The Los Angeles Times on Monday examined the recent expansion of birth control options in the U.S., including oral contraceptives that can reduce or eliminate monthly menstrual periods. FDA earlier this year approved the oral contraceptives YAZ and Loestrin 24 Fe, which are taken once a day for 24 days followed by four days of placebo pills to induce a menstrual period (Roan, Los Angeles Times, 7/10). Most oral contraceptives are taken for 21 consecutive days followed by seven days of placebo pills. Loestrin is manufactured by Warner Chilcott, and Berlex, a subsidiary of Schering, produces YAZ (Kaiser Daily Women's Health Policy Report, 3/30). FDA also is considering an application to approve the continuous daily oral contraceptive Lybrel and a new contraceptive implant Implanon, which is a single rod placed under the skin of the arm that can prevent pregnancy for three years. According to the Times, the "shift to continuous-use oral contraceptives acknowledges a little known fact: Women don't need to have periods." Some public health experts say taking oral contraceptives daily with no break is safe, will not effect fertility and will not be harmful to fetuses if taken early during a pregnancy. However, some public health experts say there is little data on continuous-use oral contraceptives, the Times reports. According to the Times, the "level of hormones in birth control pills has dropped dramatically in the last two decades." As a result, taking an active pill 365 days a year is considered safe, according to David Portman, director of the Columbus, Ohio, Center for Women's Health Research. Still, researchers continue to study how to reduce the risks associated with hormonal contraceptives, including blood clots, heart attacks, strokes, liver disease and cancers of the breast or sex organs (Los Angeles Times, 7/10).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
вторник, 27 марта 2012 г.
вторник, 20 марта 2012 г.
mtm's P16/Ki-67 Dual Immuno-Staining Identifies High-Grade Cervical Disease In ASC-US And LSIL With High Sensitivity And Specificity
mtm laboratories, a privately held diagnostics company developing, manufacturing and globally commercializing in vitro diagnostics for cervical cancer early detection and diagnosis, today announced the publication of a new paper showing that dual staining for p16 and Ki-67 can pinpoint the underlying high-grade cervical disease with a high degree of sensitivity and specificity in women with ASC-US or LSIL cytology results. These are a group of patients currently poorly served by existing screening technologies, with too many referred for unnecessary colposcopy. The paper, which details the EEMAPS study results, has been published electronically in Cancer Cytopathology on March 25, 2011 ahead of print.
The EEMAPS study used the advanced biomarker combination CINtec® PLUS, which was launched by mtm in early 2010 in Europe. Residual materials from a previous pan-European retrospective cytology study were used to prepare additional slides for p16 and Ki-67 dual immuno-staining. In total, 361 ASC-US and 415 LSIL cases with corresponding biopsy results and HPV test results were available for dual stain cytology analysis. The presence of one or more dual-stained cervical epithelial cell(s) defined a positive test result with CINtec® PLUS, independent from morphology interpretation. The clinical results showed that the sensitivity of the dual stain for high-grade disease was 92.2% (71/77) for ASC-US, and 94.2% (129/137) for LSIL cases, which is equivalent to the sensitivity results obtained for HPV testing. However, specificity was significantly higher for CINtec® PLUS as compared to HPV testing; 80.6% vs. 36.3% for ASC-US and 68.0% vs. 19.1% for LSIL.
"mtm's CINtec® PLUS is the first test that provides high sensitivity and high specificity for underlying high-grade cervical disease in a single product, irrespective of women's age and the individual HR-HPV genotype," commented Bob Silverman, CEO of mtm laboratories. "Because the test can pinpoint which women are most likely to have cervical disease and need follow up, this should reduce a large number of the unnecessary, uncomfortable and costly colposcopies carried out on women with ASC-US or LSIL."
ASC-US and LSIL are definitions for equivocal and mild to moderate abnormal cytology findings on Pap tests, and may represent 5-8% of all cervical cytology cases. While most of these findings are negative for high-grade disease, 15-20% of LSIL and 6-10% of ASC-US will harbour high-grade disease. Together, these two categories of cytology represent the source for about 60% of all cases of high-grade cervical disease in women. Unfortunately, these Pap cytology results are not adequate predictors in determining which ASC-US or LSIL cases require intervention due to the low rates of underlying disease. Adjunctive HPV testing also has limitations due to unsatisfactory specificity.
