on the radar: International AIDS Conference
Ms. correspondents Joanne Omang and Sally Ethelston attended the 16th International AIDS Conference in Toronto, a week-long conference dedicated to discussing breakthroughs and roadblocks on the path to slowing the AIDS epidemic worldwide. Omang and Ethelston discuss the findings of the conference from a feminist perspective.
At right: Thousands of delegates fill the streets of Toronto to rally for AIDS treatment. Photo: AIDS 2006
International AIDS Conference Ends on Cautious Note - August 18
What Do Women Want? HIV Protection - August 17
Men's Liberation Would Help Women, Conference Told - August 17
Is ABC Enough? - August 16
Researchers Have Proof of What Works for Young People - August 16
Prevention Issues Dominate Second Day of AIDS Conference - August 15
Poverty Causes AIDS and Vice-Versa, Conference Told - August 15
Female Condoms: a Tool to Stop AIDS - August 15
Sex Workers Open "Stiletto Lounge" at AIDS Conference - August 14
Women March for Women at AIDS Conference - August 14
International AIDS Conference Ends on Cautious Note
By Joanne Omang and Sally Ethelston
TORONTO, Aug. 18 - The 16th International AIDS Conference wound up today with agreement among the 26,000 participants that progress against the pandemic is possible but in serious jeopardy, both from the relentless disease itself and from the failure of leaders to deliver on previous commitments of resources and policies, especially their commitments to women.
"All roads lead from women to social change," said Stephen Lewis, United Nations Special Envoy for AIDS in Africa at the closing session, "and that includes subduing the pandemic."
Researchers presented more than 400 papers during the six-day gathering on what conference co-chair Mark Wainberg called "ground-breaking science" on new drugs and prevention strategies being tested now. "The pipeline is healthy," said rapporteur Chris Collins of the AIDS Vaccine Advocacy Coalition, summing up the conference at the final plenary. "We know what to do.but the tools must be accessible, affordable, acceptable and used."
Lewis electrified the closing session by denouncing the South African government as "still obtuse, dilatory and negligent" in its approach to AIDS, which has ravaged the country. Health ministry recommendations of garlic and lemon juice as early treatment options are "theories more worthy of a lunatic fringe than of a compassionate state," Lewis said. He also attacked the "warped and abysmal gender architecture of the UN," which he leaves in December, and called on the UN to establish "a powerful international agency for women, funded and staffed to the teeth."
He said oppression and violence against women worldwide "is driving this epidemic" but world leaders' promises to end it have not been kept. "We will never subdue the gruesome force of AIDS until the rights of women become paramount in the struggle," Lewis said. "If ever there were a cause to mobilize AIDS activists around the world, this is it."
The overall conference theme, Time to Deliver, asked world leaders and donors to change their policies and produce long-promised increases in funding for treatment, care and prevention programs. Anders Nordstrom, acting director-general of the World Health Organization, noted that spending against AIDS in 2006 totaled $8.3 billion, but the estimated need in low- and middle-income countries is $15 billion this year and $22 billion by 2008. Lewis agreed: "We're billions and billions short," he said, noting that financial commitments by the Group of Eight industrialized countries in June 2005 "are already unraveling." U.S. spending of $3 billion per year against AIDS is "pretty paltry from the world's superpower," he added.
The global shortage of at least 4 million health workers emerged as a major conference concern and a chief reason why 70 percent of people living with HIV/AIDS are not being treated. "More people registered to attend this conference than there are doctors in the whole of Eastern and Central Africa ," observed Nordstrom. An urgent first step would be to make anti-AIDS drugs available to all health care workers on the front lines, including nurses, aides, and paramedics, he said, and then to pay them decent salaries to keep them there.
"If the United States just took a two-day break in the war in Iraq ," the money saved could finance training and pay for enough health workers to make AIDS prevention and treatment services universally available, Collins said.
What Do Women Want? HIV Protection
By Sally Ethelston and Joanne Omang
| Above: Panelists discuss challenges facing women during a session on "Women at the Frontline in the AIDS Response." Credit: AIDS 2006
TORONTO , Aug. 17 - A new strategy to accelerate development of a microbicide for women's use against HIV today reinforced the continuing focus on women at the 16th International AIDS Conference. The "Microbicide Development Strategy" seeks to ensure that donors can identify and fund gaps in the process, that funds are used effectively, and that when a product is ready it will be made available as quickly as possible.
