Saturday, November 30, 2013

3 surprising global AIDS facts (feat. the HIV Story Project)

At BeforeWeDo, we acknowledge the fact that a lot of the great work in sexual health that is being achieved today does not come from private industry. It is the foundations, the charity institutions and non-profits that are driving awareness and change in this country every day. Today, we want to feature one of them which caught our eye in San Francisco.

This non-profit was started by the two award-winning film directors Marc Smolowitz and Jörg Fockele as they realized that most documentaries about HIV treated the past. However, only looking at the topic from a history perspective might lead to the danger of treating HIV/AIDS as a thing of the past. With still over a million HIV infected individuals in this country, this is clearly not the case. Therefore, they founded the HIV Story Project to use film to tell today’s diverse stories about the disease - in the United States and abroad.



Their latest film 'Keep the Promise - The Global Fight Against AIDS' (IMDB) documents the campaign ‘Keep the Promise’ that brought thousands to Washington, including celebrities like Wyclef Jean, Al Sharpton and Margaret Cho and representatives from over 50 countries. All coming to remind the world governments to keep their promise to maintain funding for HIV/AIDS research, treatment and prevention. 

So I went to the event for you and besides the documentary discussed below I also had the opportunity to listen to the 'Messengers of Hope' - a gospel choir that works HIV/AIDS topics into their songs. Additionally, I had the honor of speaking to Terri Ford, Chief of Global Policy and Advocacy from the AIDS Healthcare Foundation that sponsored not only the event but the documentary as well. The film and her personal stories brought up facets that HIV/AIDS has in other countries that can be quite surprising to people who grew up in the Western hemisphere.



Demonstration in Washington D.C from Keep the Promise film (2013)


1.) On a global scale, HIV can still be a death sentence.
In the US, retroviral medication to keep HIV at bay and the viral load undetectable can cost up to 30,000 USD per year with lifetime costs for patients being estimated at over 500k USD.  Despite the multiple state-level and federal support programs (list by AIDS.gov) such as ADAP that are providing medication to uninsured with low income, many still struggle with affording their drugs. In many states for example, assistance is limited to individuals with an income less than 22k USD / year - disabling patients to make efforts to leave lower income classes as medication expense would be unbearable. This problem takes another dimension in developing countries. Generics and international drug assistance can lower the costs down to 150 USD / year but even that is hard to afford if you are not making less than 2 USD / day. How many people do you think have such low income worldwide? 10 Million? 100 Million? 500 Million? No, think again - Current estimations are at 2.7 Billion - 38% of the world population.

Terri Ford, AHF
Terri told me about her recent trip to Myanmar. One of the Asia’s poorest country which until AHF made an effort to open office practically had no retroviral medication. "People are still dying from AIDS related complications " - just like in San Francisco in the 80ies and early 90ies. Now, despite bureaucratic hurdles, they are bringing in medication to the country and soon will be enabling  patients access to treatment. So for many, out of poverty, HIV is still a death sentence.






2.) 50% of all HIV-infected individuals are women.
If you like me grew up in a country were most HIV cases affected men who have sex with men, then you must have been as surprised as me to learn that half of HIV+ patients worldwide are women. Many factors are still contributing to this development. Violence is one of them: HIV transmission risks from a positive man to a woman can increase during forced sex due to tearing and lacerations. But also cultural factors such gender norms, lack of mobility and education hinder the lowering of new HIV infection rates amongst women. At the same time, the WHO states that most HIV/AIDS programs do not address gender inequality. There is still a lot to be done!


Margaret Cho, Scene from Keep the Promise film (2013)


Connected to positive women is the topic of positive babies - one of the saddest transmission routes of HIV. Terri told me about her last trip in India where she talked to a positive woman who with her doctor visited 4 different medical aid programs that all refused to give her medication because despite being HIV positive, her T-Cell count was not low enough. "Frist of all, her T-Cell count was below 500 which is the current WHO limit and secondly she is pregnant! The WHO guidelines stipulate all pregnant women to be treated anyway. Her child may be born positive! That makes me angry!" Such stories are incredibly frustrating to ear - especially considering how successful medical treatments can prevent babies from contracting HIV from the mother. 