The title of the publication and the authors are as follows:
Schmidt D, Bergeron C, Denton KJ, Ridder R, for the European CINtec Cytology Study Group. p16/Ki-67 Dual-Stain Cytology in the Triage of ASCUS and LSIL Papanicolaou Cytology. Cancer Cytopathol (2011); 119, DOI: 10.1002/cncy.20140
Notes
CINtec® PLUS
CINtec® PLUS is a screening and diagnostic tool combining high sensitivity and high specificity for detecting high-grade cervical disease in a single test. The CINtec® PLUS kit detects and stains for two biomarkers: the multiply validated cell cycle regulatory protein p16INK4a (p16) and Ki-67, a marker of active cell proliferation. Clinical trials involving over 32,000 women have demonstrated that when used together, this biomarker combination is both highly sensitive and highly specific to identify those women most likely to have existing high-grade disease. Moreover, the CINtec® PLUS test is independent of age and HR-HPV type of infection.
Applied in combination the co-detection of p16 plus Ki-67 in the same cell serves as an indicator of cell cycle de-regulation that occurs during HR-HPV induced oncogenic transformation and provides an objective criterion to identify those women who are likely to harbour high-grade disease. CINtec® PLUS can be applied on conventional and liquid based cytology slides. Double immuno-reactive (or: Dual-stained) cells in cytology are positively stained for both proteins:
- Brown cellular staining indicates p16 over-expression
- Red nuclear staining indicates Ki-67 expression
Classification of Cervical Cytology
The Pap smear classifications are related to the nature of the cells sampled from the cervix showing single cells or groups of cells. The most recent classification is the Bethesda system, which divides the results of the morphologic interpretation into four main groups:
1) Cervical specimens negative for intra-epithelial lesions or malignancies (NILM) - cases with morphological interpretation within normal limits
2) Atypical Squamous Cells of Undetermined Significance (ASC-US) - cases with no definitive cellular abnormality but enough suspicion to keep the case from being considered "normal" (this is an ambiguous category)
3) Low-grade Squamous Intraepithelial Lesion (LSIL)
4) High-grade Squamous Intraepithelial Lesion (HSIL)
Broadly speaking LSIL corresponds to mild to moderate pre-cancerous disease and HSIL corresponds to high-grade pre-cancerous disease. Screening with cytology provides an indicator to the physician that something may be wrong with a woman's cervix and can be used to direct this patient towards further evaluation (eg colposcopy).
Source:
mtm laboratories AG
The EEMAPS study used the advanced biomarker combination CINtec® PLUS, which was launched by mtm in early 2010 in Europe. Residual materials from a previous pan-European retrospective cytology study were used to prepare additional slides for p16 and Ki-67 dual immuno-staining. In total, 361 ASC-US and 415 LSIL cases with corresponding biopsy results and HPV test results were available for dual stain cytology analysis. The presence of one or more dual-stained cervical epithelial cell(s) defined a positive test result with CINtec® PLUS, independent from morphology interpretation. The clinical results showed that the sensitivity of the dual stain for high-grade disease was 92.2% (71/77) for ASC-US, and 94.2% (129/137) for LSIL cases, which is equivalent to the sensitivity results obtained for HPV testing. However, specificity was significantly higher for CINtec® PLUS as compared to HPV testing; 80.6% vs. 36.3% for ASC-US and 68.0% vs. 19.1% for LSIL.
"mtm's CINtec® PLUS is the first test that provides high sensitivity and high specificity for underlying high-grade cervical disease in a single product, irrespective of women's age and the individual HR-HPV genotype," commented Bob Silverman, CEO of mtm laboratories. "Because the test can pinpoint which women are most likely to have cervical disease and need follow up, this should reduce a large number of the unnecessary, uncomfortable and costly colposcopies carried out on women with ASC-US or LSIL."
