@ jAnaM blog

THE ENDING OF 2008

2008-12-27T00:14:00.000-08:00

Just want to take the opportunity to salute and thank those who managed to positively change lives of others/and or were courageous enough to do good in one way or another.

Also to get this out of the way.....this blog is still alive and well and the only reason why there have been almost zero posts in the last month or so is because of circumstances beyond my control for now. But, my promise is this, it will pick up the pace once I am back on regular normal schedule.

Thank you for your understanding.

HAPPY NEW YEAR EVERYONE!!!!! AND MAY 2009 BE EVEN MORE INTERESTING!

OBAMA AND AMERICA

2008-11-04T22:25:00.000-08:00

BARACK OBAMA ELECTED 44TH PRESIDENT OF THE UNITED STATES OF AMERICA!

CHANGE HAS COME TO AMERICA-YES THEY DID!

The Illinois senator becomes first African-American leader in U.S. history.

History has been made today -04/11/2008 and I have to record it on this blog to look back on. Right this minute I got nothing more to add, just celebrating!

*****The end******

THINGS YOU SHOULD KNOW ABOUT BARACK OBAMA

2008-10-24T16:22:00.000-07:00

50 things you should know about Barack Obama-corrected

1. Barack Obama's father was a Kenyan. Period. (there is no such thing as “a black Kenyan”in Kenya! For those who are unaware) and his mother was a Kansas native. The two met while attending the University of Hawaii.

2. Barack Obama Sr. (Obama’s father) must have fluently spoken Luo as his mother tongue, Kiswahili and English among other languages.

3. Now Kiswahili is not Creole as some people are suggesting online, rather-Swahili language- Is the native language of various groups traditionally inhabiting about 1,500 miles of the East African coastline. About 35% of the Swahili vocabulary derives from the Arabic language, resulting from the fact that the language evolved through centuries of contact between Arabic-speaking traders and many different Bantu/and or others-speaking peoples inhabiting Africa's Indian Ocean coast. It also has incorporated Persian, German, Portuguese, Indian and English words into its vocabulary due to contact with these different groups of people. Swahili has become a second language spoken by tens of millions in three countries, Tanzania, Kenya, and Congo (DRC), where it is an official or national language. The neighboring nation of Uganda made Swahili a required subject in primary schools in 1992 – although this mandate has not been well implemented – and declared it an official language in 2005. Swahili, or other closely related languages, is also used by relatively small numbers of people in Burundi, Rwanda, Mozambique, Somalia, and Zambia, and nearly the entire population of the Comoros.

Dialects of Swahili:

.Kiunguja-Spoken in Zanzibar City and environs on Unguja (a Zanzibar Island). Other dialects occupy the bulk of the island.

.Kitumbatu and Kimakunduchi- The countryside dialects of the island of Zanzibar.
Kimakunduchi is a recent renaming of "Kihadimu"; the old name means "serf", hence it is considered pejorative.

.Kimrima-Spoken around Pangani, Vanga, Der-es Salaam, Rufiji and Mafia Island.

.Kimgao-Formerly spoken around Kilwa and to the south.

.Kipemba-Local dialect of the island of Pemba.

.Kimvita-the major dialect of Mombasa (also known as "Mvita", which means "war", in reference to the many wars which were fought over it), the other major dialect alongside Kiunguja.

.Kingare-subdialect of the Mombasa area, Kenya.

.Chijomvu-subdialect of the Mombasa area, Kenya.

.Chi-Chifundi-dialect of the southern Kenya coast.

.Kivumba-dialect of the southern Kenya coast.

.Kiamu-spoken in and around the island of Lamu (Amu).

4. Mr. Obama grew up in Hawaii and lived in Indonesia for a few years. From age 10 on, he lived with his maternal grandparents in a Honolulu apartment.

5. He admits that as a teenager, he used drugs such as marijuana and cocaine to cope with questions of racial identity.

6. Mr. Obama played forward on his high school basketball team and was known as "Barry O'Bomber" for his left-handed double pump shot.

7. He wasn't the first in his family to attend Harvard. His father, Barack Obama Sr, also attended the university earning a post-graduate degree.

8. Barack Obama Jr. was the first African –American to be elected president of the Harvard Law Review.

9. He stopped going by the nickname "Barry" in college after reading The Autobiography of Malcolm X.

10. Mr. Obama is only the third African-American U.S. senator since Reconstruction.

11. His wife, Michelle, agreed to allow him to run for president only if he agreed to quit smoking. But he recently admitted that he still has an occasional cigarette.

12. Mr. Obama uses "Renegade" as a code name for his Secret Service detail.

13. He has never faced significant opposition from a Republican opponent before this year’s presidential election.

14. His desk in the Senate once belonged to Robert Kennedy. Mr. Obama was only 6 when Mr. Kennedy, who was running for president, was assassinated in 1968.

15. If elected, he will be the third president in a row without sons. Mr. Obama has two daughters: Sasha, 7, and Malia, 10.

16. Mr. Obama says his daughters made him promise that, as a condition for running for president, they can get a dog after the election, win or lose.

17. He was elected to the Illinois Senate in 1996. He initially had a hard time fitting in because the chamber was controlled by Republicans, and some of his fellow Chicago Democrats thought he was pretentious and "a white man in blackface."

18. As a state senator, he was selected to give his now-famous keynote speech at the Democratic convention in 2004 after presidential nominee John Kerry heard him speak in Chicago.

19. He is 6 feet 2 inches tall, and his wife is almost 6 feet in heels.

20. Barack Obama was referred to as “THAT ONE” by his opponent, the republican Presidential candidate Sen. John McCain during their 2nd presidential debate.

21. As a kid, he collected Spider-Man and Conan the Barbarian comics, and as a teen, he listened to jazz saxophonist Grover Washington Jr. and Earth, Wind and Fire among others.

22. He grew up without any particular religious beliefs. His mother, Stanley Ann Dunham, was not religious, and his father was not either. Mr. Obama joined the United Church of Christ as a young man in Chicago, saying he was inspired by the good work of Christians he had met and "felt God's spirit beckoning me."

23. Mr. Obama earned a starting salary of $13,000 a year as a community organizer in Chicago in the 1980s. In 2007, he and his wife made $4.2 million, according to their tax return.

24. He won a Grammy award this year for the audio version of his book The Audacity of Hope.

25. In 2000, he lost by a landslide when he challenged former [Black Panther] Bobby Rush, an Illinois Democrat, for his seat in the U.S. House. Mr. Rush is still in office.

26. Mr. Obama easily won his 2004 U.S. Senate race, defeating Republican Alan Keyes with 70 percent of the vote. Mr. Keyes was a late replacement for primary winner Jack Ryan, who dropped out of the race when after his divorce records revealed sex club allegations from his ex-wife, actress Jeri Ryan.

27. Mr. Obama formally announced his presidential candidacy in February 2007 on the steps of the Old State Capitol in Springfield, Ill., where Abraham Lincoln once declared that "a house divided against itself cannot stand."

28. Throughout 2007, he trailed Hillary Rodham Clinton, whom many pundits characterized as the Democrats' "inevitable" presidential nominee. He found an opening in an October debate, when Mrs. Clinton gave a convoluted answer to the question of whether she supported driver's licenses for illegal immigrants. After that, the race became more competitive.

29. Oprah Winfrey joined Mr. Obama on the campaign trail in December, after endorsing him earlier in the process, for a series of rallies starting in Des Moines, Iowa. Nearly 30,000 people came to see them in Columbia, S.C.

30. Mr. Obama wasn't an overwhelming favorite among “black American” voters early in the campaign. Some didn't think he was "black enough," and others doubted that an African-American could be elected president. But his victory in predominantly white Iowa convinced many black voters that he could win the nomination.

31. Mr. Obama's campaign inspired many music video spin-offs, including "Obama Girl" from the Web site barelypolitical.com. Hip-hop star will.i.am of the Black Eyed Peas also wrote a song, "Yes, We Can," based on a speech given by Mr. Obama after his loss in the New Hampshire primary and made it into a video for the Web.

32. In February, Mr. Obama racked up 11 straight victories and gained the lead in the number of delegates needed to win the nomination.

33. Mr. Obama lost the Texas primary to Mrs. Clinton but drew big crowds, including an estimated 15,000 at Dallas' Reunion Arena in late February. He ended up winning a majority of delegates in the Lone Star State because his supporters flooded precinct caucuses on election night.

34. During primaries, Mr. Obama did well in states with large numbers of “black” and college-educated voters in general. But he struggled to draw working-class whites, Latinos and rural residents, especially after making comments in San Francisco that some rural voters "cling to their guns and religion."

35. Ms. Obama stirred up controversy after saying that for the first time in her adult life, she was "really proud" of her country. She later said she was misrepresented/and or misinterpreted, and others, including first lady Laura Bush, defended her. The exact comment was this- “For the first time in my adult lifetime, I’m really proud of my country … not just because Barack has done well, but because I think people are hungry for change, I have been desperate to see our country moving in that direction and just not feeling so alone in my frustration and disappointment.”

36. During the primaries, tensions grew between Mr. Obama and former President Bill Clinton over the ex-president's comments that seemed to belittle Mr. Obama's victory in South Carolina.

37. The tension between Mr. Obama and Mrs. Clinton grew as well. The New York senator released a TV ad that questioned whether Mr. Obama would be ready for a "3 a.m." foreign crisis phone call, and Mr. Obama criticized her judgment and derided her as a Washington insider.

38. Mr. Obama's association with longtime pastor Jeremiah Wright proved troublesome during the primary season. Dr. Wright was criticized for racially incendiary sermons and views. Mr. Obama initially tried to defend him and gave a widely praised speech on racial relations in America, but he later renounced Dr. Wright after the pastor made controversial remarks at the National Press Club. The Obama’s left Trinity United Church of Christ soon afterward.

39. Opponents – most recently the McCain-Palin campaign – have criticized Mr. Obama's association with 1960s radical Bill Ayers, a member of the Weather Underground. Mr. Ayers and Mr. Obama were involved with a Chicago education reform group, and Mr. Ayers hosted a party for Mr. Obama when he announced his Illinois Senate run. Mr. Obama has denounced Mr. Ayers' "detestable acts" but says he was only 8 years old during Mr. Ayers' bombing campaign. THIS GUILT- BY- ASSOCIATION have been all but debunked as their association has been deemed remote at best.

40. Mr. Obama clinched the nomination June 3 and claimed victory in a speech in St. Paul, Minn., later the site of the GOP convention. Four days later, Mrs. Clinton suspended her presidential campaign and endorsed Mr. Obama.

41. A few weeks later, Mr. Obama and Mrs. Clinton campaigned together for the first time in the appropriately named town of Unity, N.H. But he struggled to win over her supporters, including white blue-collar voters.

42. Mr. Obama spoke to a huge crowd in Berlin (estimated – at 200,000 people) this summer, just as former President John F. Kennedy had done decades ago.

43. In a campaign ad, Mr. Obama talked about his mother's death from cancer in 1995 and how, in her final days, she was more worried about paying her medical bills than getting well.

44. Mr. Obama's momentum stalled during the summer when the McCain campaign ran ads –including one with Paris Hilton – accusing him of being a vapid celebrity without substance or a proven record of leadership. But after the debates and the financial crisis, he has managed to assure voters with his cool temperament demeanor and the depth of knowledge he has shown.

45. Mr. Obama selected Delaware Sen. Joe Biden as his running mate to help bolster his foreign-policy credentials, disappointing many Democrats who favored Mrs. Clinton. Early in the presidential campaign, Mr. Biden had questioned Mr. Obama's readiness to be president.

46. Mr. Obama was the first presidential candidate since Kennedy to accept his party's nomination at an outside venue. He gave his acceptance speech at Denver's Invesco Field on Aug. 28, drawing a crowd of about 85,000.

47. Mr. Obama was accused of sexism and disparaging Republican vice presidential nominee Sarah Palin when he referred to Mr. McCain's policies as "lipstick on a pig." His campaign clarified the point he was making, saying he was referring to Mr. McCain's policies as the "pig." Even Mr. McCain himself have used similar phrase before when describing Ms. Clinton’s healthcare plan.

48. Campaigning in Pennsylvania, Mr. Obama tried to connect with blue-collar voters by bowling, but ended up with an embarrassing score of 37. "My economic plan is better than my bowling," he told fellow bowlers. "It has to be," a man called out.

49. Mr. Obama told 60 Minutes earlier this year that every time he played basketball before a key primary, he'd win. He said he plans to play before the general election.

50. If elected, Mr. Obama will be the fifth-youngest president ever at inauguration.

THE WAKI-COMMISSION REPORT

2008-10-18T15:06:00.000-07:00

Unlike the joke that the kriegler commission was and it's below average report-The joker report that - among other things said /or and recommended the ECK commission be ‘radically reformed, or replaced, with a new name, image and ethos, composed of a lean policy making and supervisory board, selected in a transparent and inclusive process.’ JUSTICE WAKI should be the Kenya’s new HERO and deserves a NATION-WIDE STANDING OVATION for a job well done! The 529 page report is as good as it gets-I am elated! He did exceptionally well where others like Kriegler failed us. The South African Pandered to the power of the elites in Kenya. And the fact that one could trace his roots from/through colonialism, it’s no surprise to many.

THE WAKI REPORT:

The WAKI Commission started out with a well- planned out goals and objectives and went through every task diligently. Even though there were some initial setbacks like time constrains among others that are noted in the final report.

The Time Constrains Part-The Commission reported that it concluded early in its tenure that it would not have enough time to visit all areas that had been heavily affected by the post election violence. The life of the Commission, as provided in the Gazette, was only three months and set to expire on 22 August 2008. Hence, the Commission immediately wrote to His Excellency the President of Kenya and to the Panel of Eminent African Personalities asking for a 60 day extension so that it could plan ahead. While the Panel supported the request, the National Dialogue and Reconciliation team, which was the final decision maker, did not. Instead the Commission was granted only a 30 day extension, published in the Gazette Notice no. 7288 Vol. cx – no. 67 dated 12th August 2008. The Commission conducted hearings in public in the following areas: Nairobi between 9 and 25 July 2008 and again from 19 to 27 August 2008, Naivasha on 28 and 29 July, Nakuru from 30 July to 1 August 2008, Eldoret from 5 to 7 August 2008, Kisumu from 11 to 13 August 2008, Borabu on 14 and 15 August and Mombasa on 1 and 2 September 2008. Because of the failure to obtain a 60 day extension of time the Commission abandoned its original plans to conduct public hearings and investigations in Kakamega, Busia, Kericho, Bungoma, Laikipia, Thika and Limuru. Eventually, the Commission received another two week extension for the purpose of preparing this report through Gazette Notice No. 8661 in Vol CX – 74 dated 12th September 2008. The difficulty of receiving limited extensions piecemeal rather than all at once diminished the capacity to engage in forward planning.

How the commission established a communication strategy

The commission recognized that the public legitimately expected the Commission to work transparently and to keep the public informed. Both to manage public expectations concerning information and to develop a reciprocal relationship with the media, the Commission appointed Ms Mildred Ngesa, an experienced journalist, as media relations officer.

In addition, the Commission designed and established a website www.cipev.org to facilitate public access to information about its mandate and its work. The Commission also set up a secure email address, info@cipev.org for receiving confidential information and correspondence. Once the Commission began hearings, the verbatim record of public proceedings were posted on the website.

Aside from the above, the Commission conducted periodic media briefings to inform the public of its work. The three Commissioners appeared together on television interviews in the initial phase after which the Chair issued press releases and engaged with the media in other ways.

Consultations with Government Departments and Others

Is this a coincidence that both President Kibaki and former President Moi avoided to be interviewed by the commission?

The WAKI commission stated that the initial meetings with officials were held in private. The officials with whom the Commission met at this stage included the Commissioner of Police, the Commissioner of Prisons, the Commandant of the Administration Police, the Chief of the General Staff, the Attorney General, the Chairman of the Electoral Commission of Kenya (ECK) (represented by members of his Commission), the Director General of the National Security Intelligence Service, the Permanent Secretary to the Ministry of Justice, National Cohesion and Constitutional Affairs, and the Permanent Secretary in the Office of the President in charge of Internal Security and Provincial Administration. This Commission appreciates the level of co-operation received from the various government departments throughout its work.

The Commission also sought audience with the political leadership and managed to interview the Vice-President, the Prime Minister and one Deputy Prime Minister. An appointment sought with the President did not materialize while the former President declined to meet with the Commissioners.

Role of Civil Society in the WAKI report

In the report, the Commission highlighted that it deliberately decided to work closely with Kenyan civil society organizations and seek their assistance with information, contacts, and expertise in areas related to post-election violence. A number of these organizations attended the Commission’s hearings through lawyers who represented victims and communities and provided useful feedback to members of the public on the Commission’s work.

These included Kenyans for Peace with Truth and justice (KPTJ), the Inter-Religious Forum, the Kenyan Section of the International
Commission of Jurists, (ICJ-K), the Kenya Human Rights Commission (KHRC), the Kenya National Commission of Human Rights (KNCHR), different chapters of the Catholic Peace and Justice Commission, and various religious and faith based organizations.
Civil society and human rights organizations greatly contributed to the
Commission’s work by:
•Providing background material and reports concerning the history and patterns of human rights violations in Kenya. This helped the Commission establish a foundation from which to proceed;
•Giving access to their records, often including statements from witnesses they had interviewed and helping map out geographic regions that should be the focus of investigations;
•providing contacts with local community leaders, individual victims, and other key contacts in communities where they had established trust and credibility;
•Assisting and providing victims the Commission interviewed in public and in private with emotional support, based on long established relationships with them; and
•Offering various types of assistance to victims, including medical services, counseling, and various types of community support.

Standing before the Commission

The Commission also addressed the question of legal standing from persons who wished to participate in its proceedings. The following government departments were covered by its mandate and hence were allowed to participate in the hearings: the Kenya Police Service, the Administration Police, the Provincial Administration, the Electoral Commission of Kenya, the National Security Intelligence Service, the Kenya Prisons Service and the Armed Forces.

It also said that-Groups of citizens and civil society organizations also applied to participate in the proceedings. They included victims’ representatives, experts on specific aspects of the Commission’s work, and organizations that had been involved in addressing the post-election violence itself. All had useful information for the Commission.

The Commission considered that the quality of proceedings would benefit from allowing as many interest groups as possible to participate. In the end, the
Commission gave legal standing to the Federation of Women Lawyers (FIDA) and the Center for the Advancement of Women and Children, both of which were allowed to represent the interests of women in the context of the post election violence. The Commission also granted the Kenyans for Peace with Truth and Justice, the Rift Valley Internally Displaced Persons Association, the Center for Justice and Crimes against Humanity, and the Tegla Lorupe Foundation standing as interveners. Outside Nairobi, the Commission granted regional law societies standing in its proceedings. These included the Rift Valley Law Society in Nakuru, the North Rift Law Society in Eldoret, and the West Kenya Law Society in Kisumu, and the Law Society of Kenya (South Rift Branch) even though the Commission did not hold proceedings in Kericho, where the society is based. The Commission declined requests for standing by Kenya’s two main political parties, the Orange Democratic Movement (ODM) and the Party of National Unity (PNU) because it did not think their participation was necessary. However, each of them testified through their Secretaries General.

All groups participating in the proceedings were asked to furnish the Commission with lists of their witnesses and statements from the witnesses. A significant number of the witnesses who testified before the Commission were identified and processed by lawyers acting on behalf of various civil society organizations. To maintain control over its proceedings the Commission insisted that such witnesses coming in had to be processed with the full participation of Counsel Assisting the Commission. This ensured that relevant and credible evidence was presented. Whenever necessary to avoid grandstanding, the Commission intervened to limit questions from lawyers.

The Commission’s experience was that allowing the diverse interests seeking representation greatly increased the quality of the inquiry. The lawyers for the various parties brought useful perspectives before the Commission that might have been missed altogether, if they had been excluded. In addition, the participation of these same lawyers enabled the Commission to reach out to witnesses who might not otherwise have come forward. This broadened participation and enriched understanding. Furthermore, a number of the lawyers admitted into our proceedings had sharply opposing points of view. This increased the objectivity and the credibility of the testified received.

US POLITICS-24 DAYS TO GO

2008-10-11T23:13:00.000-07:00

McCain’s ever changing campaign themes.

Unlike his democratic presidential candidate opponent Barack Obama, who has consistently stuck with his initial theme of change, McCain-the republican presidential candidate has seen/introduced variations of themes-one after another. For example, since he started running- a little over a year ago, now he has managed to morph into at least 5 different themes. Notably-

1) Straight talk express- as the banner on his bus and campaign plane suggests and his earlier starting theme during the primary contests.

2) Change we can believe in-immediately after the republican convention and a surprise pick of the Alaska gov. Sarah Palin, (- barracuda-pit bull with lipstick-or pig with lipstick, whichever!)

3) maverick- introduced concurrently with change theme immediately after the republican convention with his running mate on/at his side.

4) Reformer? Or this also means maverick? - Also introduced just around the time after the republican convention. It might have been overtaken by the events. Who knows?

5) Country first-the current theme. This might also means “suspensions”-including his campaign during the initial first free fall week of the Wall Street and don’t forget the first presidential debate. And as of late-if the last week is anything to go by, it also might mean getting really negative with your... the opponent.

DISEASES OF CENTRAL NERVOUS SYSTEM-2

2008-10-11T22:32:00.000-07:00

Meningitis:

Clinical manifestations-CONTINUED

Meningitis can be either acute or chronic in the onset and progression of the disease.

1) Acute:-cases of acute meningitis are characterized by –fever, stiff neck, headache, nausea, and vomiting, neurologic abnormalities and change in mental status. With acute bacterial meningitis, CSF usually contains large numbers of inflammatory cells (>1000/mm3), primarily polymorphonuclear neutrophils.

The CSF shows a decreased glucose level relative to serum glucose level (the normal ratio of CSF to serum glucose is approximately 0.6), while there is increased protein concentration is shown (normal protein is 15-50mg/dL in adults and as high as 170mg/dL with an average of 90mg/dL in newborns).

The sequelae of acute bacterial meningitis in children are frequent and serious with seizures occurring in 20%-30% of cases in large urban area hospitals. Other neurologic changes are also common. The acute sequelae include; cerebral edema, hydrocephalus, cerebral herniation, and focal neurologic changes.

Permanent deafness can occur in 10% of the children who recover from bacterial meningitis. And a more subtle physiologic and psychological sequelae may follow an episode of acute bacterial meningitis.
Although the morbidity associated with meningitis is still significant, the Haemophilus influenzae type b conjugate vaccine has played a major role in reducing postmeningitis sequelae.

2) Chronic- chronic meningitis often occurs in patients who are immunocompromised, although this is not always the case. Patients experience and insidious onset of disease, with some or all of the following; - fever, headache, stiff neck, nausea, and vomiting, lethargy, confusion, and mental deterioration.

Symptoms may persist for a month or longer before treatment is sought. The CSF usually manifests an abnormal number of cells (usually lymphocystic), elevated protein and some decreased in glucose content. The pathogenesis of chronic meningitis is similar to that of acute disease.

Epidemiology/Etiologic Agents.

The etiology of acute meningitis is very dependent of the age of the patient, with the majority of cases occurring in children younger than age 5. Neonates have the highest prevalence of meningitis, with a concomitant increased mortality rate as high as 20%.
Organisms causing disease in the newborn are different from those that affect other age groups; many of them are acquired by the newborn during the passage through the birth canal. And are likely to be infected with;-group B Strep., E.Coli, other Gram-Negative Bacilli, and Listeria Monocytogenes, in that order. And occasionally other organisms may be involved. For example Flavobacterium meningosepticum has been associated with nursery outbreaks of meningitis. This is usually a normal inhabitant of water in the environment and is presumably acquired nosocomially.

Important causes of meningitis in the adult, in addition to the meningococci in young adults, includes; - Pneumococci, Listeria Monocytogenes, and less commonly, Staph. Aureus and various Gram-Negative bacilli. With meningitis caused by the latter organisms resulting from the hematogenous seeding from various sources, including urinary tract infections.

Aseptic meningitis:-***** TO BE CONTINUED.******

CIRCUMCISION IS NO CURE FOR HIV/AIDS PART 3

2008-10-10T20:53:00.000-07:00

Do Not Cloud the Message!

Following some African countries government’s advice that circumcision lessened chances of contracting HIV/Aids, many young men formed very long lines outside health centers to have their foreskins severed. Innocent “Onyango” had just given the nod to circumcision when he acknowledged that he has been made a ware that, men who are circumcised are 60% more likely to be protected against HIV during sexual intercourse.

The response to the circumcision program has been vigorous, and sometimes spontaneous, that it should get most people worried, instead of exciting them. Until u meet the freshly circumcised young men dressed up in a loose garments –as regular clothing is mostly out of the question at this time of healing.

Young men like “Onyango” point out that, these Aids people(activists) have spoken for long about fighting the disease, but they had never come up with a practical solution as good as this one(circumcision). Don’t have sex, don’t do this, don’t do that. Eh, man, how can a young man such as I forfeit sex, eh? And the condoms – where is the sense in putting on a condom when you are having sex? Sex is about feeling, and so no young person likes them!"
You can view it from young men’s side and be humbled by it, but you should be doubly afraid for the future as far as the hydra known as HIV/AIDS is concerned, and its potential to wreak more havoc against a young population that loves and values fun more than security of life.

There you have it!- whatever sensitization programs that might have been done about ways of protecting oneself against HIV/AIDS infection would be headed to the drain and thrown to the wind, because circumcision would now provide full coverage! NO WORRIES!

It is appalling, to say the least as this explains the long circumcision lines in front of the health centers – young men and women were now going to indulge in all the sex they wanted without any inhibitions, any fears about HIV/AIDS infection.
Anything that will give a person a chance to escape HIV/AIDS infection is gladly welcomed.

The efforts should be to urge the governments, the entire public and in your own communities to step up the campaign against HIV/AIDS. And by taking counseling to another level, who knows that the World Health Organization and Unaids’ statistics might not have taken every single factor into consideration?
It is counseling that will help those young men who are rushing to get circumcised in order to ‘enjoy’ their sex unhindered, to get informed that there are many things to consider before they place their unprotected little friends into the mouth of infected vessels, placing all their faith in their circumcision hype. This is not bashing circumcision per se but rather looking at things in perspective.

Therefore, HIV/AIDS fight should not follow the line of least resistance blindly. Fighting HIV needs discipline, and so an undisciplined person will not manage to walk within the strictures of Abstinence, Faithfulness, Condoms, etc …etc – all of which give high chances, but only when one sticks to them religiously.

And look now; there is another group that has grown into maturity and is infected, but without ever having had sexual contact with any member of the opposite sex – or of the same sex. There are many unfortunate children who were just born with the HIV virus. The level of resistance of these people and many others is quite different from Adults, just as it is different in a general sense. So, it is always a danger to indulge in the kind of sex that the young men want – wild and unprotected – when it is your resistance that is weak and therefore your life is put in uncalled for danger.

CIRCUMCISION IS NO CURE FOR HIV/AIDS PART 2

2008-10-10T19:24:00.001-07:00

Do Not Cloud the Message!

Let’s be realistic and brutally honest about most of the western countries, especially US view towards Africa and other developing countries.

Polygamy and other cultural/[religious-as is the case with Muslim faith] practices such as “wife inheritance- (the way its being put/addressed” without actually trying to understand what at all their deeper meanings are to those communities)- is and has been a cultural practice in many societies including most of African countries.

And as usual, whenever there is a belief system or cultural norms that are at odds with the western cultures- the action is to demonize and expunge the practice and inject the western-friendly culture/practice into the vacuum created. This time the tactics are no different. By looking at any possible link that may exist between HIV/AIDS and these customs, aiming to “tie” the disease with these cultural practices that run counter to theirs. Several means/tactics had to be tried for example blaming it to the “toxic mix” of factors that has fueled the HIV/AIDS epidemic, cultures that "condones, even encourages" polygamy but denies women the right to negotiate condom use, as the women in these societies are perceived to hold “less power”, some in the west argue.

This changes the subject to an equality and human rights issue, hence getting the subject more broad and appealing world over. And their answer is CIRCUMCISION?

The fact is, foreskins are the least of these countries problems and the pushers of circumcision in lieu of dealing with the real issues do nothing but displace the focus from where it should be and put lives at risk thereby.

Development and proper[appropriate]education programs are some of the only solution to these countries' HIV crisis. And development realistically will only come from within AND only when/if the underlying causes of corruption and cultural issues acting as a platform from which the disease spreads unchecked are addressed.

If you think for a moment about the above realities, you will eventually want to ask why anyone would focus on circumcision at all -- at least until these severe barriers preliminary to any prevention campaign are addressed.

The answer is probably a cultural one. For example American culture, the place from which this campaign originates, has more to do with it than any of these problematic studies do. As usual, and in accordance with the observations of many, the West, particularly the United States, is following its own well-worn path in the crusade to save Africa for example, from itself without understanding a thing about the place it seeks to help. Never mind that places like Lesotho and Swaziland, as just one example, share similar rates of HIV and economic pain while one is largely circumcised and the other is not.

The target here bears the appearance of being not just Africa, but America's own slipping rates of neonatal circumcision. Whether this is true or not is another matter, but the possibility cannot be discounted after the recent discussions at the CDC and among the vaccine initiatives' leadership.
The future is more chilling than ever and the politicization of HIV/AIDS has never been so far advanced and confused.

****TO BE CONTINUED****

CIRCUMCISION IS NO CURE FOR HIV/AIDS PART 1

2008-10-05T15:41:00.000-07:00

Do Not Cloud the Message! - Kenyan politicians hailing from Lake Region.

There has been some excitement at international conferences around the globe on HIV/Aids like the one held in Mexico and others that, male circumcision can help prevent the spread of the pandemic.
Regrettably, some false hope is thus being indirectly cultivated that the cut is the means to keep the virus at bay.

The emerging statistics clearly call for caution. If the infection rate among circumcised men has declined from, say 7.5 to 6.5 per cent, on average, it is scant comfort, indeed. This means clearly that there is only one percent difference! As debate on whether circumcision reduces the risk of HIV infection or not rages, it is amazing how each side of the divide is getting carried away by emotions to the extent of losing sight of the available evidence.

This reminds one of the saying that "a good slogan can stop analysis for years".
It is true that there is evidence that HIV prevalence is lower among communities that practice male circumcision than among those that do not.
But there is also evidence to the contrary: that HIV prevalence is higher among communities that practice male circumcision than among those that do not.

This sounds somehow confusing, one would say. But in a nutshell, it shows that the evidence on whether male circumcision protects one against HIV infection is mixed.
Unfortunately, both the proponents and the opponents of the protective role of male circumcision have refused to soberly confront this reality, and thus think through an appropriate prevention strategy.

Since so much has been said about studies that show the protective role of male circumcision, Lets talk about the evidence that shows the contrary.
Two data sets from Malawi (the 2004 Malawi Demographic and Health Survey (MDHS) and the 2004 and 2006 Malawi Diffusion and Ideational Change Project (MDICP)) show that HIV prevalence was highest in the Southern region than in the Central or Northern regions.

Yet, a higher proportion of men from the Southern region, compared to those from the other regions, reported having been circumcised.
In contrast, individuals from the other regions were less likely to report multiple life-time sexual partners than those from the Southern region.
They were also more likely to report condom use during the 12 months preceding the survey than those from the Southern region.
At the individual level, HIV prevalence was higher among circumcised than among uncircumcised men. Among circumcised men, those who were HIV-positive were more likely to report multiple life-time sexual partners than their HIV-negative counterparts.

Similarly, among married women with circumcised husbands, HIV prevalence was higher among those whose spouses reported multiple life-time sexual partners than among their counterparts whose spouses reported one life-time sexual partner.
At a recent meeting when engaging a fellow participant on this exceptional evidence from Malawi, one of the participants got carried away and branded opposing view a circumcision-basher. Is circumcision some tender pet or victim whose feelings we ought to respect?

That one of the participants did not even stop to listen to what the opposing side had to say. Yet, the intention was to see whether, given the two sets of contrasting evidence, that there could be a way of thinking through a better way of confronting the HIV and Aids scourge.

It was surprising at to how low some scholars have sunk, to the extent of reducing the debate to "us versus them". It left one, wondering how the so-called circumcision-bashers refer to those on the other side of the divide.

In any case, HIV and Aids should concern everyone and any effort aimed at combating it is laudable.