3.) HIV is most rapidly expanding in Eastern Europe
While we mostly focus on Sub-Saharan Africa when we are talking about the biggest impact, it was surprising to see in the documentary that the highest growth of HIV infections take place in Eastern Europe. The former Soviet Union countries were considered low risk by the WHO just 20 years ago. Travel restrictions into and out of the country during the cold war made it very hard for the virus to invade the country. However, with the fall of the union and subsequent opening of the newly formed countries this changed and with the economic downturn, an increase of drug use accelerated the spread. Until 2007, the main mode of transmission was sharing needles and as we look at the statistics of 2008 further, we see another very sad transmission route: children born HIV-Positive. A very sad fact given that we can already prevent the transmission from mother to child with great success.




Modes of HIV transmission in Ukraine in 2007, UNGASS via Wikipedia

Another concentration of HIV is the prison system. For example, studies in the Ukraine in 2005 showed that between 15 - 30% of prison inmates were HIV positive.


So why, as a US based startup focusing on the American market first are we blogging about the world. It is because we live in a global village, aren’t we? We drive cars from Japan, dance to music from Korea and drink beer from Germany. Lets take a minute during World AIDS day to consider the many aspects the disease has on this little blue planet.



Margaret Cho, Wyclef Jean, Scene from Keep the Promise film (2013)

Thursday, October 24, 2013

10 Amazing and Shocking Facts About Condoms You Didn't Know

For literally thousands of years we have tried myriad ways to prevent pregnancy. From trying to predict (in-)fertile periods via coitus interruptus, anal sex and herbal remedies to - of course - rubbers, Johnnies, French Letters or however you call your condoms. By and large condoms do a good job at preventing STDs and pregnancies when used correctly. But embarrassment, awkwardness and ignorance often rule our relationship with our lubricated rubbery friends.


In our research on STDs and condoms we came across a several fun and a few shocking facts about condoms. Here’s BeforeWeDo’s Top 10.


1) The first rubber condom was introduced in 1855. Young Rubber Company from the United States was the first to produce latex condoms. Their “Trojan” brand has been around for 90 years (but was subsequently bought by Church & Dwight). Little known however is that before World War 1 most condoms were actually produced by Germany and exported around the world.


Condom advertising displayed at the Dittrick Museum
2) A 15,000 Year History. Wow!
Before that, chemically treated linen cloth, animal skins and intestines and tortoise shells were used for contraception. The shells for example covered the penile gland only. Historians speculate loincloths worn by wealthier individuals also served as contraception when the urges hit. Reliability must have been an issue: Casanova used to blow up his condoms before donning them to check for holes! Check out the below 10,000 to 13,000  B.C. cave painting from the French Grottes des Combarelles apparently showing a man using a condom-like covering.



3) The Bill and Melinda Gates Foundation has offered a grant 100,000 US$ to sponsor the development of the Next Generation Condom
The goal is to find a pleasure-enhancing condom! We applaud the Gates Foundation’s effort to improve today’s condoms and further de-stigmatize condoms! A main contender is the Origami Condom, designed and produced in California. The condom folds unfolds in line with your natural movement. It fits more loosely than traditional latex condoms sacrificing none of the safety and the additional friction due to the folding movement creates additional sensation. Alas, it won’t be available on the market before 2015 due to the FDA’s approval process!

Origami’s folding male condom - due in 2015



4) 80% - that’s the average effectiveness of condoms in preventing STDs and pregnancy. Sounds low? 
Well, effectiveness in ideal use is roughly 97%. Most of us - me admittedly included - make less than ideal use of it. In 18% of cases we commit errors such as not grabbing the condoms base when pulling out, not checking expiry dates or touching the outside with our penis before putting it on…

For a more detailed summary see the Sex Out Loud blog or this study linking common mistakes with the amount of prostate-specific antigen found in vaginal fluids.


5) Magnum Condoms are a marketing marvel or has there been a growth spurt in US penis size?
Nobody seems to want to be seen buying a “small: condom (the industry term is ‘snug fit’). Between 2000 and 2010 Magnum sales grew 14% taking up 18.8% of the market. Magnum condoms produced by US market leader Trojan were propelled to fame by the likes of Busta Rhymes, Remy Ma and Ludacris. The Magnum condoms measure 8.07 inches in length and 2.13 in diameter. See below for the average American size. Some men report that the looser fitting condoms are more comfortable. Well, almost time for the weekend - so let’s pick up some ego-boosting Magnums!

