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    ABSTRACT: Traditional male circumcision practices have been strongly discouraged by HIV prevention campaigns in Lesotho. Traditional circumcision rituals are perceived as a possible transmission route for HIV because of the reuse of unsterilized cutting instruments. While individuals living in urban areas and the lowlands have increasingly considered traditional circumcision a practice of the past, foregoing the procedure all together, those dwelling in rural areas continue to consider the practice vital in the construction of male national identity. Initially, the national government voiced strong concern over the publicizing of medical male circumcision (MMC) – conducted by surgeons in sterile clinics. There have been claims that male circumcision (either traditional or MMC) does not have the same level of protective benefit against HIV in Lesotho that research suggests it has in other countries in the region. This article critically examines the development of government responses to international expectations on MMC scale-up. It also explores the impact of government responses on the attitudes of youth who serve to benefit most from such biomedical HIV prevention measures. Given the existing distinction between traditional practices and MMC, recent international calls for male circumcision in the region are positioned at the divides of modern/traditional, urban/rural, educated/ignorant, uninfected/infected.
    06/2013; 3(2):284-299. DOI:10.1080/23269995.2013.804700
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    ABSTRACT: To estimate the cost-effectiveness of daily oral tenofovir-based PrEP, with a protective effect against HSV-2 as well as HIV-1, among HIV-1 serodiscordant couples in South Africa. We incorporated HSV-2 acquisition, transmission, and interaction with HIV-1 into a microsimulation model of heterosexual HIV-1 serodiscordant couples in South Africa, with use of PrEP for the HIV-1 uninfected partner prior to ART initiation for the HIV-1 1infected partner, and for one year thereafter. We estimate the cost per disability-adjusted life-year (DALY) averted for two scenarios, one in which PrEP has no effect on reducing HSV-2 acquisition, and one in which there is a 33% reduction. After a twenty-year intervention, the cost per DALY averted is estimated to be $10,383 and $9,757, respectively - a 6% reduction, given the additional benefit of reduced HSV-2 acquisition. If all couples are discordant for both HIV-1 and HSV-2, the cost per DALY averted falls to $1,445, which shows that the impact is limited by HSV-2 concordance in couples. After a 20-year PrEP intervention, the cost per DALY averted with a reduction in HSV-2 is estimated to be modestly lower than without any effect, providing an increase of health benefits in addition to HIV-1 prevention at no extra cost. The small degree of the effect is in part due to a high prevalence of HSV-2 infection in HIV-1 serodiscordant couples in South Africa.
    PLoS ONE 01/2015; 10(1):e0115511. DOI:10.1371/journal.pone.0115511 · 3.53 Impact Factor
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    Biomedical Engineering - From Theory to Applications, 09/2011; , ISBN: 978-953-307-637-9