However, aware of the two sets of contrasting evidence, the concern has always been the manner in which male circumcision is being presented to the public, as if it is the ultimate method of protection against HIV/AIDS infection.
The ultimate view should be, the promotion of male circumcision should be accompanied by riders encouraging people to use other means of protection even after the cut.

Otherwise we run the risk of creating the false impression that once a man is circumcised, he can start sleeping around without any care in this world.
Given the evidence from Malawi, one can only shudder at what this might lead to. The Malawi exception also brings into focus the issue of the position of the woman.
It suggests that we can circumcise the men alright, but as long as they remain promiscuous and do not use any protection, their women are still at risk. The question then is; how do we protect the women?

It is against this backdrop that a new way of thinking has started gaining ground within program circles, what is known in program parlance as MC-plus (Male Circumcision plus other preventive methods). Isn't this what we ought to be promoting?

The grave danger still lurks out there, and it must be made clear to all that circumcision is no panacea.
There is need to continue waving the banners of abstinence, being faithful to one's partner or using condoms, because the naked reality is that no cure for Aids has been found.

Circumcision is thoroughly unhelpful if one's partner is infected or if its taken for immunization. It's no good reason for people to dance around, clouding the message that the scourge is curable.AS OF NOW IT IS NOT!

****TO BE CONTINUED****

CIRCUMCISION AND HIV/AIDS AS A CURE OR PREVENTIVE?–CONT. PART 7

2008-10-04T22:10:00.000-07:00

NO.CIRCUMCISION IS NOT THE ANSWER OR CURE FOR HIV/AIDS.

WHY? (3)-CONTINUED-Uncircumcised men are thought to be more susceptible to AIDS because the underside of the foreskin is rich in Langerhans’ cells, which attach easily to the virus. The foreskin may also suffer some small tears during intercourse, making it more susceptible to infection.

New factors to consider

Scientists Discover 'Natural Barrier' to HIV
E.J. Mundell of HealthDayNews reported that;

Researchers have discovered that cells in the mucosal lining of human genitalia produce a protein that "eats up" invading HIV -- possibly keeping the spread of the AIDS more contained than it might otherwise be.
Even more important, enhancing the activity of this protein-(Langerin) could be a potent new way to curtail the transmission of the virus that causes AIDS, the Dutch scientists added.

Langerin is produced by Langerhans cells, which form a web-like network in skin and mucosa. This network is one of the first structures HIV confronts as it attempts to infect its host.
However, "we observed that Langerin is able to scavenge viruses from the surrounding environment, thereby preventing infection," said lead researcher Teunis Geijtenbeek, an immunologist researcher at Vrije University Medical Center in Amsterdam.

And since generally all tissues on the outside of our bodies have Langerhans cells, we think that the human body is equipped with an antiviral defense mechanism, destroying incoming viruses," Geijtenbeek said.
The finding, reported some time ago in an online issue of Nature Medicine, "is very interesting and unexpected," said Dr. Jeffrey Laurence, director of the Laboratory for AIDS Virus Research at the Weill Cornell Medical College, in New York City. "It may explain part of the relative inefficiency of HIV in being transmitted."
Even though HIV has killed an estimated 22 million people since it was first recognized more than 25 years ago, it is actually not very good at infecting humans, relatively speaking.

For example, the human papillomavirus (HPV), which causes cervical cancer, is nearly 100 percent infectious, Laurence noted. That means that every encounter with the sexually transmitted virus will end in infection.
"On the other hand, during one episode of penile-vaginal intercourse with an HIV-infected partner, the chance that you are going to get HIV is somewhere between one in 100 and one in 200," Laurence said.

Experts have long puzzled why HIV is relatively tough to contract, compared to other pathogens. The Dutch study, conducted in the laboratory using Langerhans cells from 13 human donors, may explain why.
When HIV comes in contact with genital mucosa, its ultimate target -- the cells it seeks to hijack and destroy -- are immune system T-cells. But T-cells are relatively far away (in lymph tissues), so HIV uses nearby Langerhans cells as "vehicles" to migrate to T-cells.

For decades, the common wisdom was that HIV easily enters and infects Langerhans cells. Geijtenbeek's team has now cast doubt on that notion.
Looking closely at the interaction of HIV and Langerhans cells, they found that the cells "do not become infected by HIV-1, because the cells have the protein Langerin on their cell surface," Geijtenbeek said. "Langerin captures HIV-1 very efficiently, and this Langerin-bound HIV-1 is taken up (a bit like eating) by the Langerhans cells and destroyed."
In essence, Geijtenbeek said, "Langerhans cells act more like a virus vacuum cleaner."

Only in certain circumstances -- such as when levels of invading HIV are very high, or if Langerin activity is particularly weak -- are Langerhans cells overwhelmed by the virus and infected.

The finding is exciting for many reasons, not the least of which is its potential for HIV prevention, Geijtenbeek said.
"We are currently investigating whether we can enhance Langerin function by increasing the amount of Langerin on the cell surface of Langerhans cells," he said. "This might be a real possibility, but it will take time. I am also confident that other researchers will now also start exploring this possibility."

The discovery might also help explain differences in vulnerability to HIV infection among people.
"It is known that the Langerin gene is different in some individuals," Geijtenbeek noted. "These differences could affect the function of Langerin. Thus, Langerhans cells with a less functional Langerin might be more susceptible to HIV-1, and these individuals are more prone to infection. We are currently investigating this."
The finding should also impact the race to find topical microbicides that might protect women against HIV infection. Choosing compounds that allow Langerin to continue to work its magic will enhance any candidate microbicide's effectiveness, the Dutch researcher said.

Laurence did offer one note of caution, however.
"In the test tube, this is a very important finding," he said. "But there are many things in the test tube that don't occur when you get into an animal or a human. Having said that, this is a very intriguing finding, he said."

WHY?(4)-Other factors also to consider:

Kebaabetswe et al obviously believe the conventional wisdom that heterosexual sex is the major vector for the transmission/reception of HIV, and that male circumcision is an effective deterrent to infection. Based on that belief, they have constructed an elaborate and impressive study of the acceptability of circumcision as a prophylactic measure in Botswana. Furthermore, they argue for a programme of neonatal circumcision in Botswana in the hope of reducing the HIV infection rate 15 years later.

Discussion

It has been believed since about 1988 that heterosexual coitus accounts for 90% of the HIV infection in Africa.
Many studies do argue that circumcision can reduce the transmission of HIV through heterosexual coitus. The quality of these studies has been criticized for their methodological flaws, including their failure to control for numerous confounding factors.

Gray et al found that transmission by coitus ‘‘is unlikely to account for the explosive HIV-1 epidemic in sub-Saharan Africa.’’ It now appears that these studies have not accounted for the largest confounding factor of all—iatrogenic transmission of HIV. Sometimes back, the International Journal of STD & AIDS published a trilogy of articles.

These articles strongly argue that unsafe health care practices, especially non-sterile injections, not heterosexual intercourse, are the principal vectors by which HIV is transmitted. A program of mass circumcision would be ineffective against iatrogenic transmission of HIV through unsafe health care. Heterosexual transmission of HIV that one sees in Africa also cannot explain the incidence of HIV in children. Circumcision has some little known effects that may promote rather than deter HIV infection. The human foreskin has physiological functions designed to protect the human body from infection. The sub-preputial moisture contains lysozyme—an enzyme that attacks HIV. Circumcision destroys this natural protection.
Circumcision removes erogenous tissue, desensitizes the penis, changes sexual behavior, and makes males more likely to engage in unsafe sex practices. Circumcised males, therefore, are less willing to use additionally desensitizing condoms.

Male circumcision produces hardened scar tissue that encircles the shaft of the penis. The scar scrapes the inside of the partner’s vagina during coitus and, therefore, may enhance the transmission/reception of HIV. A program of mass circumcision would expose African males to unsafe genital cutting, would destroy the natural protection of the foreskin, would not be effective against iatrogenic unsafe health care, would divert scarce medical and social resources from measures of proved effectiveness, and, therefore, is likely to increase the transmission of HIV. The proportion of HIV infection attributable to heterosexual intercourse has been placed at 90%. Gissellquist and Potterat now estimate the proportion attributable to heterosexual intercourse at only about 30%—only a one third of the previous estimate.
Circumcision has not yet been shown to be an effective deterrent against HIV infection. The Council on Scientific Affairs of the American Medical Association says that ‘‘circumcision cannot be responsibly viewed as ‘protecting’ against such infections.’’ The Task Force on Circumcision of the American Academy of Pediatrics identifies behavioral factors, not lack of circumcision, as the major cause of HIV infection. The article by Kebaabetswe et al seems to show a strong cultural bias on the part of the authors in favor of circumcision. This may be due to their desire to preserve their culture of origin.

WHY?(5)-Bioethics and human rights-Finally, to address the legal and ethical issues. As noted above, male circumcision excises a large amount of functional healthy erogenous tissue from the penis. It is a clear violation of the basic human right to security of the person.

Several authorities report that circumcision degrades the erectile function of the penis. Circumcision, therefore, must be regarded as degrading treatment. Degrading treatment is an additional violation of human rights.
The leading international statement of medical ethics is the European Convention on Human Rights and Bioethics. Article 20(1) prohibits non-therapeutic tissue removal from those who do not have the capacity to consent. Children have a right to the protection of the security of their person and to protection from degrading treatment. Circumcision would violate those human rights. Doctors must respect patient human rights. Prophylactic circumcisions ethically may not be carried out on minors. Circumcisions, therefore, would have to be limited to adult males who legally may give informed consent.

WHY?(6)-Political factors

Ntozi warns-He says-It is important that, while circumcision interventions are being planned, several points must be considered carefully. If the experiment fails, the groups(Africans and others being used in these experiments) are likely to feel abused and exploited by scientists who recommended the circumcision policy. In a region highly sensitive to previous colonial exploitation and suspicious of the biological warfare origin of the virus, failure of circumcision is likely to be a big issue. Those recommending it should know how to handle the political implications.

Approval of circumcision by the surveyed Botswana people apparently is based on their belief that circumcision is efficacious in preventing the spread of HIV. If circumcision fails to control HIV, there would be disillusionment and anger. African and others- males would have sacrificed their erogenous tissue for a false hope of preventing HIV infection. There is no evidence that Kebaabetswe et al have considered the political issues that would arise if a circumcision experiment should fail.

Conclusion

Kebaabetswe et al propose the universal circumcision of male children in Botswana. They accept without question that HIV is primarily sexually transmitted in Africa and other areas by heterosexual coitus and that circumcision reduces or prevents the transmission of HIV; however, medical authorities do not accept the evidence of this. Kebaabetswe et al propose to provide in-hospital circumcision of male children in Botswana. However, there is already a substantial incidence of infection among children in South Africa as a result of iatrogenic infection from non-sterile injections, etc. They have not shown that safe, aseptic circumcisions can be delivered in Botswana. A program of mass circumcision would destroy the natural protections of the foreskin, further expose children to an apparently unsafe health care system, and would be more likely to increase than decrease infection.
Even if circumcision eventually should be shown to provide some protection against HIV infection, that protection could only work to reduce the 30% of infections that now are attributed to sexual activity. It would have no effect on the other 70%. Its effect, therefore, would be minimal at best and could not have an effect for the first 15 years during which time behavioral changes could be introduced into society through education, and a HIV vaccine could be developed to provide immunity.
Circumcision of male children with the intent of reducing an epidemic not of their making is unacceptable from medical, ethical, and legal perspectives. As a public health measure, male neonatal circumcision fails all tests.

US FIRST PRESIDENTIAL DEBATE

2008-09-28T23:12:00.000-07:00

TEXAN JOKE ABOUT SERAH PALIN

while suturing a cut on the hand of a 75-year old Texas rancher whose hand was caught in a gate while working cattle, the doctor struck up a conversation with the old man.
Eventually the topic got around to Sarah Palin and her bid to be a heartbeat away from being President.
The old rancher said, 'Well, ya know, Palin is a post turtle.'
Not being familiar with the term, the doctor asked him what a post turtle was.
The old rancher said, 'When you're driving down a country road and you come across a fence post with a turtle balanced on top, it's a post turtle.'
The old rancher saw a puzzled look on the doctor's face, so he continued to explain.
'You know she didn't get up there by herself, she doesn't belong up there, she doesn't know what to do while she is up there, and you just wonder what kind of dumb a*s put her up there to begin with.

***********************************************************************************

IMPRESSION ON FIRST DEBATE:

After listening and reading most of the reactions from news pundits, blogs, news-both cable and e-news and having watched the debate live as it proceeded. It became increasingly clear that the Democratic candidate did a good job! And maybe-just maybe this country could be ready for a change and make history while at it.

At this point I am willing to bet a democratic presidency this time around. I usually don’t bet and as a matter of fact, I am anti-betting. But history is looking at me in the face and I want to be a tiny part of it, even if it means breaking my own rules.

Having said the above, given that the “right leanings” said the debate was a tie and the “left leanings” and “in-betweens” said Obama won I am going to go with Mr. Mark Halperin’s of US TIMES grading. I think he summed it up pretty good-What do you think!

Here we go….

John McCain
Substance: His arguments were hard to follow at the beginning, but he found his voice as the debate progressed, although he never seemed fully in control of his message. He had plenty to say about the economy, Iraq, Afghanistan, and Russia, but often bogged down his own answers when trying to unfurl quips and sound bites. Stuck with bumper sticker slogans on the economy, and while he got a bit more detailed on foreign policy, he stayed at his usual level of abstraction. If he truly knows more about the world than Obama, he didn't show it in this debate.
Grade: B-

Style: Cluttered, jumpy, and often muddled. Frequent coughing early on helped neither his arguments nor his image. Jokes about being deaf and anecdotes about Normandy and George Shultz seemed ill-advised — even his pen was old. His presentation was further hindered by his wandering discussion of the differing heights of North and South Koreans and his angry assertion about how well he knows Henry Kissinger. Fell into the classic politician's trap of inserting familiar stump speech applause lines into debate responses — which only works if done with enthusiasm and clarity (and if received by applause — a big No-No in Lehrer's auditorium, which the audience obeyed seriously and silently). Keenly aware of the grand, grave occasion, McCain wavered between respectful and domineering, and ended up awkward and edgy.
Grade: C-

Offense: Emphasized his bread and butter issues of taxes and spending, and hit Obama on his failure to visit Iraq and his expressed willingness to meet with dictators. But while mocking his opponent on a few occasions, which reflected his acute disrespect for Obama, he did so in an insufficiently sharp and detailed manner — and unevenly worked elements of his rival's record into his attacks. Still he was utterly confident about his own experience, knowledge, and policies, even when tripped by his own tongue and distracted by the strains of debate practice. The main problem: Obama's obvious preparation and sharp answers contradicted McCain's frequent claims that the Democrat was uninformed and "didn't understand" key issues.
Grade: C+

Defense: He managed to ignore most of Obama's jibes, but was eventually baited into giving an extended answer about his policy differences with President Bush, after his opponent repeatedly mentioned McCain's regular support of Bush's budgets. Was visibly riled when clashing with Obama over a variety of issues, including Iraq, sanctions, and spending. He also chose to boast about Sarah Palin (although not by name) as his maverick partner, who, after her shaky week, may no longer be his ace in the hole.
Grade: B-

Overall: McCain was McCain — evocative, intense, and at times emotional, but also vague, elliptical, and atonal. Failed to deliver his "country first versus Obama first" message cleanly, even when offered several opportunities. Surprisingly, did not talk much about "change," virtually ceding the dominant issue of the race.
Overall grade: B-

Barack Obama
Substance: Quite manifestly immersed in the past, present, and future details of policy, and eager to express his views, which have been expanded, honed, and solidified during the last 18 months of hard campaigning. Still, he did avoid the nitty-gritty details of policy positions in favor of broad principles and references to working Americans, thereby not presenting the kind of specifics that some voters are waiting to hear from him.
Grade: B+

Style: Polished, confident, focused. Fully prepared, and able to convey a real depth of knowledge on nearly every issue. He was unhurried, and rarely lost his train of thought even when the debate wended and winded — and uttered far fewer of his trademark, distracting, "ums." At times, however, Obama revealed the level of his preparation by faltering over a rehearsed answer. He seemed to deliberately focus on the moderator and the home audience, with McCain as an afterthought — except when on the attack. Chose to avoid humor, for the most part, in favor of a stern demeanor, and in the process, came off as cool as a cucumber.
Grade: A

Offense: Linking McCain to Bush in his very first answer, he kept it up as his primary line of attack. Forcefully hit McCain for his early support of the Iraq War. Though he never drew blood, he did keep McCain a bit off balance, often with clever references to McCain's recent statements.
Grade: B

Defense: Had a reasonable answer for every charge that came his way — with little anger, bluster, or anxiety. Often interrupting McCain attacks with swift explanations and comebacks, he managed to spin accusations of being liberal as evidence of his relentless opposition to George Bush (in replies that were clearly planned). Offered a rather clumsy alternative to McCain's well-known, moving story of wearing the bracelet of a soldier lost in Iraq (a gift from the soldier's mother), with a story about a bracelet of his own. Fearless, without condescension, he attempted the gracious move of agreeing with or complimenting a McCain position, occasionally to his own detriment.
Grade: A-

Overall: Went for a solid, consistent performance to introduce himself to the country. He did not seem nervous, tentative, or intimidated by the event, and avoided mistakes from his weak debate performances during nomination season (a professorial tone and long winded answers). Standing comfortably on the stage with his rival, he showed he belonged — evocative of Reagan, circa 1980. He was so confident by the end that he reminded his biggest audience yet that his father was from Kenya. Two more performances like that and he will be very tough to beat on Election Day.
Overall grade: A-

CIRCUMCISION AND HIV/AIDS AS A CURE OR PREVENTIVE?–CONT. PART 6

2008-09-27T14:29:00.000-07:00

**WHY CIRCUMCISION MAY NOT BE THE ULTIMATE SMOKING GUN ON HIV/AIDS-GIVEN IT'S HISTORY? CONTINUED**

NO.CIRCUMCISION IS NOT THE ANSWER OR CURE FOR HIV/AIDS.

Why? (1)-In most of the western countries-Circumcision has sometimes been described as a solution in search of a problem. In the mid-19th century the problem was masturbation. Towards the end of that century it was syphilis. In the 1930s it was penile cancer. In the 1950s it was cervical cancer. 1980s - Urinary tract infections. And don’t forget the phimosis, the balanitis, and the cleanliness part.

For example, outside the Jewish community, where it’s a religious rite, circumcision was practically unheard of in America until 1870, when Lewis Sayre, M.D., claimed to have cured a 5-year-old boy of paralysis by stretching out his foreskin and snipping it off. For the next two decades, Dr. Sayre and his associates crusaded for circumcision, claiming it could cure hip-joint disease, epilepsy, hernia, convulsions, elephantiasis, poor eyesight, tuberculosis, and rectal prolapse, among other things. This was all disproved, of course, and circumcision would probably have vanished from the American medical scene had its backers not found a compelling new way to sell it: as a cure for masturbation. To the publicly puritanical but privately lascivious Victorians, masturbation was the root of numerous social maladies and physical illnesses, including blindness and even insanity. Naturally, they believed, if circumcision could prevent masturbation, it would prevent other diseases as well.

Doctors of the time reported that “removal of the protective covering of the glans tends to dull the sensibility” of the penis and “thereby diminishes sexual appetite.” In 1888, John Harvey Kellogg, M.D., of cereal fame, summed up the medical profession’s opinion and gave justification for the next 60 years of foreskin removal. “A remedy for masturbation which is almost always successful in small boys is circumcision. The operation should be performed by a surgeon without administering an anesthetic, as the pain attending the operation will have a salutary effect upon the mind since the infant wouldn’t be able to remember anything at this stage in his life-meaning-infants don’t feel pain.” By the end of World War II it was clear that circumcision was not stopping men from masturbating; but, by then, the procedure was institutionalized in America’s medical system. It had become the norm for white, middle-class American men. The uncircumcised were often recent immigrants or “African-Americans”. Probably as a result of racial prejudice, the uncircumcised penis was viewed as unhygienic and unclean. But this, too, turns out to be false.

It seemed that with the passing of time, the purported problems had gotten more trivial. It’s no Small wonder then that circumcision’s on the wane. But suddenly, there comes another big one–HIV/AIDS! Several eminent scientists and medical researchers have determined that a link exists between circumcision status and the rate of HIV transmission and they are urging universal adults/infants circumcision to help combat the disease. Circumcision promoters appear to have suddenly and finally found the mother of all problems’ solution. Regrettably, Smoke-screens, half truths and flat out lies have ensured. The issue is so enmeshed in emotion and advocacy that it's hard to know/tell where the truth is.
“The uncircumcised penis is self-cleaning,” explained Robert Van Howe, M.D., a pediatrician from Wisconsin who had been studying the causes of circumcision for 20 Years. “Every time you urinate, you flush out the preputial cavity. The hygiene issue was just another excuse. Since its inception, circumcision has been a surgery looking for a rationale. First it was disease, then masturbation, then hygiene; now it’s back to disease.” In 1971 the American Academy of Pediatrics (AAP) stated that circumcision was medically unnecessary. At the time more than 80 percent of American baby boys were circumcised. Then in 1989, the AAP released a new position paper that equivocated: “Newborn circumcision has potential medical benefits, as well as disadvantages and risks.” Still, by the following year, the rate was down to 59 percent.

Dr. Schoen chaired the AAP task force that made that reversal. He still stands by the position, claiming that the foreskin is the genital equivalent of the appendix, and that newborn circumcision is “a preventive health measure analogous to immunization.”

“The most important health benefit of circumcision is the decreased risk of urinary-tract infections,” explains Dr. Schoen, citing a well-known 1985 study, which he said has since been “overwhelmingly confirmed” by other studies. But Martin Altschul, M.D., a pediatrician and M.I.T.-trained mathematician, has reexamined the evidence and finds it fraught with problems “The whole body of research on this issue is a how-to-lie-with-statistics classic,” argues Dr. Altschul. “Depending on how you collect the data, you can get almost any result you want.” Dr. Altschul’s own research also found that many of the urinary-tract infections in uncircumcised boys were “attributable to congenital anomalies.” Recently, several studies have suggested that neonatal circumcision may actually increase the infection rate.
Dr. Schoen cited two other medical benefits of circumcision, namely decreased risks of developing penile cancer and contracting sexually transmitted diseases, such as HIV and syphilis.

“You’re more likely to be struck by lightning than to suffer from penile cancer,” counters Dr. Van Howe. “Japan, Norway, Finland, and Denmark all have lower rates than the United States, and they don’t circumcise their boys.”
In fact, in 1996, representatives of the American Cancer Society wrote a letter to the AAP in which they pointed out that “fatalities caused by circumcision accidents may approximate the mortality rate from penile cancer.” The letter also stated that “perpetuating the mistaken belief that circumcision prevents cancer is inappropriate.” Altschul. “It’s preposterous to even suggest that because we have some minuscule risk of disease, we should cut off the foreskin of every little boy.”

“Breast cancer in women is common,” says Dr. Denniston, “more common than all the purported health risks of the foreskin combined. Does that justify cutting off all breasts at puberty?”

What about circumcised men and STDs? A study published in the Journal of the American Medical Association around that time found that circumcised men did have a lower incidence of syphilis and HIV. But they had a higher rate of infection with herpes, hepatitis, and Chlamydia. Overall, the study authors wrote, “We found no evidence of a prophylactic role for circumcision, and a slight tendency in the opposite direction.”

“The bottom line,” says Dr. Denniston “is that the alleged benefits of circumcision don’t approach the risks.”

“Penile cancer is extremely rare-less than one case for every 100,000 men,” adds the Dr.
“Why is this procedure still covered by HMOs and health-insurance companies in America? The simple answer is, because parents want it,” says Patricia Wald, M.D., regional coordinating chief of pediatrics for Kaiser Permanente Medical Center in southern California. The doctors counsel parents so they’re making an informed decision, and don’t perform the operation unless asked. “We cover it as a courtesy. But to me it’s cosmetic surgery, like ear piercing.”

“After you counsel the parents appropriately and do the procedure,” Dr. Shoemaker explained, “it’s not a profitable use of time.”
Circumcision is the only surgery in America routinely performed without anesthesia. Sixty-four to 96 percent of circumcised infants endure the procedure with nothing to deaden the pain. Until recently, doctors often told parents they didn’t feel the same pain as adults.

“I didn’t know what circumcision really was when I consented to have my three sons circumcised,” says Marilyn Milos, founder and executive director of the National Organization of Circumcision Information Resource Centers (NOCIRC). “My doctor told me it was necessary, that it didn’t hurt, and that it took only a moment to perform-like cutting the umbilical cord, I thought.”
Ten years after her last son was born, Milos went back to school to become a registered nurse. As a student, she was asked to assist at a circumcision. “To see a part of a baby’s penis being cut off – without an anesthetic – was devastating.” Later, while working as a nurse, she made a videotape of the procedure and called it Informed Consent.

“Parents had no idea what was happening to their baby boys,” she explains. “The point was to show them what circumcision really entailed.” The hospital, Marin General in California, refused to allow expectant parents to view the tape. “They said it was too much for parents to see. I said, ‘then perhaps it’s too much for babies to experience.’”

In 1985, Milos founded NOCIRC. “It’s all such an unspeakable cover-up. The doctors are in denial, so the hospitals are in denial, so the parents are intentionally, illegally uninformed. Circumcision is the worst fraud in American medical history.” Recent studies support Milos’ gut reaction to unanesthetized circumcision. A issue of the Journal of the American Medical Association reported that “newborns...who did not receive an anesthetic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk (from choking or apnea).” The report goes on to say that the skill of the surgeon did not reduce the pain, and that infantile amnesia (the “he-won’t-remember-it-anyway” argument) can’t justify it.
But even if doctors did use anesthesia, the reduction in pain would have to be measured against other concerns, such as the danger of using potent painkillers on day-old babies.

Then there is the question about how long the hurt lasts. “Circumcision causes such traumatic pain in newborns that it may have damaging effects upon the developing brain,” says James Prescott, Ph.D., director of the Institute of Humanistic Science in Long Beach, California. A psychologist who has written extensively on childhood trauma and its long-term effects, Prescott says the stress of circumcision damages the neural systems that mediate genital pleasure. In effect, he says, the baby’s brain is encoded to associate pain with pleasure. In fact, the pain is so severe that it’s not unusual for babies to go into a kind of shock, suddenly becoming silent and ceasing to struggle.

Most of the world’s leading medical establishments have come out against this surgery. “Circumcision of newborns should not be routinely performed,” says the Canadian Pediatric Society. “To circumcise...would be unethical and inappropriate,” says the British Medical Association. The Australasian [Australia and New Zealand] Association of Pediatric Surgeons states: “Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anesthesia to remove a normal, functional and protective prepuce.”

Kent Kleppinger, M.D., a pediatrician who performs circumcisions, says, “I tell parents circumcision is cosmetic surgery. It isn’t difficult to dissuade the mothers, but the fathers generally override their decisions. They want their boys to look like other boys in the locker room. They want their boys to look like them.”
Like father, like son. This may be one of the hidden reasons why infant boys are still being circumcised in America and may be a round the globe!

It may all come down to the basic human rights of the child. In 1996, the Canadian Medical Association approved a code of ethics that instructs doctors to “refuse to participate in or support practices that violate basic human rights.” This suggests that, in the case of circumcision, parental preference should not override the child’s physical rights to his body.

Margaret Somerville, professor of law and medicine at McGill University in Montreal –Canada and founding director of the Centre for Medicine, Ethics and Law, raised eyebrows at all North American pediatricians by declaring circumcision “technically criminal assault.”
“Once you decide that circumcision is not medically necessary, you take away the therapeutic intent. Take away therapeutic intent, and circumcision becomes an unjustified wounding,” she said.

Leo Sorger, M.D., writing in ObGYN News, is even more explicit: “Circumcision causes pain, trauma, and a permanent loss of protective and erogenous tissue. Removing normal, healthy, functioning tissue [for no medical reason]... violates the United Nations Universal Declaration of Human Rights (Article 5) and the United Nations Convention on the Rights of the Child (Article 13).”
In September 1996, the United States Congress passed a law banning the mutilation of female genitalia. “Americans are horrified by female genital mutilation,” said attorney Svoboda, “but they somehow don’t/didn’t recognize the routine torture going on in their own culture.” He acknowledged that a clitoridectomy is a more serious and detrimental surgery than circumcision, but he argued that “human-rights law doesn’t say if you cut off four toes, it’s a human rights violation, but if you cut off only three, it’s okay. That’s not how human-rights law works. If it’s wrong, it’s wrong. Involuntary circumcision is wrong.”

Why?-(2) Research studies-the most cited studies and probably the most referenced to date. As proving to have broken the camel’s back on circumcision - HIV/AIDS correlation are the two “researches” done in East Africa (Kenya and Uganda). The reports go like this: Adult Male Circumcision Studies-One study included nearly 5,000 men in Rakai, Uganda; the other almost 2,800 men in Kisumu, Kenya. Both were funded by the U.S. National Institute of Allergy and Infectious Diseases (NIAID). The NIAID should ring a loud bell here for those who are interested in looking at its affiliations/intentions and the facts thoroughly!

None of the study participants had been circumcised before the studies started. The report notes. The Ugandan men were 15 to 49 years old; the Kenyan men 18 to 24. They were randomly assigned to get circumcision (surgical removal of the foreskin) right away or after a two-year delay. Both studies enrolled participants by September 2005 and were scheduled to last until the middle of 2007.
That plan changed on Dec. 12, 2006, when researchers reviewed the studies' interim results, which showed that the men who had gotten circumcised were about half as likely to contract HIV. In the Ugandan study, the circumcised men were 48% less likely to acquire HIV. In the Kenyan study, they were 53% less likely.
Based on those results, the trials were stopped early so any participant who wanted to could get circumcised.

Let's start with the evidence. Several other studies carried out in Africa including the above two examples are reported to have found a positive correlation between HIV infection and non-circumcised status. Of note is that there are also some studies that have found a negative (read circumcision to increasing the risks of contracting HIV/AIDS) correlation. None of these studies are flawless, however. In some cases the sample size are either too small to give meaningful conclusions, or in some, the methodology are suspect and in others the logical inferences are unsupported by the evidence. That doesn't mean these studies are without merit. In the best of situations it's very difficult to conduct a controlled experiment with living human beings. People lie, change/modify their behavior, move, quit, die and worst of all for experimenters – people have rights.

An "ideal" experiment would be to randomly select a large sample of uncircumcised, non-HIV positive participants, circumcise half of them, force them all to repeatedly have sex with HIV infected partners, then conduct tests to see which group (circumcised or uncircumcised) has the highest rate of infection. That would be definitive. This is the only way we could confidently assert that a correlation exists. Alas, any conclusions drawn from any study that falls short of this "ideal" will have to be taken with at least some degree of analytic skepticism i.e. a pinch of salt-maybe?

The studies which allegedly show a reduction in HIV among circumcised men are highly questionable. Not one of them was finished, despite the protective affect appearing to decline well below the often-reported 65%, and several of the subjects disappearing. The fact that one study described circumcision as “comparable to a vaccine of high efficacy” seems to show clear bias. They appear to have been seeking a certain result. One has to wonder how many of the people promoting circumcision in Africa are themselves circumcised. Daniel Halperin is the grandson of a mohel, and seems to think that “maybe in some small way (he’s) destined to help pass along (circumcision)” so his objectivity is questionable.
Other epidemiological studies have shown no correlation between HIV and circumcision, but rather with the numbers of sex workers, or the prevalence of “dry sex”.

The two continents with the highest rates of AIDS are the same two continents with the highest rates of male circumcision. Rwanda has almost double the rate of HIV in circumcised men than the uncircumcised men, yet they’ve just started a nationwide circumcision campaign. Other countries where circumcised men are “more” likely to be HIV+ are Cameroon, Ghana, Lesotho, Malawi, and Tanzania. That’s six countries where men are more likely to be HIV+ if they’ve been circumcised.

Something isn’t right somewhere. Or could it be that these people aren’t interested in fighting HIV, but in promoting circumcision (or sometimes anything-but-condoms), and their actions will cost lives not save them in the long run? Think about it. Given the fact that NIAID doesn’t think there are any implications for U.S. Thus the “African studies will likely not have a large impact on the incidence of HIV/AIDS in the United States or Europe, where heterosexual transmission is low compared with areas like sub-Saharan Africa and parts of Asia," Bailey one of the two groups who conducted the East Africa “researches” said.