"Microbicides are no longer the stepsister in prevention," Judy Auerbach, a vice president with the American Foundation for AIDS Research, told a press conference. Annual funding has reached about $163 million, according to Polly Harrison, director of the Alliance for Microbicide Development, which coordinated the strategy development, but the level is still short of the $280 million needed each year for five years more.
The high cost is due in part to the size of clinical trials required to test effectiveness, according to Dr. Salim Abdool Karim of the University of KwaZulu-Natal in South Africa. Such trials promote prevention messages, including condom use, he said. "As soon as we start these trials, incidence rates drop rapidly.so we have to run even bigger trials." This increases the cost, but "I would much rather see that problem than witness the current incidence," he said.
The strategy seeks a vaginal microbicide, but ones for rectal use are being evaluated for safety, Auerbach and Abdool Karim said.
More potential good news for women came from research sponsored by Family Health International on whether an existing AIDS treatment drug, tenofovir, might also prevent infection. The drug passed a safety trial in West Africa, and the next step is to see if it will prevent HIV infection. "We need to move forward quickly," said Dr. Willard Cates, Jr., president of FHI's Institute for Family Health.
Elaine Abrams of Columbia University reviewed the success of programs to prevent mother-to-child transmission of HIV. "Many high-prevalence countries have programs," said Abrams, "but we are not reaching women in need." She repeated a statistic heard often this week, that fewer than 10 percent of HIV-positive women have access to drugs for preventing transmission of the virus to their babies. And "no one is talking about pregnant women and they are excluded from the roll out" as access to AIDS treatment drugs is ramped up, Abrams said.
Yet new World Health Organization guidelines call for all women with viral loads above a certain level to receive anti-retroviral drugs, including during pregnancy and delivery. A single dose of Nevirapine at delivery to prevent HIV transmission to the baby is still a safe and effective option, Abrams said.
She called for "reframing the discussion" so that pregnancy management for HIV-positive women is seen in the context of a "life-long chronic disease." At the 2008 AIDS conference, "we should hear about the number of men, women, children and pregnant women" on AIDS drugs, Abrams said.
Women, especially grandmothers, bear most of the burden of caring for people living with HIV/AIDS and for their orphans, and are often "devastated economically, emotionally and physically" by it, yet receive little thanks or care for themselves, Do Thi Thanh Nham of the Vietnam Women's Union said at another session. An International Plan of Action on Aging that dealt with care for caregivers was adopted by all United Nations member states in 2002 but is largely ignored, reported Jo Maher of HELP International, a London-based agency.
Men's Liberation Would Help Women, Conference Told
By Joanne Omang and Sally Ethelston
TORONTO, Aug. 17 - If AIDS has a woman's face, as the 16th International AIDS Conference has stressed this week, men's behaviors are much of the reason, and conference participants looked today at possible solutions ranging from circumcision to "positive masculinity" to cyberspace sex partner registries.
Much hallway buzz greeted findings from mathematical models and field research that circumcision is associated with a 60 percent reduction in HIV transmission from an infected woman to a circumcised man. The procedure doesn't necessarily prevent an infected man from giving HIV to a woman, nor to another man, researchers told a news conference organized by the World Health Organization, but logic suggests that if fewer men are infected fewer women will be too. Circumcision also lowers the risk of other sexually transmitted infections, according to French and American researchers.
But cultural beliefs about masculinity, which are major problems for women and AIDS programs in many ways, also limit the utility of circumcision. "Acceptance is not straightforward," warned Kevin De Cock of WHO. "People said we were crazy," said Bertran Auvert of France about initial reaction to research proposals. "Can you imagine five years ago us saying that surgery could help reduce transmission of HIV?"
"Attitude transplants" were recommended at a separate session on men who are irresponsible, risk-taking, violent or controlling in relation to women, including those at policy-making levels. "Men may make the rules but they also have needs, and the patriarchy also affects them," said Dr. Abhijit Das of India , head of Men's Action for Stopping Violence Against Women. The "hegemonic" or traditional model of masculinity idealizes aggression, competence and stoicism, but such men are ridden with anxieties and have limited choices that may frustrate and drive them to violence against both the women in their lives and other men, Das said.