ASC-US and LSIL are definitions for equivocal and mild to moderate abnormal cytology findings on Pap tests, and may represent 5-8% of all cervical cytology cases. While most of these findings are negative for high-grade disease, 15-20% of LSIL and 6-10% of ASC-US will harbour high-grade disease. Together, these two categories of cytology represent the source for about 60% of all cases of high-grade cervical disease in women. Unfortunately, these Pap cytology results are not adequate predictors in determining which ASC-US or LSIL cases require intervention due to the low rates of underlying disease. Adjunctive HPV testing also has limitations due to unsatisfactory specificity.
The title of the publication and the authors are as follows:
Schmidt D, Bergeron C, Denton KJ, Ridder R, for the European CINtec Cytology Study Group. p16/Ki-67 Dual-Stain Cytology in the Triage of ASCUS and LSIL Papanicolaou Cytology. Cancer Cytopathol (2011); 119, DOI: 10.1002/cncy.20140
Notes
CINtec® PLUS
CINtec® PLUS is a screening and diagnostic tool combining high sensitivity and high specificity for detecting high-grade cervical disease in a single test. The CINtec® PLUS kit detects and stains for two biomarkers: the multiply validated cell cycle regulatory protein p16INK4a (p16) and Ki-67, a marker of active cell proliferation. Clinical trials involving over 32,000 women have demonstrated that when used together, this biomarker combination is both highly sensitive and highly specific to identify those women most likely to have existing high-grade disease. Moreover, the CINtec® PLUS test is independent of age and HR-HPV type of infection.
Applied in combination the co-detection of p16 plus Ki-67 in the same cell serves as an indicator of cell cycle de-regulation that occurs during HR-HPV induced oncogenic transformation and provides an objective criterion to identify those women who are likely to harbour high-grade disease. CINtec® PLUS can be applied on conventional and liquid based cytology slides. Double immuno-reactive (or: Dual-stained) cells in cytology are positively stained for both proteins:
- Brown cellular staining indicates p16 over-expression
- Red nuclear staining indicates Ki-67 expression
Classification of Cervical Cytology
The Pap smear classifications are related to the nature of the cells sampled from the cervix showing single cells or groups of cells. The most recent classification is the Bethesda system, which divides the results of the morphologic interpretation into four main groups:
1) Cervical specimens negative for intra-epithelial lesions or malignancies (NILM) - cases with morphological interpretation within normal limits
2) Atypical Squamous Cells of Undetermined Significance (ASC-US) - cases with no definitive cellular abnormality but enough suspicion to keep the case from being considered "normal" (this is an ambiguous category)
3) Low-grade Squamous Intraepithelial Lesion (LSIL)
4) High-grade Squamous Intraepithelial Lesion (HSIL)
Broadly speaking LSIL corresponds to mild to moderate pre-cancerous disease and HSIL corresponds to high-grade pre-cancerous disease. Screening with cytology provides an indicator to the physician that something may be wrong with a woman's cervix and can be used to direct this patient towards further evaluation (eg colposcopy).
Source:
mtm laboratories AG
вторник, 13 марта 2012 г.
Daily Women's Health Policy Report Summarizes Editorials, Opinion Pieces On Embryonic Stem Cell Policy Change
Several media outlets recently published editorials and opinion pieces responding to President Obama's executive order on Monday that lifted some federal restrictions on embryonic stem cell research, as well as his directive to "guarantee scientific integrity" in federal policymaking. Summaries appear below.
~ William Saletan, Slate: According to Saletan, "The best way to understand" the issue of embryonic stem cell research is "to look at an issue that has become the mirror image of the stem cell fight. That issue is torture." He writes that after Obama "signed an executive order prohibiting interrogation methods used by the Bush administration," former Bush aide Karl Rove "accused Obama of endangering the country by impeding interrogations of the enemy." He continues that most people "believe, as Obama does, that it's possible to save lives without crossing a moral line that might corrupt us" and that the "same Bush-Rove tactics are being used today in the stem-cell fight." According to Saletan, "Proponents of embryo research are insisting that because we're in a life-and-death struggle ... anyone who impedes that struggle by renouncing effective tools is irrational and irresponsible." He writes that proponents are "parroting" the Obama administration's "spin" on the scientific integrity directive, adding, "Think about what's being dismissed here as 'politics' and 'ideology.'" He continues that it is not necessary to see embryos as equal to full-grown human beings to "appreciate the danger of exploiting them" and suggests to "try shifting the context from stem cells to torture." Saletan asks, "How much ruthless violence should we use to defeat ruthless violence? The paradox and the dilemma are easy to recognize." He adds that proponents of stem cell research have made the dilemma "more compelling" by asking opponents, "How precious is that little embryo? Precious enough to forswear research that might save the life of a 50-year-old man?" He continues, "The danger of seeing the stem cell war as a contest between science and ideology is that you bury these dilemmas." Saletan writes, "The stem cell fight wasn't a fight between ideology and science. It was a fight between five-day-olds and 50-year-olds. The 50-year-olds won." He concludes, "The question now is what to do with our five-day-olds, our 5-week-olds, and our increasingly useful parts" (Saletan, Slate, 3/9).
