Africa Theological Institute gets full accreditation

In a bid to promoting high academic standard, the Africa Theological Institute (ATI) has secured a full accreditation from Global Partnership for Theological Accreditation and Mission, South Korea, to offer certifications ranging from Diploma to Master's Degrees in both Evangelism, Missions and Theology.

This was made known recently in Benin by the Rector of the institute- Dr. Sunday Aigbefoh. He said ATI formerly known as Africa Theologian Bible Institute for Global Opportunities, has trained Leaders that are currently doing exploits for the Lord in their various areas of Ministry. 

"One thing that is unique with this institute is that the tuition fee is affordable even to low income earners. This is to give those that are called by God apple opportunity to be trained and certified. 

"One other unique feature of ATI is that the lecturers are well trained in various theological disciplines, and their lecturing style is participatory and highly interactive. That is a communication policy in ATI. This is to make the courses practical in nature.

"We are located in the heart of Ugbowo- 16, Oviasogie Street, opposite Ojo junction, off Uwasota Road, Ugbowo, Benin City. Our dedicated lines include +2348035630262, +2348078272708. Call us and kick-start your theological certification journey, as admission is currently in progress", said Dr. Sunday Aigbefoh.

Highly Hazardous Pesticides: Awareness and Precautions

 By Sustainable Development for Environment Initiative (SEDI), Nigeria

International Pollutants Elimination Network (IPEN)                           What is a pesticide?

A pesticide is any substance, or mixture of substances of chemical or biological ingredients intended for repelling, destroying or controlling any pest, or regulating plant growth. [1]. Pesticides can also be used as vector control and agriculture control agent in public health programmes [2]. The group includes herbicides, insecticides, and fungicide so. Pesticides may be used for crops on the field, harvested produce, agricultural commodities or animal feeds and fish, 2.1% of pesticides used in the world come to Africa [3]. The cost of labor, choice of pesticide application, and the promise of swift pest control have made the use of pesticides judicial or rampant all over the world [4]. A survey on pesticides usage in Nigeria indicated that annually about 15,000 metric tons of pesticides comprising about 135 pesticide chemicals marketed locally under 200 different produce brands and formulation were imported during 1983-1990 thus making Nigeria one of the largest pesticides users in sub-Sahara Africa [5].

More than 95% of the applied herbicides and 98% of insecticides reach non-target soil micro-organisms than their target pest, as they are sprayed proportionately across the entire field, irrespective of the affected areas [6]. Hence, of the total quantity of applied pesticides, about 0.1% reaches the target organisms while the remaining quantity pollutes the soil and environment. There are 25 million occupational pesticide poisonings each year among agricultural workers in developing countries alone [7].

What are highly hazardous pesticides (HHPs)?

Pesticides are inherently hazardous, and among them, a relatively small number of Highly Hazardous Pesticides (HHPs) cause disproportionate harm to environment and human health including: severe environmental hazards, high acute and chronic toxicity [8]. Pesticides that appear to cause severe or irreversible harm to health or the environment under conditions of use in a country may also be considered to be and treated as highly hazardous”.

Stakeholder reflection on the failure of existing pesticide controls to reduce the incidence of damage to yhuman health and environment led FAO and WHO to launch a new initiative for a progressive ban on Highly Hazardous Pesticides (HHPs) in 2006. The HHP initiative recognizes that WHO Class II pesticide active ingredients (‘moderately hazardous’ in terms of acute mammalian toxicity as determined in laboratory testing), such as endosulfan, paraquat and chlorpyrifos, can be as problematic in reality as the ‘extremely’ and ‘highly’ hazardous pesticides which make up WHO Class I. This conclusion is also drawn from PAN’s poisoning cases data in West Africa [9] and locust cost externality assessment in Senegal [10]. In 2009 PAN International published its ‘List of Highly Hazardous Pesticides’ as a contribution to UN discussions [11]. It provides a catalogue of the most harmful pesticides that is more comprehensive, and takes into account more potential pesticide hazards, than current listings by official bodies.

HHPs are considered to represent a fraction of all registered pesticides worldwide; in some cases as small as 6 percent (Southern African countries) while in other cases as high as 30 percent of the registered products [8]. They are still in use in many low and middle income countries because of inadequate regulation and monitoring and are primarily used in agriculture and in public health (DDT and Clothianidin) for malaria vector control, but also used in domestic gardens. They have been detected in air, water, soil, animals and humans and have been found in local food systems and global food commodities such as bananas, coffee and rice, but the most contaminated crops are fruits and vegetables. They can also cause loss of biodiversity, kill fish and birds and poison wildlife. Therefore, HHPs should be progressively phased out by more sustainable alternatives.

Impacts of HHPs

The impacts of the highly hazardous are divided into human health and environmental impacts. 