Some "transformative" programs that create "positive masculinity" involve men in role-playing scenarios of conflict with women, while others encourage men to discuss their assumptions, the researchers said. Gary Barker, executive director of the Instituto Promundo in Brazil , reviewed 57 programs and found that the best ones involved one-on-one work that recognized cultural pressures and addressed the vulnerabilities of both boys and men. Few programs engaged women and girls, however, and none lasted more than two years. "To look at changing this big structure called patriarchy will take more than two years," Barker said.
At a jammed session on cyberspace interventions against HIV/AIDS, which Dr. Simon Rosser of the University of Minnesota called "the cutting edge of science and prevention," one researcher described efforts to develop an HIV-status email notification service for use by both homosexual and heterosexual partners who meet online, guaranteeing everyone confidentiality. Others described Web sites, including www.mysexycity.com , that offer safer sex advice guidelines, referrals and face-to-face counseling disguised as sexually explicit chat rooms, cartoons, photos and movies. Traditional pages of didactic fact sheets "like any government Website" don't work because "people don't read them," Rosser said.
Questioners asked how to phrase grant proposals for such programs, especially to government agencies under pressure from conservative religious and other groups averse to open discussion of sexuality. "Scientists are the gatekeepers who allow various communities to speak for themselves," Rosser said. "We shouldn't let those groups deny people the information that can save their lives."
Is ABC Enough?
By Sally Ethelston
TORONTO , Aug. 16 - AIDS activists say they need simple ways to express what works to prevent HIV infection, both to influence individuals toward safer behavior and to persuade funders to give and policymakers to act. But is it too simple to say ABC-Abstain from sex, Be faithful if you don't, and use Condoms?
As the 16th International AIDS Conference entered its third day, researchers and program operators stressed the need for interventions tailored to specific social and cultural settings and the reality of people's lives.
At a symposium yesterday, psychologist and researcher Vera Paiva of Brazil said AIDS is far from people's minds when they are making love, creating a child, or expressing their sexuality. "The exact moment I was infected by HIV, I was not getting infected," Paiva quoted one young woman as saying. A Sao Paulo initiative uses daily life scenarios to inspire discussion of HIV/AIDS, Paiva said, because AIDS care and education should be viewed as an encounter of experts: scientific and technical experts on one side, and experts in an individual daily experiences and scenarios on the other.
"Education for prevention takes time," said Clara Sutherland, who read a presentation by Mary Crewe. "Most education is information and facts," but does not equip people to live their lives, she said.
Juan Jacobo Hernández Chávez of Colectivo Sol in Mexico was one of several participants at a session sponsored by the International Planned Parenthood Federation who questioned the effectiveness of many AIDS education programs, particularly those aimed at young people. Most tell people what to do instead of teaching them to think critically and challenge the forces that affect their lives, he said. The ABC approach is "seeping like humidity" into Latin American programs, although the region receives little U.S. AIDS funding. It is resisted because it appears to be imposed from the outside, he said. "How can you preach abstinence to a commercial sex worker.or to a young gay male in a dark room?"
Kevin Osborne of IPPF noted that abstinence does work for some people, but "We try to make it simple when we know it's not." Others noted that conditions attached to U.S. funding further increase resistance to ABC. Speaking from the audience, Raoul Fransen-dos Santos of the Netherlands said a Ugandan network of young people had used the ABC approach, but it was their idea.
Summing up, Nono Simelela of IPPF reemphasized the complexity of HIV/AIDS. How many of us feel comfortable in talking with our own children about sex, she asked rhetorically. In trying to reach others with HIV/AIDS information, "We need to be honest that we don't know much about sex," she said.
Researchers Have Proof of What Works for Young People
By Joanne Omang
TORONTO , Aug. 16 - AIDS researchers for the first time have hard evidence of what works to get young people to adopt safer sexual practices, an inter-agency task force announced here today.
Mass media messages work, as do school-based programs based on solid curricula, and so do health services where the facilities offer confidentiality and care providers have training in youth-friendly approaches, according to the report, titled Steady, Ready, Go! The study, timed for release at the 16th International AIDS Conference this week, "provides a clear agenda for action for governments around the world if they want to prevent HIV among young people," said Joy Phumaphi, WHO's assistant director-general for family and community health, at a news conference.
The UNAIDS Inter-Agency Task Force on Young People looked at the results of 80 studies of programs to curb the spread of HIV among young people in many different developing countries and settings. It divided the approaches used into three categories: "Steady," those that showed promise and merit more research; "Ready," those that should be widely implemented but also evaluated further; and "Go!" those that clearly work well and should be employed on as large a scale as possible, with continued monitoring.