**Below are some of the lists of those who conducted the much cited “African experiment-research”**

1) Weiss HA, Quigley M, Hayes R. [Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. AIDS 2000; 14:2361-70.]

2) Bailey C, Moses S, Parker CB, et al. [Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial. Lancet 2007; 369: 643-56.]

3) Gray H, Kigozi G, Serwadda D, et al. [Male circumcision for HIV prevention in young men in Rakai, Uganda: a randomized trial. Lancet 2007; 369:657-66.]

4)Auvert B, Taljaard D, Lagarde E, et al. Randomized, controlled intervention trial of [male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med 2005; 2(11):e298.]

**Remember the CDC clarifies that it hasn't made any recommendations on male circumcision to reduce HIV transmission and is studying risks and benefits of circumcision as an HIV prevention strategy.***

If you read those reports, the level of knowledge about HIV is quite frightening. In Malawi for instance, only 57% know that condoms protect against HIV/AIDS, and only 68% know that limiting sexual partners to only trusted and with known HIV negative status protects against HIV/AIDS. There are people who haven’t even heard of condoms. It just seems really misguided to be hailing male circumcision as the way forward. It would help if some of the aid donors didn’t refuse to fund condom education, or work that involves talking to prostitutes. There are prostitutes that sleep with 20-50 men a day, and some of them say that hardly any of the men use a condom. If anyone really cares about men, women, and children dying in Africa, they’d be focusing on education as a toll to teach about safe sex rather than surgery that offers limited protection at best, and runs a high risk of risk compensatory behavior.

**Somebody needs to tell politicians to stick to what they know and do best and not misguide the citizens about health issues. It is not helping, especially Kenyan’s politicians hailing from around the Lake Region- when they promote something that they seem not to have knowledge about or careless to know without consideration of cultural/customs ramifications attached. It is reckless! Hon., the PM. Raila Odinga and others promoting circumcision as a cure/prevention of HIV/IDS. I have to say respectfully , here you are wrong! Citizens need proper and appropriate measures/programs-educational, cultural or otherwise and safe ways to prevent and contain this tragedy. Stop the gimmick already! ****

Some findings have suggested that circumcised male virgins are more likely to be HIV+ than intact male virgins, as the operation sometimes infects men. The latest news is that circumcised HIV+ men appear more likely to transmit the virus to women than intact HIV+ men (even after the healing period is over). Eight additional women appear to have been infected during that study, solely because their husbands were circumcised. This is not the first time that HIV in women has been linked to partner circumcision.
ABC works against HIV. Circumcision appears not to. Remember that circumcision won’t make any difference unless someone isn't having unsafe sex with an HIV+ partner.

******Why? (3)- TO BE CONTINUED*********

CIRCUMCISION AND HIV/AIDS AS A CURE OR PREVENTIVE?–CONT. PART 5

2008-09-21T15:40:00.000-07:00

CIRCUMCISION-THERAPEUTIC/NON THERAPEUTIC CONT.

Circumcision -The practice has been performed since ancient times, when it was done as a religious rite or as an initiation of boys into adulthood. Most Jewish and Muslim parents throughout the world today continue to have their sons circumcised for religious and cultural reasons. In the United States overall, the practice is somewhat less common today than it was 50 years ago, but is still done almost routinely with parental consent of course. In the 1800s, it was believed that circumcision helped prevent masturbation. Any circumcised man, however, will tell you this is not true.

Health Issues:

Researchers have attempted to learn more about whether circumcision prevents infection and certain types of cancer, but more studies need to be done to answer these questions. It is known that circumcision prevents infection and inflammation of the foreskin. It seems to decrease the risk of cancer of the penis. This disease occurs in less than one of every 100,000 men in the United States and probably in other countries too. But there has been a lot of argument in the medical community about circumcision and the risk of cancer.

Some reports quote studies having shown a greater risk of cervical cancer in female sexual partners of uncircumcised men who are infected with human papillomavirus. Circumcision might also have a role in reducing the risk of sexually transmitted diseases. But using a condom is a far more important factor in preventing these diseases than whether a man is circumcised or not!

Cleanliness

Some physicians say circumcision makes it easy to keep the end of the penis clean and easier for the parents of infant boys to keep them clean also. This may be one reason why so many parents were told to circumcise their sons. (This is nothing but, just another speculation)

Other Reasons

Circumcision is often chosen by parents so that their son will not "look different" from his father or peers. The belief is that an intact (uncircumcised) boy will feel uncomfortable if he does not "match" or look-like his others. Many parents say they don't want their son to feel "strange" or "weird" in the locker room at school.

Phimosis

Phimosis –a condition where the male foreskin cannot be fully retracted from the head of the penis. As most boys are born with a non-retracting foreskin, the term is confusing because it denotes both a normal stage of development, and a pathological condition (i.e. a condition that causes problems for a person). This confusion is particularly pronounced in regard to infants. Conflicting incidence reports and widely varying post-neonatal circumcision rates reflect looseness in the diagnostic criteria Phimosis has become a topic of contention in circumcision debates. It is normal for a baby's foreskin not to retract, but as the child grows the foreskin is expected to become retractable. Some have suggested that physiological infantile phimosis be referred to as developmental nonretractility of the foreskin to more clearly distinguish this normal stage of development from pathological forms of phimosis. Different management is appropriate. In other words, there are different degrees of phimosis, and treatment may vary on the degree of phimosis.
Women also can suffer from clitoral phimosis.

Infantile or congenital phimosis

For most of the Twentieth Century, most of the medical profession had recognized that most male infants have foreskins which are still attached to the epithelium of the glans penis and cannot easily be retracted. There have been four types of medical responses and attitudes toward this fact:

1.In the first half of the Twentieth Century, some physicians recommended that the foreskin be repeatedly retracted, if necessary with some force, to free it from the glans. It was thought that this could prevent later (pathological) phimosis and urinary problems in older boys by permitting washing of the glans and foreskin. Poor hygiene was thought to predispose to pathological phimosis. This approach has not been recommended by physicians for many decades.
2.Particularly in the middle of the Twentieth Century, some physicians promoted routine neonatal circumcision to avoid phimosis. While circumcision prevents phimosis, at least 10 to 20 infants must be circumcised to prevent each case of potential phimosis according to some incidence statistics. If one believes even lower phimosis incidence estimates, far more must be circumcised to prevent each case of phimosis. While some still promote this view, most pediatricians do not considered it a compelling argument for routine neonatal circumcision.
3.In the last three decades, as the circumcision rate in North America has declined, the most common official recommendations and guidelines from medical societies, as well as infant care books written by experts, have emphasized that it is normal not to be able to retract an infant's foreskin fully and that it need not be done. The American Academy of Pediatrics recommends gentle soap and water cleaning, but specifically recommends against forcible retraction. There is now some suspicion that forceful retraction that results in inflammation may actually contribute to pathological phimosis at an older age. Although the rate of surgical treatment of phimosis (usually circumcision) is falling, some pediatric urologists have argued that many physicians continue to have trouble distinguishing developmental non-retractility from pathological phimosis, and that phimosis is over diagnosed. Phimosis is sometimes used as a justification for circumcision, so that it will be covered by a national health system or insurance plan. The definition may be stretched by a physician for an older child; particularly where (as in North America), post-neonatal circumcision is usually outpatient surgery by a pediatric urologist, more expensive than the neonatal procedure. Most infantile phimosis is simply physiological.

Though uncommon, phimosis can occasionally lead to urinary obstruction or pain. Causes of pathological phimosis in infancy are varied. Some cases may arise from balanitis (inflammation of the glans penis), perhaps due in turn to inappropriate efforts to separate and retract an infant foreskin. Other cases of non-retractile foreskin may be caused by preputial stenosis or narrowness that prevents retraction, by fusion of the foreskin with the glans penis in children, or by frenulum breve, which prevents retraction. In some cases a cause may not be clear, or it may be difficult to distinguish physiological phimosis from pathological if an infant appears to be in pain with urination or has obvious ballooning of the foreskin with urination or apparent discomfort. However, even ballooning does not always indicate urinary obstruction. There are several management approaches to infant phimosis. Most cases of simple physiological phimosis need no "management" but will disappear with time or simple stretching of the foreskin. Various topical steroid ointments have been effective at hastening separation without surgery. Several surgical techniques have been devised, which range from simple slitting of a segment of the foreskin to removal of it (circumcision).

Acquired phimosis

Phimosis in older children and adults can vary in severity, with some men able to retract their foreskin partially ("relative phimosis"), and some completely unable to retract their foreskin even in the flaccid state ("full phimosis").
Because of the "elasticity" of the diagnostic criteria, there has been considerable variation in the reported prevalence of pathological phimosis. An incidence rate of 1% to 2% of the uncircumcised adult male population is often cited, though some studies of older children or adolescents have reported higher rates. Relative phimosis is more common, with estimates of its frequency at approximately 8% of uncircumcised men. When phimosis develops in an uncircumcised adult who was previously able to retract his foreskin, it is nearly always due to a pathological cause, and is far more likely to cause problems for the man.
An important cause of acquired, pathological phimosis is chronic balanitis xerotica obliterans (BXO), a skin condition of unknown origin that causes a whitish ring of indurated tissue (a cicatrix) to form near the tip of the prepuce. This inelastic tissue prevents retraction. Some evidence suggests that BXO may be the same disease as lichen sclerosus et atrophicus of the vulva in females. Infectious, inflammatory, and hormonal factors have all been implicated or proposed as contributing factors. Circumcision is usually recommended though alternatives have been advocated.
Phimosis may occur after other types of chronic inflammation (e.g., balanoposthitis), repeated catheterization, or forceful foreskin retraction. Phimosis may also sometimes be brought on by diabetes, due to high levels of sugar being present in the urine of some diabetics, which creates the right conditions for bacteria to breed, under the foreskin.

Potential complications of acquired phimosis

Chronic complications of acquired (pathological) phimosis can include discomfort or pain during urination or sexual intercourse. The urinary stream can be impeded, resulting in dribbling and wetness after urination. Harmful urinary obstruction is possible but uncommon. Pain may occur when a partially retractable foreskin retracts during intercourse and chokes the glans penis. A totally non-retractable foreskin is rarely painful. There is some evidence that phimosis may be a risk factor for penile cancer. The most acute complication is paraphimosis (Paraphimosis image). In this acute condition, the glans is swollen and painful, and the foreskin is immobilized by the swelling in a partially retracted position. The proximal penis is flaccid. Paraphimosis is considered an emergency.

Treatment of phimosis

Phimosis in infancy is nearly always physiological, and needs to be treated only if it is causing obvious problems such as urinary discomfort or obstruction. In older children and adults phimosis should be distinguished from frenulum breve, which more often requires surgery, though the two conditions can occur together.
If phimosis in older children or adults is not causing acute and severe problems, nonsurgical measures may be effective. Choice of treatment is often determined by whether the patient (or doctor) views circumcision as an option of last resort to be avoided or as the preferred course. Some adults with nonretractile foreskins have no difficulties and see no need for correction.
•Circumcision is the traditional surgical solution for pathological phimosis, and is effective. Serious complications from circumcision are very rare, but minor complication rates (e.g., having to perform a second procedure or meatotomy to revise the first or to re-open the urethra) have been reported in about 0.2-0.6% in most reported series, though others quote higher rates. Preputioplasty, in which a limited dorsal slit with transverse closure is made along the constricting band of skin, can be an effective alternative to full circumcision. It has the advantage of only extremely limited pain and a very short time of healing relative to the rather more traumatic circumcision, together with no cosmetic effects.

There is a school of opinion among the medical profession that advocates and promotes a number of alternative methods where surgery, with all the attendant risks, can be avoided.

High rates of success have been reported with several nonsurgical measures:
•Application of topical steroid cream for 4-6 weeks to the narrow part of the foreskin is relatively simple and less expensive than surgical treatments. It has replaced circumcision as the preferred treatment method for some physicians in the U.K. National Health Service. Stretching of the foreskin can be accomplished manually, sometimes with masturbation, also known as the Beaugé method. The stretching can also be accomplished with balloons placed under the foreskin skin under anaesthesia, or with a tool. The tissue expansion promotes the growth of new skin cells to permanently expand the narrow preputial ring that prevents retraction.

Dilation and Stretching

Skin that is under tension expands by growing additional cells. A permanent increase in size occurs by gentle stretching over a period of time. The treatment is non-traumatic and non-destructive. Manual stretching may be carried out without the aid of a medical doctor. The treatment is inexpensive. Relief of phimosis by a stretching technique has the advantage of preserving all foreskin tissue and the sexual pleasure nerves. The Beaugé Method has proved successful for many and also this method was elected the most efficient method by several physicians.

Incidence

A number of medical reports of phimosis incidence have been published over the years. They vary widely because of the difficulties of distinguishing physiological phimosis (developmental nonretractility) from pathological phimosis, definitional differences, ascertainment problems, and the multiple additional influences on post-neonatal circumcision rates in cultures where most newborn males are circumcised. A commonly cited incidence statistic for pathological phimosis is 1% of uncircumcised males. When phimosis is simply equated with nonretractility of the foreskin after age 3 years, considerably higher incidence rates have been reported. Others have described incidences in adolescents and adults as high as 50%, though it is likely that many cases of physiological phimosis or partial nonretractility were included.

Phimosis in some historical references

•According to some accounts, phimosis prevented Louis XVI of France from impregnating his wife, Marie Antoinette, for the first seven years of their marriage. She was 14 and he was 15 when they married in 1770. However, the presence and nature of his genital anomaly is not considered certain, and some scholars (Vincent Cronin and Simone Bertiere) assert that surgical repair would have been mentioned in the records of his medical treatments if it had occurred
•US President James Garfield was assassinated by Charles Guiteau in 1881. The autopsy report for Guiteau indicated that he had phimosis. At the time, this led to the simplistic speculation that Guiteau's murderous behavior was due to phimosis-induced insanity.

Balanitis

Balanitis- is the inflammation of the glans penis. When the foreskin (or prepuce) is also affected, it is termed balanoposthitis. This may be due to the lack of aeration and irritation because of smegma and discharge surrounding the glans penis causes inflammation and edema.
Inflammation has many possible causes, including irritation by environmental substances, physical trauma, and infection by a wide variety of pathogens, including bacteria, virus, or fungus—each of which require a particular treatment.

Prevalence

Escala and Rickwood, in a 1989 examination of 100 cases of balanitis in childhood, concluded that the risk "in any individual, uncircumcised boy appears to be no greater than 4%.”Oster reported no balanitis in 9545 observations of uncircumcised Danish boys. Balanitis in boys still in nappies must be distinguished from the normal redness seen in boys caused by ammoniacal dermatitis. While any man can develop balanitis, the condition is most likely to occur in men who have a tight foreskin that is difficult to pull back, or who have poor hygiene. Diabetes can make balanitis more likely, especially if the blood sugar is poorly controlled.

Circumcision

Some studies indicate balanitis to be more common in uncircumcised boys but, Van Howe found balanitis only in circumcised boys. Van Howe's study has been criticized for the fact that few boys were uncircumcised.

Genital washing

Many studies of balanitis do not examine the subjects' genital washing habits. However, O'Farrell et al. report that failure to wash the whole penis, including retraction of the foreskin in uncircumcised men, is more common among balanitis sufferers. Birley et al., however, found that excessive genital washing with soap may be a strong contributing factor to balanitis.
Diagnosis
Diagnosis may include careful identification of the cause with the aid of a good patient history, swabs and cultures, and pathological examination of a biopsy.

Complications

Balanitis may cause edema, resulting in phimosis, or inability to retract the foreskin from the glans penis. Adherence of the foreskin to the inflamed and edematous glans penis is the cause.

Zoon's balanitis

Zoon's balanitis also known as Balanitis Circumscripta Plasmacellularis or plasma cell balanitis (PCB) is an idiopathic, rare, benign penile dermatosis for which circumcision is often the preferred treatment. Zoon's balanitis has been successfully treated with the carbon dioxide laser and more recently Albertini and colleagues report the avoidance of circumcision and successful treatment of Zoon's balanitis with an Er: YAG laser. Another study, by Retamar and colleagues, found that 40 percent of those treated with CO2 laser relapsed.

Circinate balanitis

Circinate balantitis (also known as balanitis circinata) is a serpiginous annular dermatitis associated with Reiter’s syndrome.

Frenulum Breve

Frenulum Breve – is the condition in which the frenulum preputii penis, which is an elastic band of tissue under the glans penis that connects to the prepuce (foreskin) and helps contract the prepuce over the glans, is short and restricts the movement of the prepuce. The frenulum should normally be sufficiently long and supple to allow for the full retraction of the prepuce so that it lies smoothly back on the shaft of the erect penis. The frenulum is comparable to the small band between the tongue's lower surface and the lower jaw.

Frenulum breve is often complicated by tearing of the frenulum during sexual activity. The torn frenulum results in healing with scar tissue which is less flexible after the incident causing further difficulties.

The diagnosis of frenulum breve is frequently confounded with that of phimosis (an occurrence as well as phimosis is however possible). The condition may be easily treated without major surgery by threading a suture through the lower membrane, and then tying a tight knot around the frenulum itself. After a few days the frenulum will weaken and eventually break apart to allow the prepuce to fully retract. Stretching exercises and steroid creams may also be helpful. Alternatively, it may be treated by a reparative plastic surgery operation called a frenuloplasty, or by complete circumcision including removal of the frenulum (frenectomy).

Masturbation:

It was once believed that circumcision would prevent masturbation, in the 1800s when masturbation was not looked upon as a healthy thing to be doing. Circumcision does not prevent masturbation or increase fertility. The belief that circumcision enhances the sexual experience for men or for their sexual partners may not necessarily be true, either. I can't confirm or deny this as I am not the only one born with a penis, but many men would say or attest to the fact that they believe they are more 'sensitive' because of having a foreskin.

Cancer Risk

It is widely and falsely believed that uncircumcised men stand a greater risk of penile cancer. A big surprise- to many in the medical community who thought otherwise. But, In March of 1999, the American Academy of Pediatrics revised its circumcision policy statement and concluded that there is not sufficient data to support the supposed potential health benefits of circumcision. The organization no longer advocates routine neonatal circumcision. And after the analysis of almost 40 years of available medical research on circumcision in the US, the American Academy of Pediatrics (AAP) issued new recommendations stating that the benefits are not significant enough for the AAP to recommend circumcision as a routine procedure.

The new policy statement was published in the month's issue of Pediatrics, the journal of the AAP. “Circumcision is not essential to a child's well-being at birth, even though it does have some potential medical benefits. These benefits are not compelling enough to warrant the AAP to recommend routine newborn circumcision. Instead, we encourage parents to discuss the benefits and risks of circumcision with their pediatrician, and then make an informed decision about what is in the best interest of their child,” says Carole Lannon, M.D., MPH, FAAP, chair of the AAP's Task Force on Circumcision. The policy concluded, however, that it is legitimate for parents to take into account cultural, religious and ethnic traditions, in addition to medical factors, when making this decision. It states that to make an informed choice, parents of all male infants should be given accurate information and be provided the opportunity to discuss this decision with their pediatrician.” That was their conclusion at that time.

Either way, the eyelid/foreskin is naturally designed to protect the head of the penis from abrasion and infection. Its surface represents 50 percent of all penile skin, and folds around the opening of the penis. Its inside surface is composed of a soft mucosa that secretes antibacterial and antiviral lubricants called smegma, which further protect the glans from friction and infection. Because the glans is sheathed in this moist envelope, it retains its sensitivity. During sex, the foreskin glides along the penile shaft, providing lubrication and stimulation. And some spouses married to uncircumcised husband would say- “There’s a big industry in this country selling lubricants and jellies to enhance sex, but they’re unnecessary for those of us lucky enough to have married an uncircumcised man. An intact man’s glans is naturally moist and juicy.”

*****WHY CIRCUMCISION MAY NOT BE THE ULTIMATE SMOKING GUN ON HIV/AIDS-GIVEN IT'S HISTORY? TO BE CONTINUED**********

DISEASES OF CENTRAL NERVOUS SYSTEM-1

2008-09-20T23:17:00.000-07:00

DISEASES OF CENTRAL NERVOUS SYSTEM-1

Meningitis

Meningitis is an infection of the meninges, the thin lining that surrounds the brain and the spinal cord. There are reports that the causative agent, Neisseria meningitidis (the meningococcus), was first identified in 1887.

Infection within the subarachnoid space or through out the leptomininges is referred to as meningitis. Based on the host’s response to the invading microorganism, meningitis is divided into two major categories: Purulent and Aseptic meningitis.

PURULENT MENINGITIS

A patient with purulent meningitis will typically have marked acute inflammatory exudates with large numbers of polymorpholonuclear cells. Frequently the underlying CNS tissue, in particular the ventricles, may be involved. If the ventricles become involved, then this process is referred to as ventriculitis. These infections are frequently cased by bacteria.

Pathogenesis

The outcome of a host-microbe interaction depends on the characteristics of both the host and the microorganism. An important host defense mechanism of the CNS is the blood-brain barrier; the choroids plexus, arachnoid’s membrane and the cerebral microvascular endothelium are the key structures. Because of the unique structural properties of the vascular endothelium, such as continuous intercellular tight junctions, this barrier minimizes the passage of infectious agents into CSF in addition to regulating the transport of plasma proteins, glucose, and electrolytes.

Age

Age of the host and other underlying host factors also contribute to whether and individual will be predisposed to develop meningitis or not. Neonates have the highest prevalence of meningitis cases. This is probably due to their immature immune system, the organisms present in the colonized female vaginal tract, and the increased permeability of the blood –brain barrier of newborns. Lack of demonstrable humoral antibody against Haemophilus influenzae type [b] in children has been associated with increased incidence of meningitis. Before the age of widespread vaccination, most children developed measurable antibody by around age 5. Also adults without the necessary antibody to Neisseria meningitidis could be linked to epidemic meningitis-especially those who live in crowded areas/conditions (e.g. military barracks, high school/college dormitories). N. meningitidis has been associated with epidemic meningitis.

Because the respiratory tract is the primary portal of entry for many etiologic agents of meningitis, factors that predispose adults to meningitis are often the same as those that increase the likelihood that the adult will develop pneumonia or other respiratory tract infections/colonization. Alcoholism, splenectomy, diabetes mellitus, and immunosuppression contribute to increased risk. Patients with prosthetic devices- particularly central nervous system shunts are also at risk of developing meningitis.

For organisms to reach CNS-primarily through blood borne route, host defense mechanism must be overcome. Most cases of meningitis caused by bacteria share a similar pathogenesis. A successful meningeal pathogen must first sequentially colonize and cross the host’s mucosal epithelium and then enter and survive in the bloodstream. The most common causes of the meningitis possess the ability to evade the host’s defense mechanism at each of these levels. For example clinical isolates of the Strep. Pneumoniae and N. meningitidis secrete IgA proteases (enzymes) that destroy the action of the host’s secretory IgA, thereby facilitating bacterial attachment to the epithelium. In addition, all of the most common etiologic agents of bacterial meningitis possess an antiphagocytic capsule that helps the organisms evade the destruction by the host’s immune system.

Organisms appear to enter the CNS by interacting and subsequently breaking down the blood-brain barrier at the level of microvascular endothelium. To date one of the least understood processes in the pathogenesis of meningitis is how the organisms cross this barrier into the subarachnoid space. Nevertheless, there appear to be specific bacterial surface components, such as pili, that facilitate adhesion of the organisms to the microvascular endothelial cells and subsequent penetration into the CSF. Organisms can enter through-1) loss of capillary integrity by disrupting tight junctions of the blood-brain barrier, -2) transport within circulating phagocytic cells, or -3) by crossing the endothelial cell lining within endothelial cell vacuoles. After gaining access, the organism multiplies within the CSF, a site initially free of antimicrobial antibodies or phagocytic cells.

Clinical manifestations:
***** TO BE CONTINUED*****

CIRCUMCISION AND HIV/AIDS AS A CURE OR PREVENTIVE?–CONT. PART 4

2008-09-20T00:07:00.000-07:00

Male circumcision as a tradition/or cultural practice.

Circumcision is very ancient - the oldest recorded operation - and traditional circumcision is found worldwide, in Africa, Asia, Australia, Europe and North and South America.

AFRICA:

In North, South and West Africa, East Africa- Algeria, Cameroon, Chad, Egypt (Muslim and Christian), Ethiopia, Gabon, Gambia, Guinea, Ivory Coast, Kenya. Libya, Madagascar, Mali, Mauritius, Morocco, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Togo, Tunisia, Northern Uganda, South Africa, Zaire e.t.c e.t.c. all or part of their populations practiced circumcision as a form of their tradition.

Ancient Egypt

Ancient Egyptians carried out a complete circumcision, with the foreskin totally removed. It is believed that it is Egypt that most of the circumcision practices are traced back to.

The desert Arabs traditionally used a technique of constriction to minimize bleeding which has its counterparts in many modern surgical approaches. The foreskin was pulled forward as far as possible then tied up tightly with a cord. It was left like that for half an hour or so, then cut off in front of the knot. The string was then slipped off and the inner skin pushed back to meet the outer. The penis was bound up tightly to minimize bleeding, along with the operator's own idea of suitable bleeding remedy.

South Africa

In southern Africa the Xhosa, among others also carried/carry out a full circumcision (Umkhwetha) with a technique which is probably representative of many in AFRICAN traditions. The circumciser pulls the young man's foreskin forward, slipping it over his index finger like a glove and holding it in place with his thumb and middle finger. Stretching it tightly he cuts it around, cutting between his finger and the tip of the penis. The outer skin springs back down the shaft, and the remaining inner skin is pushed back down over the shaft to meet it.

Special herbs are applied and a tight leather bandage to control the bleeding. For Xhosa-speaking people who practice ritual circumcision as a cultural institution, alternatives are negligible to non-existent. Initiation is seen as the formal incorporation of males into Xhosa religious and societal life, and before circumcision, a male cannot marry or start a family, inherit possessions, nor officiate in ritual ceremonies.

Kenya

Most of the Kenyan societies, with the exception of only in the NILOTES. Luo-as a Nilotic group, practiced removing six of their front lower teeth as a rite of passage initiation to adulthood -some Nilotic groups removed four lower front teeth, others pierced their ears-e.t.c..e.t.c... .All as a part of traditional initiation-rites of passage with similar belief fundamentals as of circumcision) and Turkana among other Kenya's main forty -three-groupings practiced circumcision. Among the groups who practiced it, it was/is the ultimate rite of passage initiation from childhood to adulthood. And it was/is also the barometer of testing one’s courage and of readiness to join the adult club.

Among the BANTU groups, the Agikuyu,(who practiced/s both female and male circumcision) it’s known as (irua). Of all the Agikuyu members’ life stages, circumcision was and remains by far the most important, signifying not only a child's passage into adulthood, but a whole wealth of other socially significant meanings and assumptions of responsibility. For both boys and girls, initiation into adulthood - through circumcision or clitoridectomy - marks their admission into full membership of Kikuyu society, and was thus a momentous occasion, both socially and individually. Through circumcision and the period of initiation and instruction that accompanied it, an individual became a full participant in society as a whole, beyond the scope of the village and their families. Their responsibilities, therefore, extended not just to their family, but to the Agikuyu as a group. On the most basic level, which is shared across the board –for example among other Bantu and few Nilotic groups- the social consequence of a boy's circumcision meant that he would now become a warrior, and would spend several years in the service of the entire people to defend and protect, and occasionally attack neighboring groups (tribes-derogatory- please we need to find a better term!). Uncircumcised, the boy - for he would remain a boy even if he lived to ninety years they believed, and he would also be barred from getting married and raising children. For a girl, circumcision meant that she was able to bear children, and marriage was usually swift to follow.

Traditionally, there was a circumcision ceremony for boys organized by age-sets of about five-year periods. Although boys could be circumcised throughout that period, they would become part of the same age-set, and all the men in that circumcision group would take an age-set name. Times in the history of Kikuyu and others society who followed the practice could be gauged by age-set names. Circumcision was traditionally a public affair, which only added to the anxiety - and determination - of the boys to pass the ordeal without showing the slightest trace of fear. The practice of circumcision is still followed, although now it is more likely to be performed in hospitals. Traditionally, boys who underwent circumcision became warriors- this institution is no longer the case. As in so many societies all over the world, sex was seen as a weakness, both spiritual and physical. For this reason, junior warriors were barred from sexual relations, though in compensation they were also given a lot of food to make them strong. Only senior warriors, who were preparing to leave warriorhood, were allowed to marry and raise children.

ASIA AND MIDDLE EAST:

The Philippines-the Philippines stands out in ASIA as among the only group who took/take circumcision seriously. As almost 95% if not 99% are circumcised. Close to 90% use or used dorsal slit technique since most of them are done-or at least used be done in the rural setting with a minimal fee- the literature evidence points out that, this has/had been part of their culture even before Magellan landed the Philippines in 1521.

A few decades ago, genital incision of Filipino boys (pagtutuli) was purely a traditional custom. An amateur (manunuli) would perform it on local boys. It is a "coming of age" ritual, and traditional for a boy to prove his manhood properly (strong and fearless-as in many traditional beliefs), it was and thus- must be done without anesthetic. In some areas, the boys sit astride a banana log into which a wooden plug has been inserted as an "anvil". The traditional rite is only super incision, a dorsal slit, removing no tissue (but with variations).

More recently pagtutuli is becoming more western oriented-read (modern medicine) and commercialized.

The traditional Filipino circumcision had the strong elements of it-as being a rite of passage from childhood to manhood/adulthood, though once healed, very little about a boy's life actually changes. At present, peer-pressure, parental pressure, medical pressure and the stigma against being supót (intact) make childhood circumcision almost - but not quite - inevitable.

A wide variety of organizations now organize operation tuli - mass circumcision sessions - as a charitable venture. Now most of the Filipino boys aged 7 - 10 years old are being circumcised by the groups during summer time under the banana tree by a circumciser using dorsal slit method that takes only few seconds without anesthesia. They don't mind being seen by others kids to be circumcised. Probably one peculiar thing about the present circumcision is that the boys themselves choose to be circumcised the parents are sometimes caught with great surprise that their son had the procedure done without them knowing. And most people when asked about the significance of being circumcised or left intact will mostly certainly respond on the logic that- it greatly depends on the place where one live and what is considered norm for a particular group of people living together in that particular region.

History- the Filipinos were under Islamic rule when Spain took over. Magellan was killed by a Muslim chieftain. Under Islam any uncut guy that resisted conversion was to be killed. Christians and Jews were accepted as we are "of the book" meaning our religion stems from Abraham (Ibrahim). Pagans were to be converted or killed. When Spain took over they were unable to convince the locals to stop the practice which was illegal in Spain and the new world. Any Spanish citizen found practicing any form of Islamic or Jewish religious practice after baptism was tortured and then burned at the stake. This was same for the Christians that were varied from Catholics to orthodox. Heretics they were called. And back to the Philippines, the practice of circumcision continued and the locals justified it as being a Christian thing (Jesus was of course Jewish). The feast of the circumcision was celebrated I believe in the 1st or 3rd of January. Not all Filipinos practice it, but it is undoubtedly done to the majority of males usually about the time of puberty, but again many are doing it to infants presently. The Chinese or Spanish ancestry doesn’t usually circumcise, but the people of local ancestry or mixed background mostly do circumcise.

Among other groups in ASIA and the wider MIDDLE EAST plus the Islamic areas, the - Afghanistan, Bahrain, Bangladesh, Indonesia (largest Muslim nation),Malaysia, Iran, Iraq, Jordan, Kuwait, Oman, Pakistan, (Hindu minority about 10%-donnot circumcise), Qatar, Saudi Arabia, Syria, Turkey, UAE, Yemen (N+S), Tonga and Samoa circumcision is practiced. It is not far fetched to note that most ASIAN/MIDDLE EASTERN countries, almost only those with Islamic religious background have literature showing circumcision being practiced. Other groups like the Koreans and Japanese- one of those with very few/smallest percentages of population that can be classified as circumcised, Indians-non Muslims, Buddhists areas such as Myanmar, Tibetans, and Hindu areas are not known to be pro-circumcision.

SOUTH AND NORTH AMERICA:

In the Americas- circumcision is mostly influenced by religion/region except in a few cases for example the NATIVE INDIANS and amongst NATIVES IN SOUTH AMERICA where circumcision can be traced back into a form of old tradition/customs.