~ Kathleen Parker, Washington Post: Parker, a syndicated columnist, writes that "since Obama began running for president, researchers have made some rather amazing strides in alternative stem cell research. Science and ethics finally fell in love, in other words, and Obama seems to have fallen asleep during the kiss." She adds, "Either that, or he decided that keeping an old political promise was more important than acknowledging new developments." She continues that while a majority of Americans support embryonic stem cell research, "most Americans, including most journalists and politicians, aren't fluent in stem cell research. It's complicated." She explains that what people claim to "know" is that "embryonic stem cells can cure diseases and that all stem cells come from fertility clinic embryos that will be discarded anyway." However, "Neither belief is entirely true." According to Parker, "[E]very single one of the successes in treating patients with stem cells thus far -- for spinal cord injuries and multiple sclerosis, for example -- have involved adult or umbilical cord blood stem cells, not embryonic stem cells." She says that under Obama's executive order, taxpayers are "incentivizing a market for embryo creation and destruction." The "superior claim" that embryonic stem cells were necessary because they are pluripotent -- that is, capable of becoming any type of cell -- "no longer can be made" because of the introduction of induced pluripotent cells, or IPS cells, Parker writes. She continues, "One may agree or disagree with their purposes, but one may also question why taxpayers should have to fund something so ethically charged when alternative methods are available." Parker says, "The objectification of human life is never a trivial matter. And determining what role government plays in that objectification may be the ethical dilemma of the century." She concludes, "In this case, science handed Obama a gift -- and he sent it back" (Parker, Washington Post, 3/11).
~ San Francisco Chronicle: According to the Chronicle editorial, the "era of stem cells has officially begun," although "it could have started eight years ago, when then-President Bush had the opportunity to approve federal funding for new embryonic stem cell research." The editorial continues that Obama's decision to rescind Bush's executive order means that "scientists will have the ability to make choices based on science." According to the Chronicle, "California may profit handsomely from the new order," because of the 2004 approval of Proposition 71, which dedicated $3 billion in bonds to stem cell research. The California Institute for Regenerative Medicine then "negotiated a groundbreaking set of policies to share the profits from any successful therapies with the state," the editorial says. It adds, "When federal money starts flowing into California for stem cell research -- which it will -- California taxpayers will still benefit from those profit sharing policies" (San Francisco Chronicle, 3/10).
~Philadelphia Inquirer: Obama took "a welcome step toward restoring the rightful place of scientific research in guiding public policy" by reversing the Bush administration's restrictions on embryonic stem cell research, an Inquirer editorial says. It continues that although some people oppose the research because days-old embryos are used to create new stem cell lines, University of Pennsylvania medical ethicist Arthur Caplan has noted that nearly all of the approximately 600,000 embryos in storage in the U.S. eventually would be destroyed, regardless. The editorial says, "It would be a lost opportunity for the rest of humankind not to use the embryos that would otherwise be destroyed to save lives," adding that although the field of adult stem cells "holds promise, many scientists agree that research should occur using both strategies." Not doing so would "shut off a field of vast potential without knowing the possible results," according to the editorial, which concludes, "Obama's directive helps to separate ideology from scientific inquiry" (Philadelphia Inquirer, 3/10).
