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    • "By five years, the protective effect reached 73% in the Ugandan trial [163]. These results suggest that the positive effect of MC will continue [158]. However, implementation of national MC programmes triggered by the RCT findings did not begin until 2008 [7], starting in Kenya [164], and thus the long-term population impact remains to be observed in those particular areas. "
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    ABSTRACT: Heterosexual exposure accounts for most HIV transmission in sub-Saharan Africa, and this mode, as a proportion of new infections, is escalating globally. The scientific evidence accumulated over more than 20 years shows that among the strategies advocated during this period for HIV prevention, male circumcision is one of, if not, the most efficacious epidemiologically, as well as cost-wise. Despite this, and recommendation of the procedure by global policy makers, national implementation has been slow. Additionally, some are not convinced of the protective effect of male circumcision and there are also reports, unsupported by evidence, that non-sex-related drivers play a major role in HIV transmission in sub-Saharan Africa. Here, we provide a critical evaluation of the state of the current evidence for male circumcision in reducing HIV infection in light of established transmission drivers, provide an update on programmes now in place in this region, and explain why policies based on established scientific evidence should be prioritized. We conclude that the evidence supports the need to accelerate the implementation of medical male circumcision programmes for HIV prevention in generalized heterosexual epidemics, as well as in countering the growing heterosexual transmission in countries where HIV prevalence is presently low.
    Journal of the International AIDS Society 10/2011; 14(1):49. DOI:10.1186/1758-2652-14-49 · 5.09 Impact Factor
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    ABSTRACT: Abstract A potential impediment to evidence-based policy development on medical male circumcision (MC) for HIV prevention in all countries worldwide is the uncritical acceptance by some of arguments used by opponents of this procedure. Here we evaluate recent opinion-pieces of 13 individuals opposed to MC. We find that these statements misrepresent good studies, selectively cite references, some containing fallacious information, and draw erroneous conclusions. In marked contrast, the scientific evidence shows MC to be a simple, low-risk procedure with very little or no adverse long-term effect on sexual function, sensitivity, sensation during arousal or overall satisfaction. Unscientific arguments have been recently used to drive ballot measures aimed at banning MC of minors in the USA, eliminate insurance coverage for medical MC for low-income families, and threaten large fines and incarceration for health care providers. Medical MC is a preventative health measure akin to immunisation, given its protective effect against HIV infection, genital cancers and various other conditions. Protection afforded by neonatal MC against a diversity of common medical conditions starts in infancy with urinary tract infections and extends throughout life. Besides protection in adulthood against acquiring HIV, MC also reduces morbidity and mortality from multiple other sexually transmitted infections (STIs) and genital cancers in men and their female sexual partners. It is estimated that over their lifetime one-third of uncircumcised males will suffer at least one foreskin-related medical condition. The scientific evidence indicates that medical MC is safe and effective. Its favourable risk/benefit ratio and cost/benefit support the advantages of medical MC.
    AIDS Care 03/2012; 24(12). DOI:10.1080/09540121.2012.661836 · 1.60 Impact Factor
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    ABSTRACT: 5P12-RANTES is a recently developed chemokine analog that has shown high level protection from SHIV infection in macaques. However, the feasibility of using 5P12-RANTES as a long term HIV prevention agent has not been explored partially due to the lack of available delivery devices that can easily be tuned to meet release rate needs. Glycosaminoglycans (GAGs) have been known for their affinity for various cytokines and chemokines, including native RANTES. In this work, we investigated used of GAGs in generating a chemokine drug delivery device. Initial studies used surface plasmon resonance analysis to characterize and compare the affinities of different GAGs to 5P12-RANTES. These different GAGs were then incorporated into drug delivery hydrogels to engineer controlled release of the chemokines. In vitro release studies of 5P12-RANTES from the resulting hydrogels were performed and we found that 5P12-RANTES release from these hydrogels can be controlled by the amount and type of GAG incorporated. Gels containing GAGs with stronger affinity to 5P12-RANTES resulted in more sustained, and longer term release than did gels containing GAGs with weaker 5P12-RANTES affinity. Similar trends were observed by varying the amount of GAGs incorporated into the delivery system. 5P12-RANTES released from these hydrogels demonstrated good levels of CCR5 blocking activity even after 30 days of incubation.
    Molecular Pharmaceutics 07/2013; 10(10). DOI:10.1021/mp3007242 · 4.38 Impact Factor
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