Why don’t “pro-lifers” support birth control?

There has been a lot of commentary this week about the GOP-led proposal to de-fund Planned Parenthood. Commentators such as Ezra Klein note the irrationality of this stance, since Planned Parenthood itself estimates it prevents more than 620,000 unintended pregnancies each year, and 220,000 abortions. Why wouldn’t the anti-abortion crowd support this increase in contraception, and subsequent prevention of abortions?

What’s missing in this rationale is that many on the far right perceive most forms of contraception *as being equivalent to abortion.* So by their logic, Planned Parenthood isn’t “preventing” these abortions–it’s just doing them another way, via the Pill, IUDs, etc. instead of drug-induced or surgical abortions. To many who view the world this way, Planned Parenthood *is* using tax dollars to fund abortions, because they’re using tax dollars to help provide patients with oral contraceptives and other means of birth control. After all, while the Pill mainly works to prevent ovulation in the first place, there is some evidence that a secondary action may prevent implantation of a fertilized egg. If you’re of the mindset that a fertilized ovum is the equivalent of a “person”, then it becomes outrageous to allow the prescription of a product that will “kill” that egg, and it becomes more reasonable to protest organizations like PP which provide women access to such medications (or, public schools which educate our children about such alternatives–hence their opposition to comprehensive sex education as well).

Do I agree with this position? Hell no, but I think it’s necessary to understand and acknowledge it–and as such, to see why articles like Klein’s above (and many others which I’ve seen appear in the past week or so) only serve to stoke the fires for those on the extreme right, rather than making them jump on the PP bandwagon.

Science and the media: three new books

There has been a surge of interest recently in science denial, particularly revolving around the issue of vaccines. Last year saw the release of Michael Specter’s Denialism; in the last few months, three others have been released: Seth Mnookin’s Panic Virus, Robert Goldberg’s Tabloid Medicine, and Paul Offit’s “Deadly Choices.” More about each of them after the jump.
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Student guest post by Francis Mawanda.

HIV/AIDS is a major public health problem worldwide. To date, it is estimated that more than 60 million people have been infected with HIV and more than 25 million people have died as a result of HIV/AIDS worldwide1. Despite the high prevalence and mortality rates that are associated with HIV/AIDS, and after more than 29 years of aggressive research efforts, there is still no cure or vaccine to prevent against HIV/AIDS. And although the introduction of antiretroviral (ARV) drugs in the mid 1990s greatly improved the outlook, health and quality of life of people living with HIV/AIDS, ARV drugs are associated with issues of viral resistance, serious side effects and high costs which render them unavailable in developing countries with the greatest HIV/AIDS burden. Therefore, prevention remains the key in the fight against HIV/AIDS.

Since the beginning of the HIV/AIDS epidemic, prevention has always been recognized as the major method for controlling the spread of HIV/AIDS. As a result, numerous HIV/AIDS prevention programs have been implemented in countries and communities all over the world. While these programs initially succeeded in reducing the prevalence of HIV/AIDS, current trends suggest that after an initial decline HIV/AIDS prevalence in most countries has plateaued over the last decade1 with new infections still being diagnosed every day. According to UNAIDS & WHO, in 2008 alone there were more than 2.7 million new cases of HIV/AIDS worldwide1 representing an average of 7000 new cases per day.

The continued spread of HIV/AIDS despite aggressive prevention programs and widespread public awareness presents a public health dilemma. This is true not only for HIV/AIDS, but for most health conditions that are associated with behavioral and or lifestyle risk factors such as smoking and lung cancer. This is because the reasons why people continue to engage in high risk behavior despite awareness of the possible negative health consequences are multiple, complex, and not only vary from individual to individual, but even for each individual, the reasons may vary from situation to situation or from one environment to another.

However, given that HIV can only be transmitted to an uninfected person from an infected person, then the continued spread of HIV/AIDS could be attributed in part to the fact that majority of current HIV/AIDS prevention programs are aimed at increasing awareness and reducing high risk sexual behavior among HIV negative individuals. These programs not only ignore the role people living with HIV/AIDS play in the HIV transmission equation, but also assume that people living with HIV/AIDS do not engage in high risk sexual behavior. However, recent studies have shown that a significant proportion of people living with HIV/AIDS continue to engage in high risk sexual behavior even after diagnosis of HIV/AIDS2,3,4. Therefore, there is a need for prevention programs aimed at increasing awareness and reducing high risk sexual behavior among people living with HIV/AIDS as well.

However, in developing and implementing HIV/AIDS prevention programs that target people living with HIV/AIDS, the fact that the population of people living with HIV/AIDS consists of individuals with HIV/AIDS and are aware of their HIV serostatus and individuals with HIV/AIDS but are unaware of their HIV serostatus should be considered since both groups require different approaches and yet both groups should be targeted concurrently in order for prevention efforts to succeed.

A large number of people living with HIV/AIDS, especially in developing countries are unaware of their HIV serostatus. These individuals continue to spread HIV/AIDS to their partners unknowingly. The huge role this group of individuals plays in the spread of HIV/AIDS has recently been recognized and as a result some countries have implemented programs to encourage people to test for HIV/AIDS and in some countries such as Botswana, by making HIV testing part of routine medical care. However these efforts alone without efforts targeted at people living with HIV/AIDS who are aware of their serostatus would be ineffective not only because routine testing does not involve proper HIV/AIDS counseling but also because as noted above some individuals will continue to engage in high risk sexual behavior after receipt of a positive HIV serology test . In addition, because HIV prevention is one of the major factors motivating individuals from engaging in high risk sexual behavior, after an HIV diagnosis there is no longer motivation not to engage in high risk sexual behavior except as an act of altruism.

