Monday, August 31, 2009

NY Times: Hope in South Africa

A thought provoking editorial, "Hope in South Africa", appears in today's NY Times on the tide change in the South African government's approach to tackling HIV and tuberculosis after years of denial and evidence-proof policy. The piece minces few words about the former Mbeki administration's handling of the crisis: 
"Thousands of Africans were needlessly sickened and died. And the most influential country in sub-Saharan Africa squandered the opportunity to contain the AIDS epidemic. Although it has less than 1 percent of the world’s population, South Africa now accounts for 17 percent of the world’s burden of H.I.V. infection."

Sunday, August 30, 2009

Friday, August 28, 2009

35 days and counting

It's hard to believe that I'm just 5 weeks out from the start of Enduro Africa. The lengthy to-do list that I developed 8 months ago has been whittled to a final, manageable few items. Flights and hotel are set, and all of my gear has arrived. This week's items, flu shots and travel insurance, are now squared away.  
Photo Credit: Enduro Africa. 
This leaves me to focus on gearing up for a final pledge drive, and planning a gathering to thank friends and family for their encouragement and support. More on that soon.

Thursday, August 27, 2009

Lancet: Health in South Africa

The Lancet and several South African research centers have published this week a fascinating collection of articles on the country's endangered health status and health infrastructure. Together, they examine the historical context that has contributed to South Africa's current predicament, explore its most pressing threats to health, and prioritize the way forward.

For a quick read, the executive summary offers a brief and succinct overview of the country's health challenges and underscores the need for a multi-sectoral plan of action for government, universities, and civil society alike.

Key messages
1. Problem of colliding epidemics: 15 years after its first democratic election and liberation from apartheid, South Africa faces colliding epidemics – explosive HIV and TB epidemics, a high burden of chronic illness, mental health disorders, injury and violence-related deaths as well as a silent epidemic of maternal, neonatal, and child mortality. South Africa’s per capita health burden is the highest of any middle-income country in the world. The brunt of all these disease burdens is still carried by the poorest families.
2. Paradox of supportive policies with moderate spending on health, yet worsening health outcomes. The extra health burden means more investment in health systems, at least in the medium term, and more effective implementation and effective management at all levels is needed.
3. Pressure on the health system, especially at district level to cope with the heavy burden of disease. There is also a disconnect between the public and private sectors. The priorities are:
· prevention - whether for infections (notably HIV and TB), non-communicable diseases, injury, or for maternal, neonatal and child health (especially prevention of mother-to-child HIV transmission [PMTCT] and improved newborn health).
· primary health care that is integrated and effective with strong management and capable use of data.
· practising widespread scale up of successful innovations and relevant and rigorous clinical research.
4. Potential for change: South Africa could be on track for the Millennium Development Goals (MDGs) and reduce other epidemics with strategic investment, implementation, leadership and accountability for public and private sectors. Civil society has been key in promoting action for HIV/AIDS and could play a more powerful role for the wider health agenda in South Africa.

Take a look at the series

Tuesday, August 25, 2009

Pre-ride party on 26 Sep Cheltenham

This just in.
--- Forwarded Message ----
From: Nick Stubbs
To: adforsyth @
Sent: Tuesday, August 25, 2009 4:18:11 PM
Subject: [Andrew's.Enduro.Africa.2009] New comment on Enduro Africa T-Shirts are here!!.

Nick Stubbs has left a new comment on your post "
Enduro Africa T-Shirts are here!!":

Hi Andrew,

My name is Nick Stubbs and I am riding in the second leg of Enduro Africa 2009. I hope you don't mind me posting this here but if you could get any other EA 2009 riders interested, that would be great...

Myself and another EA 2009 rider are organising a get together for any and all participants to share notes and swap last minute ideas regarding this amazing trip. Of course, the chance to have a few beers and meet our fellow riders is of paramount importance too!

We are meeting on Saturday the 26th September, at 1pm in TGI Fridays in Cheltenham. It is next door to a very handy Premiere Inn, close to the railway station and the M5.