AUSTRALIA:

In Australia-the NATIVES-THE ABORIGIN NATIVES have literature pointing to their circumcision as a tradition. But amongst the other societies, the practices is purely either religious or due to other forms of influence.

****PS/NB: This post still needs more information especially circumcision as a form of rite of passage amongst African’s many customs. Suggestions/additional info are welcome.

POSSIBLE THEORIES BEHIND CIRCUMCISION AS A TRADITION:

Circumcision could have been a function of a -check-balance to reduce a young man's potential to father a child with an older man's wife. Sperm competition theory predicts that males will ways evolve to ensure that their sperm, and not another male's, fertilizes a female's eggs. Genital mutilation, in this view, could be just another way of sperm war.

In some forms of mutilation, the handicap to sperm competition is obvious. There is sub incision, for example, where cuts are made to the base of the penis. This causes sperm to be ejaculated from the base rather than the end, and is performed in several Aboriginal Australian societies among others. In some African and Micronesian cultures, young men have one of their testicles manipulated. Male genital mutilation makes it less likely that a male will manage to father a child with another man's wife if that’s the desired outcome in those societies who practiced it.

Home advantage

Circumcision is one of the less painful forms of mutilation, but it is also less effective at reducing sperm competition. Some reports suggests, however, that the lack of a foreskin could make insertion or ejaculation slower, meaning brief, illicit sex is less likely to come to fruition and lead to a pregnancy. Younger men, willingly submit to having their reproductive ability reduced because they benefit socially from the older men, by forming alliances, and by gaining access to weapons and other societal lore.

The older men have also gone through the ritual, and seen their own reproductive effectiveness reduced. But if a man with, say, four wives wants to ensure that any children his wives produce are his, there is pressure to make sure other men can't successfully impregnate them. The husband's own reproductive ability is impaired, but continuous and repeated access to his wives makes up for it, while any genital mutilation is a greater handicap to an interloper trying to sneak brief occasional sex with his wives.

Price of alliance

An older-married man must form alliances, or associates with younger or unmarried men at some point, and it would be better to associate with and invest preferentially in those who are least likely to threaten his paternity, especially in societies where cuckoldry is rife.

Men who demand genital mutilations as part of the price for alliance and investment would be less vulnerable to exploitation of such relationships and loss of paternity to peers. If the sperm competition theory were to be correct, then male genital mutilation should be more common in societies where men tend to have multiple wives, especially those in which the wives live apart from the husband.
The mutilation would also probably be carried out in a public setting, witnessed mostly by other men, and performed by a non-relative. Men who refused would face social sanctions. Most highly polygamous societies practice some form of male genital mutilation and in societies in which wives live in separate households that increases as compared to those of the monogamous societies. It might also be the case that selection works at a group level, so that societies that enforce mutilation are more stable because of less conflict over paternity. Either way there is no scientific evidence to suggest that circumcision prolongs sex or prevents premature ejaculation.

****CIRCUMCISION-therapeutic/non-therapeutic to be CONTINUED**** more info/updates will be added to the circumcision as a part of tradition topic… as I get more info either from you readers or jAnaM.

CIRCUMCISION AND HIV/AIDS AS A CURE OR PREVENTIVE?–CONT. PART 3

2008-09-13T15:22:00.000-07:00

Circumcision and other religious groups:

Hinduism- In Hinduism not being circumcised is part of the Hindu religious identity.

Buddhism-Buddhism consistently emphasizes compassion and asks followers to practice harmlessness and to avoid extremes of asceticism or self mortification. Buddhism teaches that-an opportunity to become a Buddha is open to every living being that chooses to follow the eight-fold path to enlightenment that forms the important Buddhism symbol- the eight-spoke wheel or chakra which denotes the Eight-fold path to a virtuous life as taught by Buddha. Among other symbols which are significant in Buddhism are the lotus flower, stupa, mandalas and certain physical characteristics of the Buddha. These symbols may be an iconic or centered around the physical image of Buddha.

Therefore it seems clear that, circumcision in other religions is not that popular, as the golden rule suggests.

The Golden Rule in Six Religions:

Islam:
No one of you is a believer until he loves for his brother what he loves for himself.

Taoism:
Regarding your neighbor’s gain as your own gain, and regard your neighbour's loss as your own loss.

Christianity:
All things whatsoever you would that men should do unto you, do ye even so unto them, for this is the law and the prophets.

Hinduism:
That is the sum of duty; do naught to others which if done to thee, would cause thee pain.

Confucianism:
Is there any one maxim which ought to be acted upon throughout one's life? Surely the maxim of loving-kindness is such. Do not unto others what you would not they should do unto you.

Buddhism:
Hurt not others with that which pains you.

*****TO BE CONTINUED****** "Male circumcision as a tradition/or cultural practice".

CIRCUMCISION AND HIV/AIDS AS A CURE OR PREVENTIVE? PART 2

2008-09-12T18:18:00.000-07:00

CIRCUMCISION AND HIV/AIDS AS A CURE OR PREVENTIVE–CONT. PART 2

For the sake of this topic/post, only Male circumcision as a traditional, cultural, religious, therapeutic or for non-therapeutic reasons is going to be considered.

Circumcision and religion:

A. Circumcision and Islam- Muslims are currently the largest single religious group practicing widespread circumcision as a rite/ritual. Although not mandated by the Qur’an, it serves to introduce males into the Islamic faith, and works as a sign of belonging to the wider Islamic community also viewed as an act of faith and compliance.

The Qur'an itself doesn't mention circumcision. In the time of Muhammad, circumcision was carried by many tribal Arabs, as well as by Jews for religious reasons. Muhammad himself was circumcised, and circumcised his sons. Many of his early disciples were circumcised to symbolize their inclusion within the emerging Islamic community. These facts are mentioned several times in the Hadith. Some Hadith group circumcision with the fitrah (acts considered to be of a refined person. Other such acts include: clipping or shaving pubic hair, cutting nails, cleaning teeth, plucking or shaving the hair under the armpits and clipping (or shaving) the moustache.

Despite its absence from the Qur’an, it has been a religious norm from the beginning of Islam. It is also considered hygienically clean.
Amongst Ulema, there are differing opinions about the compulsions of circumcision in Islamic law. The majority of Islamic legal opinion is that circumcision is obligatory. Imam Abu Hanifah, founder of the Hanafi School of Islamic jurisprudence, and Imam Malik maintain that circumcision is a Sunnah Mu'akkadah — not obligatory but highly recommended. Some scholars, including Imam Shafa’I and Ahmad ibn Hanbal see it as binding on all Muslims.

Time for circumcision

Islamic sources don’t fix a particular time for circumcision. It depends on family, region and country. A majority of Ulema however take the view that parents should get their child circumcised before the age of ten. The preferred age is usually seven although some Muslims are circumcised as early as on the seventh day after birth and as late as at the commencement of puberty. According to some Hadith (Abdullah Ibn Jabir and Aisha), Muhammad circumcised his children on the seventh day after their birth. This opinion is popular amongst the Hadith and Islamic jurists.

Procedure

Islamic circumcision does not have a strictly mandated procedure, or form of circumcision. These tend to change across cultures, families, and time. In some Islamic countries circumcision is performed after Muslim boys have learnt to recite the whole Qur'an from start to finish. In Malaysia and other regions, the boy usually undergoes the operation between the ages of ten and twelve, and is thus a puberty rite, serving to introduce him into the new status of adulthood. The procedure is sometimes semi-public, accompanied with music, special foods, and much festivity. Traditional circumcisions however are steadily becoming rarer throughout the Islamic world, with many Muslim families preferring to have their sons done at birth or if they are done older it is normally done by a doctor under local anesthetic. Circumcisions are usually carried out in a clinic or hospital. The circumciser is not required to be a Muslim. The general ‘style’ of circumcision is the traditional stretch and cut which is typically reasonably tight but leaves a lot of the inner foreskin.

B. Circumcision and Christianity:

Christians, depending upon their viewpoint and denomination, either consider the Holy Bible to be an authority, or the sole authority for faith and practice.

Consequently, Christian parents may seek guidance from the Bible in reference to circumcision. Christian parents may wish to test circumcision by the scriptural guidance on parenting although there are also references to the falseness of those who advocate circumcision as a recurrent theme in the New Testament. For example, the Apostle Paul says circumcision is a false teaching (Gal. 2:4). To guide Christian parents who encounter false teachings, the text therefore contains references to false prophets, apostles and brothers.

Scriptures about circumcision

The gospels

Luke 1:59-60 Circumcision of John the Baptist.
On the eighth day they came to circumcise the child, and they were going to name him after his father Zechariah, but his mother spoke up and said "No! He is to be called John."
Luke 2:21-39. the Circumcision of Jesus.
On the eighth day, when it was time to circumcise him, he was named Jesus, the name the angel had given him before he had been conceived.
John 7:21-24 Jesus teaches at the feast.
Jesus said to them, "I did one miracle, and you are all astonished. Yet because Moses gave you circumcision (though actually it did not come from Moses but from the patriarchs), you circumcise a child on the Sabbath. Now if a child can be circumcised on the Sabbath so that the law of Moses may not be broken, why are you angry with me for healing the whole man on the Sabbath? Stop judging by mere appearances and make a right judgment."

Acts of the Apostles

Acts 15:1-21 the Council at Jerusalem:
Some men came down from Judea to Antioch and were teaching the brothers: Unless you are circumcised according to the custom taught by Moses, you cannot be saved. This brought Paul and Barnabas into sharp dispute and debate with them. So Paul and Barnabas were appointed along with some other believers to go up to Jerusalem to see the apostles and elders about this question. The church sent them on their way, and as they traveled through Phoenicia and Samaria, they told how the Gentiles had been converted. This news made all the brothers very glad. When they came to Jerusalem, they were welcomed by the church and the apostles and elders, to whom they had reported every thing God, had done through them.
Then some of the believers who belonged to the party of the Pharisees stood up and said, "The Gentiles must be circumcised and required to obey the Law of Moses."
The apostles and elders met to consider this question. After much discussion, Peter got up and addressed them: "Brothers, you know that some time ago God made choice among you that the Gentiles might hear from my lips the message of the gospel and believe. God, who knows the heart, showed that he accepted them by giving the Holy Spirit to them, just as he did to us. He made no distinction between us and them, for he purified their hearts by faith. Now then, why do you try to test God by putting on the necks of the disciples a yoke that neither we nor our fathers have been able to bear? No! We believe it is through the grace of our Lord Jesus that we are saved, just as they are."
The whole assembly became silent as they listened to Barnabas and Paul telling them about the miraculous signs and wonders God had done among the Gentiles through them. When they had finished, James spoke up: "Brothers, listen to me. Simon has described to us how God at first showed his concern by taking from the Gentiles a people for himself. The words of the prophets are in agreement with this, as it is written:
`After this I will return
and rebuild David's fallen tent.
Its ruins I will rebuild,
and I will restore it,
that the remnant of men may seek the Lord,
and all Gentiles who bear my name,
says the Lord, who does these things'
that have been known for ages.
It is my judgment, therefore that we should not make it difficult for the Gentiles who are turning to God. Instead we should write to them, telling them to abstain from food polluted by idols, from sexual immorality, from the meat of strangled animals and from blood. For Moses has been preached in every city from the earliest times and is read in the synagogues on every Sabbath."
Acts 15:22-35 the Council's Letter to Gentile Believers
Then the apostles and elders, with the whole church, decided to choose some of their own men and send them to Antioch with Paul and Barnabas. They chose Judas (called Barnabus) and Silas, two men who were leaders among the brothers. With them they sent the following letter:
The apostles and elders, your brothers,
To the Gentile believers in Antioch, Syria and Cilicia:
Greetings:
We have heard that some went out from us without our authorization and disturbed you, troubling you minds by what they said. So, we all agreed to choose some men and send them to you with our dear friends Barnabus and Paul -- men who have risked their lives for the name of our Lord Jesus Christ. Therefore we are sending Judas and Silas to confirm by word of mouth what we are writing. It seemed good to the Holy Spirit and to us not to burden you with anything beyond the following requirements: You are to abstain from food sacrificed to idols, from blood, from the meat of strangled animals and from sexual immorality. You will do well to avoid these things. Thus, Circumcision is not required.

Farewell.
The men were sent off and went down to Antioch, where they gathered the church together and delivered the letter. The people read it and were glad for its encouraging message. Judas and Silas, who themselves were prophets, said much to encourage and strengthen their brothers. After spending some time with them, they were sent off by the brothers with the blessing of peace to return to those who had sent them. But Paul and Barnabas remained in Antioch, where they and many others preached the word of the Lord.
Acts 21:17-25 Paul's Arrival at Jerusalem
When we arrived at Jerusalem, the brothers received us warmly. The next day Paul and the rest of us went to see James, and all the elders were present. Paul greeted them and reported in detail what God had done among the Gentiles through his ministry.
When they heard this, they praised God. Then they said to Paul: "You see, brother, how many thousands of Jews have believed, and all of them are zealous for the law. They have been informed that you teach all the Jews who live among the Gentiles to turn away from Moses, telling them not to circumcise their children or live according to their customs. What shall we do? They will certainly hear that you have come, so do what we tell you. There are four men with us who have made a vow. Take these men, join in their purification rites and pay their expenses so they can have their heads shaved. Then everyone will know there is no truth in these reports about you, but you yourself are living in obedience to the law. As for the Gentile believers, we have written to them our decision that they should abstain from food sacrificed to idols, from blood, and from the meat of strangled animals and from sexual immorality."

The general letters

Galatians 2:1-5 Paul Accepted by Apostles:
Fourteen years later I went up to Jerusalem, this time with Barnabas. I took Titus along also. I went in response to a revelation and set before them the Gospel I preach among the Gentiles. But I did this privately to those who seemed to be leaders; for fear that I was running or had run my race in vain. Yet not even Titus, who was with me was required to be circumcised, even though he was a Greek. This matter arose because some false brothers had infiltrated our ranks to spy on the freedom we have in Christ Jesus and to make us slaves. We did not give in to them for a moment so that the truth of the gospel might remain in you.

Galatians 5:1-12 Freedom in Christ:
It is for freedom that Christ has set us free. Stand firm and do not let yourselves be burdened again by the yoke of slavery.
Mark my words! I, Paul tell you that if you let yourself be circumcised, Christ will be of no value to you at all. Again I declare to every man who lets himself be circumcised that he is obligated to obey the whole law. You who are trying to be justified by law have been alienated from Christ; you have fallen away from grace. But by faith we eagerly await through the Spirit the righteousness for which we hope. For in Christ Jesus neither circumcision nor non-circumcision has any value. The only thing that counts is faith expressing itself through love.
You were running a good race. Who cut in on you and kept you from obeying the truth? That kind of persuasion does not come from the one who calls you. "A little yeast works through the whole batch of dough." I am confident in the Lord that you will take no other view. The one who is throwing you into confusion will pay the penalty, whoever he may be. Brothers, if I am still preaching circumcision, why am I still being persecuted? In that case the offense of the cross has been abolished. As for those agitators, I wish they would go the whole way and emasculate them!

Galatians 6:12-15 Not Circumcision but a New Creation:
Those who want to make a good impression outwardly are trying to compel you to be circumcised. The only reason they do this is to avoid being persecuted for the cross of Christ. Not even those who are circumcised obey the law, yet they want you to be circumcised that they may boast about your flesh. May I never boast except in the cross of our Lord Jesus Christ, through which the world has been crucified through to me, and I to the world. Neither circumcision nor non-circumcision counts for anything; what counts is a new creation. Peace and mercy to all who follow this rule, even to the Israel of God.

I Corinthians 7:17-20 Marriage:
Nevertheless, each one of you should retain the place in life that the Lord has assigned to him and to which God has called him. This is the rule I lay down in all the churches. Was a man already circumcised when he was called? He should not be uncircumcised. Was a man uncircumcised when he was called? He should not be circumcised. Circumcision is nothing and non-circumcision is nothing. Keeping God's commandments is what counts. Each of you should remain in the situation which he was in when God called him.

Romans 2:25-28 the Jews and the Law:
Circumcision has value if you observe the law, but if you break the law you become as though you had not been circumcised. If those who are not circumcised keep the law's requirements, will they not be regarded as though they had been circumcised? The one who is not circumcised physically and yet obeys the law will condemn you who, even though you have the written code and circumcision are a lawbreaker.
A man is not a Jew if he is only one outwardly nor is circumcision merely outward and physical. No, a man is a Jew if he is one inwardly; and circumcision is circumcision of the heart, by the Spirit, not by the written code. Such a man's praise is not from men, but from God.

Romans 3:28-31 Righteousness through Faith:
Is God the God of Jews only? Is he not the God of Gentiles too, since there is only one God, who will justify the circumcised by faith and the uncircumcised through that same faith? Do we, then, nullify the law by this faith? Not at all! Rather, we uphold the law.

Romans 4:9-12:
Is this blessedness only for the circumcised, or also for the uncircumcised? We have been saying that Abraham's faith was credited to him as righteousness. Under what circumstances was it credited? Was it after he was circumcised, or before? It was not afterward but before. And he received the sign of circumcision, a seal of the righteousness that he had by faith while he was still uncircumcised. So then, he is the father of all who believe but have not been circumcised but who also walk in the footsteps of faith that our father Abraham had before he was circumcised.

Ephesians 2:11-13 One in Christ:
Therefore, remember that formerly you who are Gentiles by birth and called "uncircumcised" by those who call themselves "the circumcision" (that done in the body by the hands of men) - remember that at that time you were separate from Christ, excluded from citizenship in Israel and foreigners to the covenants of the promise, with hope and without God in the world. But now in Christ Jesus you who one was far away have been brought near through the blood of Christ.

Philippians 3:1-11 No Confidence in the Flesh:
Finally, my brothers, rejoice in the Lord! It is no trouble to write the same things to you again, and it is a safeguard for you.
Watch out for those dogs, those men who do evil, those mutilators of the flesh. For it is we who are of the circumcision, we who worship by the Spirit of God, who glory in Christ Jesus, and who put no confidence in the flesh - though I myself have reasons for such confidence.
If anyone else thinks he has confidence in the flesh, I have more: circumcised on the eighth day, of the people of Israel, of the tribe of Benjamin, a Hebrew of Hebrews; in regard to the law, a Pharisee; as for zeal, persecuting the church; as for legalistic righteousness, faultless.
But whatever was to my profit I now consider loss for the sake of Christ. What is more, I consider everything a loss compared to the surpassing greatness of knowing Christ Jesus my Lord, for whose sake I have lost all things. I consider them rubbish that I may gain Christ and be found in him, not having a righteousness that comes from the law, but that which is found through faith in Christ - the righteousness that comes from God and is by faith. I want to know Christ and the power of his resurrection and the fellowship of sharing in those sufferings, becoming like him in death, and so somehow to attain to the resurrection from the dead.

The pastoral letters:
Titus 1:10-16
For there are many rebellious people, mere talkers and deceivers, especially those of the circumcision group. They must be silenced, because they are ruining whole households by teaching thing they ought not to teach - and that for the sake of dishonest gain. Even one of their own prophets has said, "Cretans are always liars, evil brutes, and lazy gluttons." This testimony is true. Therefore rebuke them sharply, so that they will be strong in the faith and will pay no attention to Jewish myths or to the commands of those who reject the truth. To the pure all things are pure, but to those who are corrupted and do not believe, nothing is pure. In fact, both their minds and consciences are corrupted. They claim to know God, but by their actions they deny him. They are detestable, disobedient and unfit for doing anything good.

Circumcision is mentioned frequently in the bible. However, the Bible means different things to different religious groups. For example;
1.For Jews, the Bible consists of the 24 books in Hebrew (and some Biblical Aramaic) that are known as the Tanakh.
2.For Protestant Christians, the Bible consists of the 39 books of the Old Testament (following Jerome's Veritas Hebraica) plus the 27 books of the New Testament.
3.For Catholic and most Orthodox Christians, the Bible includes several other books known as the deuterocanonical books, the list being slightly different for each group. In addition, some Orthodox Christians have additional New Testament books, such as the Ethiopian Orthodox and Armenian orthodox, or less, such as the Syrian Orthodox Church.

Either way circumcision appears to be a purely elective procedure depending on geographical region and cultural influences. Today, most Christian denominations are neutral about biblical male circumcision, neither requiring it nor forbidding it. The first Christian Church Council in Jerusalem, held in approximately 50 AD, decreed that circumcision was not a requirement for Gentile converts. According to the Columbia Encyclopedia- The decision that Christians need not practice circumcision is recorded in Acts 15; there was never, however, a prohibition of circumcision, and it is practiced by Coptic Christians.

C. Circumcision and Jewish teachings:

There are references in the Hebrew Bible to the obligation for circumcision among Jews.
For example, Leviticus 12:3 says-On the eighth day a boy is to be circumcised.
And the uncircumcised are to be cut off from the Jewish people - Genesis 17:14:
Any uncircumcised male, who has not been circumcised in the flesh, will be cut off from his people; he has broken my covenant.

According to the Jewish Encyclopedia article on circumcision of proselytes:
The issue between the Zealot and Liberal parties regarding the circumcision of proselytes remained an open one in 1st and 2nd centuries; some have asserting that the bath, or baptismal rite, rendered a person a full proselyte without circumcision, as Israel, when receiving the Law, required no initiation other than the purificative bath; while R. Eliezer makes circumcision a condition for the admission of a proselyte, and declares the baptismal rite to be of no consequence. A similar controversy between the Shammaites and the Hillelites is given regarding a proselyte born circumcised: the former demanding the spilling of a drop of blood of the covenant; the latter declaring it to be unnecessary. The rigorous Shammaite view, voiced in the Book of Jubilees, prevailed in the time of King John Hyrcanus, who forced the Abrahamic rite upon the Idumeans, and in that of King Aristobulus, who made the Itureans undergo, Septuagint, the Persians who, from fear of the Jews after Haman's defeat, "became Jews," and were circumcised.

Nonetheless, disputes over the Mosaic Law soon broke out and generated intense controversy in Early Christianity. This is particularly notable in the mid-1st century, when the circumcision controversy came to the fore. Alister McGrath, a proponent of Paleo-orthodoxy, claimed that many of the Jewish Christians were fully faithful religious Jews, only differing in their acceptance of Jesus as the Messiah. As such, they believed that circumcision and other requirements of the Mosaic Law were required for salvation, if one equates fully faithful religious Jews with Legalism theology, for a counterview, see Covenantal nomism. See also Judaism and Christianity. Those in the Christian community, who insisted that biblical law, including laws on circumcision, continued to apply to Christians were pejoratively labeled Judaizers by their opponents and criticized as being elitist and legalistic, besides others claimed sin.

Circumcision and other religious groups.... *****TO BE CONTINUED******

CIRCUMCISION AND HIV/AIDS-1

2008-09-08T00:10:00.000-07:00

CIRCUMCISION AND HIV/AIDS AS A CURE OR PREVENTIVE?

But first, let’s define what circumcision is before diving into the main issues.

Circumcision-Definition:

1) Male circumcision- is the removal of some or the entire foreskin (prepuce) from the penis- whether for traditional, cultural, religious or other therapeutic or non-therapeutic reasons.

2) Female circumcision or female genital cutting (FGC), also known as female genital mutilation (FGM), female genital mutilation/cutting (FGM/C), refers to -all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs- whether for traditional, cultural, religious or other therapeutic or non-therapeutic reasons.

***TO BE CONTINUED***

AFRICA AND RELIGION

2008-09-06T18:32:00.000-07:00

Religion:

Speaking of Religion- I have been thinking and quite frankly perturbed by this- how come there are/is no real religion that has real African roots? Did Africans not have their own religion? they had music, languages etc.. etc... I strongly suspect they did or at least they had something similar. And if so, how come this vast continent, the only religions that we hear have nothing to do with the Africans as a people? They are mere importations/imitations of adventures of a few centuries or so ago. What happened to the African man/woman’s religion? I stumbled on this among other literature:

Major Religions of the World Ranked by Number of Adherents:

1. Christianity: 2.1 billion
2. Islam: 1.5 billion
3. Secular/Nonreligious/Agnostic/Atheist: 1.1 billion
4. Hinduism: 900 million
5. Chinese traditional religion: 394 million
6. Buddhism: 376 million
7. primal-indigenous: 300 million
8. African Traditional & Diasporic: 100 million
9. Sikhism: 23 million
10. Juche: 19 million
11. Spiritism: 15 million
12. Judaism: 14 million
13. Baha'i: 7 million
14. Jainism: 4.2 million
15. Shinto: 4 million
16. Cao Dai: 4 million
17. Zoroastrianism: 2.6 million
18. Tenrikyo: 2 million
19. Neo-Paganism: 1 million
20. Unitarian-Universalism: 800 thousand
21. Rastafarianism: 600 thousand
22. Scientology: 500 thousand

This list, it says; - Sizes shown are approximate estimates, and are here mainly for the purpose of ordering the groups, not providing a definitive number. This list is sociological/statistical in perspective.(adherencets.com) USA.

I need some real answers not the hog/white wash above-pertaining to African religion. Hopefully we will find the answers before we can turn the century to the future generations. What are African parents teaching their children about their religion? Bring those answers-parents, scholars!

HIV/AIDS AND ITS EFFECTS ON SOCIETY CONT. 5

2008-09-06T16:10:00.000-07:00

Islam and HIV/AIDS:

Muslim countries, previously considered protected from HIV/AIDS due to religious and cultural norms, are also facing a rapidly rising cases. Despite the evidence of an advancing epidemic, sometimes the usual response from the policy makers in Muslim regions for protection against HIV infection is a major focus on propagating abstention from illicit drug and sexual practices. Sexuality, considered a private matter, is usually a taboo topic for discussion as in many cultures.

Reducing the risks to the individual and the community associated with some often stigmatized, antisocial or illegal behaviors becomes important but sometimes elusive. The reliability of the available HIV/AIDS incidences, prevalence and mortality data for Muslims is low because many Muslim countries maybe either their strict following of the religious teachings that are less influenced by other external forces(western oriented) or they do not report their statistics/are good at under-reporting. Either way- HIV/AIDS is far more than a medical and biological problem around the world. In recent years, increasing attention is being paid to the manner in which social and cultural variables influence risk behaviors related to HIV infection transmission. Though the association of contentious ethical and moral issues with HIV risk behaviors exists in all societies, it is much more pronounced in the Muslim world. Thus understanding the role of social and cultural variables affecting HIV transmission in Muslim countries is critical for the development and implementation of successful HIV prevention programs as would in other regions.

As in this case where a Muslim missionary stationed in Gaborone, Sheikh Hategeaikimana Hassan, said that the government's ABC - Abstain, Be faithful, Condomise - model is not entirely compatible with the teachings of Islam. The 'C' is the problem."As Muslims, we encourage and emphasize abstinence until marriage," He said. Abstinence, the primary prevention message for Muslims, is viewed as an act of faith and compliance, but evidence from other parts of the world shows that not all Muslims have been able to comply all the time. A study carried out in Morocco showed that about 50 percent of Muslim women in that country who have AIDS were infected by their husbands. The implication is all too clear: the men had illicit affairs. From a common sense perspective, it would seem realistic to encourage those who find it difficult to A or B, to at least C. However, Hassan sid that as Muslims, they "don't condomise" and that compromise on that score would be tantamount to "encouraging unlawful desire". Generally, the rate of infection in Muslim communities is typically less than in other groups and that have been attributed to the Islamic way of life. Senegal, whose population is 92 percent Muslim, has one of the lowest rates of HIV infection in Africa.

The surgical operation is considered one of the five acts of cleanliness in Islam and the World Health Organization estimates that, on a global scale, 30 percent of males have been circumcised, with almost 70 percent of them being Muslims. The prime health benefit of male circumcision is that it thwarts transmission of HIV as there would be no foreskin to harbor and pass the virus to the rest of the body. While not recommending it as protection against HIV/AIDS, WHO and UNAIDS put out a statement last year that said that male circumcision significantly reduces the risk of HIV transmission. WHO has recommended that countries should implement free or low-cost male circumcision programmes if a high percentage of their population is uncircumcised, if HIV is widespread and if HIV spread is predominantly heterosexual. It says that most such nations are in southern Africa and, to a lesser extent, in eastern Africa.

Turning back the hands of time would be impossible but it is tempting to speculate on how Botswana's HIV/AIDS situation would be like if one time-travel back to the 1980s. Two American academics, Drs. Daniel Halperin of the University of California in San Francisco and Robert Bailey of the University of Illinois undertook a "what-if" study on Botswana's HIV/AIDS situation and reached a very interesting conclusion. Their findings suggested that if in 1985 all Botswana men and boys had been circumcised, HIV/AIDS might never have reached the pandemic proportions it did in subsequent years. Muslims have not established common ground on when circumcision should be done but some scholars recommend the seventh day of infancy. He said that if one converts to Islam in adult life, he should undergo the operation.

**** I WILL BE COVERING “CIRCUMCISION AND HIV/AIDS” LATER IN THE COMING ENTRIES****

The low rate of HIV infection among Muslims is also attributable to the fact that Islam forbids intoxicants for all its adherents. Compliance is helpful in avoiding the consequences of loss of inhibition that drugs like alcohol would otherwise provoke. Across the border, in South Africa, grave concern has been expressed that Muslim groups have been conspicuously absent at many provincial and national forums on HIV/AIDS. In the Botswana case, however, Hassan said that the Muslim community has been working very closely with the government and relevant NGOs.
Personally, he has participated in one of the studies carried out by the Ministry of Health. He stresses the importance of working with these parties in an effort to find workable solutions to the HIV/AIDS scourge. "We respond to their call whenever our assistance is needed. We attend their meetings and workshops and exchange views on how we should deal with this problem," Hassan said. However, that collaboration has not extended to financial matters. He says that they have not benefited from any government money or funds disbursed by AIDS NGOs.
What the Muslim community has been doing over the years is raising its own funds. However, the assistance is limited because, as Hassan revealed, no one in the Muslim community has come forward to declare his or her HIV status. Furthermore, no statistics are available to ascertain the level of prevalence and trends of the disease in that community. "This does not mean that there are no Muslims who are not infected by this disease," Hassan states, adding that they use statistics obtained from the government and various NGOs. Last year, Johannesburg, South Africa hosted a five-day Islam and HIV/AIDS conference that was attended by over 200 delegates from different countries. According to Hassan, there were no delegates from Botswana.
He also said that the local Muslim community has literature on HIV/AIDS that it distributes not just to Muslims but to everybody else who wants to get up on the Islamic. approach to fighting HIV/AIDS. "Islam is a complete way of life, it deals with any social problem when the need arises," he said.
As in any other societies- Reasons for the spread of HIV in Muslim countries are open to speculations. Islam places a high value on chaste behavior and prohibits sexual intercourse outside of marriage. It specifically prohibits adultery, homosexuality, and the use of intoxicants. Then how can the spread of HIV/AIDS in Muslim countries be explained- A logical explanation is that in spite of Islamic teachings, some Muslims do engage in activities that lead to acquiring HIV; these risky practices include illicit drug use and/or premarital or extra marital sex. Men who engage in risky behaviors have the potential of transmitting the disease to their unsuspecting wives. Women, on the other hand, also are directly susceptible; in many Muslim countries, brothels and other forms of commercial sex trade are prevalent. The sex workers have poor social support and sometimes they are not screened properly or at all for sexually transmitted diseases including HIV, thus contributing to the spread of infection. Injection drug users IDUs also are rapidly becoming a population of increasing concern in the transmission of HIV and AIDS including Muslim countries. Sex- and drug-related behaviors of IDUs can facilitate HIV transmission even when syringes are not directly shared.

HIV/AIDS and Christianity:

Mostly the Christian religious groups-especially the western leaning religious groups (religious rights movements/evangelicals as they are called sometimes) tend to look at HIV/AIDS as the African disease-a continent a few centuries ago they flocked in to redeem it/her from darkness and from it/her-self, I guess and thus feels obliged to continue doing so (forget that little instrumental part they played in colonization in the name of redemption. This Dark Continent! How only the bad things are found but never the good things?