In terms of people living with HIV/AIDS and who are aware of their HIV/AIDS serostatus, some governments have also recognized the role of this group of people living with HIV/AIDS in the continued spread of HIV/AIDS and as a result some countries have taken steps to prevent these individuals from spreading HIV/AIDS. These include laws and sentences for people living with HIV/AIDS and are aware of their serostatus who transmit HIV to an uninfected individual. However such efforts alone are also ineffective as they may instead discourage individuals from testing for HIV/AIDS to prevent prosecution and yet these programs depend on well documented and widespread HIV serostatus awareness. In addition, these programs are not practical in developing countries with the highest HIV/AIDS burden, simply because medical record keeping is inadequate making it very difficult to determine an individuals’ serostatus prior to any alleged contact.

However a combination of programs aimed at people living with HIV/AIDS who are unaware of their serostatus such as routine HIV/AIDS testing and proper counseling with programs aimed at people living with HIV/AIDS who are aware of their serostatus such laws and prosecution would address most of the issues that arise from targeting only one group.

Therefore there is not only a need for increased programs aimed at HIV/AIDS prevention through people living with HIV/AIDS but these programs should target both people living with HIV/AIDS and are aware of their HIV serostatus and people living with HIV/AIDS who are unaware of their HIV serostatus in addition to the programs aimed at people without HIV/AIDS. This would ensure that everyone regardless of their serostatus is involved in stopping the continued spread of HIV/AIDS.

1. UNAIDS, WHO (2009). 2008 report on the global HIV/AIDS epidemic. Available from http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp

2. Heckman T, Kelly J, Somiai A. Predictors of continued high-risk sexual behavior in a community sample of persons living with HIV/AIDS. AIDS and Behavior. 1998; 2: 127-135.

3. Kalichman S. Psychological and social correlates of high risk sexual behavior among men and women living with HIV/AIDS. AIDS Care. 1999; 11: 415-428.

4. Reilly T, Woo G. Predictors of high-risk sexual behavior among people living with HIV/AIDS. AIDS and Behavior. 2001; 5(3): 205-217.

What does the WHO’s pandemic scale mean? And why is anyone worried about this?

I’ve been seeing a lot of comments mocking the current outbreak of H1N1, and a lot of people (and journalists) who don’t understand what “big deal” is about the “snoutbreak” of swine influenza, or don’t get what the raising of the World Health Organization’s pandemic alert phase up to 5 means. I noted here what the alert level meant, but wanted to discuss it a bit more in a full post; after the jump.
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Obama: end malaria deaths by 2015

Well, you certainly can’t fault Obama for aiming high. Via satellite, Obama announced at yesterday’s Clinton Global Initiative forum that he would provide support to end malaria deaths in Africa by 2015–a lofty goal, but is it even close to attainable?

Obama provided the basics of his plan here, laying out why he feels this is such an important goal:

Malaria needlessly kills 900,000 people each year. In Africa, a child dies from a mosquito bite every thirty seconds. Beyond this devastating human toll, malaria undermines the economic potential of local economies and overwhelms public health systems – accounting for up to 40% of health spending in many African countries. As global warming and population displacement trends accelerate, an additional 260-320 million people worldwide could be living in malaria-infested areas by 2080.

He then discusses multiple approaches necessary to quickly reduce the mortality from this infection. Is this attainable? More after the jump…
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Laurie Garrett talks global health at U of Iowa

After Karl Rove’s appearance here Sunday night, Laurie Garrett’s talk on Monday was downright uneventful–despite a talk which included discussion of AIDS, abortion, and welfare, among other things.

Garrett, for anyone who may be unfamiliar, is currently a senior fellow for global health at the Council on Foreign Relations. She’s the author of The Coming Plague and Betrayal of Trust: The Collapse of Global Public Health. She’s reported on infectious disease and global health for almost 30 years, writing for a variety of publications in addition to her own books. Her talk last night discussed charity, global health, and what to do to re-vamp how global health funding is used.
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Sentence in for bacteria-mailing professor

Last fall I wrote about the bizarre case of University of Pittsburgh geneticist Robert Ferrell. Dr. Ferrell, you may recall, had been prosecuted for sharing generally-harmless strains of bacteria with a colleague, SUNY-Buffalo art professor Steven Kurtz. Dr. Kurtz then used the bacterial cultures in an art display, which drew the attention of authorities following the death of Dr. Kurtz’s wife. Then all hell broke loose (after the jump):
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Religion vs. public health redux

I mentioned previously a clash between religion and public health, where a Liberian immigrant was jailed for importing bushmeat. She argued that infringing upon her religious freedom in this manner was unconstitutional; authorities argued that she couldn’t put others at risk because of her religious beliefs. Another clash where religious beliefs are at odds with public health is simmering in the U.K.; more after the jump.
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Turtles: not a kid’s best friend

An ongoing outbreak of Salmonella associated with turtles has now sickened more than 100 and caused a quarter of that number to be hospitalized:

Cases have been reported in 33 states, but mostly in California, Texas, Pennsylvania and Illinois. Most of the patients have been children.

No one has died in the latest outbreak, which began in August. But some patients have experienced severe symptoms, including acute kidney failure.

The most common symptoms reported to the CDC included bloody diarrhea, abdominal cramping, fever and vomiting. The median age of patients was 7 1/2 .

More after the jump…

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