(A) Human health impacts 

Human health effects can be acute or chronic poisoning, linked to a range of serious illnesses and diseases from respiratory problems to cancer. Exposure can occur in many ways. Farmers and farm workers can be exposed through the treatment of crops, plants and grain stores. Rural residents living next door to farms can be exposed to pesticide drift or from contaminated air and ground or surface water. Consumers of food crops sprayed with pesticides can be exposed through pesticide residues. Consumption of crops and plants grown under chemical pest control like fruits and vegetables without proper washing for example, [13] reported the presence of paraquat residues in some commonly consumed vegetables in Abeokuta, Nigeria. However, no direct health impact was reported in the study.

Acute poisoning

Acute poisoning means that they can cause harmful or lethal effects after a single episode of ingestion, inhalation or skin contact. The symptoms are evident shortly after exposure or can arise within 48 hours. This can include:

- respiratory tract irritation, sore throat and/or cough

- allergic sensitisation

eye and skin irritation

- nausea, vomiting, diarrhoea

- headache, loss of consciousness

- extreme weakness and or ultimate death.

- Chronic or long-term poisoning

These are harmful effects over an extended period, usually following repeated or continuous exposure at low levels, can be very serious illnesses. They are linked to the development of Parkinson’s disease; asthma; depression and anxiety; attention deficit and hyperactivity disorder; and cancer, including leukaemia and non-Hodgkin’s lymphoma.

Environmental impacts 

1. Impact on aquatic organisms: Pesticide drifts or residues lead to deterioration of water quality, hence reducing the number of aquatic organisms.

2. Water pollution and contamination: Spraying or use of hazardous pesticides and incorrect pesticides application approach adjacent to drinking water resources may lead to their contamination, and could result to pollution of surface and underground water.

3. Soil degradation / contamination: Long-term excessive use of pesticides will cause higher pesticide resistance and pesticide residues in the soil which will cause soil contamination.

4. Extinction of non-target species: impact on the non-target species (bees, natural enemies, etc.).

5. Air pollution: Poor handling, application and disposal of pesticides products such as empty containers and obsolete products will cause air pollution.

6. Soil fertility imbalance: Pesticides cause imbalance of soil fertility which directly affects crop yield.

Pesticide going to the soil during application (Photo credit to SEDI. Location –Edo State, Nigeria) 

Effects of using specific HHPs

There is certainty that the application of Endosulfan pesticide is moderately persistent in Ibadan soil and hinders availability of some soil nutrients [14]. There was 85% population reduction of nematode as a result of Endosulfan application. Total DDT and heptachlor found in Ibadan ground water exceeded the WHO limits for these chemicals in drinking water [15].

Unintended costs incurred in using HHPs

The UN Food & Agriculture Organization (FAO) analyzed externalities caused by spraying high concentrations of organophosphate insecticides (mainly malathion and fenitrothion) for locust control operations in Senegal during the last outbreak in 2003 - 2005 [8]. It estimated external costs of over 8 million Euros including: 2.75 million for environmental costs; 2.5 million on human health; 2.1 million in agricultural production losses; and 0.7 million in damage prevention costs.

Unintended costs of using HHPs include:

1. Increased cost of production: The use of HHPs in agricultural farming systems leads to an increase in cost of production due to the fact that these pesticides are expensive.  

2. Maintenance cost: maintenance of sprayers such as power driven models with motor and hand operated sprayers. Hand operated sprayers such as Lancet, Falcon, Knapsack, Motorized mist blower, Ultra Low Volume (ULV), and Electrodyne sprayers need to be maintained regularly through procedures like washing and oiling with light oil to prevent corrosion [16]. 

3. Cost of pesticide poisoning treatment: First aid for pesticide poisoning victims and hospital bills.  

4. Cost of pesticide poisoning prevention: During spraying personal protective equipment (PPE) are worn to reduce contact with the pesticide. These include coveralls, long rubber gloves, goggles, respirators, rubber boots and waterproof hat. These PPE are usually expensive and increase the cost (unavailable in some cases or places when needed).

5. Environmentally pollution: The use of HHPs causes environmental degradation and pollution [16]. 

Applying pesticides without wearing PPE. (Photo credit to SEDI. Location –Edo State, Nigeria) 

References:

[1] FAO/WHO, 2016. The International Code of Conduct on Pesticide Management - Guidelines on Highly Hazardous Pesticides. ISBN 978-92-5-109187-6. 

[2] WHO, 1990. The public health impact of pesticides use in agriculture. World Health

Organization, Geneva. 

[3] Food and Agriculture Organization of the United Nations. 2019. FAOSTAT Statistical

Database; FAO: Rome, Italy.

[4] Bahadur, S., Verma, S.K., Prasad, S.K., Madane, A.J., Maurya, S.P., Gaurav Verma, V.K., 

Sihag, S.K. 2015. Eco-friendly weed management for sustainable crop production-A review. 

Journal of Crop and Weed 11: 181–189.

[5] Osibanjo, O.; Ikem A.; Sridhar, M.K.C. and Sobande A. 2002. Evaluation of groundwater quality characteristics near two waste sites in Ibadan and Lagos, Nigeria. Water, Air and Soil Pollution 140 (1-4): 307-333. 