~ Los Angeles Times: "The executive order that Obama signed Monday will open the door to studies on hundreds of newer and more useful stem cell lines," a Times editorial says. It adds, "Stem cell research is a long-term endeavor that should not be subject to the whims of successive administrations." Obama should urge Congress to repeal the Dickey-Wicker Amendment, as "[f]ederal legislation is needed to secure the future" of stem cell research, the editorial says. According to the editorial, "The presidential order is already a boon to California's initiative; now researchers can use federally funded labs and equipment for their state funded research, instead of being forced to duplicate facilities." It concludes, "With established infrastructure and the prospect of future state funding to keep research going, there is no better place for the federal government to invest in embryonic stem cell work" (Los Angeles Times, 3/10).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
~ William Saletan, Slate: According to Saletan, "The best way to understand" the issue of embryonic stem cell research is "to look at an issue that has become the mirror image of the stem cell fight. That issue is torture." He writes that after Obama "signed an executive order prohibiting interrogation methods used by the Bush administration," former Bush aide Karl Rove "accused Obama of endangering the country by impeding interrogations of the enemy." He continues that most people "believe, as Obama does, that it's possible to save lives without crossing a moral line that might corrupt us" and that the "same Bush-Rove tactics are being used today in the stem-cell fight." According to Saletan, "Proponents of embryo research are insisting that because we're in a life-and-death struggle ... anyone who impedes that struggle by renouncing effective tools is irrational and irresponsible." He writes that proponents are "parroting" the Obama administration's "spin" on the scientific integrity directive, adding, "Think about what's being dismissed here as 'politics' and 'ideology.'" He continues that it is not necessary to see embryos as equal to full-grown human beings to "appreciate the danger of exploiting them" and suggests to "try shifting the context from stem cells to torture." Saletan asks, "How much ruthless violence should we use to defeat ruthless violence? The paradox and the dilemma are easy to recognize." He adds that proponents of stem cell research have made the dilemma "more compelling" by asking opponents, "How precious is that little embryo? Precious enough to forswear research that might save the life of a 50-year-old man?" He continues, "The danger of seeing the stem cell war as a contest between science and ideology is that you bury these dilemmas." Saletan writes, "The stem cell fight wasn't a fight between ideology and science. It was a fight between five-day-olds and 50-year-olds. The 50-year-olds won." He concludes, "The question now is what to do with our five-day-olds, our 5-week-olds, and our increasingly useful parts" (Saletan, Slate, 3/9).
~ Kathleen Parker, Washington Post: Parker, a syndicated columnist, writes that "since Obama began running for president, researchers have made some rather amazing strides in alternative stem cell research. Science and ethics finally fell in love, in other words, and Obama seems to have fallen asleep during the kiss." She adds, "Either that, or he decided that keeping an old political promise was more important than acknowledging new developments." She continues that while a majority of Americans support embryonic stem cell research, "most Americans, including most journalists and politicians, aren't fluent in stem cell research. It's complicated." She explains that what people claim to "know" is that "embryonic stem cells can cure diseases and that all stem cells come from fertility clinic embryos that will be discarded anyway." However, "Neither belief is entirely true." According to Parker, "[E]very single one of the successes in treating patients with stem cells thus far -- for spinal cord injuries and multiple sclerosis, for example -- have involved adult or umbilical cord blood stem cells, not embryonic stem cells." She says that under Obama's executive order, taxpayers are "incentivizing a market for embryo creation and destruction." The "superior claim" that embryonic stem cells were necessary because they are pluripotent -- that is, capable of becoming any type of cell -- "no longer can be made" because of the introduction of induced pluripotent cells, or IPS cells, Parker writes. She continues, "One may agree or disagree with their purposes, but one may also question why taxpayers should have to fund something so ethically charged when alternative methods are available." Parker says, "The objectification of human life is never a trivial matter. And determining what role government plays in that objectification may be the ethical dilemma of the century." She concludes, "In this case, science handed Obama a gift -- and he sent it back" (Parker, Washington Post, 3/11).