We will be staying overnight on the Saturday and if anyone is interested in meeting up with the rest of us from EA 2009, please get in touch with one of us on:

Nick: 07518 359223 - nick_stubbs @ (no spaces)
Mike: 07917 174750 - mike.poxon @ (no spaces)

Thanks and hopefully see you there!

Monday, August 24, 2009

HIV in the News - Mon, 24 Aug 2009

Sunday, August 23, 2009

Enduro America, part II

I’m on the road again this week, this time at the National HIV Prevention Conference (NHPC) in Atlanta. The updates so far have me thinking about the need for an Enduro America, which would be a long, awareness-raising motorcycle ride through the rural Southeast, heading north along the coast and through many of the 20% of counties that account for 80% of the cases of AIDS.

Why would such a thing be needed? Here are some facts about HIV in the U.S.:

  • An estimated 56,000 people contract HIV in the U.S. every year.
  • Over 1 million people in the US are living with the virus that causes AIDS.
  • Many Americans remain at risk for HIV, especially Latinos, African Americans, and gay and bisexual men of all ethnicities.
  • Approximately 20% of persons with HIV don’t know it and they transmit the virus at much higher rates than those with diagnosed HIV infection.

Worse, as the CDC’s Kevin Fenton notes,

studies show that the level of concern about HIV in America has declined, and some of the populations at highest risk do not recognize their risk or simply believe HIV is no longer a serious health threat.

An awareness-raising motorcycle trek through the U.S. might also help convince the Obama administration to make good on its plans for a national HIV prevention strategy, similar to the sort required of all recipients of President's Emergency Plan For AIDS Relief (PEPFAR) funds, and to put the necessary resources into effect.

In the meantime, here’s a map of the U.S. counties with the highest AIDS prevalence that can inform a route for a future Enduro America:

View Enduro America -- route map in a larger map

Thursday, August 20, 2009

UNAIDS Photo stories

Portraits of Commitment
© 2008 UNAIDS. All rights reserved.

The Love Factory - Preventing HIV, preserving the environment
© 2007 UNAIDS. All rights reserved. Photos by John Spaull

Stars Against AIDS
© 2008 UNAIDS/Serge Golovach.

Nairobi 2007
© 2007 UNAIDS. All rights reserved. Photos by Damien Schuman.

Monday, August 17, 2009

Bang up job there, fellas

A recent UNAIDS report on HIV transmission was released last week at the 9th International Congress on AIDS in Asia and the Pacific in Bali, raising new concerns about the trajectory of HIV infection in the region. According to the report, an estimated 50 million women may be at risk for HIV infection by virtue of a single risk factor: Being married or in a long-term relationship with men who engage in high-risk sexual behaviors.

It is estimated that more than 90% of the 1.7 million women living with HIV in Asia became infected from their husbands or partners while in long-term relationships. By 2008, women constituted 35% of all adult HIV infections in Asia, up from 17% in 1990.

In a similar vein, a study in Northern Tanzania found that women whose partners were certainly or possibly involved in concurrent partnerships were 36% more likely to be HIV-infected than similar women with truly monogamous partners.

Increasingly, it appears that the epidemic in Asia is on a similar track as the one that has devastated sub-Saharan Africa, including South Africa, given parallels in gender norms and violence, unequal access to prevention, stigma and discrimination, and other factors.

Meanwhile, agencies in Nigeria are advocating marriage between persons living with HIV as a strategy for curbing onward transmission. Among several problems with such policies are their seemingly evidence-proof assumptions, including the following:

If someone having HIV marries another HIV-AIDS person, that means there will be no HIV transmission to another negative person," said Rilwanu Mohammed, the Bauchi State Agency for the Control of AIDS, Tuberculosis and Malaria (BACATMA) chairman.

Instead of biting the bullet and ensuring the widespread accessibility of HIV testing, scaling up effective prevention interventions (including those tailored especially to men), and providing treatment and care for those living with the virus, societies - including my own - continue to try to find easier ways around the problem.

And so it goes.

