The what, why and how of health and development

Trafficking law leaves Cambodian sex workers at risk of HIV

Efforts to tackle sex trafficking in Cambodia are leaving sex workers potentially more at risk of HIV and violent attacks, according to a report published this month in the journal Health and Human Rights.

In a survey carried out in 2009 and 2011, researchers interviewed 80 sex workers in Cambodia, where nearly one in four are living with HIV, to find out how the ‘Trafficking Law’ introduced in the country in 2008 was impacting their lives.

The new legislation was designed to tackle sexual exploitation and trafficking and led to police applying tougher force on suspected traffickers and shutting down brothels. As a result, many female sex workers were forced to continue working on the street or in entertainment venues such as karaoke bars. The researchers, led by Lisa Maher at the Kirby Institute at the University of New South Wales (UNSW), found that sex workers were now less likely to carry condoms for fear of being incriminated or being attacked by police.

One 28-year-old woman said that if police would order them to chew on any condoms they found on them and would beat sex workers with sticks and stones.

Another – 22-year-old Seiha – said that it is difficult to safely negotiate condom use with clients now she is no longer working in a brothel: “…We were safe living in brothel and we were not scared police. We also protected ourselves better by using condoms than now. Now some clients may force us not to use condoms but when we lived in the brothel we had more rights than clients and they dared not to force us because they come into our house.”

Seiha was not alone in reporting that brothels were, in relation to street prostitution, safer working environments. However, one interview where a woman explained brothels were safer because if you screamed someone would hear and come to help, reminds us that this ‘safety’ should only be understood in relative terms.

The researchers, led by Lisa Maher at the Kirby Institute at the University of New South Wales, also say they do not want to “paint a pretty picture” of brothel life but point out that their findings are in line with results from other studies.

They reference several NGO-led or academic studies that suggest the criminalisation of sex work has led to reduction in condom use, increase risk of violence, and difficulty providing health services to sex workers displaced to the street.

For example, the National Center for HIV, AIDS, Dermatology and STDs (NCHADS) reported a 26% reduction in women seeking STI services, a 16% decrease in HIV testing, and a 46% increase in the number of women working on the street following the introduction of the law in Cambodia.

Likewise, the belief that the risk of HIV is somewhat determined by the structural conditions of sex work, such as the legal and policy positions on trafficking and prostitution, was also reflected in a paper published in the Lancet last year.

Authored by Kate Shannon, from the British Colombia Centre for Excellence in HIV/AIDS, the Lancet paper used mathematical modelling to see how HIV rates amongst sex workers would be affected by changes in these ‘structural conditions’. They found that decriminalisation of sex work would have the greatest effect on the course of HIV epidemics across all settings, averting 33–46% of HIV infections in the next decade.

Now in this latest survey on Cambodian sex workers, the researchers suggests that decriminalisation does not go far enough as a sex worker remains at risk of HIV and abuse because of the “lack of recognition [of them] as a person before the law”.

They conclude: “…focusing on the legal status of sex work in the absence of a commitment to the application of human rights standards means that the rights of sex workers to legal personhood, health, and the same protections and benefits as other workers, are in conflict with well-intentioned, if misdirected, attempts to tackle human trafficking.”

First human trials for Ebola vaccine show it has potential

Efforts to find a vaccine for Ebola have taken a significant step forward this week after initial tests on humans showed promising results according to research published in the Lancet.

Results from the first phase 1 trials of the vaccine against the strain of Ebola that killed tens of thousands of people in western African last year shows it provoked a response from the participants immune system.

This was the first test of a vaccine carried out on the most recent strain of the virus, rather than the strain associated with an earlier outbreak in Zaire in the 1970s.

In the latest study, participants who received a higher dose of the vaccine produced higher quantities of antibodies than those who received a lower dose. A placebo was given to a control group who showed no immune response.

However scientists at the Beijing Institute of Biotechnology and the Tianjin CanSino Biotechnology, both in China, have warned that it is early days and it is not possible to say for sure if the immune response exhibited in participants would be enough to destroy the virus.

They said further testing will be required in Africa to establish whether it could protect against Ebola and they also need to investigate the possibility the vaccine may increase the risk of contracting the HIV virus, which has been suggested in previous research.

Professor Fengcai Zhu, who led the researchers, said: “On the basis of our findings, we believe that the Ebola vaccine we assessed has some potential, and a significant advantage of this type of vaccine is that stable and much easier to store or transport in tropical areas with inadequate cold-chain capacity, such as Africa. However, whether this candidate vaccine could become a final vaccine for widespread use against Ebola outbreaks is still uncertain, because of the issues of HIV-1 acquisition rates and the pre-existing immunity, especially in west Africa.

Scientists Launch Crowdfunding Campaign For Ecstasy And Psychedelic Medicine

A crowdfunding campaign raising money for the production of psychedelic drugs and pure ecstasy has been launched by Norwegian researchers seeking to promote their use in health care.

Researchers Pål-Ørjan Johansen and Teri Krebs are looking to raise at least 600,000 USD to kickstart their production of MDMA (ecstasy) and the psychedelic element of magic mushrooms called psilocybin.
Is this what MDMA medicine could look like in the future?