~ San Francisco Chronicle: According to the Chronicle editorial, the "era of stem cells has officially begun," although "it could have started eight years ago, when then-President Bush had the opportunity to approve federal funding for new embryonic stem cell research." The editorial continues that Obama's decision to rescind Bush's executive order means that "scientists will have the ability to make choices based on science." According to the Chronicle, "California may profit handsomely from the new order," because of the 2004 approval of Proposition 71, which dedicated $3 billion in bonds to stem cell research. The California Institute for Regenerative Medicine then "negotiated a groundbreaking set of policies to share the profits from any successful therapies with the state," the editorial says. It adds, "When federal money starts flowing into California for stem cell research -- which it will -- California taxpayers will still benefit from those profit sharing policies" (San Francisco Chronicle, 3/10).
~Philadelphia Inquirer: Obama took "a welcome step toward restoring the rightful place of scientific research in guiding public policy" by reversing the Bush administration's restrictions on embryonic stem cell research, an Inquirer editorial says. It continues that although some people oppose the research because days-old embryos are used to create new stem cell lines, University of Pennsylvania medical ethicist Arthur Caplan has noted that nearly all of the approximately 600,000 embryos in storage in the U.S. eventually would be destroyed, regardless. The editorial says, "It would be a lost opportunity for the rest of humankind not to use the embryos that would otherwise be destroyed to save lives," adding that although the field of adult stem cells "holds promise, many scientists agree that research should occur using both strategies." Not doing so would "shut off a field of vast potential without knowing the possible results," according to the editorial, which concludes, "Obama's directive helps to separate ideology from scientific inquiry" (Philadelphia Inquirer, 3/10).
~ Los Angeles Times: "The executive order that Obama signed Monday will open the door to studies on hundreds of newer and more useful stem cell lines," a Times editorial says. It adds, "Stem cell research is a long-term endeavor that should not be subject to the whims of successive administrations." Obama should urge Congress to repeal the Dickey-Wicker Amendment, as "[f]ederal legislation is needed to secure the future" of stem cell research, the editorial says. According to the editorial, "The presidential order is already a boon to California's initiative; now researchers can use federally funded labs and equipment for their state funded research, instead of being forced to duplicate facilities." It concludes, "With established infrastructure and the prospect of future state funding to keep research going, there is no better place for the federal government to invest in embryonic stem cell work" (Los Angeles Times, 3/10).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
вторник, 6 марта 2012 г.
Women's Perspectives On Medical Male Circumcision For HIV Prevention: Community-Led Research In 5 African Countries
A new report from the Women's HIV Prevention Tracking Project (WHiPT), a collaborative initiative of AVAC and the ATHENA Network, features an unprecedented collection of voices from Kenya, Namibia, South Africa, Swaziland and Uganda reflecting on what male circumcision for HIV prevention means for women. It highlights women's perspectives, advocacy priorities and recommendations on this new prevention strategy.
Making Medical Male Circumcision Work for Women is the first report from WHiPT, which was launched in 2009 to bring community perspectives, particularly women's voices, to the forefront of biomedical prevention research and the broader response to HIV.
The report highlights community-level support as well as concerns and misperceptions that can hinder effective implementation.
"Women are excited for medical male circumcision because they're desperate for new prevention options, but they lack detailed factual knowledge of its benefits and risks," says Cebile Dlamini of Swaziland for Positive Living. "For example, the fact that it only provides partial protection can be overlooked and some women and men believe once a man is circumcised, he is by definition HIV-negative."
In total, nearly 500 women in HIV-affected communities completed a questionnaire, developed and administered by the women-led WHiPT teams in five countries. Almost 40 focus groups provided additional information about women's attitudes about medical male circumcision. In each country, research took place in different locales, selected to reflect a diversity of circumcision practices, including communities that practice traditional male circumcision and those that do not circumcise, as well as those practicing female genital mutilation.
The majority of teams conducted their research in settings where male circumcision for HIV prevention had not yet been introduced as part of a national HIV strategy. Therefore many reported perceptions and concerns can be integrated into emerging programs - making this report both timely and urgent.
The Kenyan WHiPT team surveyed women in settings where male circumcision was evaluated in a clinical trial and subsequently introduced. Reports from women reached by the Kenyan WHiPT team underscore women's fears that male circumcision may lead to changes in men's behaviors and perception of risk.