[6] Miller, G.T. 2004. Sustaining the Earth; Brooks/Cole: Monterey County, CA, USA; ISBN

9780534400880. 

[7] Jeyaratnam, J. 1990. Acute pesticide poisoning: a major global health problem. World Health 

Statistics Quarterly 43: 139-144.

[8] FAO and WHO. 2019. Detoxifying agriculture and health from highly hazardous pesticides

 – A call for action. Rome. 

 [9] PAN UK, 2008. Hazardous pesticides and health impacts in Africa. Food & Fairness briefing 

no. 6, London. Via http://www.pan-uk.org/Publications/ 

[10] Leach, A., Mullié, WC, Mumford, JD and Waibel, H. (2008). Spatial and historical analysis 

of pesticide externalities in locust control in Senegal- first steps. Imperial College London, 

University of Hanover and FAO.

[11] PAN Germany, 2009. PAN International List of Highly Hazardous Pesticides Via 

http://www.pan-germany.org/

[12] Pesticide Action Network International, 2016. PAN International List of Highly Hazardous 

Pesticides - 12/2016.

[13] Akinloye O. A.; Adamson I.; Ademuyiwa O. and Arowolo T. A. 2011. Paraquat toxicity and its mode of action in some commonly consumed vegetables in Abeokuta, Nigeria. International Journal of Plant Physiology and Biochemistry 3(4): 75-82.

[14] Aikpokpodion, P.E., Lajide, L., Ogunlade, M.O., Ipinmoroti, R., Orisajo, S., Iloyanomon, C.I. and Fademi, O. 2010. Effect of Endosulfan on soil and root-knot nematodes in cocoa. Journal of Applied Biosciences 26: 1640-1646. 

[15] Osibanjo, O. and Aiyejuyo, A. 1994. Organochlorine pesticide residue in foodstuff of animal origin in Nigeria. Bull Environ Toxicol 54:460-464.

[16] Ekeleme, I.Y. Dugje, F. Ekeleme, A.Y. Kamara, L.O. Omoigui, A.Tegbaru, I.A. Teli, 

And J.E. Onyibe. 2008. Guide to safe and effective use of pesticides for crop production in Borno State, Nigeria. 23 pp.

(Photo credit to SEDI. Location –Edo State, Nigeria) 

5 Natural Ways To Keep Your Kidneys Safe

Creammedia Sep 2, 2021

Kidneys are one of the most subtle and susceptible organs inside a mortal torso. Kidneys begin forfeiting their function once a mortal torso comes to be 35 years old. Their filtration capability generally begins decreasing at a constant rate. In fact, a current announcement discloses that kidney functions drop by 10% every decade after an individual enters his 30s. As a result, kidneys also become highly sensitive to several infections at later phases in life.

Although it's true that your kidneys will begin ceasing to function gradually, there are means by which you can lessen the harm rate. Thus, it is essential for you to contemplate some helpful tips to keep your kidney safe.

1. Drink lots of Water: You need to gulp as much water as feasible. It will not only enable your torso to stay hydrated, but also encourage the kidneys to clean every poison. Also, this will enable you to regulate your torso temperature, reduce indigestion, and help blood volume. Thus, it is essential that you drink at least 2 litres of water every day.

2. Avoid Smoking and Drinking: Smoking is very toxic for health, although it does not implicate the kidneys immediately, it decreases kidney function significantly. Undue liquor consumption can disrupt a torso's hormonal control and electrolyte proportion. These upheavals also implicate the kidneys very badly, and they will slowly diminish your kidney's energy.

3. Reduce your Salt Intake: I am certain you know that salt is accountable for improving the quantity of sodium in nourishment. Excessive salt in food can make you suffer from high blood pressure. You can also become a patient of more toxic cases like the formation of kidney stones. This is the reason you should reduce your salt infusion.

4. Go for Daily Exercises: Recent surveys indicate that chubbiness and overweight are the main problems behind kidney crises. If you are overweight or suffering from adiposity, then your kidney function will reduce at a more abrupt scale. Thus, you must exercise regularly to forfeit weight or keep it in check.

5. Don't Resist to Urinate: This is an extremely familiar practice, mostly discerned in women. They are usually careful about hygiene, and thus, suppress the urge to urinate unless they find a neat latrine. They do not comprehend that avoiding this urge puts a great burden on their urinary bladders and kidneys. They should urinate more frequently to make sure their kidneys are safe from danger.

The world’s most vulnerable people are suffering and dying from effects of the “shadow pandemic"

The international community's must recommit to the health of women, children, and adolescents, write Helen Clark, board chair of PMNCH and former prime minister of New Zealand, and Kersti Kaljulaid, president of Estonia and newly appointed United Nations’ Secretary-General’s global advocate for Every Woman Every Child.

The spillover effects of the covid-19 pandemic on women, children, and adolescents have been under-reported in the media, yet they are significant. While women, children, and adolescents are not more likely than other population groups to get ill or die from covid-19, they are experiencing interruptions to essential health and social services caused by lockdowns and by the diversion of resources to manage the virus. The impact of this amounts to a “shadow pandemic,” which is affecting many millions of people.