So here they come in the name of missionaries, Ngo’s, World Banks, IMFs, and in other big sounding names that the locals bleed to pronounce. They come with material aids in the name of investments-(read opportunists), misinterpretations, stigmatization, and disregard of local cultural practices pronouncing them as non-modern and manipulation of geopolitical agenda, data inflation-(High cases of diseases/other catastrophies ring a bell?) so that they can keep getting more funds from their countries of origin and usually they start/pretend by initial formation of support groups-
The routine activities of the support group typically begin with the singing of choruses and hymns, followed by a Word of God and the prayer. After that new members were welcomed through the exchange of hugs and motivated to live positively by any confident member who had already spent a reasonable amount of time with the group. At times, an opportunity was created for other members to testify about the greatness of God over their HIV infection.

According to this abstract- Although a large majority of South Africans (about 79% according to 2001 census) are affiliated to Christian churches
(Statistics South Africa, 2004), an epidemic fuelled by sexual behavior remains a major challenge in the fight against AIDS (Garner, 2000). In South Africa, one in
ten people aged 15 to 24 years is said to be HIV positive (Campbell, Foulis, Maimane & Sibiya, 2005). As many people presumably contract HIV outside
Wedlock, it is perceived as a double-sin (Duffy, 2005). This perception is not only based on the view that premarital HIV infection suggests premarital sex, and at
Worst promiscuity (Duffy, 2005), but more so, given the prevailing moral judgement about the ‘ungodliness’ of HIV infection (Machyo, 2002), it can be viewed as a
‘Punishment’ or curse from God (Takyi, 2003). However, there are mixed views about the relationships between ‘ungodliness’ and HIV infection, as well as sin or evil and diseases in general (Sanders, 2006; Wiley, 2003) Gilman (2000) draws connections between sexually transmitted diseases (STDs) and religious impurity or
Dirtiness. He argues that stigmatization of people suffering from STDs dates as far back as the end of the first millennium when leprosy emerged. In Europe,
Lepers were required to wear identifying clothes and to warn of their presence (Green & Ottoson, 1994). Like leprosy, and as a STD, the diagnosis of syphilis at the
end of the 19th century evoked similar moral judgment and stigma. Despite the complexities of these inextricable connections (disease, HIV infection
And sin/evil, and or dirtiness), there is no conclusive evidence that the presence of any disease, and AIDS in particular, suggests a ‘punishment’ from God or any
sort of dirtiness (Gilman, 2000).This view recalls Jesus Christ’s response in the Book of John 9: 2-3: when confronted with a question about the man born blind, and whether it was through his sins or his parents’ sins that he was blind, His response was,” Neither he nor his parents sinned. He was born blind so that the works of God might be displayed in Him” (Machyo, 2002, p. 6). Machyo further warns against the passing of premature judgment on HIV positive people, citing the unconditionality of God’s love as a guiding
principle. Fatovic-Ferencic and Durrigl (2001) have documented the non-refutation of the relationship between sin or evil and disease by medieval medical authors, further presenting evidence of Christ casting out a devil from a boy suffering from epilepsy. The relationship between HIV infection and sex further complicates attempts to connect it with sin or ‘punishment’ from God. A search for studies that connect sin/evil and HIV infection largely unsuccessful, and we only managed to gather materials that present anecdotal connections between sin/evil and disease. Limited discussion of sex among most, if not all, religious denominations, as well as a lack of commitment in the fight against this pandemic by some religious groups, in our view further Complicates existing stigma and moral judgments. Despite these multifaceted arguments, religion and spirituality remain invaluable coping resources for dealing with pain (Rippentrop, Altmaier, Chen, Found& Keffala, 2005), particularly for people living with HIV (Simoni, Martone & Kerwin, 2002; Takyi, 2003), as well as throughout life in general (Machyo, 2002; Stuckey, 2001). In a study conducted among people living with HIV/AIDS (PLWHA) in Australia, Ezzy (2000) established an increased likelihood of religiosity resulting from HIV diagnosis.

**** IS MISSIONARY WORK RELEVANT IN 21/22 CENTURY?****

DEFINING A COMMON GOAL:

If the common goal is to end the global epidemic then it is time to look at the problem beyond a focus on the virus, as it exists within the human body, and to find ways to alter the social and economic environment that enable it to flourish. It is time for global education not only about HIV/AIDS but also about the social context of underdevelopment and poverty that engulfs many of those communities which also have the highest rate of infection. It is time for human society to work at all levels to develop ways to find lasting solutions to the right problems. Finding treatments that protect babies from infection or that add years to the lives of people living with HIV/AIDS is a brilliant first step and has saved children from infection and restored life and hope to many infected people. Such improvements must continue. However, this progress is grossly inaccessible where most needed. If, one day, a vaccine for HIV and cure for AIDS are developed, they must be available to the developing world.

Even then, will enough have been accomplished if the spread of HIV is halted, but the human suffering that provided fertile ground for the epidemic in the first place is allowed to continue until the next virus that might get the world's attention?
The Impact on the Rural Economy:
It is widely acknowledged within general development literature that the urban and rural economies are usually intrinsically interlinked and that incomes within the rural environment depend upon wages earned within the urban economic environment. Thus it is clear that the impact of HIV/AIDS on the formal, largely urban-based economies of Southern and Eastern Africa will increasingly have an impact in reducing the options and the cash flows between the two sectors.
Within Southern and Eastern African countries, HIV/AIDS has been acutely experienced in rural areas. A recent Fact Sheet prepared by the FAO (2000) clearly describes the threat to rural Africa:
•More than two-thirds of the populations of the 25 most-affected African countries live in rural areas.
•Information and health services are less available in rural areas than in cities. Rural people are therefore less likely to know how to protect themselves from HIV and, if they fall ill, less likely to get care.
•Costs of HIV/AIDS are largely borne by rural communities as HIV-infected urban dwellers of rural origin often return to their communities when they fall ill.
•HIV/AIDS disproportionately affects the economic sectors such as agriculture, transportation and mining that have large numbers of mobile or migratory workers.

As discussed earlier, the extensive labor migration between and within countries, associated with annual or more frequent visits home, has facilitated the spread of HIV/AIDS to the most remote rural. The prevalence of HIV/AIDS in rural areas is not adequately documented due to poor health infrastructure, restricted access to health facilities and inadequate surveillance. This emphasizes the fact that rural communities have fewer resources to prevent infection and to nurse ill people. Access to treatment and other services, as well as education, are often limited in such contexts.

The effects of HIV/AIDS within a rural economy may include:
•Redistribution of scarce resources with an increasing demand for expenditure on health and social services;
•A collapse of the educational system due to high morbidity and mortality rates amongst educator and learners;
•Younger and less experienced workers replacing older AIDS related casualties, causing reduction in productivity;
•Employers becoming more likely to face increased labor costs because of low productivity, absenteeism, sick leave and other benefits (attending funerals), early retirement and additional training costs.

Agricultural production is often central to the rural economy. This form of production is usefully differentiated into the commercial farming sector, where the organization and running of a farm/shamba often approximates a business, and the subsistence sector, which is characterized by a close relationship between the general activities of a household (including child rearing, supporting relationships between adult members, home maintenance and food processing) and the production of crops and of animals.

The Impact on Agricultural Production:

Agriculture is one of the most important sectors in many developing countries, providing a living or survival mechanism for up to 80 percent of a country’s population. However, while agriculture is extremely important to many African countries, not least of all for household survival, there are marked differences among countries in terms of current economic conditions and agricultural and economic potential.

Agriculture faces major challenges including unfavorable international terms of trade, mounting population pressure on land, and environmental degradation. The additional impact of HIV/AIDS is also severe in many countries. The major impact on agriculture includes serious depletion of human resources, diversions of capital from agriculture, loss of farm/shamba and non-farm income and other psycho-social impacts that affect productivity.

The adverse effects of HIV/AIDS on the agricultural sector can, however, be largely invisible as what distinguishes the impact from that on other sectors is that it can be subtle enough so as to be undetectable. In the words, even if rural families are selling cows to pay hospital bills, one will hardly see tens of thousands of cows being auctioned at the market...Unlike famine situations, buying and selling of assets in the case of AIDS is very subtle, done within villages or even among relatives, and the volume is small Furthermore, the impact of HIV/AIDS on agriculture, both commercial and subsistence, are often difficult to distinguish from factors such as drought, civil war, and other shocks and crises.

For these reasons, the developmental effect of HIV/AIDS on agriculture continues to be absent from the policy and programmes agendas of many African countries. Many studies on HIV/AIDS that have focused on specific sectors of the economy such as agriculture have been limited to showing the wide variety of impacts and their intensity on issues such as cropping patterns, yields, nutrition, or on specific populations. They have not adequately touched on questions such as the effects of changes in prices of commodities, such as tea or cocoa, land tenure and the rights of women and children.

Impact on the Commercial Sector:

Commercial agriculture is particularly susceptible to the epidemic and is facing a severe social and economic crisis in some locations due to its impact. Morbidity and mortality due to HIV/AIDS significantly raise the industry’s direct costs (medical and funeral expenses) as well as indirectly through the loss of valuable skills and experience.
The epidemic thus adversely affects companies’ efficiency and productivity. Thus HIV/AIDS is leading to falling labor quality and supply, more frequent and longer periods of absenteeism, losses in skills and experience, resulting in shifts towards a younger, less experienced workforce and subsequent production losses. These impacts intensify existing skills shortages and increase costs of training and benefits.

At a FAO Conference on HIV/AIDS and agriculture, an example was given of the costs to this particular sector. It was argued that in Sub-Saharan Africa’s 25 worst affected countries, seven million agricultural workers have died from the epidemic since 1985 and sixteen million more may die by 2020, according to that report. Table below depicts the grim picture of the agricultural labor force decreases in the ten most heavily affected countries in the continent. Intensive agriculture will be severely impacted through the loss of this specialized labor. Areas of production such as harvesting and processing that require a high level of skill will be most severely affected.

Impact of HIV/AIDS on agricultural labor in some African countries (projected losses in percentages)

Country 2000 2020

Namibia 3.0 26.0
Botswana 6.6 23.2
Zimbabwe 9.6 22.7
Mozambique 2.3 20.0
South Africa 3.9 19.9
Kenya 3.9 16.8
Malawi 5.8 13.8
Uganda 12.8 13.7
Tanzania 5.8 12.7
C.A. Republic 6.3 12.6
Ivory Coast 5.6 11.4
Cameroon 2.9 10.7

It should also be emphasized that the impact on commercial agriculture is only one side of the story. In much of southern Africa, agriculture is not the dominant economic sector, even while access to land and its resources is important for the diverse multiple livelihood strategies of many rural denizens.

Impact on the Small-Scale and Subsistence farming Sectors:

Many studies conducted on the impact of HIV/AIDS in Africa have focused on the farm-household level - where agricultural production at the subsistence or small-scale level is often embedded within multiple-livelihood strategies and systems. Over the past two decades there have been profound transformations in these livelihood systems in Africa, set in motion by Structural Adjustment Programmes, the removal of agricultural subsidies and the dismantling of parastatal marketing boards. As a result of these and other issues, many African households have shifted to non-agricultural income sources and diversified their livelihood strategies accordingly.

However, despite the evident of diversification out of agriculture, rural production remains an important component of many rural livelihoods throughout Sub-Saharan Africa. ‘African rural dwellers ...deeply value the pursuit of farming...food self-provisioning is gaining in importance against a backdrop of food inflation and proliferating cash needs. Participation in “small-plot/shamba agriculture” is highly gendered, with women taking major responsibility for it as one aspect of a multiple livelihood strategy. Access to land-based natural resources remains a vital component of rural livelihoods particularly as a safety net. In this context, land tenure becomes increasingly important for the diverse livelihood strategies pursued by different households.

Diversification out of agriculture may be compounded by the affect of HIV/AIDS in a number of ways. These include its impact on labor, the disruption of the dynamics of traditional social security mechanisms and the forced disposal of productive assets to pay for such things as medical care and funerals. In turn, local farming skills are drained and biodiversity in crop variety diminished. Indigenous knowledge systems and technology adapted by farmers to suit the particular conditions of specific areas often die with the farmers, a dangerous trend as far as cultural practices are concerned. A large number of Sub-Saharan African countries have already experienced a shift in the allocation of labor especially by subsistence households. A study in Zimbabwe conducted by the Zimbabwe Farmers Union (some times back-but still relevant )showed that the death of a breadwinner due to AIDS will lead to a reduction in maize production in the small-scale farming sector and communal areas of 61 percent.

The loss of agricultural labor is likely to cause farmers to move to production of less labor intensive crops in a bid to ensure their survival. This often means a shift from cash to food crops or high value to low value crops. The impact of HIV/AIDS on crop production relates to a reduction in land use, a decline in crop yields and a decline in the range of crops grown, mainly with reference to subsistence agriculture. Reduction in land use occurs as a result of fewer family members being available to work in cultivated areas and due to poverty resulting in malnutrition leading to the inability of family members to perform agricultural work. This, in turn, leads to less cash income for inputs such as seeds and fertilizer. In Ethiopia, for example, labor losses reduced time spent on agriculture from 33.6 hours per week for non AIDS-affected households to between 11.6 to 16.4 hours for those affected by AIDS.

At another workshop on HIV/AIDS and land, the then FAO director in South Africa stated that the food shortages facing several Southern African countries, including Lesotho and Zimbabwe, were ‘a stark demonstration of the collective failure to recognize and act upon the deep-rooted linkages between food security and HIV/AIDS’. This reiterates the argument that the continuous interruption of labor may also impact on the type of crops grown, and hence substitution between crops may take place. This is especially true for labor intensive crops, which would likely result in the substitution for less labor intensive production and a possible decrease in the area being cultivated. Food security therefore becomes an important issue in the context of HIV/AIDS.

Food security implies that every individual in a society has a sustainable food supply of adequate quality and quantity to ensure nutritional needs are satisfied and a healthy active life be maintained. At a household level, food security refers to the ability of households to meet target levels of dietary needs of their members from their own production or through purchases.

Therefore, the impact of HIV/AIDS on agriculture directly affects food security, as it reduces:

•Food availability (through falling production, loss of family labour, land and other resources, loss of livestock assets and implements).
•Food access (through declining income for food purchases).
.The stability and quality of food supplies (through shifts to less labour intensive production).

HIV/AIDS can therefore be a cause of food insecurity and a consequence thereof. For example, during times of food insecurity, such as during drought, individuals or families can be forced to engage in survival strategies that increase their vulnerability to contracting HIV.

Natural resource management has also been directly impacted on by HIV/AIDS, which has important implications for non-agriculturally based multiple livelihood systems. Conservation and resource management are also dependent on human factors such as labor, skills, expertise and finances that have been affected by the epidemic. Therefore the reduction in the number and capacity of ‘willing, qualified, capable and productive people’ who have managed natural resources has negatively impacted on sustainable utilization of these resources. In addition, the epidemic can impact natural resource conservation and management by accelerating the rate of extraction of natural resources to meet increased and new HIV/AIDS demands.
These issues relating to labor, production, natural resource management and food security are elaborated in more detail in the following section describing household production.

The Impact on Household Livelihood Strategies:

As demonstrated above, various “research” initiatives have shown that HIV/AIDS first affects the welfare of households through illness and death of family members, which in turn leads to the diversion of resources from savings and investments into. It is expected that the premature death of large numbers of the adult population, typically at ages when they have already started families and become economically productive, can have a radical effect on virtually every aspect of social and economic life. This is clearly indicated by an increase in the number of dependents relying on smaller numbers of productive household members and increasing numbers of children left behind to be raised by grandparents or as child-headed households or extended family members.

Once a household member develops AIDS, increased medical and other costs, such as transport to and from health services, occur simultaneously with reduced capacity to work, creating a double economic burden. The households with an AIDS sufferer frequently seek to keep up with medical costs by selling livestock and other assets including land. Members who would otherwise be able to earn or perform household and family maintenance may then be spending their time caring for the person with AIDS. An example a son with a sick mother in Zambia- reported that he spent more time looking for money to make ends meet by working in the field and doing casual jobs, and in addition having to contribute an average of three hours a day towards caring for his mother and staying up part of the night attending to her needs. Cases like that are not unique; rather they are more frequent and familiar in most families in developing countries.

This emphasizes an impact of HIV/AIDS illness and death, which often results in the re-allocation of livelihood tasks amongst household members. Reports that intensive use of child labor increases as a major strategy and it’s typically used by the afflicted household during care provision. Children may be taken out of school to fill labor and income gaps created when productive adults become ill or are caring for terminally ill household’s members or are deceased. Another example from Tanzania-and many other countries whose populations are struggling with the effects of the disease- shades light on to how the illness affects time allocation puts pressure on children to work, divert household cash and the disposal of household productive assets. HIV/AIDS is therefore an impoverishing process that leads to other problems such as malnutrition, inaccessibility to health care, increased child mortality and hence intergenerational poverty.

It is important to recognize that the impact of HIV/AIDS on rural households is not equal: the poorer- especially those with small land holdings are much less able to cope with the effects of HIV/AIDS than wealthier households who can hire casual labor and are better able to absorb shocks. The question as to who benefits from the sales of assets by farming-households attempting to cope with the long drawn-out effects of HIV/AIDS could be unclear. Number of occurrences evident could lead to significant changes in the socio-economic structures of villages, redistribution of wealth and of land. HIV/AIDS infection ultimately stretches the resources of an extended family beyond its limits as both material and non-material resources are rapidly consumed in caring for the infected.

The manner, in which HIV/AIDS can cause affected households to become socially excluded, thus diminishes their ability to cope with further crises. Similarly, extended family networks sometimes collapse, not least due to pressure of having to support orphaned children. Moreover, it has been argued that for instance in KwaZulu-Natal, South Africa, HIV/AIDS has forced a change in household composition, severely weakening and often breaking the young adult nexus between generations. This, in turn, exacerbates an already existing social crisis of care, which worsens as the epidemic progresses. It is a social context that is unlikely to withstand the weight of need that HIV/AIDS related deaths generate and many, especially children and the aged, face economic and social destitution.

It is increasingly clear that as a result of HIV/AIDS causing significant increases in morbidity and mortality in prime-age adults, increasing negative social, economic and developmental impacts will occur. As can be clearly indicated, the economic impact at the household level will be decreased, increased health-care costs, decreased productivity capacity and changing expenditure patterns. Major survival strategies developed in response to the epidemic may include the altering household composition the withdrawal of savings and the sale of assets, the receipt of assistance from other households. Following death the impact breaks out the households and cutting into the community in the form of increasing number of dependents such as orphans.

Coping Strategies - or simply surviving?

In the face of the extreme impact of HIV/AIDS, individuals and households undergo processes of experimentation and adaptation when adult illness and death impacts whilst an attempt is made to cope with immediate and long-term demographic changes. Several factors determines a household’s ability to cope including access to resources, household size and composition, access to resources of the extended family, and the ability of the community to provide support. The interaction of these factors will determine the severity of the impact of HIV/AIDS on the household.

Household Coping Strategies:

Strategies aimed at improving food security Strategies aimed at raising & supplementing income to maintain household expenditure patterns Strategies aimed at alleviating the loss of labor
•Substitute cheaper commodities (e.g. porridge instead of bread)
•Reduce consumption of the item
•Send children away to live with relatives
•Replace food item with indigenous/wild vegetables
•Income diversification
• Migrate in search of new jobs
• Loans
• Sale of assets
• Use of savings or investment • Intra-household labor re-allocation and withdrawing of children from school
• Put in extra hours
• Hire labor and draught power
• Decrease cultivated area
• Relatives come to help
• Diversify source of income

The household experience in the context of HIV/AIDS and may divert policy-makers from the enormity of the crisis. AIDS-induced morbidity and mortality has an immense impact on rural households but questions whether the observed effects should be defined as “coping strategies”. And any meaningful analysis of coping behavior must include the real and full costs of coping.

There are several reasons why the concept is of limited use and explores alternative ways of conceptualizing the impact of HIV/AIDS in more detail. Firstly one could define the concept as being essentially concerned with the analysis of success rather than failure of the household as it implies that the household is managing or persevering. This ignores evidence that households often dissolve completely with survivors joining other households. This runs contrary to a concept of strategy intended to avert the breakdown of the household unit.

Secondly, households do not act in accordance with a previously formulated plan or strategy but react to the immediacy of need, disposing of their assets when no alternatives present themselves. Decisions are not based on the importance or usefulness of the asset to the household as saving lives is deemed more important than preserving assets. More evidence is emerging that even land, the “most important agrarian asset”, may not be spared in the quest to ‘cope’ with illness. Indeed, a recent study on the impact of HIV/AIDS on female microfinance clients in Kenya and Uganda, found that there was a clear sequence of “asset liquidation” among AIDS caregivers in order to cope with the economic impact - first liquidating savings, then business income, then household assets, then productive assets and, finally, disposing of land. This last resort of disposing of land has profound consequences for people losing their economic base. People are likely to be those with fewest options and those who are most vulnerable.

Thirdly, coping strategies tend to be defined as short-term responses to entitlement failure giving the impression that it involves few additional costs thereby obscuring the true cost of coping. In Tanzania, short and long-term costs included curtailing the number and quality of meals that a household could afford which resulted in poor nutrition with obvious implications for health. Another household option was the withdrawal of children, mostly girls, from school in order to utilize their labor and save money, which, amongst other things, had ramifications for future literacy levels and the child’s participation in the modern economy. The positive gloss accorded to coping invariably ignored long-term costs that fundamentally jeopardize recovery of a household let alone sustainability.

In summary, one would argue that references to coping strategies may make sense in circumstances of drought or famine but not for the impact of HIV/AIDS, which not only changes communities and demographic patterns but also agro-ecological landscapes with long-term implications for recovery. The fact that AIDS kills the strong people and leaves behind the weak undermines the capacity of households and communities, especially in the long-term. It is therefore important to further differentiate the household according into their various possible members with an emphasis on the power relations between people forced to respond to the compounding impact of HIV/AIDS on their livelihood strategies.

Women and HIV/AIDS:

There are a number of interlocking reasons why women are more vulnerable than men to HIV/AIDS, which include female physiology, women’s lack of power to negotiate sexual relationships with male partners, especially in marriage, and the gendered nature of poverty, with poor women particularly vulnerable (Walker, 2002: 7). Inequities in gender run parallel to inequities in income and assets. Thus women are vulnerable not only to HIV/AIDS infection but also to the economic impact of HIV/AIDS. This is often a result of the gendered power relations evident in rural households, which can leave women prone to the infection of HIV. With increasing economic insecurity women become vulnerable to sexual harassment and exploitation at and beyond the workplace, and to trading in sexual activities to secure income for household needs.
As a result, women have experienced the greatest losses and burdens associated with economic and political crises and shocks with particularly severe impact from HIV/AIDS.

The epidemic exacerbates social, economic and cultural inequalities (economic need, lack of employment opportunities, poor access to education, health and information), which define women’s status in society;
•Breakdown of household regimes and attendant forms of security: Decades of changes in economic activity and gender relations have placed many women in increasingly difficult situations. HIV/AIDS has accelerated the process and made “normal” sexual relations very risky. Women whose husbands have migrated for work are afraid of the return of the men knowing that they may be HIV-infected. Although poorly documented, the range and depth of women’s responsibilities have increased during the era of HIV/AIDS. More active care giving for sick and dying relatives have been added to the existing workload. Children have been withdrawn from school, usually girl-children first, to save both on costs and to add to labor in the household.

Thus HIV/AIDS is facilitating a further and fairly rapid differentiation along gender lines.
•Loss of livelihood: Whether women receive remittances from men working away from home, are given “allowances”, or earn income themselves, HIV/AIDS has made the availability of cash more problematic.
•Loss of assets: Although poorly documented, fairly substantial investments in medical care occur among many households affected by HIV/AIDS. These costs may be met by disinvestments in assets. Household food security is often affected in negative ways. Furthermore, in many parts of Africa, women lose all or most household assets after the death of a husband.
•Survival sex: Low incomes, disinvestments, constrained cash flow - all place economic pressures on women. Anecdotal evidence and some studies indicate that these pressures push a number of women into situations where sex is coerced in exchange for small cash or in-kind payments.

Women frequently carry a double burden of generating income outside the home and for care giving as well as maintaining family land. In this regard, women are responsible for caring for sick members of the household as well as being heavily involved in generating income and supplying food for their households through agricultural production. Further, the burden of caring for people living with HIV/AIDS and for orphans’ falls largely on women. Thus, it has been argued that the illness and death of a woman has a “particularly dramatic impact on the family” in that it threatens household food security, especially when households depend primarily on women’s labor for food production, animal tendering, crop planting and harvesting.

In rural areas, women tend to be even more disadvantaged due to reduced access to productive resources and support services. The issue of AIDS and inheritance is therefore particularly important when discussing the impact of HIV/AIDS on women. Many customary tenure systems provide little independent security of tenure to women on the death of their husband, with land often falling back to the husband’s lineage. While this may, traditionally, not have posed problems, it may create serious hardship and dislocation in the many cases of AIDS-related deaths. While this may create an opportunity for communities to tweak/ and or address the land-ownership related cases, by no means this should be an opportunity for others (parties/groups) - Read (westerners and the like, who have little knowledge or care not to understand other people’s customs) to condemn/denounce-ridicule-belittle or categorize it as inferior. In other words it should be an inside job –done by the community members as they understand their customs, thus better to address it accordingly.

The Elderly and HIV/AIDS:

As already illustrated, the HIV/AIDS epidemic has immense ramifications for the structure of households with prolonged emotional and financial responsibilities of child-raising for grandparents. Large numbers of orphans have been left in the care of their grandparents across the globe. The role of the elderly in rural development in the context of the HIV/AIDS epidemic has been neglected. The elderly play a crucial role, not just in care giving, but in ensuring the food security of millions of affected rural farm-households as they become an alternative for the family.
The reports on population projection with HIV/AIDS scenario highlights changes in sex and age structure from the perspective of elderly at the national level, particularly for countries like Botswana and South Africa, two of those that have been worst affected countries. Thus the population pyramids for these countries suggest that:

•In 20 years time a significant number of 60-69 year olds will be dead (HIV mortality peaks around 30-34 years for women and 40-44 years for men),
•The surviving younger elderly of 60 years or more will have a role as care and subsistence of older ones.
•Number of children will decline significantly over 20 years,
•Due to change in sex ratio for adults, female age group, middle age and young elderly will have a burden of care and housework and this will force changes in division of labor.
•In Botswana more rapid ageing is seen in rural areas than in urban areas. This is also reflected in South Africa as a result of younger working age people migrating from rural communities and older people often returning. In countries such as Kenya, infection rates tend to be higher in densely populated areas, which are the most productive agricultural areas. With this spread of HIV/AIDS, it can be concluded that if this is not addressed aggressively, there will be fewer young adults who will be able to carry out essential tasks.

Therefore the elderly will increasingly be required to do such tasks. Thus it’s easy to conclude that the elderly are a largely invisible resource in the context of HIV/AIDS, requiring assistance and empowerment in order to fulfill its indispensable potential in areas of crisis. Thus the rural elderly have a potential to play a pivotal role of holding together farm households, ensuring food security and survival of orphans.

A Conceptual Framework: HIV/AIDS and Land:

A man is taken ill. While nursing him, the wife can’t weed the maize and cotton fields, mulch and pare the banana trees, dry the coffee or harvest the rice. This means less food crops and less income from cash crops. Trips to town for medical treatment, hospital fees and medicines consume savings. Traditional healers are paid in livestock. The man dies. Farm tools, sometimes cattle, are sold to pay burial expenses. Mourning practices in most Africa countries forbid farming for several days. In the next season, unable to hire casual labor, the family plants a smaller area. Without pesticides, weeds and bugs multiply. Children leave school to weed and harvest. Again yields are lower. With little home-grown food and without cash to buy fish or meat, family nutrition and health suffer. If the mother becomes ill with AIDS, the cycle of asset and labor loss is repeated. Families withdraw into subsistence farming. Overall production of cash crops drops-that is a typical scenario.

The narrative captures the stark reality of the cruel impact that HIV/AIDS has on the household producing on the margins (and above) the subsistence level. Many of these experiences indicate the powerful linkages between HIV/AIDS and land. There are therefore it is clear that prolonged illness and early death alter social relations. It can therefore be assumed that such relations would include institutions governing access to and inheritance of land.

Prolonged morbidity and mortality would also contribute to the disposal of land to cater for the care, treatment and funeral costs. this is a double-edged sword as on the one side access and utilization are affected among households and individuals, and on the other hand it would affect land planning and administration at various levels. These changes, particularly as they relate to individuals and households, would have dimensions across both age and gender. Therefore, in summary, HIV-related mortality would alter the land rights or the command positions held by people of different age and gender over land. An analysis of the impact of HIV/AIDS on land is essentially an analysis of changes in social institutions in which rights to land are anchored.

Therefore the analysis needs to take cognizance of a range of social attributes that affect the dynamics of land relations:

•Cultural, legal, political and other social dimensions affecting entitlement;
•How HIV/AIDS affects land entitlement and how land entitlement affects HIV/AIDS;
•Whether lack of entitlement to land increases vulnerability to HIV/AIDS;
•How HIV/AIDS impacts on institutions involved in land administration;
•The inputs needed to secure effective use of land by HIV/AIDS affected households;
•The fact that entitlement is not static and changes across gender and age;
•The complex continuum from landed to landless;
•The fact that although access to land may not be the most effective strategy for HIV/AIDS affected households, in rural areas it is likely to remain central to their survival.

From this- it is evident that the concept of land issues is extremely broad. To further help conceptualize the impact of HIV/AIDS, these issues have been differentiated into three main areas, namely land use, land rights and land administration. The impact on these areas is usefully conceptualized through the lens of the household particularly as HIV/AIDS is depriving families and communities of their young and most productive people:

•HIV/AIDS-affected households generally have less access to labor, less capital to invest in agriculture, and are less productive due to limited financial and human resources. Thus the issue of land use becomes extremely important as a result of the epidemic’s impact on mortality, morbidity and resultant loss of skills, knowledge and the diversion of scarce resources. A range of multiple livelihood strategies, often involving land, has been affected resulting in changes as rural households fight for survival in the context of the epidemic.

•The focus on land rights considers the extent of impact on the terms and conditions in which individuals and households hold, use and transact land. This has particular resonance with women and children rights in the context of rural power relations, which are falling under increasing pressure from HIV/AIDS. Anecdotal evidence from around the globe indicates that dispossession, particularly for AIDS-widows, is increasingly becoming a problem in locations with patrilineal inheritance of land. There are, however, a number of other issues to be examined in relation to HIV/AIDS and land tenure especially in localities that are experiencing increasing land pressure, land scarcity, commercialization of agriculture, increased investment, and intensifying competition and conflicts over land.

•The impact on land administration is a related issue and is a result of epidemic affecting people involved in the institutions that are directly or indirectly involved in the administration of land. These include local level or community institutions such as traditional authorities, civil society, various levels of government, and the private sector.

**** TO BE CONTINUED****

HIV/AIDS AND ITS EFFECTS ON SOCIETY CONT. 4

2008-08-30T15:03:00.000-07:00

HIV/AIDS and Poverty continue.

They include poverty and economic marginalization, poor nutrition, opportunistic infection, migration, sexual networking and patterns of sexual contact, armed conflict, and gender inequality. Some of these are discussed below.
Poverty as a key transmission factor:

The relationship between poverty and HIV transmission is not simplistic. It should be emphasized that poor segment of the population who are infected with HIV are considerably more likely to become sick and die faster than the non-poor since they are likely to be malnourished, in poor health, and lacking in health attention and medications.
In effect, all factors, which predispose people to HIV infection, are aggravated by poverty, which creates an environment of risk;

1. Deep-rooted structural poverty, arising from such things as, land ownership inequality, ethnicity and geo-graphical/political isolation, and lack of access to services.
2. Developmental poverty, created by unregulated socio-economic and demographic changes such as rapid population growth, environmental degradation, rural-urban migration, community dislocation, slums and marginal agriculture.
3. Poverty created by war, civil unrest, social disruption and refugees. High levels of rape and the breakdown of traditional sexual mores are associated with military destabilizations, refugee crisis and international influences on local communities.

