The APRP was an affiliate of Harvard University from August 2007 through April 2010 under a grant from the John Templeton Foundation. All content is archived as of June 1, 2010.



April 23, 2009

APRP NEWS & EVENTS

Click on link to access article.

1. APRP co-hosts two-day meeting on multiple and concurrent partnerships with UNAIDS and World Bank in Gaborone, Botswana

2. Consensus document on multiple and concurrent partnerships (MCP) produced by UNAIDS with input from Harvard APRP, World Bank, and other experts

3. Dr. Edward Green and APRP Affiliate Dr. Norman Hearst respond to media criticism of Pope Benedict XVI's comments on AIDS prevention and condoms

4. Dr. Daniel Halperin comments on HIV rate in Washington, DC

RESEARCH

5. Study launched of "Current Attitudes and Practices Regarding HIV/AIDS Prevention in Poor Peri-Urban Neighborhoods of Kampala, Uganda"

6. Dr. Timothy Mah completes qualitative assessment on most-at-risk populations in The Gambia

PUBLICATIONS AND PRESENTATIONS BY APRP RESEARCHERS

7. Dr. Green, Dr. Mah, Allison Ruark, and Dr. Hearst publish Commentary in Studies in Family Planning: "A Framework of Sexual Partnerships: Risks and Implications for HIV Prevention in Africa"

8. Dr. Halperin and Ms. Ruark publish letters to The Lancet on combination HIV prevention and HIV testing and treatment for HIV prevention

9. Dr. Halperin and Ms. Ruark critique Robert Thornton's book Unimagined Community: Sex, Networks and AIDS in Uganda and South Africa in Wilson Quarterly

10. Presentations


APRP NEWS & EVENTS

1. APRP co-hosts two-day meeting on multiple and concurrent partnerships with UNAIDS and World Bank in Gaborone, Botswana

Jointly with UNAIDS and the World Bank, the Harvard APRP held a two-day meeting on Addressing Multiple and Concurrent Partnerships in Southern Africa: Developing Guidance for Bold Actions, January 28-29, 2009 in Gaborone, Botswana. This meeting brought together more than 40 representatives from various organizations working in the southern Africa region, including program implementers from governments, NGOs, and community- and faith-based organizations, in order to share program experiences and move forward in establishing best practices in addressing MCP.

The meeting achieved its goal of developing a consensus document to guide communication around multiple and concurrent partnerships in the Southern Africa region. Click here to view this document (which was produced by UNAIDS with key input from the Harvard APRP, World Bank, and other experts), and other presentations from the meeting.

2. Consensus document on multiple and concurrent partnerships (MCP) produced by UNAIDS with input from Harvard APRP, World Bank, and other experts

This concise guidance document arose "from recognition of the need for regional guidance on the principles and good practice for MCP campaigning to assist national programmes, in particular, to strengthen HIV prevention efforts for MCP reduction." This document was produced by UNAIDS with key input from the Harvard APRP, World Bank, and other experts.

According to the guidance, "To maximize prevention outcomes around MCP the following two outcomes need to be prioritized:

  • First Priority: A reduction in multiple and concurrent partnerships– through social and behavioural change and, where feasible, through addressing structural factors (such as lengthy separation of partners) that increase the likelihood of MCP.
  • Second Priority: A reduction in the transmission of HIV within multiple and concurrent partnerships as well as within known discordant relationships – including through consistent correct male or female condom use, male circumcision, HIV testing (though antibody tests during the acute infection period are generally negative) and treatment adherence."

The document also listed a number of strategic principles to guide MCP communication and programs, and the individual and societal transformation that must take place to reduce the prevalence of MCP and ultimately HIV incidence in the region.

The guidance was featured at a March 31 UNAIDS-sponsored satellite session at the South African AIDS Conference, held in Durban, South Africa.

Click on http://www.unaidsrstesa.org/files/MCP Guidance.pdf (original link) to view the complete guidance document.

3. Dr. Edward Green and APRP Affiliate Dr. Norman Hearst respond to media criticism of Pope Benedict XVI's comments on AIDS prevention and condoms

Pope Benedict XVI's March 17 statement (while on a flight to Africa) that, "If the soul is lacking, if Africans do not help one another, the scourge [of HIV] cannot be resolved by distributing condoms; quite the contrary, we risk worsening the problem," set off a firestorm of protest and controversy in the media and public health communities.