Surveys conducted over the past year have revealed the scale of the impact: 39% of 124 countries surveyed reported a drop in coverage of family planning services; 38% reported drops in the coverage of maternal health services (antenatal and postnatal); and up to 200 000 additional stillbirths could occur over 12 months in 117 low and middle income countries.

We should heed the words of a pregnant woman in Kenya who feared being left to give birth without expert care and support: “I am worried because I’m not sure if I will find the facility open or if I will find nurses during delivery”, she said. Sadly, she is far from alone. 

In India, an adolescent girl bears witness to the lack of even the most basic sanitary supplies, saying: “Girls in quarantine tore up and used their own clothes as they didn’t have access to sanitary pads.”

An 18 year old Colombian woman with polycystic ovarian syndrome reports being unable to get any kind of medical appointment during the pandemic: “I stopped getting my period, and I want to find out what’s going on, but I can’t.”

These are themes repeated by disadvantaged and vulnerable people the world over. They desperately need healthcare, services, and supplies, and are entitled to receive them, but the pandemic has torn away the fragile support structures they rely on.

More than one third of countries are still reporting disruptions to immunization services. This particularly puts children at risk. Our attempts to manage covid-19 must not compromise our campaigns against other killer diseases, such as measles and polio.

Act together, act swiftly

These disruptions to essential services cannot continue. The international community must come together swiftly to protect the most vulnerable from the indirect effects of covid-19, even as it urgently addresses the virus itself through mass vaccination and other public health measures.

It is not simply a matter of preventing suffering and hardship. Women, newborns, children, and adolescents are at risk of dying as a result of the covid-19 pandemic without ever catching the disease.

In our respective roles of board chair of Partnership for Maternal, Newborn and Child Health (PMNCH) and newly appointed United Nations global advocate for Every Woman Every Child, we call on world leaders to commit to bold, meaningful, and co-ordinated global action on women’s, children’s, and adolescents’ health.

In 2015, global leaders agreed on sustainable development goals (SDGs) for the next 15 years. Progress toward them, however, has stalled, or even reversed, as a result of the pandemic. The world urgently needs to get back on track to achieving them—including the targets of the health SDGs and of the Every Women Every Child Global Strategy for Women’s, Children’s, and Adolescents’ Health (2016-2030).

All efforts to get back on track must be driven by the central principle of the SDGs: “leave no one behind.” At the moment, millions are slipping further and further behind, with those caught in the cross-currents of conflict, fragile situations, and migration bearing a disproportionate burden. Getting back on track will require an unprecedented global effort, co-ordinated and led at the highest level and resourced by massive fresh investment. Working in partnerships and through multilateral cooperation will be critical.

Progress on the health SDGs was already too slow before the pandemic began—with huge health inequities persisting between countries and regions. This is highlighted by regional disparities in maternal deaths. Globally, while the number of maternal deaths dropped 35% between 2000 and 2017, sub-Saharan Africa and South Asia accounted for 86% of all maternal deaths.

Vaccines, equity, and data

So, what should the world be doing to protect the most vulnerable? A high priority is to do everything possible to ensure the equitable distribution of covid-19 vaccines through the international COVAX initiative. Access to therapeutics and testing, and to other vital tools and commodities such as personal protective equipment (PPE) and medical oxygen, also needs to be massively scaled up.

PMNCH lists other urgent priorities in its Call to Action on COVID-19 campaign. This has seven key goals: protecting access to sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) services; improving gender equality and access to sexual reproductive health and rights; improving quality care; supporting and protecting frontline health workers; ensuring stronger social safety nets; clean water and sanitation; and prevention of violence.

An equity based approach is essential to ending the covid-19 pandemic, but this depends on first gaining a detailed understanding of where inequities exist and who is affected. In May, the World Health Organization presented the 194 member states of the World Health Assembly with stark evidence of how badly the pandemic is affecting women’s, children’s, and adolescents’ health. It highlighted weaknesses in data systems, and especially the inability to monitor disruptions to essential health services in real time. To improve the volume and quality of health data dramatically, we strongly recommend expanding access to and use of digital technologies in health. These can be transformative, as we’ve already seen in Estonia. With the right infrastructure in place, they are a great equalizer, serving and uniting a whole country and enabling the most disadvantaged to access and shape health services.

We urge countries and the international community at large to recommit to the health and wellbeing of women, children, and adolescents. The pandemic has set progress back, but we owe it to the most vulnerable people in our world to get back on track and build back better and fairer. 

Helen Clark is the PMNCH board chair. She was prime minister of New Zealand from 1999–2008. From April 2009 she was administrator of the UN Development Programme, serving two terms.

Competing interests: none declared.

Kersti Kaljulaid is president of Estonia. Recently appointed the first global advocate of the United Nations Secretary-General for Every Woman Every Child (EWEC). In 2018-2020, Mme Kaljulaid was the co-chair to the High-Level Steering Group for EWEC. 

Competing interests: none declared.