Thursday, August 13, 2009

Photo Series of Supporters: Birgit & Elizabeth

Birgit & Elizabeth
Engineer & School Psychologist

Tuesday, August 11, 2009

Rider puts body on line for science, donations - and fails

This week, I had hoped to participate in a promising H1N1 vaccine trial being conducted at the University of Maryland School of Medicine that is testing the immunogenicity and efficacy of two doses of a vaccine that may be used later this year to prevent infections and to save lives. But I got punted out. And not for the reasons you might have thought.

In fact, I screened out and wasn’t allowed to enroll because I was recently vaccinated against hepatitis A and typhoid as part of my travel preparations for Enduro Africa. Among the exclusion criteria was vaccination with live or inactivated viruses within 2 – 4 weeks of the initial dose. So they tossed me during the screening phase, with only free parking to show for my effort.

If I had planned differently and hadn’t been midway through my travel vaccinations, I might have skipped them in favor of receiving an H1N1 vaccine that is already approved for use in the EU.

Why? Because, as recent news and the design of the trial itself suggested, my chances of exposure to H1N1 are probably greater here in the States than are the chances of running into hep A and typhoid on an 8-day trip to modern South Africa.

In fact, most of the EA cohort will be departing from Heathrow, a known H1N1 hotspot due to trans-atlantic air travel from the Americas. Surely, one of them will pick up a little something enroute, and I don’t mean the cute, huggable variety.

Further, the CDC is concerned that a variant of H1N1 is headed back to the northern hemisphere and is likely to “result in a particularly severe flu season this year.” It is already stepping up its information campaigns and guidance to schools and public health departments. Getting vaccinated early could have conferred considerable personal and social benefits via herd immunity.

And in this case, completing the trial would have meant getting paid $600 to be vaccinated, which I had planned to donate to Enduro Africa. Fail.

Now, why did it seem more reasonable to get travel vaccinations (and pay $210 out of pocket in the process) for very low probability events (exposure to hep A, typhoid) than to get a vaccination against a high probability event (exposure to H1N1), and in the process help advance the testing of a product that could save lives, including my own?

I’m not certain, but I’d wager that it was due to the sorts of cognitive biases that cause all of us to be predictably irrational in many areas of life, not just ones like these. Sure, I’d have to factor in the severity and consequences of getting hep A or typhoid against H1N1 to be sure.

But I can tell you that I already wish I could hit “reset” and play this hand again.

Wednesday, August 5, 2009

$210.91 (or more) for this??

At present, the U.S. is in the midst of a rather fierce ideological battle on the topic of health care. On the right, we have freemarketeers who prefer to give Wall Street even greater influence over a system wherein profits trump patients. On the left, we have progressives who believe in a role for government in keeping healthcare accessible, cost effective, and top quality (e.g., Medicare, Veterans Affairs). And the fog of war is obscuring many simple, verifiable facts.

What's the relevance to Enduro Africa, you ask? Recall that I recently went in for preventive medical care in anticipation of traveling to rural South Africa, where there is a slight risk of exposure to things like Hepatitis A, typhoid, malaria, and other nasties. With excellent health insurance in hand, here's what it cost me to get inoculated here in the U.S.:
  • Typhoid vaccine (4 pills): $42.03
  • Anti-malarials (25 pills): $25.00
  • Hepatitis A vaccine (2880 ml): $128.88
  • Physician office co-pays (3 visits): $15
That comes to $210.91. And I pay only a small fraction of the actual costs, which could be many times higher. Just thinking about these exorbitant fees makes me feel warm and fuzzy all over -- or is that one of the side effects?

Monday, August 3, 2009

Off-road Rider Gear, Part II

Last week, the rest of my riding gear showed up, including helmet, goggles, and chest and knee protection. A few extras also arrived, such as extra goggle lenses and hot weather socks for the monster motocross boots I'm taking.

I'll plan to use the Camelbak I always use for long bike rides, which has plenty of capacity for water and assorted gear (wallet, tools, phone, energy bars). And I have a set of rubberized, prescription glasses on order, something I should have gotten years ago for mountain biking.

Taken together, this should largely complete the essential gear recommended by Enduro Africa organizers. As promised, I'll be sure to post a picture of me all suited up, as soon as my better half returns from her kayaking expedition in California.