All three have severe effects on individuals’ and communities’ vulnerability to the spread of HIV, their ability to handle risks, and opportunity to participate in prevention and care activities. The experience of HIV/AIDS by poor individuals, households and communities is likely to lead to an intensification of poverty, push some non-poor into poverty and some of the very poor into destitution. In turn, poverty can accelerate the onset of HIV/AIDS and tends to exacerbate the impact of the epidemic. Thus, as a result of the effect on mortality, morbidity, life expectancy and population growth, HIV/AIDS is having a direct negative impact on poverty, especially as experienced by poor rural households. In the 2001 report on the Special Session of the General Assembly on HIV/AIDS, the United Nations Secretary-General warned that HIV/AIDS was reversing decades of development in the hardest-hit regions of the world:

HIV/AIDS changes family composition and the way communities operate, affecting food security and destabilizing traditional support systems. By eroding the knowledge base of society and weakening production sectors, it destroys social capital. By inhibiting public and private sector development and cutting across all sectors of society, it weakens national institutions. By eventually impairing economic growth, the epidemic has an impact on investment, trade and national security, leading to still more widespread and extreme poverty. The most devastating consequences of HIV infection arise not simply because many people will die but because the deaths will occur mainly among adults between the ages of 25 and 45 years, the very people who work to support families and should be most productive economically. Therefore HIV/AIDS is changing the contours and dynamics of poverty through its demographic and socio-economic impacts, which may:
•Create inter-generational poverty by impoverishing surviving orphans (often forcing them out of school, thus limiting their livelihood options), by fragmenting or dissolving households and by decimating the fragile asset base of the poor;
•Alter the age structure and composition of the poor, by decimating the young adult population while impoverishing an increasing number of children and elderly people;
•Result in irreversible survival mechanisms for the poorest as what is to some extent unique about HIV/AIDS is that the shock it inflicts is one from which many households are unable to recover. In particular, the erosion of the household asset base tends to be permanent;
•Intensify discrimination and marginalization of poor people living with HIV/AIDS as well as their families. This is especially the case with women who are often perceived to be responsible for transmitting the HIV virus;
•Increase the prevalence of poor female-headed households (young widows with small children as well as elderly grandmothers looking after grandchildren) and thus the feminization of poverty and agriculture;
•Exacerbate unequal asset distribution (land, livestock, labor) leading to landlessness and de-stocking. Once land and livestock are sold, the recovery potential of these households is severely diminished. Destitution is the culmination of this process of asset depletion; and
•Intensify poverty-driven labor migration as a coping strategy, thereby increasing the risk of HIV infection among the survivors.

As often is the case, many of these strategies involve people migrating from their homes to other places, usually urban or rural centers, where they hope to find employment. For some women, the pressures of poverty may lead them to engage in sexual transactions in order to support themselves. Therefore migration and commercial sex work are two activities closely associated with risk for HIV infection, two issues that require closer elaboration as they often form central options in the multiple livelihood strategies developed by rural households.

The conceptualization of the factors contributing to the spread of the epidemic and linking it to issues such as poverty, migration in search of labor, income inequalities, and gender relations are crucial to an understanding of HIV/AIDS and its impact on society and the household in particular. From the discussion it is clear that poverty increases vulnerability to HIV infection and poverty is compounded by HIV/AIDS. The latter is a result of the shocks, which result from HIV/AIDS-related deaths and infection that intensify the usual problems associated with severe poverty. As a result, options such as commercial sex work that affected households may be forced to adopt in the face of the epidemic and increasing levels of poverty becomes inevitable. This indicates the need for a more focused discussion around the household and the multiple livelihood strategies that are constituted for survival in an increasingly difficult economic context.

HIV/AIDS and its impact on the Economy:

Economies tend to react more dramatically to economic restructuring than to long, slow corrosions as those wrought by AIDS. However, it is clear that the epidemic has profound implications for economies in affected regions as primary wage earners and caretakers fall sick, require care, and eventually dies, usually consisting of individuals of prime working age.

Macro-Economy and HIV/AIDS:

The impact of HIV/AIDS on the macro economic environment takes two dimensions, namely the direct and indirect costs. The former refers to the cost of treatment associated with HIV related illness, which has serious implications for health care budgets around the region. Those segments of the population that are poverty-stricken stand to lose the most as pressures on the health budgets increases resulting in higher medical costs. Indirect costs are more difficult to measure as the refer to loss of value of production, the loss of current wages, the loss of the present value of future earnings, training cost of new staff, high staff turn-over, cost of absenteeism, higher recruitment costs, the drainage of savings, lower labor force; Lower labor productivity through absenteeism and illness; Cost pressures for companies through benefit payments and replacement costs; Lower labor income, as employees bear some of the AIDS-related costs; Increased private sector demand for health care services; Higher government expenditure on health care services amongst others.

It should be emphasized that the impact on human and social development will be much more profound than can be reflected in limited indicators such as GDP or per capita GDP. These impacts would be felt throughout the economy, from the macro-level to the household, particularly as wage opportunities become scarcer.
The impact of HIV/AIDS at the household level also negatively impacts on the macro-economic context. The repercussions of HIV/AIDS is felt most acutely at the household level, with the burden weighing most heavily on the poorest households, those with the fewest resources with which to cushion the economic impact. The burden of HIV/AIDS and other related consequences readily translates into an overall cost on national development and the macro economies of individual countries, a situation aggravated by the fact that the portion of the population most affected by HIV/AIDS is the most economically active.

Ownership or access to rural land is a key part of many families’ well-being and livelihood. It is, however, only a small part in some contexts: small-scale agriculture in many parts of the world has been shown over the past decades to have become impossible without inputs from labor migrant remittances. This indicates that rural livelihoods are complex and aimed at managing risk, reducing vulnerability and enhancing security and are therefore based upon environmental stability. It is therefore important to have a sense of both the role of land and the broader labor market and macro-economic environment, which often underpin the incomes within the rural economy and the diverse livelihood strategies. These all come under increasing pressure with the broad impact of HIV/AIDS.

**TO BE CONTINUED**

HIV/AIDS AND ITS EFFECTS ON SOCIETY CONT. 3

2008-08-29T23:21:00.000-07:00

HIV/AIDS and Socio-economic impact on society:

Human development is the end, economic growth the means. The purpose of wealth should be to enrich people's lives, to broaden people's choices and to enable every citizen, every child, every woman and every man to reach his or her full potential. But HIV has found a wealth of opportunities to thrive among tragic human conditions fueled by poverty, abuse, violence, prejudice and ignorance.

Social and economic circumstances contribute to vulnerability to HIV infection and intensify its impact, while HIV/AIDS generates and amplifies the very conditions that enable the epidemic to thrive. Just as the virus depletes the human body of its natural defenses, it can also deplete families and communities of the assets and social structures necessary for successful prevention and provision of care and treatment for persons living with HIV/AIDS. This is demonstrated by the estimated millions of people living with HIV/AIDS world wide, mostly in developing countries the reports suggest. And a sizable number of those infected die from HIV/AIDS and related illnesses yearly suggesting that the epidemic is not slowing down fast enough. The impact of HIV/AIDS extends beyond those living with the virus, as each infection produces consequences which affect the lives of the family, friends and communities surrounding an infected person.

The overall impact of the epidemic encompasses effects on the lives of multiples of the millions of people living with HIV/AIDS or of those who have died. Those most affected by HIV/AIDS are children. Children are affected by HIV/AIDS in ways that can diminish their childhoods and as a result limit choices and opportunities for successful survival throughout their lives.

The circumstances of an individual's life and their social context in family and community during childhood can increase the probability they will one day be exposed to, and infected by, HIV. In order to develop appropriate means of enabling and protecting people, either as children or as adults, against infection and the effects of HIV/AIDS, adequate and judicious attention needs to be given to the rights and realities of childhood.

Children living in poverty because of being orphaned due to HIV/AIDS or other related cases are especially prone to victimization and in most cases become an easy pray for traffickers- as commodities for sale in local and global sexual prostitution and pornography industries.

The roles that children fill as poor, hungry, exploited and abused human beings increase their vulnerability to HIV infection. This can occur directly through those activities known to be associated with transmission, or indirectly as when the earlier harm turns children into vulnerable adults. For example those with a history of childhood physical or sexual abuse have also been found in adolescence or adulthood to be more likely than non-abused peers to engage in behaviors that place them at high risk of HIV infection.

Poverty as among the Leading Promoters of HIV and AIDS:

Poverty is clearly a factor in the spread and impact of HIV/AIDS. The struggle to survive everyday overshadows attention and concern about a virus that does not demonstrate any immediate harm. HIV/AIDS is a distant threat until it has a visible presence manifested by illness and death. Poverty, in depriving people of access to health facilities, schools and media also limits their access to information and education on HIV/AIDS.

Poverty pushes families, often unaware of the risks, to send children into the work force or to hand them over to recruiters promising jobs in a distant place where, unprotected, they might be forced into a childhood of harsh labor or sexual abuse. When HIV/AIDS appears in an already impoverished household- there are limited means for response. The mortality rate is high, the impact is severe and the pressures and pain of poverty increases. As increasing numbers of infected young adults are unable to contribute to their communities through their work as parents, teachers, laborers, drivers, farmers, etc., entire economic and social structures of communities suffers and demands for services increase with fewer able people to provide them. And there comes the big danger of the whole society being wiped out. Although life-saving drug regimens have dramatically decreased mother-to-child transmission of HIV and have kept mothers well and alive longer in the industrialized countries, poverty and the lack of necessary medical infrastructure and services make them inaccessible in those places where they are most needed.

Many women who know that they have tested positive for HIV may have no choice but to breast feed their babies when clean water and formula are unobtainable, even though they risk transmitting infection to their babies. Without access to health care or a nutritious diet, infected infants often die before they are two or three years old. For those who survive longer, or the uninfected ones whose parents or guardians are incapacitated by HIV/AIDS, or those orphaned- childhood can be dramatically shortened in other ways.

The illness or death of parents or guardians because of HIV/AIDS can rob a child of the emotional and physical support that defines and sustains childhood. It leaves a void where parents and guardians once provided love, protection, care and support. Since HIV is often (but by no means always) transmitted to sexual partners, children are more likely to lose both parents to HIV/AIDS. Someone is needed to step into parental roles so that children can survive and develop into healthy and productive adults. Grandparents, aunts, uncles or other caring adults frequently assume responsibilities that enable children to remain in their homes or take them into their own families and households. However, where the infection rate is high or harsh social or economic conditions exist, adults may be unable to assume the additional responsibilities of these families and children affected by HIV/AIDS. Other barriers grow out of ignorance and social attitudes. Fear of discrimination leads to families keeping secret the knowledge of HIV infection and AIDS within the household rather than seeking help. Others seek help but are rejected or abandoned, even by family members, when they reveal the nature of the illness. Fear, discrimination, ignorance, and social stigma associated with HIV/AIDS, in addition to overwhelming demands on caring adults, leave children isolated with their grief and suffering while they watch parents and other loved ones die as the families languish.

In many families and communities the environment for healthy growth and well-being has been devastated by HIV/AIDS. Instead of receiving special care and assistance, childhood is spent providing care and assistance. Children become decision-makers, responsible for the social and economic future of the family, and fill these roles without the physical and emotional protection, guidance and support that, as children, they deserve. They may act like adults, but it cannot be forgotten that these are still children acting (heads of households) and are children whose childhoods have been impoverished by HIV/AIDS. In such households, all children are affected. The care that older siblings can provide for younger children is likely to be inadequate because of the increased poverty of the household and the lack of maturity and experience of the caretaker, leading to poor health, hygiene and nutrition; absence from school, and developmental delays. The loss of material, emotional and developmental support from an adult exposes children to the distress which results from lack of affection, insecurity, fear, loneliness, grief or despair. It limits the possibility of a successful childhood which, in turn, affects the future as adults.

Solutions that Address Reality:

Protecting Well-being

The problems the children are facing are monumental but so is the HIV epidemic which weaves through us all. The social context cannot be ignored or neglected in efforts to contain the virus. If success in prevention, treatment and cure is ever going to reach the majority of the population of the world affected by HIV/AIDS, then the elimination of conditions which nurture and strengthen its hold on individuals and communities and which provide obstacles to prevention and care must be zealously sought.

Prevention is usually easier than cure and recovery not only in matters of physical health but in all ways that affect the total well being of persons. Opportunities that foster the well being of a person begin in the uterus and depend on long term support from others. This dependency and support must exist throughout childhood only diminishing as the child approaches adulthood equipped with the strength and skills for independence and self sufficiency. The lifelong well being of a person depends on opportunities for the development of strengths and skills during childhood.

Aiding and Protecting Development:

Sustainable development, simply stated as the continued ability to develop and provide for one's needs, is a concept that can be applied to individuals or societies. The process towards the sustainable development of a human being, childhood, takes place at the center of many interdependent layers of social structures. The first tier is most often the basic social unit of the family. Outside the boundaries of the family the child is enveloped in broader social components of the community - extended family, peer groups, school, social and religious organizations, work places, etc. The development of children is determined by the willingness and ability of family and community members to contribute to their successful survival and growth. In the most concrete ways this includes the provision of food, shelter, clothing, health care, schools and recreational opportunities. It also includes emotional needs such as love, security, guidance, and encouragement.

In much the same way the family or community which has not achieved sustainability is dependent on the willingness and ability of other social entities (the state, international) to provide support and assistance. At all levels the ability of each social entity to sustain itself and provide support for others is dependent on the ability of its individual members to contribute to the existing demands within the social group. Just as a family benefits from the contributions and achievements of individual members, so does the community or nation.

The provision of a full and productive childhood for the potential future contributors of any society is necessary for the continuation of that society's sustainable development.

Building on Existing Strength and Human Assets:

The provision of sustainable conditions which will decrease the vulnerability of all people to HIV infection requires cooperative efforts on all levels of society to provide for the healthy growth and development of children. Children, by necessity, require continued support, but they also possess enormous potential for growth and sustainability. Successful approaches have been developed which focus on increasing the ability of families and communities to care for their children. The following are examples of such approaches.

Community support groups:

For children and family members who are living with HIV and for uninfected family members and affected others, this can provide:
•emotional support
•a forum where family members, including children, can discuss concerns and ask questions
•opportunities for sharing information about available services
•a platform for speakers to discuss prevention, care and treatment
•a focus for educational activities
•a focus for mutual support and income generating projects
•a platform for community advocacy and activism.

Services and assistance:

To support families affected by HIV/AIDS in ways that enable them to stay together and maintain their home. Such services can be offered by a combination of formal and informal service providers, including government or privately supported agencies, and might include:
•health and nutritional support
•home health care providers
•Income generating projects or direct financial support.

Training for those in the community who interact with HIV/AIDS affected families, can allow more people to contribute to prevention and the provision of quality care, and to offer support to dying parents and their children in planning for the future. Such training can also reduce the fear and discrimination which result from misunderstanding and misinformation.

**TO BE CONTINUED**

HIV/AIDS AND ITS EFFECTS ON SOCIETY CONT. 2

2008-08-24T16:22:00.000-07:00

CAUSES OF HIV/AIDS:

Infection by the human immunodeficiency virus (HIV) causes AIDS. It is spread primarily through sexual contact, and also through blood-to-blood contact, needle sharing among intravenous drug users or accidental inoculation during medical procedures by health care professionals, and in pregnant women, from mother to child. Seventy percent of HIV transmission occurs through sexual contact. Blood transfusions and blood products caused many infections in the early years of the epidemic, but screening procedures have nearly eliminated this risk in many countries in both developed and developing ones. A mother can spread the virus to a newborn during delivery and through breast feeding, however drug therapy is now available that can greatly reduce the risk to infants.

Risk factors include:

•Having unprotected sex (without using a condom) and having more than one partner, whether you are heterosexual or homosexual
•Having another sexually transmitted disease
•Using intravenous drugs and sharing needles

PREVENTION:

Avoiding all the above risk factors and staying healthy are among the only effective ways of preventing HIV/AIDS.

KNOWING YOUR STATUS:

It is important that everyone is a ware of their HIV-status and more seriously so if you suspect any of the above risk factors. It is recommended that an effort is made to visit any nearest health care facility so that you are aware of your status regarding the HIV infection. You may receive a "rapid test," which can give a result in 20 minutes. If the test is positive, then confirmatory tests will follow. If tests confirms as positive, at this point usually a Physician will want to know the CD4 count and viral load (an indication of the amount of virus present. This information, along with your symptoms, helps evaluate the stage of the disease and assists in determining the best course of treatment/care.
HIV tests may not be accurate immediately after infection because it can take up to 12 weeks for the body can develop antibodies against the virus. If infection is suspected and the test is negative, retesting may be needed to confirm the prior results. Individuals who test positive are advised to inform their sexual partners immediately so that they can also be tested. This goes along way to preventing the spread of the virus.

Treatment and treatment Options:

There are medications that slow the progression of HIV infection to full-blown AIDS. Generally, combinations of these medicines, including a type called protease inhibitors, are used. In addition, antibiotics and other therapies are used to prevent or treat specific complications.

Drug Therapies:

Combinations of drugs are used in an effort to treat HIV very aggressively, with the aim of reducing the amount of virus in your blood to very low or undetectable levels, and to suppress symptoms for as long as possible.
Antiretroviral drugs help slow the progression of HIV by inhibiting the reproduction of the virus in the body. It's important to keep a steady dose of antiretroviral drugs in your system to prevent the virus from developing resistance to the drugs. Antiretroviral medications include:
•Protease inhibitors (PIs) stop an HIV enzyme from replicating. This class of drugs includes saquinavir (Invirase), nelfinavir (Viracept), ritonavir (Norvir), tipranavir (Aptivus), indinavir (Crixivan), amprenavir (Agenerase), and atazanavir (Reyataz). Other new ones includes; darunavir (Prezista), which is used in combination with other drugs for people who have not responding well to the treatment. A combination of ritonavir and lopinavir (Kaletra) is among the most prescribed protease inhibitors. Protease inhibitors are considered the most powerful of HIV drugs and often interact with other medications, so they must be monitored carefully and effectively.
•Nucleoside analogue reverse transcriptase inhibitors (NRTIs) also stop a particular HIV enzyme from replicating. These drugs were among the first to be developed and include zidovudine or azidodeoxythymidine (Retrovir or AZT), lamivudine (Epivir), didanosine (Videx), abacavir (Ziagen), stavudine (Zerit), and zalcitabine (Hivid). Emtricitabine (Emtriva) is a newer drug in this class and is taken with at least two other HIV medications. Combinations of several other drugs are also available. All have side effects that must be monitored carefully by your healthcare provider.

•Nucleotide reverse transcriptase inhibitors (NtRTIs) work similarly to NRTIs but act more quickly. So far there is only one drug in this class, tenofovir (Viread), which seems to be effective in people who develop resistance to NRTIs.

•Non-nucleoside reverse transcriptase inhibitor (NNRTIs) stops the virus from making DNA, so that it can't replicate itself. There are three drugs in this class: nevirapine (Viramune), efavirenz (Sustiva), and delavirdine (Rescriptor). They are often used if people cannot tolerate the side effects of protease inhibitors, want to delay protease inhibitor therapy, or if they have taken protease inhibitors but did not experience a drop in levels of the virus. Many of these drugs are cross-resistant, meaning that if you develop resistance to one drug in this class it's likely you will be resistant to all.

•Fusion inhibitors prevent the HIV membrane from fusing with the membrane of healthy cells in your body. Enfuvirtide (Fuzeon) is often used in combination with other drugs in people who have become resistant to other medications. It must be administered by injection.
In addition, any opportunistic infections are treated with the appropriate medications, or in some cases medications are given to prevent the infections from occurring (prophylaxis).
Complementary and Alternative Therapies:
Many people with HIV turn to complementary and alternative therapies to reduce symptoms of the virus, lessen side effects from medications, improve overall health and well-being, and for a sense of empowerment by being actively involved in their own care.

Different therapies are used to:
•Inhibit the virus
•Treat symptoms of the virus or side effects of medication
•Treat or prevent opportunistic infections
Since the major impact of HIV is that it leaves patients vulnerable to opportunistic infections, making adjustments to ensure your overall health through improving stress reduction, exercise, and building a social support network can significantly boost immune function. In fact, these actions are some of the most powerful tools a person has to impact the course of the disease.

Other changes, such as improving oral and general hygiene and limiting exposure to environmental pollutants, can also bolster your health and vitality. These small steps can add up to a longer and healthier life for many people.
However, HIV should never be treated with alternative therapies alone. It is extremely important that you share information on your use of complementary and alternative therapies with your healthcare provider, so that it can built on in helping you determine what is safe and appropriate.
Nutrition and Supplements:

Vitamin C can inhibit the virus in test tubes, although it has not shown the same effect in the human body. It can help boost the immune system, however. Very high doses of vitamin C are sometimes used as supportive therapy. The dose must be determined and monitored appropiately.
N-acetyl cysteine or NAC (800 mg per day), an amino acid, may also slow the growth of the virus in test tubes, though study results have been mixed on whether it reduces the level of virus in the body. It does help the body synthesize glutathione, an antioxidant found in the body that is often low in people with HIV or AIDS. NAC may also help with AZT side effects.
Because of the loss of appetite, people with HIV have low levels of some essential vitamins and nutrients, including:

•Vitamin A and beta-carotene -- these are often deficient in people with HIV, and low levels of vitamin A may be associated with lower CD4 counts. A high supplemental dose may be beneficial, but very high doses have been associated with higher death rates from AIDS. Your health care provider may help determine the proper dose for you, and, since high doses can also damage the liver, monitor your liver function.
•B-complex vitamins (75 - 100 mg per day). Low levels of vitamin B12 and B1 (thiamine) in people with HIV have been linked to lower CD4 counts and neurological problems. B6 deficiency has been associated with poor immune function. A type of B3 (niacinamide) seemed to slow the progression of HIV.
•Vitamin E (400 IU two times per day) may help reduce side effects of AZT while improving the drug's effectiveness, although evidence is slight.
•Selenium (100 - 400 mcg per day) needed for the immune system to function properly, and higher levels of selenium in the body may help boost CD4 counts. Some studies have shown results with 400 mcg per day. At this dose, however, it should be monitored by your health care provider.
•Zinc (45 mg per day) may boost the immune system and help prevent opportunistic infections, but there is also some evidence that zinc can be harmful for HIV infection. Talk to your healthcare provider to see if you are deficient in zinc before taking it.
•Iron is often deficient in people with HIV. Your doctor must determine and monitor the proper dose because too much iron can increase bacterial infections.
*All in all, it’s clear that nutrition and overall health of the whole body is important in remaining healthy and a good balanced diet regiment including regular exercise is not only of at most importance for healthy individual but also for those living with HIV infection.

Weight loss can be a serious problem for people with HIV. This symptom may begin early in the course of the disease and can increase the risk for developing opportunistic infections. Weight loss is exacerbated by other common symptoms of HIV and AIDS, including lesions in the mouth and esophagus, diarrhea, and poor appetite. Over the last several years, weight loss has become less of a problem due to the new protease inhibitors used for treating HIV. Reduction of muscle mass, though, remains a significant concern. Working with professionals in nutritional science can help in developing for example a meal plan to prevent weight loss and muscle breakdown is extremely helpful. Resistance training (lifting weights) can also protect against muscle breakdown and increase lean body mass.

Preventing diarrhea and ensuring that the body absorbs enough protein to maintain muscle strength has become a major goal of HIV/AIDS preventative care. One program for combating diarrhea includes using soluble fiber/and or foods that provides it. For some people, soluble fiber can help food stay in the digestive tract for longer periods of time, increasing the amount of nutrients that are absorbed, and lessening bowel frequency. Because diarrhea can be a potentially life-threatening situation, soluble fiber therapy should be used under the strict supervision of a trained professional.

Using certain supplements may help in maintaining body weight. A well-designed study compared the use of a daily supplement regimen that included enormous amounts of the amino acid glutamine (40 g per day), along with vitamin C (800 mg), vitamin E (500 IU), beta-carotene (27,000 IU), selenium (280 mcg), and N-acetyl cysteine (2,400 mg) to placebo. People who took the supplements gained significantly more weight after 12 weeks than those who took the placebo.

Another study found that a combination of glutamine (7 g per day), arginine (7 g), and an amino acid derivative called hydroxymethylbutyrate or HMB (1.5 g) helped people gain lean body weight during 8 weeks of treatment compared to placebo. High doses of arginine however, may be linked to an increase in herpes viral outbreaks. To find the right dose that offers benefits without dangerous side effects, consult with a trained nutrition professional.
Other supplements sometimes used for supportive treatment include:
•Dehydroepiandrosterone or DHEA (200 - 500 mg per day) is a hormone that is often low in people with HIV. One study found that DHEA supplements improved minor depression with no serious side effects. Because DHEA is a hormone, you should not take it without your doctor's supervision.
•Coenzyme Q10 (200 mg per day) appears to help improve immune system function and slow progression of the disease.
•SAMe or S-adenosyl-L-methionine (intravenous dose of 800 mg per day) is used to treat AIDS-related myelopathy (diseases that affect the spinal cord).
•Injections of vitamin B6 and B12 can dramatically improve neuropathies (damage to peripheral nerves) associated with some HIV medications such as Zerit.

Herbs:

You may use herbs as supportive therapies, but you should never use them alone to treat HIV or AIDS. It is important that you keep all of your health care providers informed of any treatments, conventional or alternative, that you are taking so they can monitor interactions and side effects, and provide the best care.
A few herbs have antiretroviral effects, though none are as effective at reducing the level of virus in your systme as conventional drugs. Herbs that have antiretroviral effects include:
•Boxwood (Buxus sempervirens) was studied before many conventional drugs were developed to treat HIV. A special extract of stems and leaves given in the amount of 990 mg per day slowed the progression of the disease and decreased levels of virus in the blood. No side effects were reported, although high doses of a substance found in boxwood can cause muscle spasms and paralysis. For that reason, and because only the extract of boxwood has been evaluated for HIV, you should only take boxwood under supervision.
•Licorice (Glycyrrhiza glabra) -- Two studies used an extract of licorice, which appeared to slow growth of the virus. Because the amounts used are high and large doses can have serious side effects including high blood pressure, you should only take licorice under supervision. Do not take licorice if you have high blood pressure, kidney disease, or heart failure.
•Turmeric (Curcuma longa, 1.5 - 3 g per day) -- Some test-tube studies suggest turmeric and its active ingredient curcumin can slow replication of the virus. In a human study, turmeric appeared to increase CD4 counts.
You may also use herbs to support the immune system. They may include:
•Andrographis ( Andrographis paniculata) -- A pilot study found that components of andrographis increased CD4 counts and decreased the amount of virus in the blood, but caused potentially dangerous side effects. Because of that, you should not take andrographis without supervision.
•Korean red ginseng or Asian ginseng (Panax ginseng) -- Several studies suggest Korean red ginseng has benefits, including raising CD4 counts and increasing the effectiveness of AZT. You may want to consult a trained practitioner in traditional Chinese medicine to assess whether ginseng will be beneficial for your individual constitution.
•Sangre de Drago (Croton lechleri, 500 mg every six hours) -- One study and anecdotal evidence suggest Sangre de Drago may be helpful in combating AIDS-related diarrhea. Because very high amounts of the herb were used, it should only be taken under supervision.
•Cat's claw (Uncaria tomentosa) -- In one study of 13 patients with human immunodeficiency virus (HIV) who refused to take conventional treatments, an extract of cat's claw at a dosage of 20 mg per day for up to 5 months significantly increased white blood cell counts (the infection-fighting cells in the body that HIV destroys). There is some preliminary indication that it may reduce side effects from AZT. However, there are also studies suggesting a negative result from cat's claw. You should consult a trained, botanically oriented professional before adding cat’s claw to your regimen, and all other health care providers should be aware of all your treatments.
Other herbs sometime used to treat symptoms of HIV or opportunistic infections include tea tree oil (Melaleuca alternifolia), which has been used to treat thrush (15 ml of solution used as a mouthwash), and garlic (Allium sativum), which has helped treat AIDS-related diarrhea and stop weight loss. Garlic interacts negatively with several HIV medications, however, so you should never use garlic without supervision.

Homeopathy:

No specific scientific research supports the use of homeopathy for HIV or AIDS. A licensed, certified homeopathic professional should do individual evaluation to assess the value of homeopathy for reduction of symptoms or side effects from medication as an adjunct to standard medical treatment.
Physical Medicine:
Exercise is another way to help develop a general sense of well-being, improve mental attitude, decrease depression, diminish weight loss, and increase lean body mass. Resistance or weight training is particularly useful to increase strength and enhance lean body mass.

Acupuncture:

People with HIV have used acupuncture to improve general well-being, alleviate symptoms such as fatigue, insomnia, and night sweats, and to minimize side effects from medications, such as nausea. Some people also find relief from peripheral neuropathy, caused occasionally by certain medications used for HIV, reporting less pain, increased strength, and improved sensation.
As mentioned earlier, diarrhea can be a major problem for people with HIV throughout the world. In China, acupuncture and moxibustion (a heat treatment performed by the acupuncturist over points where the needles are placed) are the standard treatments for HIV-related diarrhea.
Acupuncture can also be used to treat the neuropathic (nerve) pain associated with certain HIV medications. Inserting needles bilaterally in the hand and foot points known as Baaxie and Bafeng, respectively, can lessen neuropathic pain.

Massage:

Massage can relieve chronic muscle tension and stress, which may help the immune system.

HIV and Pregnancy:

HIV-positive pregnant mothers- taking certain antiretroviral medications may reduce the likelihood of transmitting the virus to the baby. Your healthcare provider should determine which medicine is best and safe for the baby. Depending on individual’s condition, a health care provider may decide to postpone treatment until after the first trimester to reduce the risk of birth defects. Breastfeeding should be avoided because of the risk of transmitting the virus to the baby.

**TO BE CONTINUED**

Beijing 2008 Olympic Games

2008-08-23T23:59:00.000-07:00

Beijing 2008 Olympic Games August 8-24, 2008.
Kenya’s 2008 Olympics: Top Medalists.

SPORT- MEDALS- ATHLETE- EVENT

Track &field: Gold- W.Bungei - Men’s 800m
Gold -P. Jelimo - Women’s 800m
Gold- N. Langat - Women’s 1500m
Gold -B. Kiprop Kipruto - Men’s 3000m
Gold -S. Wanjiru - Men’s Marathon
Silver- J. Jepkosgei - Women’s 800m
Silver- A. Kiprop - Men’s 1500m
Silver- E. jepkorir - Women’s 3000m
Silver- E. Kipchoge - Men’s 5000m
Silver- C. Ndereba - Women’s marathon
Bronze-A. Kirwa Yego- Men’s 800m
Bronze-R. Mateelong- Men’s 3000m
Bronze-E. Soi Men’s - 5000m
Bronze-M. Kogo - Men’s 10,000m

The total Medal haul from Beijing 2008 Olympics stands at 14;
5-Golds, 5-Silvers and 4-Bronze.

That brought Kenya’s Medals overall ranking at number 15th worldwide. Not a bad feat at all I would say! And For all the Men and Women, who sacrificed too much for our beloved country, let’s say, **ASANTENI SAANA! AND BRAVO**!

HIV/AIDS AND ITS EFFECTS ON SOCIETY 1

2008-08-17T15:25:00.000-07:00

What is HIV/AIDS?

Introduction:

HIV- (human immunodeficiency virus) belongs to the retrovirus family (HIV-1 and HIV-2). Retroviruses are unique because they possess the enzyme reverse transcriptase. Reverse transcriptase allows the viral RNA genome to be replicated into DNA, rather than the usual RNA copies. The HIV attacks the immune system, the body’s natural defense system. Without a strong immune system, the body is unable to fight any disease that it encounters.

Both the virus and the infection it causes are all together referred to as HIV infection. The virus takes over certain immune system cells to make many copies of its own (replication). While many viruses can be controlled by the immune system, HIV targets and infects that same immune system i.e. cells that are supposed to protect the body from illnesses. These are a type of white blood cell called CD4 cells. HIV takes over CD4 cells and turns them into virus factories that produce thousands of viral copies. As the virus grows, it damages or kills CD4 cells, weakening the immune system, thus causing slow but constant damage to the body’s natural defense system of which at this stage is commonly called AIDS.

The virus may be passed from one person to another when infected blood, semen, or vaginal secretions come in contact with an uninfected person’s broken skin or mucous membranes. In addition, infected pregnant women can pass HIV to their baby during pregnancy or delivery, as well as through breast-feeding. People with HIV have what is called HIV infection. Some of these people will develop AIDS as a result of their HIV infection.

AIDS – (Acquired Immunodeficiency Syndrome):

Acquired – means that the disease is not hereditary but develops after birth from contact with a disease causing agent (in this case, HIV).
Immunodeficiency – means that the disease is characterized by a weakening of the immune system.
Syndrome – refers to a group of symptoms that collectively indicate or characterize a disease.