Related

Originally published: BANK

Young women and pregnant women can effectively use vaginal rings and oral PrEP for HIV prevention

 

https://www.aidsmap.com/news/jul-2021/young-women-and-pregnant-women-can-effectively-use-vaginal-rings-and-oral-prep-hiv

Liz Highleyman

28 July 2021

Adolescent girls and young women can consistently use the dapivirine vaginal ring and daily pills for HIV pre-exposure prophylaxis (PrEP) when they receive adherence support, according to a study presented last week at the 11th International AIDS Society Conference on HIV Science (IAS 2021). Encouragingly, adherence to both methods was higher in this study than rates seen in prior trials. Another study found that both the ring and oral PrEP were safe for pregnant women, which to date has been an understudied population for HIV prevention.

IAS 2021

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"In many ways, these results exceeded even our own expectations, yet at the same time, it's not surprising to find that these young women have the capacity and desire to protect themselves against HIV," Dr Gonasagrie 'Lulu' Nair of Stellenbosch University in Cape Town, South Africa, said in a statement from the Microbicides Trials Network. "They simply need to feel empowered and have the agency to make choices based on what they feel is right for them."

In January 2021, the World Health Organization recommended the vaginal ring, a silicone device that slowly releases the non-nucleoside reverse transcriptase inhibitor dapivirine, as an additional prevention option for women at substantial risk for HIV.

A pair of phase III randomised clinical trials in sub-Saharan Africa, the Ring Study and ASPIRE, found that the ring reduced the risk of HIV infection by about 30%. An open-label extension of ASPIRE, known as HOPE, found that effectiveness rose to 39% with longer use. Two studies of oral PrEP using tenofovir disoproxil fumarate/emtricitabine (TDF/FTC; Truvada or generic equivalents) for women in Africa, VOICE and FEM-PrEP, found that the daily pills did not reduce the risk of infection more than a placebo.

These results were disappointing, given that oral PrEP is highly effective for gay and bisexual men and heterosexual couples. Further analysis showed that both the ring and oral PrEP worked well for women when adherence was high, but many African women – especially young women – had difficulty using the methods consistently. In VOICE and FEM-PrEP, less than 25% of young women maintained good adherence. In ASPIRE, the ring was 61% effective for women older than 25, only 10% effective for those younger than 25 and showed no efficacy for those 18 to 21.

But interim results from the REACH trial point to a more hopeful conclusion. This Microbicides Trials Network study, launched in February 2019, enrolled 247 adolescent girls and young women aged from 16 to 21 in South Africa, Uganda and Zimbabwe. The average age was 18 and more than a third were 16 or 17. They were not pregnant and were using reliable contraception.

Most of the participants were unmarried and 40% had previously been pregnant. Three-quarters had a secondary school education, with 37% currently in school; about one in five earned an income. Most (89%) reported having a primary sexual partner, 75% were aware of their partner's HIV status and 24% thought their primary partner had other partners. The women had an average of 2.5 sexual partners during the last three months and 35% had one or more sexually transmitted infections at baseline, with chlamydia being most common. While 7% said they were very worried about getting HIV, 39% said they were not at all worried.

The study aimed to assess the safety, adherence, acceptability and preference for the dapivirine ring and oral TDF/FTC. Using a crossover design, one group was randomly assigned to use the ring for six months (one ring per month) then switched to oral PrEP for six months. The second group used the methods in the opposite order. During the final six months, the women used the method of their choice, or neither.

Participants were offered a menu of adherence support including daily text message reminders, weekly check-ins by text or phone, pairing up with another participant as an adherence buddy, support groups and adherence counselling.

Nair presented interim findings after the first two six-month periods; at that point, most of the women (94.4%) had attended all study visits.

Both methods were generally safe and well-tolerated. About a third of participants reported adverse events related to the ring and about half reported side effects related to oral TDF/FTC. However, there were no serious adverse events with either method and no one stopped using the ring or PrEP pills for this reason.

The researchers estimated adherence based on the amount of residual dapivirine left in the returned rings or tenofovir drug levels in dried blood spots. Non-use or minimal use during the first 12 months was very uncommon, Nair said. Half the ring users (50.2%) achieved high use, 45.4% showed evidence of some use and just 4.4% showed no evidence of use. For oral TDF/FTC, the corresponding figures were 58.6% (four or more doses per week), 39.9% (one to three doses per week) and 1.5% (no tenofovir detected).

More news from IAS 2021

In terms of full compliance, however, the ring fared better. Half left the ring in place for a full month compared with less than a quarter who took at least six doses per week of TDF/FTC.

Moreover, the women reported a clear preference for the ring: 88.5% said the ring was acceptable while 63.9% said the same about oral TDF/FTC.

Although the study was not designed to evaluate effectiveness, Nair noted that there was just one new HIV infection, for an incidence rate of 0.5 per 100 person-years.

"Adherence to the ring and oral PrEP was higher than anticipated among African adolescent girls and young women. Both were well-tolerated and highly acceptable," the researchers concluded. "Adherence to both products can be achieved with tailored adherence support."