David Ross, an epidemiologist at the London School of Hygiene and Tropical Medicine, said the report also identified "glaring gaps" in knowledge about what worked to change behavior among marginalized young people such as orphans and street children, prisoners and injecting drug users. Most studies did not separate results for young women and young men, he said, despite the fact that in areas such as southern Africa , young women 15 to 24 are three times as likely to be HIV-positive as males of the same age.
Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa , said it was "staggering" that young people had been "continually ignored in the HIV activities of the international system" and were rarely consulted on programs targeted at them. "It drives them crazy," he observed.
Frika Chia Iskander, 24, an Indonesian AIDS activist, agreed. "The subject of this book is that if you could turn back time, you could prevent me from getting HIV," she said. "I'll be able to use it as an advocacy tool to get progress from my government."
Prevention Issues Dominate Second Day of AIDS Conference
By Sally Ethelston and Joanne Omang
President Bill Clinton calls for new and sustained global leadership in the HIV/AIDS fight. Photo: AIDS 2006
TORONTO , Aug. 15 - The promise of new prevention methods took center stage during the second full day of the 16th International AIDS Conference, where participants agreed that the ABC approach -Abstain from sex, Be faithful and use Condoms - is not enough. They also took time out to sing "Happy Birthday" to former U.S. President Bill Clinton.
Gita Ramjee of South Africa won cheers from a capacity plenary session audience by suggesting several more letters: two more Cs, for male circumcision and counseling, plus D for Diaphragms; E for Exposure-protection drugs, F for Female-controlled microbicides, G for Genital-tract infection control, H for genital Herpes treatment, and I for Immunity that a vaccine could provide.
With clinical trial results for several methods due to be published in 2007, "2008 is going to be a very good year for prevention," Ramjee said, although mass production and distribution won't occur until about 2010. She predicted that microbicides, which women would apply vaginally to protect themselves from HIV, would prove popular because male partners of women in current clinical trials are saying "the gel makes the sex more pleasurable."
Clinton, who turns 60 on Saturday, told a separate session that individuals speaking out against stigma and demanding care can do more to stop the pandemic than he or other political leaders ever could. "There's one person at this conference for every 1,500 HIV-positive people in the world," he said. "Each of us can account for 1,500 lives if we are organized, persistent and passionate." The 24,000 participants cheered and then sang to him.
Cristina Pimenta of Brazil warned the plenary audience that "people are not well-behaved research subjects" and that "prevention is still the best solution." Barriers including poverty, stigma and discrimination raise people's risk of catching HIV/AIDS and prevent them from using prevention methods already available, she said. New technologies "are not magical solutions" when lack of funding and poor delivery systems already bar treatment for most. "In a world where some of us are living with HIV/AIDS, we are all living with HIV/AIDS," she said.
The World Health Organization today announced a "Treat, Train, Retain" global program to address the growing shortage of health care workers that hampers HIV prevention worldwide. The problem is most acute in sub-Saharan Africa, which has only 3 percent of the world's health care workers and 64 percent of its HIV/AIDS cases, the agency said. The new program will allocate $7.2 million over five years in 60 countries in partnership with governments for programs to reduce the gap.
Another conference session looked at ways people living with HIV/AIDS view sex and reproduction. One presenter focused on the danger that HIV-positive people getting anti-retroviral therapy might resume risky sexual behavior once they were feeling healthy again, thus spreading the disease further. A study of 183 patients in Mombasa, Kenya, found no evidence of that and some "encouraging" sign of increased condom use, according to researcher Adina Sarna.
Other speakers addressed political barriers to effective prevention programs. "We are very able to control infections among injecting drug users and have known how for more than 15 years," said Alex Wodak of Australia at the morning plenary. "It's the politics in so many countries that prevents us from doing what we have to get done." He noted that the U.S rate of AIDS among drug users was the highest in the industrialized world, yet U.S. policy opposes the clean-needle programs and other "harm reduction" approaches that most other countries have adopted. "The scientific debate is now over," Wodak said.
At a session on the ways law enforcement affects AIDS, participants agreed that a punitive approach to drug users and sex workers increases stigma and discrimination that discourages those high-risk groups from seeking testing and treatment, thus spreading the virus. However, Richard Elliott, deputy director of the Canadian HIV/AIDS Legal Network, pointed out that litigation could be good: lawsuits led to court rulings in Canada and Costa Rica overturning job discrimination against people living with HIV/AIDS. The Costa Rica suit had triggered similar litigation in El Salvador and other parts of Central America , he said.