Magnum ad featuring Ludacris
Magnum ad featuring Ludacris



Penile size worldmap


6) The largest condom manufacturer sits in… Malaysia. 
In a predominantly muslim country Karex Industry reportedly produces around 3bn condoms and holds around 25% of global market share by quantity. The US government is its largest customer via USAID. However, Reckitt Benickser’s Durex leads the market in terms of value with a market share of 30%.


7) Men lie about their penis sizes. 
Americans of all color overstate their penis length. While African Americans overstate by 1 inch (7.9 to 6.9 inches), white Americans overstate by 1.7 inches claiming 6.8 inches but measuring 5.1 inches on average. In a European study the French report to need the largest condoms (6.09 inches) but come out slightly below European average (which is 5.7 inches). That said, studies in Europe vary a lot. alphadesigner as well as the corresponding Daily Mail article give further information.

Europe according to penile sizes
Europe according to penile sizes




8) Do condoms made out of animal bladder, stomach and other intestines sound gross to you? 
They’ve been used for centuries and they are still used today. Not vegetarian-friendly, they are an alternative for lovers with a latex allergy. They’re sometimes also referred to as lambskins, but the professional term is ‘natural membrane condoms’.
Animal membrane condom
Animal membrane condom

The Durex US website doesn’t list any non-latex condoms, but both Trojan and LifeStyles sell more advanced version of their historic cousin.


9) Outright scary: condom sabotage
In a study of single, heterosexual guys who’ve had at least one unprotected encounter in the last year the researchers studied how guys persuade women to no insist on condoms. Common techniques included risk-level assurance (I’m clean) and seduction (Getting her so excited she’ll forget). However, 9% admitted to having intentionally sabotaged and opened a condom when putting it on!


Dr. Lehmiller’s blog offers a great summary of the study & plenty of news surrounding human sexuality.


10) As scary: fake Chinese condoms. 
China Daily reported 2m fake condoms labelled as Durex, Trojan and Jissbon (sounds like James Bond in Chinese) were seized by police. Now, China isn’t known for small business. Ghana’s FDA rejected 110m condoms from China due to holes, dried lubricant and generally shoddy quality (What would Ghana want with Chinese condoms in the first place? Check out the penile size world map again!). On an entertaining note: these pictures of Michelle Obama and Ann Romney were posted more than 60,000 times on China’s microblogs.


Pure Fun: Durex Ballooninmals

This is one of the most entertaining condom advertising’s I came across. It's an ad you'll never see on TV:



Are You an Expert?

How expert a condom user are you? What do you think most people would say if asked whether their skill of using condoms was above-average?


How satisfied are you with the current condom offerings on the market? Have you used non-latex condoms, female condoms and are you looking forward to Origami’s innovations? 

Let us know!

Friday, September 27, 2013

25 years prison for HIV Non-Disclosure. Medieval or Appropriate?

Last week I got a first and powerful impression of the stigma and fear that still surrounds HIV/Aids. At the Roxie Theater in San Francisco, Stefan and me attended an event to promote three new documentaries that showed current issues of the disease. The issue of criminalization of HIV left such a deep impact with me that it prompted me to write my first ever blog article.


People living with HIV in many countries are still subject to not only discrimination but also criminal lawsuits. A shocking example was that of Nick Rhoades, a 34-year old former hotel manager from Iowa, who was sentenced to 25 years in prison for not disclosing his positive HIV-status prior to a one-time safe sexual encounter in 2008. Although a condom was used, Nick’s viral load was at undetectable levels and there was actually no transmission of HIV, he was found guilty of ‘Criminal HIV Transmission’. The one-night stand was qualified as an aggravated sexual assault.

Nick and his partner had consensual sex, used protection and thanks to HIV-medication Nick’s viral load was undetectable. However, when Nick’s partner later learned about his HIV-positive status, he went to a hospital whose’ staff then pressed charges.  