"What strikes me most about REACH is that not only are we seeing high adherence, but persistence appears to be high as well," said REACH protocol co-chair Professor Connie Celum of the University of Washington in Seattle. "Clearly, the ongoing support and individual attention paid to participants seems to make a difference. To see this kind of high adherence – it's pretty remarkable, especially during this time of COVID-19."

PrEP for pregnant women

A second study by the Microbicides Trial Network, dubbed DELIVER, evaluated the safety of the dapivirine vaginal ring and oral TDF/FTC in pregnant women.

DELIVER enrolled 150 women aged 18 to 40 in Malawi, South Africa, Uganda and Zimbabwe. The median age was 25 and nearly a third had a prior pregnancy. Of these, 101 were randomly assigned to use the monthly ring and 49 to use daily oral PrEP. They started using the methods during late pregnancy (about 36 to 38 weeks of gestation) and continued until delivery. The mothers and infants were then followed-up for six additional weeks.

Professor Bonus Makanani of the Malawi College of Medicine-Johns Hopkins University Research Project presented pregnancy outcomes for 141 participants.

Both prevention methods were found to be safe. Only one severe adverse event (nausea) was deemed related to TDF/FTC. No infants had severe adverse events linked to the methods.

Pregnancy complications were rare, with hypertensive disorders being the most common. Three women in the vaginal ring group and two in the TDF/FTC group had gestational hypertension (high blood pressure), and two in the TDF/FTC arm developed pre-eclampsia. Two women in each group experienced haemorrhage. One woman in the ring group and two in the TDF/FTC group had pre-term deliveries. There was one stillbirth and one newborn death, both in the TDF/FTC arm. These were comparable to the rates seen in other pregnant women at the clinics taking part in the study.

"In this first study of a long-acting HIV prevention agent in pregnancy, adverse pregnancy outcomes and complications were uncommon when the dapivirine vaginal ring and TDF/FTC were used in late pregnancy and were generally similar to rates observed in the communities where the study is being conducted," the researchers concluded. "These data support plans for subsequent investigation of safety among pregnant women using [the] dapivirine vaginal ring earlier in pregnancy."

Subsequent cohorts in the study will include 150 women who will start using the prevention methods at 30 to 35 weeks of gestation and 250 women who will do so starting at 12 to 29 weeks.

References

Nair G et al. Adherence to the dapivirine vaginal ring and oral PrEP among adolescent girls and young women in Africa: interim results from the REACH study. 11th IAS Conference on HIV Science, abstract OALC01LB01, 2021.

Makanani B et al. Prioritizing the evaluation of HIV prevention interventions in pregnancy: Interim results from a randomized, open-label safety trial of dapivirine vaginal ring and oral tenofovir disoproxil fumarate/emtricitabine use in late pregnancy. 11th IAS Conference on HIV Science, abstract PECLB26, 2021.

HIV has changed, but public knowledge and attitudes lag behind

https://www.aidsmap.com/news/jul-2021/hiv-has-changed-public-knowledge-and-attitudes-lag-behind

Mercy Shibemba

30 July 2021

A new report reveals patchy knowledge of HIV, low awareness of key developments like U=U and PrEP, and stigmatising perceptions of people living with HIV. The findings reveal “confusing and contradictory” views about HIV among the general public in the UK.

“The findings were not surprising, a little bit reassuring, but the report has just highlighted what we’ve always known and continue to experience in our daily lives,” commented advocate Rebecca Mbewe at the launch of the report yesterday.

The data comes from a National AIDS Trust and BritainThinks report on public knowledge and attitudes on HIV, which highlights differences across a range of demographic groups in the UK. BritainThinks conducted community stakeholder groups, held exploratory focus groups, conducted a nationally representative online survey of 3000 people and held deep dive focus groups to explore the key themes from the survey responses. They identified six key findings.

1. Most of the public don’t think or hear much about HIV.

Most participants reported feeling that they only ‘occasionally’ heard about HIV. TV programmes and films were reported as the most common way to hear about HIV, although just 21% of the public could recall one. One of the focus group participants shared:

“A lot of the adverts on TV and radio are about mental health and cancer, and don’t really concentrate on this at all. There’s not much awareness or education.”

Around six in ten people reported not having heard anything about HIV in the last six months. The most prominent difference amongst key demographics was that around two-thirds of both south Asian and White people reported that they had not heard anything about HIV, in comparison to 40% of Black people.

2. Knowledge of HIV is patchy amongst the general public.

Awareness of high-risk modes of transmission such as unprotected sex or sharing a syringe is high amongst the general public. However, 57% of the general public have a ‘middling’ knowledge of HIV transmission, commonly identifying at least one mode of transmission that carried no risk at all. The most frequently selected ‘no risk’ modes selected by the public were: standing on a used needle (61%), a blood transfusion in the UK (59%) and biting (36%).

More news from United Kingdom

South Asian people were significantly more likely to have a ‘lower than average’ knowledge of HIV transmission at 56%. Similarly, younger people (35%) and Londoners (32%) were also more likely to be in this category.