The search for a vaccine was high on the agenda. Françoise Barré-Sinoussi of France criticized the research community for persisting with "more of the same" approaches during some 30 vaccine trials going on now. "We need to be more creative," she said at a press conference after the plenary session. But she applauded "fantastic progress" in understanding the AIDS virus and predicted a vaccine within this century.
Poverty Causes AIDS and Vice-Versa, Conference Told
By Joanne Omang
TORONTO, Aug. 15- Progress against poverty, especially among women, is essential to combat AIDS in developing countries, and vice-versa, but decades of promises have to be fulfilled for that to happen, development specialists told the 16th International AIDS Conference here today.
At an evening panel discussion, Sigrun Mogedal, Norway's Ambassador for HIV/AIDS, said world leaders had pledged repeatedly at many international conferences to raise investments in women's needs as central to the fight against poverty, but have so far failed to deliver. "The missed opportunities of those agendas are very central" links to the AIDS pandemic, she said. "The gap is a fatal one." Norway leads the world in the percentage of national income devoted to international assistance.
Geeta Rao Gupta, president of the International Center for Research on Women, said girls and women in poor households feel the impact of AIDS most: in caring for the sick and orphans and often in losing their homes and possessions to their in-laws if their husbands succumb. She called for guarantees of property and inheritance rights to women in developing countries as "one of many ways" those governments could fight both women's poverty and AIDS. "AIDS feeds on our past mistakes and on the gender and fault lines that divide our societies," she said.
Dr. Simon Miti, secretary of Zambia 's Ministry of Health, said his country's poverty kept it from paying health workers enough to keep them working and in the country, which allowed AIDS to spread. Donors tend to favor groups that already have the capacity to write a good grant proposal and often do not demand enough accountability, he said. Asked about corruption's effect, he agreed "it makes business very, very expensive" but noted that the country's former president and leaders are facing prosecution on corruption charges.
Female Condoms: a Tool to Stop AIDS
By Joanne Omang
TORONTO, Aug. 15- Female condoms, a potent weapon against AIDS, are an idea whose time has not only come but has been waiting around for years, researchers told the 16 th International AIDS Conference yesterday - they just need better marketing.
The latex or
polyurethane devices, first marketed in the mid-1990s, have won broad acceptance in field trials in 40 countries, according to UNFPA, the United Nations Population Fund, which sponsored the evening panel discussion, one of more than 400 scheduled at this week-long gathering. "Things we know today, like female condoms, could stop this epidemic," said Mitchell Warren, now executive director of the International AIDS Vaccine Initiative and a longtime advocate for the devices. He called it "shocking" that only about 12 million are produced annually, half of which go to Brazil and South Africa, and most people still do not know the product exists.
Bruce Campbell, former UNFPA representative in Zimbabwe, said the agency had distributed as many there as it could get. "Female condoms are expensive," about $1.70 each, "and we don't have enough money to bring in more supplies," he said. The price is a function of volume, Mitchell said: the greater the demand, the more producers would create, bringing down the unit price.
"However low the price is, for some people it's unaffordable," said Esperance Fundira, UNFPA representative in Malawi, where per capita income is less than $1 per day. She said the agency marketed female condoms in non-traditional places such as food markets and hair salons, but noted that the visibility of the devices means male partners must be recruited to cooperate in their use. She said UNFPA targeted sex workers in Malawi who introduce them as toys. But Campbell said that in Tanzania the agency had not targeted sex workers initially so as to avoid stigmatizing female condoms by association.
Such mixed approaches are required for varying cultural situations, the panelists agreed. Simone Martins da Silva, a consultant to Brazil's successful AIDS prevention efforts, said specific strategies were used for each target group, but that all got individual counseling and free male condoms as well. Conference participants each received a cloth packet containing a sample female condom and pictorial instructions on its use.
Mitchell praised The Pleasure Project, a British-based organization that works "to put the pleasure back in safer sex" and presents female condoms as a sex toy. "The social marketing for male condoms has been very successful but isn't matched yet for female condoms," he said.