Is this what MDMA medicine could look like in the future?

They believe the world might become ‘a happier and healthier place’ if these drugs were more widely available because of their links to treatment for alcoholism and post-traumatic stress disorder (PTSD).

Johansen, a clinical psychologist who along with Krebs has had a visiting research fellowship at Harvard Medical School, started looking into researching the use of psychedelic drugs after he found they helped him recover from alcohol and nicotine addiction, saying:

“I was a smoker, had PTSD and alcohol problems. MDMA and psychedelics helped me quit smoking and sober up. Now I want to contribute to help make MDMA and psychedelics more available to others.”

In a large survey carried out with people in the US and featured in the scientific journal Nature, Johansen and Krebs also found that users of LSD and similar drugs were no more likely to have mental-health conditions than other respondents.

They argued that a ban on the use of psychedelics is “a violation of the human rights to belief and spiritual practice, full development of the personality, and free time and play”, although conceded that they could not “exclude the possibility use of psychedelics might have a negative effect on mental health for some individuals or groups”.

Now through their non-profit organisation EmmaSofia, based in the Norwegian capital Oslo, they have launched a campaign on crowd-funding website indiegogo to cover the “estimated start-up cost and the first batch of MDMA and psilocybin for medicine, therapy and research”. The money will also support the organisation’s work to legalise recreational use.

They explain on their campaign page that MDMA and psilocybin, which they want to distribute for free for medical or other legally authorised use, can already be used today in therapeutic settings, although procedures differ from country to country.

“Medications can be used after consultation with a physician and after making a request to your local medicines regulatory agency,” the campaign says, adding that distribution will be subject to legal conditions in manufacturer’s and receiver’s country.

The initiative has received support from British campaigner for the decriminalisation of drugs, psychiatrist and neuropsycho-pharmacologist Professor David Nutt who said: “I’m delighted to support the crowdfunding campaign by my colleagues Krebs and Johansen. For a long time I have been fighting to change the view that we have of psychedelics and MDMA. These drugs have enormous potential as treatment for patients with a range of psychiatric disorders.”

Guest Columnist: Paul Maginn

Originally posted on The Honest Courtesan:

Dr. Paul Maginn is an Associate Professor of Urban Planning at the University of Western Australia; he is the co-editor and co-author of several chapters in the recently published book (Sub)Urban Sexscapes:  Geographies and Regulation of the Sex Industry.  I asked him to comment on his book and explain why a planner & geographer is so interested in sex work.

Suburban SexscapesAt social events whenever we meet someone new for the first time it can be guaranteed that they will ask, “So, what do you do for a living?”  In the past, my stock response was generally:  “I’m an academic…an urban planner”!  The stock replies to this usually range from:  “Oh! What does that mean?” to “Oh, that’s nice! I have to go now because there’s my friend over there”.  You see, being an academic doesn’t seem to capture too many non-academic peoples’ attention.  So nowadays, when I’m asked what…

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The Do’s and Dont’s of substance use language, according to journal editors

Back when I was City journalism student learning about health reporting – and later a copywriter for health charities – the sensitivity of language around medical subjects was drilled into me by various experts in fields such as mental health, HIV, and TB. The choice of terminology determines the tone of an article and sometimes even the journalist can be unaware of the implications of the language they’re using – something I often see as a freelance sub-editor of tabloid news.

The biggest mistakes do tend to appear in tabloid press, although all health journalists have a responsibility to find a middle ground between rigid medical terminology and the more illustrative language of journalism. But according to a guidance paper published by a a group of journal editors last week, scientists don’t always get it right either.

Editors of the journal Substance Abuse were apparently so concerned at some of the terms found in submitted papers they published an article appealing for researchers to use language that ‘respects the worth and dignity of all people…focuses on the medical nature of substance use…and avoids perpetuating negative stereotypes and biases through the use of slang and idioms’.

Some of the ‘what not to do’ examples sound like they could have come out of a column of a judgemental newspaper editorial:

“Although it is perhaps surprising, our journal has received submissions that contain explicitly morally laden language, e.g., referring to the “depraved and degenerate lives” of individuals who use substances,” wrote the Substance Abuse editors. They also revealed that some submissions included slang words such as ‘addicts’, ‘speedball’, and ‘clean’/’dirty’ urine.

Less obvious, but equally important, was the advice on using ‘people-first’ language, and highlighting that a person’s condition is only one aspect of them and not their defining characteristic. ‘Addicts’, ‘users’, or ‘alcoholics’ are terms, according to the authors, that erase individual differences and presumes an homogeneity in experiences. They advise instead on using: ‘person with a ‘cocaine use disorder’ or ‘adolescent with an addiction’.

By the same token, they suggest that referring to a convict by their crime – murderer, drug dealer, thief – may be dehumanising. Instead they advice using the terms ‘people in prison’ or ‘people on parole’, a phrase perhaps suitable for scientific papers but not one I can ever see getting past a newspaper editor (although I did recently read an article that used the phrase ‘people with vaginas’).