Public awareness of U=U is low, with 57% believing it is false that effective treatment prevents transmission of HIV. Few people were aware that most people living with HIV in the UK are on effective treatment and that this reduces transmission risk. Many were worried that U=U relies on people living with HIV consistently taking their treatment. There was a strong sense that it is “too good to be true”, with specific doubts about its real-world efficacy.

“People are not aware whether they can catch it or not catch it. People are not fully experts about this, I don’t think anyone is.”

Only a quarter of the general public believe that there is medicine available that can stop someone acquiring HIV. Awareness of PrEP and U=U was highest among gay and bisexual men and those who know someone living with HIV.

3. HIV continues to be seen as a serious health condition by the public.

Around 48% of the general public think of HIV as a serious health condition. Those most likely to agree were Black men (69%) and south Asian people (56%). However, there was a strong sense among the general public that HIV is a less urgent issue now than it had previously been.

“HIV is not as much of an issue as it used to be for UK society.”

Participants explained feeling this way because of:

• rarely hearing about HIV in the media, particularly in comparison to previous decades
• personally knowing someone living with HIV in the 80s or 90s, but not knowing anyone now
• hearing about advances in treatment for HIV, which mean the condition is now more manageable.

Some focus group participants felt that a ‘new narrative’ around HIV has started to cut through. Participants mentioned recent examples of information and content about HIV (such as the TV drama It’s a Sin) as ways to improve education and address stigma. In particular, depictions in TV and film, and celebrities and influencers talking about HIV, are seen as particularly vivid and engaging formats.

4. Most of the public say they are empathetic towards those living with HIV. However, sympathy and support is often qualified.

Around 85% of the public agree that people living with HIV deserve the same support and respect given to those with other health conditions. Those most likely to agree with this were those who recognise barriers against LGBT people, those with a high or middling knowledge of transmission, and those with a high or medium awareness of PrEP.

There are also key differences in racial demographics, with White and Black people significantly more likely to agree (86% and 88%) than south Asian people (75%). However, only a third of the public say they have sympathy for all people living with HIV, regardless of how they acquired it. Around a quarter of the public agree that a family member telling them that they are living with HIV would negatively impact their relationship with them.

“I think there is a bit of a difference sadly… someone who is born with it, it is out of their control. Someone who has acquired it, is it sex without a condom, or an exchange of bodily fluid, it could be because they’re not protecting themselves.”

5. Stigma towards those living with HIV continues to exist and is felt to be deeply entrenched.

The majority of the public believe society is more positive towards people living with HIV than it has been in the past. However, LGBT people and those who personally know someone living with HIV were most likely to disagree with this statement.

“Everything you hear about HIV is negative. Until they change the narrative, that’s not going to change.”

In the focus groups, many were concerned that people living with HIV are still stigmatised. This belief was particularly strong in the focus groups with south Asian people. Over four fifths of the general public believe that people living with HIV still frequently face negative judgement from others.

Stigma centred around three main themes:

• acquiring HIV is often linked with ‘irresponsible’ behaviours
• low knowledge of transmission routes, treatment and outcomes, leading to negative misassumptions about HIV
• negative attitudes towards LGBT people, who are closely associated with HIV.  

However, many in the focus groups were hesitant to share their unfiltered views about people living with HIV. This indicated a strong element of social desirability.

6. Most of the public say they are uncomfortable with having a sexual relationship with someone living with HIV.

Only 3% of the public indicated that they would be comfortable having a sexual relationship with someone living with HIV. The concerns about this centred on two themes: risk of acquiring HIV, and stigma and judgement from others. A specific focus was the safety of future children, which participants assumed would also acquire HIV.

“People living with HIV should always tell any sexual partners, even if they definitely can’t pass it on because they are on effective treatment.”

A large majority of the public think that people living with HIV should always tell sexual partners their HIV status. Participants expressed that there is a risk to personal health and that people should be able to make an informed decision about whether or not to continue with the relationship or sexual encounter.

However, there was sympathy for people living with HIV and the complexities of having to navigate this. It was recognised that this could be a cause for stress and anxiety and that there could be situations in which personal safety is put at risk because of sharing. 

Knowing key information about HIV decreases some discomfort about relationships with people living with HIV. Some focus group participants felt that key messages such as U=U were important for reducing stigma and that they should be shared more widely. It was felt that that this would encourage people to want to find out more and be more open to the idea of a relationship with someone living with HIV.

“Knowing there’s something that almost eradicates it [makes a difference].”

Speaking at the report launch, Professor Jane Anderson of Fast-Track Cities London said, “This is only the start, we know much more know [now] about what we might need to challenge, which is an important head start.”

References

National AIDS Trust and Fast-Track Cities London. HIV: Public knowledge and attitudes, 
July 2021.