In the case of AIDS this can include the development of certain infections and/or cancers, as well as a decrease in the number of certain cells in a person’s immune system.

Acquired Immune Deficiency Syndrome is a set of symptoms and infections resulting from the damage to the human immune systems caused by the (HIV). This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors. It is the condition diagnosed when there are a group of related symptoms that are caused by severe human immunodeficiency virus infection. AIDS makes the body vulnerable to life-threatening illnesses called opportunistic infections. But having HIV does not mean you have AIDS. Even without treatment, it takes a long time for HIV to progress to AIDS—usually 10 to 12 years. If HIV is diagnosed before it becomes AIDS, medicines can slow or stop the damage to the immune system. With treatment, many people with HIV are able to live long and active lives.

Immune system: (as pertains to the HIV/AIDS)

Your immune system is your body's natural defense against infection and illness. Specialized cells and organs all work in concert to protect your body and keeping your body away from diseases and thus healthy. Understanding these different parts of your immune system and how your immune system works will help to better understand HIV and AIDS. There will be more discussions dedicated to immune system in another entry.

Organs and Cells of the Immune System:

•Bone Marrow.
All the specialized cells of the immune system are formed in the bone marrow. Their formation is begun in bone marrow and then they move into the blood stream where they mature.
•Thymus.
This small but important organ produces T-cells. In addition, the thymus actually chooses which T-cells are best suited for the immune system. The remaining ones are eliminated by the body, assuring a healthy, effective immunity.
•Spleen.
You can think of the spleen as a filter for the blood. It catches foreign material in the blood and activates different types of immune system cells.
•Lymph Nodes.
The lymph nodes filter foreign material from the lymph fluid. Fluid that drains from various tissues in the body collects in the lymph system and passes through the nodes, being filtered as it passes.

•Cells-Leukocytes or WBCs.
The leukocytes are further subdivided into granulocytes (containing large granules in the cytoplasm) and agranulocytes (without granules). The granulocytes consist of neutrophils (55–70%), eosinophils (1–3%), and basophils (0.5–1.0%). The agranulocytes are lymphocytes (consisting of B cells and T cells) and monocytes. Lymphocytes circulate in the blood and lymph systems, and make their home in the lymphoid organs. For the sake of the topic we'll consider T-cells here.

T-Cells also called CD4 Cells:

T-Cells- There are two subsets of T-cells: CD4 cells and CD8 cells. CD4 cells secrete factors that activate other white blood cells that participate in the immune response. HIV attacks CD4 cells, damaging the body's ability to initiate the immune response.

CD8 cells are important in directly killing tumor cells, viral infected cells and some parasites. T/CD4 cells are also called “helper” cells. And in other words lead the attack against infections. While the T-8 cells (CD8) are called “suppressor” cells that end the immune response. CD8 cells can also be “killer” cells that kill cancer cells and cells infected with a virus.

It is important for people who are HIV+ to know their CD4 cells count as this can give a picture of the effectiveness or the status of their immune system.

Knowing how many functioning CD4 cells are circulating in the blood gives an idea of how strong the HIV+ person's immune system really is. A CD4 cells count measures the number of functioning CD4 cells in the body and therefore measures the health of the immune system.
The CD4 test ranges vary but Normal Values - In a healthy adult is typically 600 to 1200 cells per cubic millimeter of blood. And Between 600 and 350 - In an HIV+ person is considered "very good". And Between 350 and 200 - The immune system is weakened and therefore the HIV+ person may be at increased risk for infection and illness.

Signs and Symptoms:

Symptoms of infection with HIV can vary. Often a flu-like syndrome occurs in 50 to 80% of those who contract HIV within the first 2 - 6 weeks, including a combination of the following symptoms:
•Fever
•Sore throat
•Swollen lymph nodes
•Joint pain
•Muscle aches
•Rash
•Mouth ulcers
•Nausea
•Diarrhea
•Headache
After you are infected with HIV, you may remain relatively symptom-free for years or the disease may progress more rapidly. In this stage, the CD4 count may be below 500 per cubic millimeter. You may develop infections or chronic symptoms including:
•Swollen lymph nodes
•Diarrhea
•Weight loss
•Fever
•Cough and shortness of breath
•Low platelet count, which may manifest as easy bruising, bleeding gums, or nose bleeds
During the last stage of the disease, HIV infection may meet the official criteria for AIDS, which is the presence of an opportunistic infection (such as Pneumocystis carinii pneumonia, or PCP) or a CD4 count below 350-200 per cubic millimeter. At this stage, symptoms may include
•Pneumonia, including PCP
•Tuberculosis
•Night sweats
•Persistent fatigue
•Extreme weight loss and wasting, exacerbated by diarrhea. Up to 90% of HIV patients worldwide experience diarrhea
•Meningitis and other brain infections
•Fungal infections
•Syphilis
•Malignancies such as lymphoma, cervical cancer, and Kaposi's sarcoma (KS) (affects the skin and oral mucosa and may spread to the lungs. KS can actually occur in earlier stages of HIV as well).

****TO BE CONTINUED****

COMMON LIVER DISEASES(HEPATITIS)-SUMMARY

2008-08-09T10:14:00.000-07:00

SUMMARY OF HEPATITIS; A, B, D, C, & E:

Hepatitis is a disease characterized by inflammation of the liver, usually producing swelling and, in many cases, permanent damage to liver tissues. A number of different agents can cause hepatitis, including infectious diseases, chemical poisons, drugs and alcohol. Viral hepatitis refers to a set of at least six viruses that are known to cause hepatitis: hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), hepatitis E (HEV), and hepatitis G (HGV). Recent scientific evidence also suggests the existence of other, as yet unidentified hepatitis viruses.
The most common types of viral hepatitis are hepatitis A, B, and hepatitis C. Both hepatitis B and C can lead to serious, permanent liver damage, and in many cases, death.
There are two primary types of viral hepatitis, food-borne and blood-borne hepatitis. The former, which is spread through contaminated food and water, does not cause chronic liver disease. By contrast, blood borne viral hepatitis may lead to long-term, persistent infections and chronic liver disease that has lethal consequences many years after infection.

Hepatitis A: is an acute liver disease caused by the hepatitis A virus (HAV), lasting from a few weeks to several months. It does not lead to chronic infection.
Transmission: Ingestion of fecal matter, even in microscopic amounts, from close person-to-person contact or ingestion of contaminated food or drinks.
Vaccination: Hepatitis A vaccination is recommended for all children starting at age 1 year, travelers to certain countries, and others at risk.

Hepatitis B: Is a liver disease caused by the hepatitis B virus (HBV). It ranges in severity from a mild illness, lasting a few weeks (acute), to a serious long-term (chronic) illness that can lead to liver disease or liver cancer.
Transmission: Contact with infectious blood, semen, and other body fluids from having sex with an infected person, sharing contaminated needles to inject drugs, or from an infected mother to her newborn.
Vaccination: Hepatitis B vaccination is recommended for all infants, older children and adolescents who were not vaccinated previously, and adults at risk for HBV infection.

Hepatitis C: is a liver disease caused by the hepatitis C virus (HCV). HCV infection sometimes results in an acute illness, but most often becomes a chronic condition that can lead to cirrhosis of the liver and liver cancer.

Transmission: Contact with the blood of an infected person, primarily through blood-blood/broken skin contact.
Vaccination: There is no vaccine for hepatitis C.

Hepatitis D- Is a serious liver disease caused by the hepatitis D virus (HDV) and relies on HBV to replicate.
Transmission: Contact with infectious blood, similar to how HBV is spread.
Vaccination: There is no vaccine for hepatitis D.

Hepatitis E- Is a serious liver disease caused by the hepatitis E virus (HEV) that usually results in an acute infection. It does not lead to a chronic infection. Hepatitis E is fairly common in many parts of the world.
Transmission: Ingestion of fecal matter, even in microscopic amounts; outbreaks are usually associated with contaminated water supply in regions with poor sanitation.
Vaccination: There is no currently approved vaccine for hepatitis E.

LIVER DISEASES(HEPATITIS) -PART THREE CONTINUES

2008-08-09T08:08:00.000-07:00

Hepatitis C Virus

Introduction:

Although its means of transmission is fairly well documented, the hepatitis C virus itself largely remains a mystery. Hepatitis C is extremely small, even for a virus - it is only about 50 nanometers in diameter. A nanometer is one billionth of a meter - if you placed 200,000 hepatitis C viruses end to end, they would be only a single centimeter long. However, what is known about hepatitis C underscores the type of threat that it poses.

Hepatitis C is an RNA virus - which means that it mutates frequently. Once an infection has begun, hepatitis C creates different genetic variations of itself within the body of the host. The mutated forms are frequently different enough from their ancestors that the immune system cannot recognize them. Thus, even if the immune system begins to succeed against one variation, the mutant strains quickly take over and become new, predominant strains. As a result, the development of antibodies against HCV does not produce immunity against the disease like it does with most other viruses. More than 80% of the individuals infected with HCV will progress to a chronic form of the disease.

As a result of this, hepatitis C is usually not self-limited as a disease. In more than 85% of all cases, whether they progress to chronic liver disease or not, the infected individual carries the virus for life. This means that they also remain contagious for a lifetime, able to transmit the virus to others. And because of the long progression of the illness, even patients who will eventually die as a result of hepatitis C carry the virus for decades before it takes their lives. Most epidemics are self-limiting - they spread rapidly, but over a short period of time the affected population either dies or develops immunity to the disease, and it stops spreading. Not so with hepatitis C. Much like HIV and AIDS, it lasts a lifetime, and kills slowly - giving the virus plenty of time to spread.

There are six basic genotypes of HCV, with 15 recorded subtypes, which vary in prevalence in different regions of the world. Each of these major genotypes can differ significantly in their biological effects - in terms of replication, mutation rates, type and severity of liver damage, and detection and treatment options. However, these differences are not yet clearly understood.

The 21 current variations in genotype, complicated by the constant mutation of the virus within infected individuals, represents a major challenge for the development of treatments and vaccines against HCV - and even for reliable detection of the virus. There is no guarantee that a treatment, test, or vaccine against one strain will be effective against all of them. Moreover, individuals cured of one strain will be prone to re-infection by any of the other strains.

The infection is often asymptomatic, and can often lead to chronic infection and cause inflammation of the liver (chronic hepatitis). This condition can progress to scarring of the liver (fibrosis), and advanced scarring (cirrhosis). In some cases, those with cirrhosis will go on to develop liver failure or other complications of cirrhosis, including liver cancer. No effective vaccine against hepatitis C is available. The symptoms of infection can be medically managed, and a proportion of patients can be somewhat cleared of the virus by a course of anti-viral medicines. Although early medical intervention is helpful, people with HCV infection can experience mild symptoms, and consequently do not seek treatment. (Approximately 150-200 million or more) people are infected with hepatitis C world wide.

Although HCV is not known to efficiently be transmitted sexually, persons at risk for infection through injection drug use might seek care in STD treatment facilities, HIV counseling and testing facilities, prisons/and or correctional facilities, drug treatment facilities, and other public health settings where STD and HIV prevention and control services are available.

Sixty to 70% of persons newly infected with HCV typically are usually asymptomatic or have a mild clinical illness. HCV RNA can be detected in blood within 1–3 weeks after exposure. The average time from exposure to antibody to HCV (anti-HCV) seroconversion is 8–9 weeks, and anti-HCV can be detected in >97% of persons by 6 months after exposure. Chronic HCV infection develops in 70%–85% of HCV-infected persons; 60%–70% of chronically infected persons have evidence of active liver disease. The majority of infected persons might not be aware of their infection because they are not clinically ill. However, infected persons serve as a source of transmission to others and are at risk for chronic liver disease or other HCV-related chronic diseases decades after infection.

HCV is most efficiently transmitted through large or repeated percutaneous exposure to infected blood (e.g., through transfusion of blood from non screened donors or through use of injecting drugs). Although much less frequent, occupational, Perinatal, and sexual exposures also can result in transmission of HCV.

Since the clinical characteristics are similar for all types of acute viral hepatitis, the specific viral cause of illness cannot be determined solely on the basis of signs, symptoms, history, or current risk factors, but must be verified by specific serologic testing.

In most of the developed countries, the people at risks of HCV infection include; Current or former injection drug users, including those who injected only once many years ago, Recipients of clotting factor concentrates made before 1987 when more advanced methods for manufacturing those products were developed, Recipients of blood transfusions or solid organ transplants before July 1992 when better testing of blood donors became available, Chronic hemodialysis patients, Persons with known exposures to HCV such as health care workers after needle sticks involving HCV-positive blood recipients of blood or organs from a donor who tested HCV-positive Persons with HIV infection, Children born to HCV-positive mothers.

Is it possible for someone to become infected with HCV and then spontaneously clear the infection?

Yes. Approximately 15%–25% of persons clear the virus from their bodies without treatment and do not develop chronic infection; the reasons for this are not well known. HCV infection becomes chronic in approximately 75%–85% of cases.

Why most persons remain chronically infected with HCV?

A person infected with HCV mounts an immune response to the virus, but replication of the virus during infection can result in changes that evade the immune response. This may explain how the virus establishes and maintains chronic infection.

What are the chances of developing chronic HCV infection/liver disease, cirrhosis, or liver cancer or dying as a result of hepatitis C.?

For every 100 persons infected with HCV, approximately 75–85 will go on to develop chronic infection 60–70 will go on to develop chronic liver disease, 5–20 will go on to develop cirrhosis over a period of 20–30 years, 1–5 will die from the consequences of chronic infection (liver cancer or cirrhosis). And persons can become infected with a different strain of HCV after they have cleared the initial infection. Prior infection with HCV does not protect against later infection with the same or different genotypes of the virus. This is because persons infected with HCV typically have an ineffective immune response due to changes in the virus during infection.

For the same reason, no effective pre- or post exposure prophylaxis (i.e., immune globulin) is available. Currently there is no vaccine for hepatitis C available. Research into the development of a vaccine is still ongoing.

Transmission and Symptoms:

How HCV is transmitted:

HCV is transmitted primarily through large or repeated percutaneous (i.e., passage through the skin) exposures to infectious blood, such as Injection drug use. Receipt of donated blood, blood products, and organs (once a common means of transmission but now rare in most developed countries, Needle stick injuries in healthcare settings, Birth to an HCV-infected mother, HCV can also be spread infrequently through:
Sex with an HCV-infected person (an inefficient means of transmission),Sharing personal items contaminated with infectious blood, such as razors or toothbrushes (also inefficient vectors of transmission). Other healthcare procedures that involve invasive procedures, such as injections (usually recognized in the context of outbreaks)

Can HCV be spread during medical or dental procedures?

Yes, therefore Standard Precautions and other infection control practices should be followed routinely and consistently. There are However cases that HCV has been spread in healthcare settings when injection equipment, such as syringes, was shared between patients or when injectable medications or intravenous solutions were mishandled and became contaminated with blood. Healthcare personnel should understand and adhere to Standard Precautions, which includes safe injection practices and other guidance aimed at reducing blood borne pathogen risks for patients and healthcare personnel. If healthcare-associated HCV infection is suspected, this should be reported to state and local public health authorities.

Can HCV be spread within a household?

Yes, but does not occur very often. If HCV is spread within a household, it is most likely a result of direct, through-the-skin exposure to the blood of an infected household member.

Signs and symptoms of acute HCV infection:

Persons with newly acquired HCV infection usually are asymptomatic or have mild symptoms that are unlikely to prompt a visit to a healthcare professional. When symptoms occur, they can include; Fever, Fatigue, Dark urine, Clay-colored And approximately 20%–30% of those newly infected with HCV experience fatigue, abdominal pain, poor appetite, or jaundice. In those persons who do develop symptoms, the average time period from exposure to symptom onset is 4–12 weeks (range: 2–24 weeks).

Signs and symptoms of chronic HCV infection:

Most persons with chronic HCV infection are asymptomatic. However, many have chronic liver disease, which can range from mild to severe, including cirrhosis and liver cancer. Chronic liver disease in HCV-infected persons is usually insidious, progressing slowly without any signs or symptoms for several decades. In fact, HCV infection is often not recognized until asymptomatic persons are identified as HCV-positive when screened for blood donation or when elevated alanine aminotransferase (ALT, a liver enzyme) levels are detected during routine examinations.

Testing and Diagnosis HCV testing is recommended for anyone at increased risk for HCV infection, including:

Persons who have ever injected illegal drugs, including those who injected only once many years ago Recipients of clotting factor concentrates made before 1987, Recipients of blood transfusions or solid organ transplants before July 1992, Patients who have ever received long-term hemodialysis treatment.
Persons with known exposures to HCV, such as health care workers after needle sticks involving HCV-positive blood recipients of blood or organs from a donor who later tested HCV-positive

All persons with HIV infection. Patients with signs or symptoms of liver disease (e.g., abnormal liver enzyme tests), Children born to HCV-positive mothers (to avoid detecting maternal antibody, these children should not be tested before age 18 months)Several tests are performed for HCV infection,including; Screening tests for antibody to HCV (anti-HCV)enzyme immunoassay(EIA)enhanced chemiluminescence immunoassay (CIA)Recombinant immunoblot assay(RIBA)Qualitative tests to detect presence or absence of virus (HCV RNA polymerase chain reaction [PCR])Quantitative tests to detect amount (titer) of virus (HCV RNA PCR).
False-positive anti-HCV tests appear more often when persons at low risk for HCV infection (e.g., blood donors) are tested. Therefore, it is important to confirm a positive anti-HCV test with a supplemental test, such as RIBA (recombinant immunoblot assay), as most false positive anti-HCV tests are reported as negative on supplemental testing.

Persons with early HCV infection might not yet have developed antibody levels high enough that the test can measure which might result into a false negative. In addition, some persons might lack the (immune) response necessary for the test to work well. In these persons, further testing such as PCR for HCV RNA may be considered. A confirmed positive anti-HCV test is usually followed by other additional tests such as ALT (alanine aminotransferase, a liver enzyme). An elevated ALT indicates inflammation of the liver. The patient should be checked further for chronic liver disease and possible treatment. The evaluation should be performed by a medical doctor/ healthcare professional familiar with chronic hepatitis C. Also one can have a normal liver enzyme (e.g., ALT) level and still have chronic hepatitis C. It is common for patients with chronic hepatitis C to have liver enzyme levels that go up and down, with periodic returns to normal or near normal levels. Liver enzyme levels can remain normal for over a year despite chronic liver disease.

Management and Treatment:

HCV-positive persons should be evaluated (by referral or consultation, if appropriate) for presence of chronic liver disease, including assessment of liver function tests, evaluation for severity of liver disease and possible treatment, and determination of the need for hepatitis A and hepatitis B vaccination. A specialist can be consulted in the management of HCV-infected persons but, any physician who manages a person with hepatitis C should be knowledgeable and current on all aspects of the care of a person with hepatitis C; this can include some internal medicine and family practice physicians as well as specialists such as infectious disease physicians, gastroenterologists, or hepatologists.

Treatment for chronic hepatitis C:

Combination therapy with pegylated interferon and ribavirin is the treatment of choice, resulting in sustained virologic response (defined as undetectable HCV RNA in the patient's blood 24 weeks after the end of treatment) rates of 40%–80% (up to 50% for patients infected with genotype 1, and up to 80% for patients infected with genotypes 2 or 3). Combination therapy using interferon and ribavirin is approved for use in children ages 3–17 years in some countries. Treatment success rates are now being improved with the addition of polymerase and protease inhibitors to standard pegylated interferon/ribavirin combination therapy. At least six distinct HCV genotypes (genotypes 1–6) and more than 50 subtypes have been identified. It is necessary to do viral genotyping when managing a person with chronic hepatitis C. Because there are at least six known genotypes and more than 50 subtypes of HCV, genotype information is helpful in defining the epidemiology of hepatitis C and in making recommendations regarding treatment.

Knowing the genotype can help predict the likelihood of treatment response and, in many cases, determine the duration of treatment. Patients with genotypes 2 and 3 are almost three times more likely than patients with genotype 1 to respond to therapy with alpha interferon or the combination of alpha interferon and ribavirin. When using combination therapy, the recommended duration of treatment depends on the genotype. For patients with genotypes 2 and 3, a 24-week course of combination treatment is adequate, whereas for patients with genotype 1, a 48-week course is recommended. Once the genotype is identified, it need not be tested again; genotypes do not change during the course of infection. Super-infection is possible if risk behaviors (e.g., injection drug use) for HCV infection continue, but it is believed to be very uncommon.

Does chronic hepatitis C affect only the liver?

A small percentage of persons with chronic HCV infection develop medical conditions due to hepatitis C that are not limited to the liver. These conditions are thought to be attributable to the body's immune response to HCV infection. Such conditions can include;Diabetes mellitus, which occurs three times more frequently in HCV-infected persons, Glomerulonephritis, a type of kidney disease caused by inflammation of the kidney, Essential mixed cryoglobulinemia, a condition involving the presence of abnormal proteins in the blood, Porphyria cutanea tarda, an abnormality in heme production that causes skin fragility and blistering, Non-Hodgkins lymphoma, which might occur somewhat more frequently in HCV-infected persons, Counseling Patients.

Patients should be informed about the low but present risk for transmission with sex partners. Sharing personal items that might have blood on them, such as toothbrushes or razors, can pose a risk to others. Cuts and sores on the skin should be covered to keep from spreading infectious blood or secretions. Donating blood, organs,tissue, or semen can spread HCV to others. HCV is not spread by sneezing, hugging, holding hands, coughing, sharing eating utensils or drinking glasses, or through food or water. Patients may benefit from joining support group.

HCV-positive persons should be advised to avoid alcohol because it can accelerate cirrhosis and end-stage liver disease. Viral hepatitis patients should also check with a health professional before taking any new prescription pills, over-the counter drugs (such as non-aspirin pain relievers), or supplements, as these can potentially damage the liver.

Hepatitis C and Healthcare Personnel:

What is the risk for HCV infection from a needle stick exposure to HCV-contaminated blood?

After a needle stick or sharps exposure to HCV-positive blood, the risk of HCV infection is approximately 1.8% (range: 0%–10%).

Other than needle sticks, do other exposures, such as splashes to the eye, pose a risk to healthcare personnel for HCV transmission?

Although a few cases of HCV transmission via blood splash to the eye have been reported, the risk for such transmission is expected to be very low. Avoiding occupational exposure to blood is the primary way to prevent transmission of blood borne illnesses among healthcare personnel. All healthcare personnel should adhere to Standard Precautions. Depending on the medical procedure involved, Standard Precautions may include the appropriate use of personal protective equipment (e.g., gloves, masks, and protective eyewear).

What follow-up testing is recommended for healthcare personnel exposed to HCV-positive blood?

For the source, perform baseline testing for anti-HCV.For the person exposed to a HCV-positive source, perform baseline and follow-up testing, including baseline testing for anti-HCV and ALT activity and follow-up testing for anti-HCV (e.g., at 4–6 months) and ALT activity. If earlier diagnosis of HCV infection is desired, testing for HCV RNA may be performed at 4–6weeks. Confirmation by supplemental anti-HCV testing of all anti-HCV results reported as positive by enzyme immunoassay.

Pregnancy and HCV Infection:

Should pregnant women be routinely tested for anti-HCV?

No. Since pregnant women have no greater risk of being infected with HCV than non-pregnant women and interventions to prevent mother-to-child transmission are lacking, routine anti-HCV testing of pregnant women is not recommended. Pregnant women should be tested for anti-HCV only if they have risk factors for HCV.

What is the risk that an HCV-infected mother will spread HCV to her infant during birth?

Approximately 4 of every 100 infants born to HCV-infected mothers become infected with the virus. Transmission occurs at the time of birth, and no prophylaxis is available to prevent it. The risk is increased by the presence of maternal HCV viremia at delivery and also is 2–3 times greater if the woman is co-infected with HIV. Most infants infected with HCV at birth have no symptoms and do well during childhood. More research is needed to find out the long-term effects of Perinatal HCV infection.

Should a woman with HCV infection be advised against breastfeeding?

No. There is no evidence that breastfeeding spreads HCV. However, HCV-positive mothers should consider abstaining from breastfeeding if their nipples are cracked or bleeding.

When should children born to HCV-infected mothers be tested to see if they were infected at birth?

Children should be tested for anti-HCV no sooner than age 18 months because anti-HCV from the mother might last until this age. If diagnosis is desired before the child turns 18 months, testing for HCV RNA could be performed at or after the infant's first well-child visit at age 1–2 months. HCV RNA testing should then be repeated at a subsequent visit, independent of the initial HCV RNA test result.

LIVER DISEASES(HEPATITIS) -PART THREE

2008-08-03T16:04:00.000-07:00

HEPATITIS B:

Hepatitis B virus (HBV) is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses, (partly double-stranded; icosahedral capsid with an envelope; virion-also called Dane particles as the main characteristics). It is not related to the hepatitis A virus or the hepatitis C virus. HBV primarily infect liver cells. The name of the family comes from hepa- meaning liver; dna- referring to deoxyribonucleic acid, the virus' genetic material; and viridae- meaning virus. Other viruses in this family can also cause hepatitis in certain animals e.g. mammalian and avian hepadnaviruses are known to exist. The Hepadnaviridae are very similar to one another. Accordingly, several animal models have been developed to study the hepatitis B virus and to evaluate new drugs to treat hepatitis B virus.The genes of the hepatitis B virus contain genetic codes to make a number of protein products, including hepatitis B surface antigen (HBsAg), hepatitis B core antigen (HBcAg), hepatitis B e antigen (HBeAg), and DNA polymerase.

These four proteins are important because their tests are used to diagnose hepatitis B virus. The hepatitis B virus consists simply of a core particle (central portion) and a surrounding envelope (outer coat). The core is made up of the HBcAg, whereas the envelope is made up of the HBsAg. The core particle contains the hepatitis B virus DNA, HBeAg, and DNA polymerase. The HBeAg serves as a marker of the virus' ability to spread the infection. The DNA polymerase is an important part of the virus' uniqueness of its reproduction. Of relevant importance here is that, the human immunodeficiency virus (HIV) also reproduces using this same process. As a result, many drugs that have been developed to inhibit this process of reproduction to treat HIV infection may also be effective in treating chronic hepatitis B viral infection.

HOW HBV CAUSES INJURY TO THE LIVER:

The hepatitis B virus itself does not directly cause damage to the liver. Rather, the body's immune (protective) response to the virus (a foreign material) paradoxically causes the damage. Thus, in a hepatitis B viral infection, the body's immune response to the virus is responsible for both the elimination of the hepatitis B virus from the body and recovery from the infection. Yet, at the same time, the injury to the liver cells is caused by that same immune response to the hepatitis B virus in the liver cells.

Therefore, there is a balance between the protective and destructive effects of the immune system's response to the hepatitis B virus. How this balance is achieved determines the outcome in an individual infected with hepatitis B virus. Therefore, an acute hepatitis B viral infection can lead to recovery (the usual outcome), to acute liver failure (rarely), and sometimes to chronic infection. The chronic infection can result in a healthy carrier state (in which the affected person harbors the virus but remains healthy) or progress to cirrhosis (severe scarring, or fibrosis, of the liver) and its complications, including liver cancer.

TRANSMISSION:

Hepatitis B virus is spread or acquired through exposure to infected blood or the body's secretions. The highest concentrations of hepatitis B virus are found in the blood, semen, vaginal discharge, breast milk, and saliva. There are only low concentrations of hepatitis B virus in the urine and none in the feces. Therefore, hepatitis B is not spread through food or water or by casual contact. Furthermore, hepatitis B virus is no longer or rarely transmitted by blood transfusions in most countries because all blood for transfusion is screened (tested) to exclude contamination with hepatitis B virus. In much of the developing world, (sub-Saharan Africa, most of Asia, and the Pacific), most people become infected with HBV during childhood, and 8% to 10% of people in the general population become chronically infected. In these regions liver cancer caused by HBV figures among the first three causes death by cancer in men.

High rates of chronic HBV infection are also found in the Amazon and the southern parts of Eastern and Central Europe. In the Middle East and Indian sub-continent, about 5% are chronically infected.

TRANSMISSION –IN SUMMARY:

Hepatitis B virus is transmitted by contact with blood or body fluids of an infected person in the same way as human immunodeficiency virus (HIV), the virus that causes AIDS. However, HBV is 50 to 100 times more infectious than HIV.

The main ways of getting infected with HBV are

Perinatal (from mother to baby at the birth)

Child-to-child transmission

Unsafe injections and transfusions

Sexual contact.

Worldwide, most infections occur from infected mother to child, from child to child contact in household settings, and from reuse of non sterilized needles and syringes.

In many industrialized countries (e.g. Western Europe and North America, the pattern of transmission is different. In these countries, mother-to-infant and child-to-child transmission accounted for up to one third of chronic infections before childhood hepatitis B vaccination programmes were implemented.

Today however, the majority of infections in these countries are acquired during young adulthood by sexual activity, and injecting drug use. In addition, hepatitis B virus is the major infectious occupational hazard of health workers, and most health care workers have received hepatitis B vaccine. Hepatitis B virus is not spread by contaminated food or water, and cannot be spread casually in the workplace. High rates of chronic HBV infection are also found in the Amazon and the southern parts of Eastern and Central Europe. In the Middle East and Indian sub-continent, about 5% are chronically infected. In U.S., adolescents and young adults account for the majority of reported cases of hepatitis B infection. Sexual contact (intercourse) being the most common means of transmission. The virus also can be spread by hepatitis B virus-contaminated blood or body fluid in several different ways. These ways include intravenous drug use, skin-popping (injecting under the skin), tattooing, body piercing, and acupuncture using non-sterile instruments. Additionally, hepatitis B virus can be transmitted through the sharing of toothbrushes and razors. Finally, blood-sucking insects such as mosquitoes and bed bugs that are common in the tropics have reportedly spread hepatitis B virus.

Young children who become infected with HBV are the most likely to develop chronic infection. About 90% of infants infected during the first year of life and 30% to 50% of children infected between 1 to 4 years of age develop chronic infection. The risk of death from HBV-related liver cancer or cirrhosis is approximately 25% for persons who become chronically infected during childhood.

SYMPTOMS OF ACUTE HEPATITIS B:

Acute hepatitis B is the initial, rapid onset, short duration of illness that results from infection with hepatitis B virus. About 70% of adults with acute hepatitis B have few or no symptoms. The remaining 30% develop significant symptoms two to four months following exposure to the hepatitis B virus. This period of time between the exposure and the first symptoms is what is usually referred to as the incubation period. The most common symptoms of acute hepatitis B includes; fatigue, loss of appetite, nausea, and abdominal pain over the region of the liver. Jaundice (yellow skin) often accompanies these other symptoms. When this happens, the infection is commonly termed as acute icteric (jaundiced) hepatitis. Occasionally, individuals with acute hepatitis B develop the so-called prodromal symptoms. These are symptoms that start just the onset of the commonly showing symptoms. Sometimes, the prodromal symptoms resemble an allergic reaction, such as skin rash, pain and swelling of the joints, and low-grade fever. Other times, the prodromal symptoms resemble the symptoms of the flu. Rarely (in less than 0.5% of adults), individuals with acute hepatitis B can develop acute liver failure (fulminant hepatitis). These patients are extremely ill with the symptoms of acute hepatitis already described and the additional problems of confusion or coma (encephalopathy) and bruising or bleeding (coagulopathy). In fact, up to 80% of people with fulminant hepatitis can die within days to weeks.

DETERMINANT OF THE OUTCOME OF THE ACUTE HBV:

The individual's ability to eliminate (clear) the hepatitis B virus from the body and recover from acute hepatitis B depends on the strength of the body's immune response to the infection. The stronger the immune response, the greater is the likelihood of eliminating the virus and recovering. By the same token, however, the stronger the immune response, the more likely is the occurrence of acute liver injury and symptoms. On the other hand, a weaker immune response results in less liver injury and fewer symptoms. At the same time, however, the weaker immune response results in less viral elimination (clearance) and a greater likelihood of developing chronic hepatitis B viral infection. Indeed, most infants and children who acquire acute hepatitis B viral infection are asymptomatic, but their rate of developing chronic hepatitis B virus is greater than 95%. Most adults (about 95%), particularly those with acute, symptomatic, icteric hepatitis B (with jaundice), will recover completely from the infection within two to three months. They also will develop immunity, that is, protection from a subsequent hepatitis B viral infection. Moreover, these individuals rarely develop chronic liver disease. In contrast, those adults with few or no symptoms during their episode of acute hepatitis B, as compared to other adults with symptoms, are less likely to clear the infection and are more likely to develop chronic hepatitis B.