They also turn the mirror on to themselves however, acknowledging that the very title of the journal they’re editing – Substance Abuse – could be deemed pejorative, referencing addiction expert William L. White’s article The Rhetoric of Recovery Advocacy: An Essay On the Power of Language.

In his essay, White writes that “of all the words that have entered the addiction/treatment vocabulary, ‘abuse’ is one of the most ill-chosen” and “to suggest that the addict mistreats the object of his or her deepest affection is a ridiculous notion”. He argues this word comes from an historic religious and moral concept of addiction and can be compared to the now – thankfully – defunct term ‘self-abuse’ that was once used to describe masturbation.

Both White and the Substance Abuse authors agree however that people recovering from these conditions are really the ones who should shape their own language and definitions.

“Most importantly, we need to know much more about the thoughts and preferences of the individuals and families who are affected by drug and alcohol use: how do they feel about
their own and others’ use of the terminology discussed above? What language would they like us to use, and what are the implications for the services and policies they need?” the journal editors ask.

To summarise, I’ll borrow a fitting quote from the introduction to White’s paper (that he borrowed himself nonetheless):

“The difference between the right word and the almost right word is the difference between lightning and the lightning bug.” – Mark Twain

Increasing rates of HIV on World AIDS Day 2014

The battle to curb HIV infections in some regions of Europe is failing after new figures released last week show an 80 percent increase in the rate of infection in 2013 when compared to 2004.

The vast majority of new cases occur in Eastern Europe and Central Asia, which has seen a two fold surge of HIV infections in the past decade, thought to be due to insufficient policies in many countries aimed at preventing the spread of infection among drug users and men who have sex with men.

The latest figures released by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organisation Regional Office for Europe show that in 2013 there were 176,000 new HIV diagnosis, a huge increase from the 79,000 new cases that were registered in 2004.

Over 100,000 of the new cases in 2013 were registered in Eastern Europe and Central Asia, one of the few regions around the world were HIV infections continue to rise.

The lack of harm reduction programmes in drug policies, particularly needle exchange programmes, is thought to be partly responsible for the surge in infections in this region. However disease prevention experts point out that some of the main people affected across all of Europe are still men who have sex with men.

“The number of HIV diagnoses among this group has increased by 33% compared to 2004 – and has been going up in all but four EU/EEA countries. This is why prevention and control of HIV among men who have sex with men has to be a cornerstone of national HIV programmes across Europe,” explains ECDC Director Marc Sprenger.

Across much of this region there aren’t many programmes designed to specifically target and support the LGBT communities, which can partly be due to societal attitudes towards homosexuality that can make it difficult for to seek treatment. For example a 2009 European Social Survey found that the level of acceptance of the statement “gay men and lesbians should be free to live their own life as they wish” was lowest in former Soviet bloc countries.

A 2012 study looking at the experience of gay HIV positive men in Hungary found that many avoided being discriminated against by keeping their HIV status secret. One interviewee said: “If the whole town knows about my HIV status, then the dentist won’t have me and people will avoid me on the street. … So, I never inform anyone about my HIV status and, even if someone would directly ask about it, I wouldn’t say anything because it is none of their business.”

And researchers found that when the men were required to disclose their status to medics and hospital staff it was then they faced the strongest discrimination, with one nurse telling a patient to wash themselves because “she didn’t know how the disease spread” and even doctors encouraging someone to keep their status a secret.

Experts say the increasing rates of HIV infection and the societal problems that often surround the epidemic can be tackled with effective education campaigns backed up by strong policies and funding for testing and treatment programmes. And what better day to think about the road ahead than today – World AIDS Day – which this year is campaigning under the slogan “Focus, Partner, Achieve: An AIDS Free Generation.”

Free online global health courses

Since leaving London and setting up as a freelancer here in Vienna, I’ll admit that I’ve found myself with much more time on my hands than I’ve been used to. But having this extra time means I can browse the internet at a much more leisurely pace, resulting in the discovery of some fantastic free online resources. This ‘Daily German’ website’s online course has given a great kickstart to my German learning. And just last week I also signed up to this free data journalism course from the European Journalism Centre, starting in January.

Online resources health blog

A keyboard and an internet connection is all you need for an online course!

On a more health related note, health sector professionals in low income countries or working with limited resources might find this online course useful:

Called eSCART, it’s a 4 month distance learning course that aims to provide people with the knowledge they need to treat HIV patients with antiretroviral therapy (ART) in resource limited settings. It’s tutor-led, and also provides access to a discussion forum where those who signed up can discuss their learning with other ‘classmates’. It has 13 modules including an introduction to HIV, HIV and TB, side effects and monitoring and evaluation of an ART programme. Not bad for a free course that just needs an internet connection and a computer with speakers (and a brain connected to it might help too!).

For other free online global health courses check out this handy resource called Global Health elearning. From family planning and childhood development to health logistics and infectious diseases, this is a gold mine for professors or students looking for global health education resources, or just health professionals wanting to bolster their knowledge or train other staff.


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