the Promotion of Health (CEDAPS).

Circumcision often forms part of Islamic tradition and is practiced in many Muslim communities in Africa, which is by far the continent most heavily affected by the HIV/AIDS pandemic.

Both activists participated in a "community sector" meeting which gathered civil society representatives and people living with HIV/AIDS to evaluate the findings presented at the IAS conference.

The conference highlighted advances made in the development of AIDS drugs, as well as such crucial issues as "re-infection", the results of which are "more serious than had been imagined," said Edmundo.

A person who is already HIV-positive can be infected with another strain of HIV, increasing the virus' resistance to drugs and making treatment much more complex, she explained.

But research focused on Africa tends to draw attention away from aspects that are of particular interest to Latin America, where drug treatment has been available to people living with HIV/AIDS for a longer period of time, she said.

Edmundo cited the examples of lipodystrophy, the redistribution of body fat caused by some antiretroviral AIDS drugs, and the development of resistance to the drugs currently in use.

The IAS conference, aimed primarily at the scientific, pharmaceutical and medical community, drew together 5,500 researchers, health authorities, health professionals and people living with HIV/AIDS from 128 countries.

Over 1,400 papers were presented during the course of close to 40 seminars, symposia and plenary meetings.

The fact that there are now an estimated 40 million people around the world infected with the virus makes HIV/AIDS "an unprecedented challenge for science and public policies," said Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS).

The HIV/AIDS epidemic has become an issue closely linked to poverty, he noted, given that 95 percent of new cases of infection now take place in poor countries. He also pointed to the role played by domestic sexual violence in spreading the virus.

But according to Lopes, these considerations are more pertinent to the realities of Africa and Asia, where women face greater "submission", sometimes for religious reasons.

In Brazil, HIV/AIDS has also emerged as a problem in the wealthier sectors of society, and is even more difficult to address, because of the tendency to hide the incidence of the disease by failing to report new infections, she said.

No advances were reported in the development of an HIV/AIDS vaccine, commented Edmundo, who also complained that Portuguese interpretation services were provided at very few of the conference sessions, despite the fact that the event was held in Brazil. This made it very difficult for people outside the academic community to fully participate, she said.

Both Lopes and Edmundo stressed the need to increase popular participation in prevention efforts and monitoring public health policies. They also support Brazil's right to produce AIDS drugs even if it means breaking the patents held by foreign pharmaceutical companies.

The Brazilian Health Ministry is negotiating with Abbott Laboratories in the United States to reach a deal on lowering the price for Kaletra, one of the 17 AIDS drugs distributed free of charge to around 160,000 people with HIV/AIDS in Brazil.

The government spends 400 million dollars annually on antiretroviral drugs, and 63 percent of the total is taken up by just three drugs made particularly costly by patents, one of which is Kaletra.

This is "an intolerable situation for any health care system," said Health Minister Jos Saraiva Felipe. His statements implied a threat that unless an

agreement is reached to slash the price currently charged by Abbott, Brazil will break the company's patent and produce the drug itself.

But while Brazil is internationally recognised for its programme to provide AIDS medications free of charge to all those who need them, Lopes maintains that greater efforts are needed in the area of prevention.

In her opinion, the availability of antiretroviral drugs has led the Brazilian public to "lose its fear" of the disease, and has given rise to the belief that "AIDS doesn't kill, it is just a chronic illness," a view that makes prevention efforts even more difficult.

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