Sex Workers Open "Stiletto Lounge" at AIDS Conference
By Joanne Omang
TORONTO , Aug. 14 - A huge, sexy shoe poster marks one of the most popular displays at the 16th International AIDS Conference: The Stiletto Lounge, where sex workers from around the world have come out of the shadows to announce that they want to be part of the solution to the AIDS epidemic, not part of the problem.
"You can't fight HIV without sex workers, and we can't fight HIV without workers' rights," proclaims their enormous poster-cum-program, which features a foot-high black silhouette of a muscular woman draped in the red AIDS ribbon. A similar T-shirt is a hot conference item, and the "lounge" features an oversize "bed" adorned with lush Indian fabric, sex toys and, of course, condom packages.
"We're here to meet each other and understand our issues better, and for visibility with all these AIDS activists, to get our messages out," said Anna-Louise Crago, communications coordinator for Stella, a Montreal organization of current and former sex workers that is one of the site's four sponsoring groups.
They hold that sex work should be recognized as the regular job it often is, with rights to organize unions and health care mandated by legislation. Only with an end to stigma, discrimination and violence can sex workers be recruited to practice safer sex and educate their clients to protect themselves against AIDS, Crago said.
The groups' 30 scheduled events during the week-long conference range from serious scientific research with titles like "Links between alcohol consumption and transactional sex in Malawi" to a musical revue by the "Starwhores" set Wednesday and daily "Sexxxy Demonstrations" of the safe use of sex toys.
"We're everywhere and there's a lot of us here," said a former Montreal sex worker who identified herself only as Kathryn D, "and maybe more of us than meets the eye."
Women March for Women at AIDS Conference
By Joanne Omang and Sally Ethelston
|Above: Women listen to speakers at a rally before the march demanding women's empowerment be a tool in the fight against AIDS. Photo: AIDS 2006
TORONTO , Aug. 14 - Activist women marched on the 16th International AIDS Conference today to insist that the AIDS pandemic will only be stopped by meeting women's needs for more power in dealing with men. The theme was one underlined repeatedly in the first full day of conference sessions, which focused on major challenges of the war on AIDS.
Dr. Helene Gayle, conference co-chair, told the 600 marchers their rally was the first by women in the 21-year history of these conferences. "It's hard to believe," she said, "that this is the first time we have had a march for women, by women." Stephen Lewis, United Nations Special Envoy for AIDS in Africa , said the event could be "a turning point" in focusing anti-AIDS work where it belongs. "The only thing more intractable than the virus itself is gender inequality," he said.
Dr. Chris Beyrer, an epidemiologist at the Bloomberg School of Public Health of Johns Hopkins University, said women's empowerment is important, but prevention work must be tailored to address the different major causes of new HIV infections in various regions, including social factors. At the gathering's first plenary session, he told the 24,000 activists, scientists, journalists and others in attendance that women's empowerment is critical in southern Africa and other areas where the disease is spreading through the general population.
But injecting drug users suffer 30 percent of all new infections outside Africa, especially in Central and Eastern Europe and the former Soviet states, he said, so needle-exchange programs to reduce harm to them are greatly needed there. But U.S. funding, the greatest source for AIDS programs, cannot be used for such projects. Yet less than 10 percent of injecting drug users have access to prevention and treatment worldwide, Beyrer said.
And in the United States , a new study in 33 states found that 61 percent of new HIV infections are among men who have sex with men, with men in prisons particularly at risk, but condoms are not available in most U.S. prisons.
Dr. Julie Overbaugh of the Fred Hutchinson Research Center in Seattle outlined new research on the "sugar coating" that protects HIV molecules that she said opened a window for possible new ways to attack the virus. Other recent studies show that infection with HIV may not protect again later infection with somewhat different HIV strains, she said, and should cause researchers to question this idea.
The opening plenary, where Beyrer and Overabaugh spoke, was also the occasion for the Jonathan Mann Memorial Lecture, given this year by the Indian human rights lawyer Anand Grover. He said new approaches to HIV testing raise human rights issues by testing unless clients specifically "opt out." Echoing Beyrer, he noted that 94 percent of U.S. prisons do not distribute condoms, one driver of rising infection rates among African Americans. Imprisonment rates are disproportionately high for African Americans, who are 12 to 13 percent of the U.S. population but more than half the prison population. "This is a scandal of the highest order," said Grover.
Joanne Omang is a former Washington Post reporter and foreign correspondent. Sally Ethelston is a policy analyst with 20 years' expertise in reproductive health and development.