Dr. Green responded to this controversy with a March 29, 2009 Op-Ed in The Washington Post, "The Pope May Be Right". Dr. Green argued that empirical data supported the Pope, and that condoms have not worked as a primary HIV-prevention measure in Africa. Green argued that the tendency of people in steady relationships to not use condoms (as in multiple, concurrent partnerships, believed to be especially efficient in spreading HIV in Africa), and the "risk compensation" phenomenon ("if somebody is using a certain technology to reduce risk, a phenomenon actually occurs where people are willing to take on greater risk"), may account for the failure of condoms to reduce HIV infections in Africa. Green concludes, "So what has worked in Africa? Strategies that break up... sexual networks -- or, in plain language, faithful mutual monogamy or at least reduction in numbers of partners, especially concurrent ones."

Dr. Green was interviewed about the Pope's remarks by BBC Northern Ireland on Mar 29, 2009 (click here to view the transcript), on Al Jazeera TV (March 22), on CBS Radio (Dom Giordana Show, WPHT Philadelphia, March 24), and on Sirius XM Radio (March 25). APRP Affiliate Dr. Norman Hearst appeared on the April 15 San Francisco/Bay Area Karel Show (click here to listen) and on .

A letter responding to a Lancet editorial on the Pope's remarks, has been accepted for publication by The Lancet (authored by Dr. Green and Dr. Hearst).

Other articles in which Dr. Green was discussed or cited include:

African AIDS: The facts that Demolish the Myths (Michael Cook, MercatorNet.com, 21 March 2009)

Harvard Aids expert says Pope 'correct' on condoms and spread of HIV (Bess Twiston Davies, UK Times Online, 27 March 2009)

Harvard AIDS Expert Says Pope is Correct on Condom Distribution Making AIDS Worse (John-Henry Westen, LifeSiteNews.com, 19 March 2009) [this article also contains a more complete transcript of the Pope's original comments]

From St. Peter's Square to Harvard Square (Kathryn Jean Lopez, National Review online, 19 March 2009)

HSPH Prof Arouses Condom Controversy (Emma Benitende, The Harvard Crimson, 31 March 2009)

The Politics of Condoms (Christopher B. Lacaria, The Harvard Crimson, 16 April 2009)

back to top

4.  Dr. Daniel Halperin comments on HIV rate in Washington, DC

Dr. Halperin appeared on the March 17 edition of the NPR radio show "The Takeaway" to discuss a recent report that 3% of Washington, D.C. residents are infected with HIV/AIDS.

Click here to listen to the show.

back to top

RESEARCH

5. Study launched of "Current Attitudes and Practices Regarding HIV/AIDS Prevention in Poor Peri-Urban Neighborhoods of Kampala, Uganda"

Principal Investigator Dr. Green, along with Dr. Hearst and researchers at Makerere University (Kampala, Uganda), have launched a study of "Current Attitudes and Practices Regarding HIV/AIDS Prevention in Poor Peri-Urban Neighborhoods of Kampala, Uganda."

While Uganda has in the past achieved remarkable success against HIV, there is evidence that these gains may be stagnating and that HIV risk behaviors and new infections may be on the increase. This study attempts to assess, using qualitative and quantitative methods, the current prevalence of various HIV-risk behaviors, as well as attitudes towards HIV prevention in a poor peri-urban neighborhood of Kampala, Uganda. The study will attempt to answer the question of whether the following variables could be behind trends towards riskier sexual behavior: 1) fewer or weaker interventions targeting multi-partner sex; 2) disinhibition due to ART availability or more widespread use of risk reduction technologies; 3) “prevention fatigue”; and 4) less fear of the consequences of HIV infection.

Fieldwork is currently being performed under the supervision of Dr. Moses Kamya and Ms. Phoebe Kajubi of Makerere University (and both APRP Affiliates).

back to top

6. Dr. Timothy Mah completes qualitative assessment on most-at-risk populations in Gambia

In September 2008, Dr. Mah (then a researcher with the APRP) traveled to Gambia to lead a World Bank AIDS Strategy and Action Plan study on HIV and most-at-risk populations. The researchers conducted focus groups and interviews, with the aim of providing an evidence-base for the drafting of the next five-year strategic plan. Dr. Mah's report is now available and can be accessed here.