"The women reported their partners either adapting or continuing risky behavior after 'the cut'", says Carol Odada, from Women Fighting AIDS in Kenya.
The report documents women's concerns that medical male circumcision might lead to an increase in heightened stigma for women living with HIV. This would be a result of circumcised men's misperceptions that they could not be HIV positive and/or could not transmit the virus. Thus sex and or safer sex would be less negotiable than before circumcision, putting women at greater risk for gender-based violence and HIV.
The report also highlights perceptions of male circumcision for HIV prevention in the context of traditional practices. Specifically, it underscores the need for communications campaigns that directly address the distinctions between medical male circumcision, traditional circumcision and female genital mutilation.
"Some women report the concern that the promotion of circumcision for men would increase the promotion of female genital mutilation," says Allen Kuteesa from Health Rights Action Group in Uganda.
The myths and misunderstandings identified by WHiPT teams - such as the perception that medical male circumcision is directly protective for women - underscore the urgent need for adequate education campaigns directed at women. Further, for women to access and act on information related to medical male circumcision and HIV, the information needs to be specifically tailored to women, and the socio-cultural context and realities of women's lived experience need to be taken into account.
The report summarizes advocacy activities that WHiPT teams will undertake over the coming year to ensure that male circumcision implementation addresses women's concerns.
Source:
Cindra Feuer
AIDS Vaccine Advocacy Coalition (AVAC)
Making Medical Male Circumcision Work for Women is the first report from WHiPT, which was launched in 2009 to bring community perspectives, particularly women's voices, to the forefront of biomedical prevention research and the broader response to HIV.
The report highlights community-level support as well as concerns and misperceptions that can hinder effective implementation.
"Women are excited for medical male circumcision because they're desperate for new prevention options, but they lack detailed factual knowledge of its benefits and risks," says Cebile Dlamini of Swaziland for Positive Living. "For example, the fact that it only provides partial protection can be overlooked and some women and men believe once a man is circumcised, he is by definition HIV-negative."
In total, nearly 500 women in HIV-affected communities completed a questionnaire, developed and administered by the women-led WHiPT teams in five countries. Almost 40 focus groups provided additional information about women's attitudes about medical male circumcision. In each country, research took place in different locales, selected to reflect a diversity of circumcision practices, including communities that practice traditional male circumcision and those that do not circumcise, as well as those practicing female genital mutilation.
The majority of teams conducted their research in settings where male circumcision for HIV prevention had not yet been introduced as part of a national HIV strategy. Therefore many reported perceptions and concerns can be integrated into emerging programs - making this report both timely and urgent.
The Kenyan WHiPT team surveyed women in settings where male circumcision was evaluated in a clinical trial and subsequently introduced. Reports from women reached by the Kenyan WHiPT team underscore women's fears that male circumcision may lead to changes in men's behaviors and perception of risk.
"The women reported their partners either adapting or continuing risky behavior after 'the cut'", says Carol Odada, from Women Fighting AIDS in Kenya.
The report documents women's concerns that medical male circumcision might lead to an increase in heightened stigma for women living with HIV. This would be a result of circumcised men's misperceptions that they could not be HIV positive and/or could not transmit the virus. Thus sex and or safer sex would be less negotiable than before circumcision, putting women at greater risk for gender-based violence and HIV.
The report also highlights perceptions of male circumcision for HIV prevention in the context of traditional practices. Specifically, it underscores the need for communications campaigns that directly address the distinctions between medical male circumcision, traditional circumcision and female genital mutilation.
"Some women report the concern that the promotion of circumcision for men would increase the promotion of female genital mutilation," says Allen Kuteesa from Health Rights Action Group in Uganda.
The myths and misunderstandings identified by WHiPT teams - such as the perception that medical male circumcision is directly protective for women - underscore the urgent need for adequate education campaigns directed at women. Further, for women to access and act on information related to medical male circumcision and HIV, the information needs to be specifically tailored to women, and the socio-cultural context and realities of women's lived experience need to be taken into account.
The report summarizes advocacy activities that WHiPT teams will undertake over the coming year to ensure that male circumcision implementation addresses women's concerns.
Source:
Cindra Feuer
AIDS Vaccine Advocacy Coalition (AVAC)
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