Friday, February 11, 2011

It's a miracle: the Vatican accepts that condoms stop HIV

The Vatican is set to host an HIV prevention conference on May 28, during which it will clarify its position on condom use to prevent the spread of the virus.

The catholic church's stance on the morality of health issues, especially when it comes to diseases like HIV/AIDS has always been significant, even if some scientists would prefer to ignore it, because of the large catholic populations in countries in Africa where HIV is so prevalent.

A focus on abstinence rather than contraception has in the past also heavily influenced US aid programmes for HIV.
In an interview last year that was received with great excitement by UNAIDS, HIV activists and scientists,
Pope Benedict XVI said that condom use by prostitutes could be seen as the "first step to moralisation", and that using a condom to prevent HIV transmission was a lesser evil than using contraception.

The Vatican is also about to update its 2008 guidelines on bioethics issues in stem cell research and reproductive technology, but whether those will be as pragmatic as the new stance on condom use remains to be seen.

The last edict had wordy explanations on the Church's position, but all it really came down to was a ban on any such technology. IVF? No. The morning-after pill? No. Gene therapy? No.
The 2011 update has allegedly been sparked by a slipping of Catholic standards in hospitals.

In December 2010, an Arizona hospital had its "Catholic" status revoked because it chose to abort a baby to save the pregnant mother's life. The hospital says it is disappointed by the Church's decision but remains steadfast that it took the correct path.

In a press release, the hospital said: "Consistent with our values of dignity and justice, if we are presented with a situation in which a pregnancy threatens a woman’s life, our first priority is to save both patients. If that is not possible we will always save the life we can save".

Photo credit: loveleft/flickr

Wednesday, February 9, 2011

Plumbers without borders

When a disaster strikes, aid agencies tend to focus on food, shelter and healthcare. Water and sanitation is often neglected, even though the lack of clean water and decent sewage systems can wreak havoc on healthcare. In Haiti, for instance, cholera has now become the overwhelming health problem, and 3000 people are estimated to have died from a disease that is entirely treatable.

Now, the disease has spilled over into the neighbouring Dominican Republic, and this week, three cases were reported in New York (people who had attended a wedding in the Dominican Republic).

But public health experts predicted months ago that when basic infrastructure breaks down as spectacularly as it did after the earthquake a year ago, outbreaks of waterborne diseases like cholera are inevitable. Given this knowledge, how did cholera run riot?

One Haitian blogger points to the utter failure of the Haitian government to provide its people with clean water long before the earthquake hit:

"Instead of policies or plans to invest in water treatment facilities, we have been witnessing an erosion of the few water pipes we had in the capital and the other major metropolitan areas. There is not a single waste management facility in Haiti. Overall, the politics of water in Haiti has been a complete failure, and today we are paying a dear price for it."

Recently, aid agency Médecins Sans Frontières (Doctors Without Borders) made a scathing attack on the humanitarian aid response to Haiti. MSF's international president Unni Karunakara wrote in an opinion piece that agencies given funds to provide chlorinated water and improve sanitation took little action for months, which contributed enormously to the rapid spread of cholera after the initial outbreak.

Karunakara is particularly suspicious of the trend to cluster the provision of aid. In theory, this should harmonise the provision of similar types of aid. In reality, he says, it seems to mean awkwardly forcing together organisations of differing capabilities and experience.

"Instead of providing the technical support that many NGOs could benefit from," he says, "these clusters, at best, seem capable of only passing basic information and delivering few concrete results during a fast-moving emergency."

This urgently required technical knowledge could come from a new grassroots organisation called
Plumbers Without Borders. The organisation, which is currently looking for expert plumbers, engineers, electricians, and carpenters, aims to provide the know-how for agencies that are trying to respond to emergencies in water and sanitation.

Tuesday, February 8, 2011

Should Bill Gates call the shots with polio?

Bill Gates is waging war with polio. The world has been on the verge of eradicating it for years, but stubborn pockets of disease remain in countries like India and Nigeria. Gates is now putting the might of his foundation behind eradication and is calling on governments and scientists to join him.

This latest move that has drawn fierce criticism from leading global health experts, including Donald A Henderson, the lynchpin in the smallpox eradication campaigns. The editor of The Lancet, Richard Horton, recently tweeted that global health does not depend on polio eradication.

The Gates Foundation has stirred controversy over disease eradication before. In 2007, it took the global health community by surprise when it announced a drive to eradicate malaria. Then too, malaria experts were concerned that it would divert from urgent research to control the disease through drugs and vaccines, and the jury still seems to be out on whether pushing for eradication is sensible.

Those who support Gates' polio plan argue that while eradication is more complex than it was for smallpox, aiming high can't hurt. The problem is that any move Gates makes is significant. Where Bill Gates go, the rest of global health follows. Arguably this then means that his foundation cannot ignore the judgement of the scientific community.

It is worrying then that in an article in the New York Times, Ezekiel J. Emanuel, chief bioethicist for the US National Institutes of Health says that since he had not seen enough data to form an opinion, he deferred "to people who’ve really studied the issue, like Bill Gates.”

Surely the balance has tipped the wrong way if a key figure in one of the world's most important health institutions, and who is said to be highly influential in the Obama administration, is looking to a philanthropist for advice on public health?