PRESENTATIONS BY APRP RESEARCHERS

7. Dr. Green, Dr. Mah, Allison Ruark, and Dr. Hearst publish Commentary in Studies in Family Planning: "A Framework of Sexual Partnerships: Risks and Implications for HIV Prevention in Africa"

In this commentary, Green et al state, "The global diversity of HIV epidemics can be explained in part by types and patterns of sexual partnerships. We offer a typology of sexual partnerships that corresponds to varying levels of HIVtransmission risk to help guide thinking about appropriate behavioral interventions, particularly in the epidemics of sub-Saharan Africa. Declines in HIV prevalence have been associated with reductions in numbers of sex partners, whereas many other prevention strategies have not been demonstrated to reduce HIV transmission at a population level. We suggest a reorientation of current prevention efforts, based on the epidemiology of sexually transmitted HIV epidemics and trends in sexual behavior change. Concurrent sexual partnerships are likely to play a large role in transmission dynamics in the generalized epidemics of East and Southern Africa, and should be addressed through improved behavior-change interventions."

Green EC, Mah TL, Ruark A, Hearst N. A Framework of Sexual Partnerships: Risks and Implications for HIV Prevention in Africa. Studies in Family Planning 2009; 40(1): 63-70.

back to top

8. Dr. Halperin and Ms. Ruark publish letters to The Lancet on combination HIV prevention, HIV testing and treatment for HIV prevention

In a letter to The Lancet, "Combination HIV prevention must be based on evidence", Daniel Halperin argues "Although the general notion of 'comprehensive prevention' is appealing, the specific elements of the mix are essential." This letter was in response to a critique by Merson et al. of Wilson and Halperin's earlier article, ' “Know your epidemic, know your response”: a useful approach, if we get it right.'

In "Universal voluntary HIV testing and immediate antiretroviral therapy", Allison Ruark and Daniel Halperin (with co-authors Jim Shelton, Maria Wawer, and Ron Gray) challenge an article by Granich et al which claimed (based on modeling) that universal testing and treatment could succeed as an HIV prevention strategy in a generalized epidemic such as South Africa's.

back to top

9. Dr. Halperin and Ms. Ruark critique Robert Thornton's book Unimagined Community: Sex, Networks and AIDS in Uganda and South Africa in Wilson Quarterly

Ms. Ruark and Dr. Halperin critiqued Robert Thornton's 2008 book Unimagined Community: Sex, Networks, and AIDS in Uganda and South Africa in the Winter 2009 edition of the Wilson Quarterly. While Mr. Thornton offers some insightful descriptions of the divergent HIV epidemics in Uganda (where HIV has declined) and South Africa (where it has not), Ruark and Halperin criticize him for failing to discuss the most important difference between the two countries: the significant sexual behavior change in Uganda (particularly reduction in number of sexual partners), and the lack of such change in South Africa. They conclude, "The prescription for reducing the sexual transmission of HIV in these epidemics is clear: Sexual networks must be broken up, primarily through reductions in number of sexual partners. The declines in HIV infection not only in Uganda but also more recently in countries such as Kenya, Zimbabwe, Ethiopia, and Malawi suggest that it is possible to promote such changes successfully."

Click here to read the review in the Wilson Quarterly.

10. Presentations

Dr. Halperin has given recent presentations at Harvard Medical School's 4th Annual Student AIDS Conference on January 23, at University of California Berkeley's Advancing Prevention Technologies for Sexual and Reproductive Health: A Strategy Symposium on March 24-25, and to a number of AIDS organizations and programs during an April trip to Mozambique.

In May Dr. Green will present a poster on "Indigenous institutions & leaders in African AIDS prevention" at the Global Health Council conference in Washington, DC (May 26-30), and Ms. Ruark will give a presentation on research and policy advances in efforts to reduce multiple and concurrent partnerships at the Christian Connections for International Health conference in Frederick, VA (May 23-25).

 
 
 This is an archived website as of June 1, 2010. Some of the links above may no longer be available.