The initial 25-year sentence was later suspended, but Nick still has to live with being marked a sex offender - a huge burden not allowing him to have an email account, use Facebook or spend time unsupervised with his nephews and nieces. Watch more in the short film below that was kindly made available for free by the Sero Project:


This is not an isolated case. Robert Suttle was similarly accused by a former lover of non-disclosure and had to register as a sex offender. Since then Robert has become a vocal and articulate advocate for the rights of people with HIV in the Sero Project. Neither in Robert’s nor in Nick’s case did transmission of the virus actually happen. In total more than 200 people have been convicted due to non-disclosure in the US.




HIV-Specific laws in 36 US states

Such cases are not restricted to the United States with many cases documented in Canada, Sweden and other countries. In this country, criminal law is often applied for cases of non-disclosure. More than 30 states have HIV-specific laws. Harsh sentences are often the result.

As Monique says in the Sero Project’s film: criminalization may actually deter people from getting tested. The American Journal of Public Health published a study showing no decrease in transmissions in state with mandatory disclosure. UNAIDS concurs and published a brief urging governments to de-criminalize HIV/Aids. Such laws can also create a false sense of security: if my partner had HIV he’d have to tell me.

A newly infected person will be highly unlikely to come forward with the names of people he had sexual contact with out of fear of further charges. Recently infected people cause a lot of new infections making early detection critical!

Additionally, the fact that one has disclosed to a partner is difficult and embarrassing to prove and document. Diary entries, video recordings or a joint doctor visit may all help. Testing Together is available for male gay couples in many states and offers free testing, also when one partner knows he’s positive but hasn’t told yet.Al
Laws were passed in many states in the 1990 to make the exposure of partners who are unaware of one’s status to HIV a crime. Two aspects are important here to consider:
  • Firstly, the risk of transmission in a setting
  • Secondly, the severity of an infection

Both these aspects have changed drastically in the last two decades.

What do you think the chance is you’ll catch HIV from unprotected anal sex?

As per Aidsmap the risk during unprotected sex (in contrast to the cases above where condoms were used) with an HIV-positive person per exposure is: (compare CDC data)

Receptive Vaginal sex (male-to-female) transmission risk: 0.08% Insertive Vaginal sex (female-to-male) transmission risk: 0.04% Receptive anal sex between men, partner HIV positive: 0.82% Insertive anal sex, between men, partner unknown status: 0.06%

The chance of infection rises dramatically if you’re in poor general health or have other STDs.

In the cases mentioned above, condoms were used which further decreases the chance of transmission. For heterosexual couples at least, studies have concluded that if the HIV+ partner has lowered their viral load to undetectable levels, the transmission risk is practically zero. I found these probabilities much lower than expected, which is still not a reason to not be careful.

On the severity: While contracting HIV/Aids will certainly change anybody’s life, it is not a death sentence anymore as retroviral medication can lower one’s viral load to undetectable levels and procrastinate the emergence of AIDS for many decades. An IAS study of 2013 even stated that individuals diagnosed with HIV today in the U.S. or Canada can expect to live an almost normal life span.

Consequently, Scott Burris at Temple University asks in Harvard’s Bill of Health blog whether non-disclosure should be a crime at all. Aaron Laxton blogs about his ‘HIV Journey’, gives his personal opinion on criminalization and whether to disclose one’s HIV status.



Dropping the H-Bomb


Should you always disclose? Personally I still think yes, which is easy to say if you’re not the one to say the words... Marianne Mollman, with Amnesty International, published a balanced article in the Huffington Post highlighting the complexities of the topic.

Many people with HIV will indeed disclose their status every time. Not because of laws, but because they’re convinced it’s the right thing to do. But ‘Dropping the H-Bomb’ as Jessica in Positive Women called it is a very hard thing to do! And because plenty of HIV-positive people have encountered stigma, discrimination and even physical abuse, disclosing is not as straightforward as it sounds.

Making people comfortable disclosing their status is our best bet in fighting HIV/AIDS. The best way to do this is with support and understanding - not criminal law. This puts the responsibility both on people with and without HIV.

So in conclusion, I have two questions for you:
  • If you were HIV-positive and wanted to tell a potential partner, how would you say it?
  • On the other hand, if you heard a potential partner say that he/she got HIV - what would you say and do?

Take a while to think and be honest to yourself - these are tough questions to answer

The Maker of this Blog: