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South African Medical Journal. 2009 Jan; 99(1):12.Add to my documents.
Lancet Infectious Diseases. 2008 Feb; 8(2):98-100.Kevin De Cock is director of WHO's HIV/AIDS department. Formerly director of the US Centers for Disease Control and Prevention in Kenya, he is an infectious disease specialist, with expertise in HIV/ AIDS, tuberculosis, liver disease, and tropical diseases such as yellow fever and viral haemorrhagic fevers. TLID: How has your time as WHO's HIV/AIDS director been? KDC: It has been extremely interesting. AIDS policy is always challenging and changing. WHO's HIV efforts up to 2005 were very much oriented around the 3 by 5 initiative. The G8 in 2005 made an announcement about working towards universal access, which became an AIDS rallying cry. So we've had to reorganise ourselves around that as a theme. Some internal reorganisation was necessary to focus not only on treatment, but also on broader issues. We now have five key strategic directions: increasing access to HIV testing and counselling, maximising prevention, accelerating treatment scale-up, strengthening health systems, and investing in strategic information. We have also been working on some important technical areas. One is the issuing of guidance on both provider-initiated testing and male circumcision. In April, 2007, we also issued a report, in response to a request from the World Health Assembly, on the health sector's progress towards universal access. (excerpt)
Lancet Infectious Diseases. 2007 May; 7(5):313.Male circumcision should now be recognised as an important intervention to reduce the risk of heterosexually acquired HIV infection in men in high-prevalence countries, said WHO and UNAIDS in a position statement published in March. In a keynote speech at the European Congress of Clinical Microbiology and Infectious Diseases in Munich (April 2), George Schmid (WHO, Geneva, Switzerland) said "combined data from three randomised controlled trials undertaken in Kenya, Uganda, and South Africa show that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. This makes male circumcision the biggest news for tackling HIV prevention that we have had in years". Circumcision is one of the oldest surgical procedures in the world and about 30% of the global adult male population is circumcised. Research shows that countries or regions in Africa with low rates of male circumcision correlate with a higher incidence of HIV infection. According to Schmid, "Modelling data show that widespread implementation of male circumcision in southern sub-Saharan Africa, a high prevalence area, could prevent 2 million infections over a 10-year period. We therefore need to target adolescent men in these areas to see an immediate public-health benefit". He added, "this is not an appropriate public-health intervention strategy for Europe". Unpublished data from Uganda, said Schmid, shows that with half of all males circumcised, there would be a 25-30% reduction in new HIV cases in Uganda. (excerpt)
In: Programming for male involvement in reproductive health. Report of the meeting of WHO Regional Advisers in Reproductive Health, WHO / PAHO, Washington DC, USA, 5-7 September 2001. Geneva, Switzerland, World Health Organization [WHO], 2002. 88-103. (WHO/FCH/RHR/02.3)Health sector priorities are ideally set according to a number of variables, including: burden of disease; whether effective and proven ‘solutions’ are available; and the calculated cost-effectiveness of those solutions. In the case of sexual health services, we argue in this paper that this conceptual framework is useful for programme planning, but needs to take into account one important additional element: the client’s perspective. We further argue that the sexual health of men in south Asia can not be adequately addressed unless men’s beliefs about their bodies, men’s health priorities, and men’s sexual health concerns are evaluated, interpreted and acted upon. Services which do not correspond to men’s own perceived sexual health needs are unlikely to attract men as clients, and thus remove many of the opportunities for male involvement in other aspects of reproductive and sexual health prevention and care. Men’s own sexual health priorities may not correspond exactly with the priorities of public health programmes; we therefore discuss how the two sets of concerns may be reconciled and men brought more equitably into programmes. Finally, we outline areas which may be of particular concern to programme managers if this approach is adopted. (author’s)