Edo socio-cultural group lauds Gov. Obaseki over anti-land grabbing law

By Isaac Eranga

Chief Dr Omogiade Enoyiogiere Edokpolo

Benin City: The Edo indigenous leader and founder of Edo Progressive Indigenous Association (EPIA)- Chief Dr Bishop Omogiade Enoyiogiere  Edokpolo has lauded the Edo State governor, Godwin Obaseki, for heeding to his plea and that of Edo indigenous people, by  assenting on the bill amending private property protection law of 2017 into the new Edo State private property protection law of 2021. This new law apart from banning the activities of community development association, also put an end to the activities of the Okhaigele. 

According to Bishop Omogiade Edokpolo, "the ousting of the activities of  Okhaigele in Benin kingdom, will help fast track  development in the kingdom. When the governor put an end to the activities of CDAs, the Okhaigele took over the proscribed CDA's activities and turned themselves to warlords in their various communities, thereby confiscating landed property belonging to individuals.

"The same duty they were doing as CDA, was what they were also doing as Okhaigele. At a time when it seems the land grab act has been abandoned, this amendment surprising came on board. With this amendment, both local and international investors in the diaspora will now have trust in the land act administration of Edo State. 

"Local and international investors in the dispora had earlier threatened a rethink in investing in the State. This was contained in a statement signed by the President and Founder of Edo Indigenous Movement (EIM), also known as Edo Progressive Indigenous Association (EPIA) and made available to newsmen in Benin City.

"The Edo indigenous investors and foreign investors in the diaspora made their position known while looking at  the attack meted on the leader of Edo indigenous movement who has been campaigning to attract Edo indigenes and nonindigenes in the diaspora to come to Edo State to invest, assuring them that Edo is a safe haven to invest. The investors opined that if the Edo indigenous leader could be a victim of land grab act and in the process assulted by his fellow indigenes, they have no option than to have a rethink about investing in Edo State. 

"This was a clarion call to Governor Obaseki, traditional rulers, and the various security agencies,  to reassure the investors and Edo indigenous people living in the diaspora who are concerned about the high level of insecurity in the State, that the State is now safe for them to invest. In measuring this assurance, the people needed a clear prove of the enforcement of the land grab act. This should serve as a renewed that the Governor would put in enforcing the land grab act", the statement said.

"However, the Police in Edo State had proved that Edo can be a safe place for investors to put their money, by arraigning in court those land grabbers that assaulted me in Benin in order to confiscate my landed property. The amendment of the 2017 private property protection law, has made Edo State safer for investors to do legitimate business", said Dr. Edokpolo.

While assenting to the amendment of the private property protection law, Gov. Obaseki said  the law affects law and order in the State, saying the law not only ban the Community Development Associations (CDAs) but also all sorts of splinter groups like Okhaigele or  people who have come up to forcefully take other people's landed properties in their communities.

The Governor said a special court shall be set up to swiftly try offenders and if guilty, they will face the consequences.

WHO warns that HIV infection increases risk of severe and critical COVID-19

A new WHO report confirms that HIV infection is a significant independent risk factor for both severe/ critical COVID-19 presentation at hospital admission and in-hospital mortality. Overall, nearly a quarter (23.1%) of all people living with HIV who were hospitalized with COVID-19, died. 

The report is based on clinical surveillance data from 37 countries regarding the risk of poor COVID-19 outcomes in people living with HIV (PLHIV) admitted to hospital for COVID-19. 

It found that the risk of developing severe or fatal COVID-19 was 30% greater in PLHIV compared to people without HIV infection.  Underlying conditions such as diabetes and hypertension are common among PLHIV. Among male PLHIV over the age of 65 years, diabetes and hypertension were associated with an increased risk of more severe and fatal COVID-19. These conditions are known to put people at increased risk of severe disease and death. 

This highlights the need for PLHIV to stay as healthy as possible, regularly access and take their ARV medications and prevent and manage underlying conditions. This also means that people living with HIV – independent of their immune status - should be prioritized for vaccination in most settings. An informal WHO poll revealed that out of 100 countries with information, 40 countries have prioritized PLHIV for COVID-19 vaccination.

The analysis is informed by data from WHO’s Global Clinical Platform for COVID-19, which collects individual-level clinical data and characterizes COVID-19 among individuals hospitalized with suspected or confirmed SARS-CoV-2 infection around the globe.

Later this week, WHO will also release updated Guidelines on HIV prevention, testing, treatment, service delivery and monitoring. These guidelines provide over 200 evidence-informed recommendations and good practice statements for a public health response to the prevention, testing, and treatment of people living with HIV.  These recommendations help to ensure that people with HIV can start and continue treatment during times of service disruption as a consequence of the COVID-19 pandemic.

“The report released today will have important policy implications – providing data to confirm that HIV is a risk for poor outcomes from COVID-19 – and increases the urgency to see all PLHIV on treatment and with access to COVID-19 vaccinations." said Dr Meg Doherty, Director of WHO’s Global HIV, Hepatitis and STI Programmes.

HIV continues to be a major global public health issue, having claimed 34.7 million lives so far. To reach the new proposed global 95–95–95 targets set by UNAIDS, countries need to redouble  efforts to avoid increasing HIV infections due to HIV service disruptions during COVID-19 thereby slowing down the public health response to HIV.