CHRONIC HEPATITIS B INFECTION:

The diagnosis of chronic hepatitis B can be made, by definition, only after six months from the onset of acute hepatitis B. It is often difficult to suspect the diagnosis of chronic hepatitis B based just on the patient's symptoms. The reason for this difficulty is that those individuals, who develop chronic hepatitis B, are usually the same individuals who had few or no symptoms to signal the onset of their acute hepatitis B.

Moreover, most individuals with chronic hepatitis B infection remain symptom free (asymptomatic) for many years, even up to two or three decades. During this time, the patient's liver blood tests usually are at most mildly abnormal and the inflammation and scarring (fibrosis) of the liver progresses little, if at all. Occasionally, however, these individuals with otherwise inactive chronic hepatitis B may develop flares (reactivation) of acute symptoms, elevated liver blood tests, and inflammation of the liver. These flares resemble acute hepatitis, but they can cause progression of the chronic liver scarring (fibrosis). They tend to occur in men who acquired the chronic infection at a young age.

At some point, however, the chronic hepatitis can progress to CIRRHOSIS (severe scarring, or fibrosis) of the liver. These patients then can develop the symptoms and signs (abnormal findings on physical examination) of cirrhosis. For example, they can become weak, fatigued, and susceptible to infections. They can also lose muscle mass, especially in the shoulders and upper legs. In fact, they can develop poor nutrition and weight loss from abnormal digestion, malabsorption, or abnormal liver metabolism of nutrients.

Thus, deficiencies can occur, for example, of vitamin A, which causes impaired vision at night, or of vitamin D, which causes thinning of the spine or hip bones (osteopenia). Patients with cirrhosis also often develop visible evidence (stigmata) of cirrhosis, including swollen breasts (gynecomastia), small (atrophic) testicles, red palms (palmar erythema), and characteristic dilated vessels on the skin (spider angioma).

ADVANCED LIVER CIRRHOSIS:

Ultimately, the progression of cirrhosis leads to what is commonly known as advanced cirrhosis, which is characterized by the development of certain complications. Advanced cirrhosis is sometimes referred to as cirrhosis or chronic liver failure. Some authorities also use the term, decompensated cirrhosis, as synonymous with advanced cirrhosis. Others, however, reserve the term, decompensated cirrhosis, for advanced cirrhosis that includes specifically any of the complications that result primarily from portal hypertension. (Some of the complications of advanced cirrhosis can have multiple causes.) This difference in terminology matters little because the important consideration in any particular case is to simply specify which of the complications of cirrhosis apply.

Accordingly, the complications of cirrhosis that indicate the presence of advanced cirrhosis are complications that include those resulting primarily from portal hypertension (fluid retention, encephalopathy, GI bleeding, hypersplenism, and the hepatorenal syndrome), as well as coagulopathy, jaundice, and the hepatopulmonary syndrome. Portal hypertension is the term for the increased pressure in the portal venous system that occurs in patients with advanced cirrhosis. (The portal venous system drains blood from the intestinal and abdominal organs to the liver.) The most common complications of cirrhosis that result primarily from portal hypertension are fluid retention, hepatic (liver) encephalopathy, and gastrointestinal (GI) bleeding. The retention of fluid leads to swollen ankles (edema) and a swollen abdomen( ascites).

Sometimes, the fluid in the abdomen becomes infected (spontaneous bacterial peritonitis), causing fever and abdominal pain. The hepatic encephalopathy causes drowsiness, confusion, and even coma. Widened (dilated) veins (varices) in the esophagus and stomach that burst can cause GI bleeding. As a result, the patient may vomit bright red blood or defecate dark (even tarry) blood. Some patients develop hypersplenism, a complication that is due, in part at least, to portal hypertension. These patients have an enlarged spleen (splenomegaly), decreased red blood cells (anemia), decreased white blood cells (leukopenia), and decreased platelets (thrombocytopenia). The anemia causes weakness; the leukopenia contributes to infections; and the thrombocytopenia impairs the clotting of blood. Patients with portal hypertension also can develop a serious problem with the functioning of their kidneys without actual damage to the kidneys themselves (hepatorenal syndrome).

In advanced cirrhosis also, other important complications can occur besides those due primarily to portal hypertension. For example, some patients are prone to easy bruising and bleeding, largely because the impaired function of the liver causes abnormalities in the blood clotting process (coagulopathy). Patients with advanced cirrhosis can also develop jaundice because the damaged liver is unable to adequately eliminate a yellow compound, called bilirubin. More rarely, some patients can develop difficulty with breathing because certain hormones released in advanced cirrhosis cause abnormal functioning of the lungs (hepatopulmonary syndrome).

LIVER CANCER (HEPATOCELLULAR CARCINOMA)-DUE TO ADVANCED CIRRHOSIS:

Finally, liver cancer can develop in chronic HBV infected patients as a complication of advanced cirrhosis. This primary (originating in the liver) cancer of the liver is most likely to occur in people with active hepatitis B virus reproduction. The way in which the cancer develops is not yet fully understood. It is thought, however, that the hepatitis B virus DNA somehow becomes incorporated into the liver cell DNA of the patient. The most common symptoms and signs of liver cancer are abdominal pain and swelling, an enlarged liver, weight loss, and fever. In addition, the liver tumors can produce and release a number of substances, including ones that cause increased red blood cells (erythrocytosis), low blood sugar (hypoglycemia), and high blood calcium (hypercalcemia). The most useful diagnostic screening tests for liver cancer are an alpha-fetoprotein blood test and an ultrasound imaging study of the liver.

HBV INVOLVEMENT OF ORGANS OUSTIDE THE LIVER-(EXTRA-HEPATIC):

Rarely, chronic hepatitis B infection can lead to disorders that affect organs other than the liver. The deposit of specific hepatitis B virus immune complexes in the various organs usually causes these disorders. A hepatitis B virus immune complex is the entity that results from the binding together of a hepatitis B virus antibody and a hepatitis B virus antigen. (An antigen is a substance that is foreign to the body and an antibody is a specialized protein that is produced by white blood cells in response to the antigen. Hepatitis B virus immune complexes that settle, or deposit, in the small arteries throughout the body can result in an inflammation of these vessels (vasculitis), called polyarteritis nodosa. This condition can cause a wide range of symptoms, including muscle weakness, nerve damage (neuropathy), deep skin ulcers, kidney problems with loss of protein in the urine, (proteinuria), and sometimes kidney failure, high blood pressure, unexplained fevers, and abdominal pain. The hepatitis B virus immune complexes can cause damage to the kidneys in yet another way. That is, the immune complexes can be deposited in the glomeruli(filtering elements) of the kidney, causing glomeronephritis, which is a different disease from polyarteritis nodosa.

DIAGNOSIS OF HBV:

Hepatitis B is diagnosed from the results of specific hepatitis B virus tests (serologies) that reflect the various components of the hepatitis B virus. These serological tests differ from the standard liver tests (such as the ALT and AST) that can become abnormal when the liver is damaged from whatever cause, including hepatitis B viral infection. HBsAg AND anti-HBs:

The diagnosis of hepatitis B infection is made primarily by detecting the hepatitis B surface antigen (HBsAg) in the blood. The presence of HBsAg means that there is active hepatitis B viral infection and the absence of HBsAg means that there is no active hepatitis B viral infection. Following an exposure to hepatitis B virus, HBsAg becomes detectable in the blood within four weeks. In individuals who recover from acute hepatitis B viral infections, the elimination, or clearance, of HBsAg occurs within four months after the onset of symptoms. Chronic hepatitis B viral infection is defined as the persistence of HBsAg for more than six months.

After the HBsAg is eliminated from the body, the antibodies to HBsAg (anti-HBs) usually appear. These anti-HBs provide immunity to subsequent hepatitis B viral infection. Likewise, individuals who are successfully vaccinated against hepatitis B virus have measurable anti-HBs in the blood.

Anti-HBc:

The hepatitis B core antigen can only be found in the liver and cannot be detected in the blood. The presence of large amounts of hepatitis B core antigen in the liver indicates an ongoing reproduction of the virus. This means that the virus is active. The antibody to hepatitis B core antigen, known as the hepatitis B core antibody (anti-HBc), however, is detectable in the blood. As a matter of fact, two types of anti-HBc antibodies (IgM and IgG) are produced.

IgM anti-HBc is a marker (indicator) for acute hepatitis B infection. The IgM anti-HBc is found in the blood during the acute infection and lasts for up to six months after the onset of symptoms. IgG anti-HBc develops during the course of the acute hepatitis B viral infection and persists for life, regardless of whether the individual recovers or develops the chronic infection. Accordingly, only the IgM type of anti-HBc can be specifically used to diagnose an acute hepatitis B viral infection. Moreover, determining just the total anti-HBc (without separating its two components) is not very helpful.

HBeAg, anti-HBe, AND PRE-CORE MUTATIONS:

Hepatitis B e antigen (HBeAg) and its antibody, anti-HBe, are useful markers to determine the likelihood of spread of the virus (transmissibility) by persons affected with chronic hepatitis B viral infection. Detecting both HBeAg and anti-HBe in the blood is usually mutually exclusive. Accordingly, the presence of HBeAg means ongoing viral activity and the ability to infect others, whereas the presence of anti-HBe signifies a more inactive state of the virus and less risk of transmission.

In some individuals infected with hepatitis B virus, the genetic material for the virus has undergone a particular structural change, called a pre-core mutation. This mutation results in an inability of the hepatitis B virus to produce HBeAg, even though the virus is actively reproducing. This means that even though no HBeAg is detected in the blood of people with the mutation, the hepatitis B virus is still active in these persons and they can infect others.

Hepatitis B virus DNA:

The most specific marker of hepatitis B virus reproduction is the measurement of hepatitis B virus DNA in the blood. You remember that DNA is the genetic material of hepatitis B virus. High levels of hepatitis B virus DNA indicate an ongoing reproduction of the virus and viral activity. Low or undetectable levels of hepatitis B virus DNA are associated with the inactive phase of hepatitis B viral infection. Several different laboratory tests (assays) are available to measure hepatitis B virus DNA.

The PCR- (polymerase chain reaction) is the most sensitive method (assay) for determining the level of hepatitis B virus DNA. This means that the PCR is the best method for detecting minute amounts of the hepatitis B virus marker. This method works by amplifying the material that is being measured up to a billion times for its detection. The PCR method, therefore, can measure as few as 50 to 100 copies (particles) of hepatitis B virus per milliliter of blood. This test, however, is actually too sensitive for practical diagnostic use.

The purpose of measuring hepatitis B virus DNA usually is to determine whether the hepatitis B viral infection is active or inactive (quiescent). This distinction can be made based on the amount of hepatitis B virus DNA in the blood. High levels of DNA indicate an active infection, while low levels indicate a dormant, or inactive, infection. Thus, patients with dormant disease have about a million viral particles per milliliter of blood, whereas patients with active disease have several billion particles per milliliter. Therefore, anyone who is HBsAg positive, even if the hepatitis B viral infection is inactive, will have detectable levels of hepatitis B virus DNA by the PCR method because it is so sensitive.

For practical purposes, hepatitis B virus DNA can be measured using a so-called hybridization method (assay), which is a less sensitive test than the PCR. Unlike the PCR method, the hybridization assay measures the viral material without amplification. Thus this test can detect hepatitis B virus DNA only when many viral particles are present in the blood, meaning that the infection is active. In other words, from a practical point of view, if hepatitis B virus DNA is detected with a hybridization assay, this means that the hepatitis B viral infection is active.

PREVENTION AND TREATMENT:

Liver cancer is almost always fatal, and usually develops between 35 and 65 years of age, when people are maximally productive and with family responsibilities. The loss of a mother or a father can be devastating to the entire family. In developing countries, most people with liver cancer die within months of diagnosis. In industrialized countries, surgery and chemotherapy can prolong life up to a few years. Chronic hepatitis B in some patients can be treated with drugs such as interferon or lamivudine, which can help some patients. However, interferon or lamivudine therapies are very costly and therefore few individuals can afford them and will never be available to most patients in developing countries due to their costs. Patients with cirrhosis are sometimes given liver transplants, with varying success. It is preferable to prevent this disease with vaccine than to try to cure it.
SAFETY AND EFFECTIVENESS OF THE HBV CACCINES:

The vaccine is given as a series of three intramuscular doses. It has been said that the vaccine is 95% effective in preventing children and adults from developing chronic infection if they have not yet been infected. In many countries where 8% to 15% of children used to become chronically infected with HBV, the rate of chronic infection has been reduced to less than 1% in immunized groups of children. And the reports are showing that. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide.

PREVENTION:

All countries have been urged by world bodies to add hepatitis B vaccine into their national immunization programmes. As of March 2000, 116 countries had included hepatitis B vaccine in their national programmes including most countries in Eastern and South- East Asia, the Pacific Islands Australia, North and South America,Western Europe and the Middle East. However, many low income countries in sub-Saharan Africa, the Indian subcontinent and in the Newly Independent States do not use the vaccine. The price of the hepatitis B vaccine has been one of the main obstacles to its introduction in many of these countries.

The Global Alliance for Vaccines and Immunization (GAVI) was created in 1999. It is a unique coalition of public and private institutions. The main mission of GAVI is to vaccinate as many children as possible against vaccine-preventable diseases. GAVI has introduced a new approach to international health funding: the Global Fund for Children's vaccines (GFCV). This fund will help 74 low-income countries including those in the sub-Saharan Africa, Asia and Southern America to reinforce their national vaccine programmes and introduce hepatitis B, yellow fever and haemophilus influenzae type b (Hib) vaccines into their national immunization programmes.

LIVER DISEASES-(HEPATITIS )CONTINUES

2008-07-20T12:42:00.001-07:00

HEPATITIS A

Hepatitis A is caused by the viral hepatitis A or (HAV). It is an acute illness (acute viral hepatitis) that never becomes chronic. It was once referred to as "infectious hepatitis" because it could be spread from person to person like other viral infections. Infection with hepatitis A virus can be spread through the ingestion of food or water, especially where unsanitary conditions allow water or food to become contaminated by human waste containing hepatitis A (the fecal-oral mode of transmission). Hepatitis A typically is spread among household members and close contacts through the passage of oral secretions (intimate kissing) or stool (poor hand hygiene). It also is common to have infection spread to customers in restaurants and among children and large groupings if hand washing and sanitary precautions are not observed.

DESCRIPTION-SIGNS AND SYMPTOMS:

Hepatitis A is a liver disease caused by the hepatitis A virus. Good personal hygiene and proper sanitation can help prevent hepatitis A. Vaccines are also available for long-term prevention of hepatitis A virus infection in persons 12 months of age and older. Immune globulin(IG) is available for short-term prevention of hepatitis A virus infection in individuals of all ages.

Adults will have signs and symptoms more often than children.
• jaundice
• fatigue
• abdominal pain
• loss of appetite
• nausea
• diarrhea
• fever

LONG-TERM EFFECTS:

There is no chronic (long-term) infection. Once you have had hepatitis A, you cannot get it again.
About 15% of people infected with HAV will have prolonged or relapsing symptoms over a 6-9 month period.

TRANSMISSION:

HAV is found in the stool (feces) of persons with hepatitis A. HAV is usually spread from person to person by the fecal-oral route. Food borne transmission occurs when an HAV-infected food handler contaminates food during preparation or when food is contaminated during harvesting or processing before reaching the food service establishment or home( putting something in the mouth-even though it might look clean) that has been contaminated with the stool of a person with hepatitis A.

PERSONS AT RISK OF INFECTION:

Household contacts of infected persons, Sex contacts of infected individuals, persons especially children- living in areas with increased rates of hepatitis A, Men who have sex with men and Users of injection and non-injection drug.

PREVENTION:

Hepatitis A vaccine is the best protection. Short-term protection against hepatitis A is available from immune globulin(IG). It can be given before and within 2 weeks of coming in contact with HAV. Always wash your hands with soap and water after using the bathroom, changing undergarments, and before preparing and eating food.

VACCINATION:

Among the vaccines available are Havrix and Vaqta. Both contain inactive (killed) hepatitis A virus. For adults, two doses of the vaccine are recommended. After the first dose, protective antibodies develop in 70% of vaccine recipients in 2 weeks and more than 95% of recipients in 4 weeks. After two doses of the hepatitis A vaccine, immunity against hepatitis A infection is believed to last for many years.

Individuals at increased risk for acquiring hepatitis A and individuals with chronic liver disease (e.g., cirrhosis or chronic hepatitis C) should be vaccinated. Although individuals with chronic liver disease are not at increased risk for acquiring hepatitis A, they can develop serious (sometimes fatal) liver failure if infected with hepatitis A and, thus, they should be vaccinated.
Individuals at increased risk of acquiring hepatitis A are:
• Travelers to areas where hepatitis A is common
• Men who have sex with men who are infected
• Illegal drug users (either injection or non-injection drug use)
• Researchers working with hepatitis A or primates that are susceptible to infection with hepatitis A
• Patients with clotting factor disorders who are receiving clotting factor concentrates that can transmit hepatitis A
Some local health authorities or private companies may require hepatitis A vaccination for food handlers.

Because protective antibodies take weeks to develop, travelers to endemic areas should be vaccinated at least 4 weeks before departure. Immune globulin is recommended to be given in addition to vaccination if departure is prior to 4 weeks. Immune globulin provides quicker protection than the vaccines, but the protection is short-lived.

KENYA IS NOT FOR SALE

2008-07-04T22:54:00.000-07:00

It is mind boggling to read this kind of garbage from the media that a full deputy- prime- minister of a coalition government is actually trying to justify corruption/and or a mismanagement-and in a not so covert way...... Deputy Prime Minister Uhuru Kenyatta also defended the Finance Minister saying that he was being subjected to a “lynching mob".

And also that there were actually some skin heads demonstrating. So I am not sure what the demonstrators were trying to prove- That embezzling/fleecing public assets are birth rights for some people/group? me think not. But will be interesting to see how this one spins out.

Actually two groups were demonstrating in support of Mr. Kimunya drawing mixed reactions from police as one was dispersed with teargas while the other marched to the hotel at the centre of the onslaught against the minister.

The first group, led by Lang’ata politician Stanley Livondo and comprising about 500 protesters, marched from the Arboretum grounds to the city centre before anti-riot police intercepted them. Waving placards, the group ignored an order from a senior police officer not to proceed to Parliament, forcing him to call for reinforcements. "You need a permit to have a procession and since you have not requested one, you should disperse,” said the officer.

Mr Livondo defied the order and urged the protesters to continue with their march.“You cannot stop us from conveying our message. These MPs who are accusing the minister are known to be corrupt and cannot throw stones at him,” he said. Mr Livondo accused Prime Minister Raila Odinga of pretending that he was not aware of the deal.

Mr Odinga has said he was briefed by Central Bank of Kenya governor Prof Njuguna Ndung’u as claimed by Mr Kimunya on Wednesday but added that at the time, there were conflicting statements from gorvernment officials about the sale of the hotel.

Meanwhile, the other group of demonstrators marched from Jevanjee Gardens to Mr Kimunya’s Treasury Building office. They chanted “Kimunya kaa Ngumu (Kimunya stay put!)” as they marched through the streets carrying placards. Some of their placards read “No Kimunya, No cabinet, MPs must be taxed, MPs are pretending.”

A spokesman, Mr Hosea Mwangi said the group comprised “concerned Nairobians” agitated by the fact that some of the MPs calling for Mr Kimunya’s resignation had been involved in mega scandals.“They are crucifying Kimunya because of his proposal to tax them. If he has done anything wrong, he should be allowed to tell his side of the story,” he said.

He accused the MPs of trying to divert Kenyans’ attention from more important issues by hounding Mr Kimunya. The demonstrators briefly gathered outside the Grand Regency where they chanted and danced before marching to the Freedom Corner at Uhuru Park.

Another blogger's perspective captured it best:

"THE ARROGANCE OF KIMUNYA- WITH THE SUPPORT OF THE KIKUYU MAFIA THE LIKES OF WAKINA UHURU KENYATTA IS DESPICABLE!!"

God complex is the self-delusion that one has a special mission to save the world. This delusion is engendered by extreme arrogance and absence of humility. It is a disease that afflicts the rich, the powerful and the privileged.

This complex is manifested in Finance minister Amos Kimunya.

When confronted by Parliament on Wednesday with a list of misdeeds, he responded by saying how he had rid the country of land-grabbers and tax dodgers, and how he had laid the institutional and legal structures to fight corruption. Mr Kimunya missed an opportunity to defend himself.

The minister is young, compared to most Kenyan political leaders, and well read, but completely naive in political leadership. Public service demands that the leaders live by the code they preach. It does not matter how many good laws one passes; it doesn’t matter how many anti-corruption institutions are set up — what matters is whether a leader abides by them.

Mr Kimunya’s public life betrays a man with contempt for systems he has set up. In the sale of Grand Regency Hotel to Libyans, if indeed they are, he broke every law applicable. He treated the hotel as casually as one would a ball-point pen.

But let us first have a look at what happened to world leaders with arrogance milder than Mr Kimunya’s so that we may realize how we have treated him with velvet gloves. David Blunkett was born blind, yet he rose to be a close and powerful confidante of British Prime Minister Tony Blair and held various Cabinet positions, including home affairs.

Socialite mistress

Mr Blunkett had a pretty and socialite mistress called Kimberley Quin, the editor of The Spectator magazine.

Ms Quin imported a Filipino nanny called Leoncia Casalme and, as required by law, she applied for a long-term work permit which takes about a year to complete. Ms Casalme qualified for the permit, but had to wait like everyone else for the process to complete its course.

Ms Quin, being the Home Affairs minister’s mistress, did not have such patience and on April 23, 2003, asked Mr Blunkett to fast-track the process.

Indeed, five days later, the permit was issued. When this fast-tracking was leaked to the media, the United Kingdom Parliamentary Committee on Standards censured him, and he quit.

In the US, Eliot Spitzer, a celebrity attorney-general for the New York state, went about his work with such gusto and chutzpah that he rid the city of economic crimes perpetrated by the large companies.

Wall Street was shaken to the ground and many were fined billions of dollars in plea bargains. In America, the law allows companies to in certain cases pay millions of dollars to avoid criminal investigations and prosecution, but on condition that one fixes up the problem.

New York was grateful and elected Mr Spitzer governor. In the same way he rid the city of economic crimes, he changed course to now deal with crimes personal: rid the city of prostitution.

It later transpired that while fighting the vice, the governor was member No 9 of an elite prostitution group, arrogantly called VIP Emperors Club. In shame, the governor resigned when he was hounded by the media.

Mr Blunkett and Mr Spitzer did not wait to be sacked or impeached respectively; they quit when their private peccadilloes were made public. Both men demanded from the public a high moral rectitude, yet they never lived by it.

They wanted to decouple their private lives from the public perceptions they had created. The false firewall was bound to fall and it did. And both men who had just begun national leadership and on the way to higher callings, have now disappeared into obscurity.

What did, or did not, Mr Kimunya do? At the outset, we must accept the fact that the entire truth and all the details surrounding the Grand Regency sale may never be told to the public.

Building the case:

But the information available to all is enough to build a case of impropriety on the part of the minister, Central Bank, National Security Intelligence Service and errant officers at Lands ministry.

The land Grand Regency is built on falls under the Registration of Titles Act, Cap 281, which is the clearest and most elaborate of the land laws. I have argued before in these columns that all land laws should be simplified and brought together within this Act.

This Act sets out the process of registering and deregistering land titles. The registrar of titles is the chief executive for properties falling under this Act and acts without any external interference.

Sections 59 and 60 of the Act allow him to recall and cancel a title deed obtained by deception, fraud, error, misrepresentations or by mistake, as has happened here.

Mr Kimunya says the land was sold for Sh2.9 billion to the Libyan government. We now know that the land was sold for Sh1.8 billion and that the buyer is a Kenyan company with Kenyan directors who have since disowned their signatures. And the minister insists that the sale is a government-to-government deal, yet this is not true.

The minister insists also that the land was sold for Sh2.9 billion even when the evidence is to the contrary. The sale agreement conveniently splits the transaction into two parts — the actual land and the hotel’s “movable assets”.

This dichotomy is false, fraudulent and misleading. Grand Regency was being sold as a going concern, yet the sale is a cannibalized one.

As a going concern, the hotel ought to have been sold at an all-inclusive price for the land, the building, the movable assets, the business goodwill, the reputation and all other intellectual property rights it has acquired.

If Grand Regency was being bought to be used as an office block, the dichotomy may make sense. No prestigious hotel has been sold the way Grand Regency has; the valuations are ridiculous, if not deceptive.

In law, land includes the physical land, the building on it and anything annexed to it. There is a legal doctrine — quicquid plantatur solo, solo cedit — that captures the entire meaning of land law.

This doctrine is that anything attached to land is part of the land. If, therefore, the wall paintings, beds, machines and kitchens at Grand Regency are firmly fixed on the floors and walls, then they are part of the land, and not separate, as the sale agreement implies. In making these false separations, the Government may have lost stamp duty worth more than Sh44 million. Who pocketed this money?

Once Grand Regency was surrendered to Central Bank, it became a public asset and its disposal was subject to the Public Procurement and Disposal Act, 2005, and the Privatization Act, 2005. Disposal of land is specifically identified as being a transaction that falls under these two Acts.

The law demands that the process of disposal include open tendering — invitation of tenders through advertisements and competitive bidding. Above all, the entire process is subject to the Cabinet’s control and vetting. Again, other than Mr Kimunya himself, every minister who has spoken has denied knowledge of the process.

And what was the National Security Intelligence Service doing at the lands offices overseeing the registration?

Normal land transactions take at times as long as three months, yet NSIS saw to it that the Grand Regency transfer was done in a day. Section 5 of the National Security Intelligence Service Act, 1998, clearly states that the security agency’s core and only duty is to protect Kenya from threats or potential threats.

When did the Grand Regency sale become part of the national security matrix? For the umpteenth time, I wish to say that NSIS is of no value to the country. We pay it Sh8 billion a year for its officers to idle till they misinterpret their mandate to think it includes running errands for politicians or dealing in properties sales. NSIS ought to be disbanded.

Throughout the entire process of the sale, Mr Kimunya was economical with the truth. The Public Officer Ethics Act, 2003, demands of him honesty, integrity, courtesy and respect to the public and the Government. But he violated every provision in the Act.

The sale shows that mandatory provisions of the Registration of Titles Act, Cap 281; the National Security Intelligence Service Act, 1998; the Central Bank of Kenya Act, Cap 491; the Anti-Corruption and Economic Crimes Act, 2003, and the Public Officer Ethics Act, 2003, were broken with impunity by Mr Kimunya, and with the tacit support of CBK governor Njuguna Ndung’u and NSIS director-general Michael Gichangi.

Mr Kimunya, Mr Ndung’u and Maj-Gen Gichangi must be indicted if the rule of law exists in this country.

In its absence, we will know that the law is two-tracked — for the powerful and the weak. We can only respect our systems if its top officers themselves respect them. Impunity that arises from political arrogance must end.

THE TWISTS AND TURNS OF THE GRAND REGENCY HOTEL OWNERSHIP

2008-06-27T21:10:00.000-07:00

cut and paste:

ANGLO-(F)LEASING PART II?

Saturday, June 28, 2008-DN.

COMMON LIVER DISEASES -PART TWO

2008-06-22T14:58:00.000-07:00

LIVER DISEASES PART TWO:

HEPATITIS:

Hepatitis in itself- is the inflammation of the liver. Many illnesses and conditions can cause inflammation of the liver, for example, drugs/medications, alcohol, chemicals, and autoimmune diseases. Also many organisms most specifically viruses,i.e virus of mononucleosis and the cytomegalovirus can inflame the liver. Most viruses, however, do not primarily attack the liver; the liver is just one of several organs that the viruses affect. When doctors/health professions speak of viral hepatitis, they usually are referring to hepatitis caused by a few specific viruses that primarily attack the liver. There are several hepatitis viruses; they have been named types A, B, C, D, E, F (not confirmed), and G. As the knowledge of hepatitis viruses grows, it is likely that this alphabetical list will become longer. The most common hepatitis viruses are types A, B, and C.

The liver, located in the upper right hand side of the abdomen and mostly behind the rib cage normally weighs close to 1.5kgs. It does the following vital functions:

1. The liver helps purify the blood by changing harmful chemicals into harmless ones. The source of these chemicals can be external, such as medications or alcohol, or internal, such as ammonia or bilirubin. Typically, these harmful chemicals are broken down into smaller chemicals or attached to other chemicals that then are eliminated from the body in the urine or stool.
2. The liver produces many important substances, especially proteins that are necessary for good health. For example, it produces albumin, the protein building block of the body, as well as the proteins that cause blood to clot properly.
3. The liver stores many sugars, fats and vitamins until they are needed elsewhere in the body.
4. The liver builds smaller chemicals into larger, more complicated chemicals that are needed elsewhere in the body. An example of this type of function is the manufacture of cholesterol.

When the liver is inflamed, it does not perform these functions well, which brings about many of the symptoms, signs, and problems associated with hepatitis.

****TO BE CONTINUED****

COMMON LIVER DISEASES -PART ONE

2008-06-22T14:32:00.000-07:00

LIVER DISEASES PART ONE

LIVER ABSCESS:

Liver abscess occurs when bacteria or protozoa destroy liver tissue, producing a cavity that fills with infectious organisms, liquefied liver cells and white blood cells. The dead tissues may then seal off the cavity from the rest of the liver making it less effective. Although uncommon, sometimes the puss-filled abscesses may rapture into another body cavity resulting into multiple abscesses, posing serious complications for the patient and can sometimes be fatal.

Causes:

The puss-filled liver abscesses commonly result from infection by such bacteria as Escherichia coli (E.coli), Klebsiella, Entrobacter, Salmonella, Staphylococcus and Enterococcus. These bacteria may invade the liver through liver wound, or spread from the lungs, skin, or other organs through the liver’s artery, veins or bile duct. And usually more than one abscess is present often allowing peritonitis, cholecystitis, pneumonia and bacterial endocarditis.

An amoebic abscess is usually caused by the infection of protozoa- Entamoeba histolytica..the same organism that is mostly associated with dysentery. And usually there is one amoebic abscess occurring in the right lobe of the liver.

Symptoms:

The symptoms vary from one individual to another. In some people, they are acutely ill while in others, the abscess is recognized only during autopsy after death from another illness. The bacterial symptoms are sudden and those of protozoan origin are more subtle. And the common signs may include; right abdominal and shoulder pains, weight loss, fever, chills, perspiration, nausea, vomiting and anemia. If the abscess extends to the diaphragm, there will be signs in the lungs. Abscess related liver damage may also cause jaundice.

Diagnosis:

Usually the doctor reviews the patients’ medical history and among other tests evaluates a liver scan to check for filling defects at the area of abscess. A liver ultrasound may also indicate the presence of an abscess but is less definitive than a liver scan. Computed tomography scan (CAT scan) can be used to confirm the diagnosis. Also laboratory tests such as blood/stool cultures are used to provide additional details as the protozoa or bacteria responsible can be easily identified.

Treatment:

The physician can start antibiotic therapy immediately if the causal organism has not been isolated. And if cultures show that the infection is caused by E.coli, the treatment includes drugs like ampicillin-(good for gram negative rods such as E.coli)

If the tests show the presence of Entamoeba histolytica, then the treatment will include Aralen or Flagyl. The therapy usually continues for 2 to 4 months. And an abscess that fails to respond can be surgically removed.

TYPHOID FEVER

2008-06-20T23:37:00.000-07:00

Typhoid fever is an enteric form of (fever) caused by Salmonella typhi, the typhoid bacillus. It is characterized by prolonged fever and multi-system involvement, including lymph nodes, liver, and spleen. The sudden onset of sustained fever, severe headache, and nausea, loss of appetite, constipation or sometimes diarrhea can be life threatening. Severe forms have been described with mental dullness and meningitis. The paratyphoid fever can be caused by any of three serotypes of Salmonella paratyphi A, B and C. It is similar in its symptoms to typhoid fever, but tends to be milder, with a lower fatality rate. In endemic areas, the incidence of typhoid fever is highest in children and young adults from 5-19 years old.

Transmission:

Upon ingestion, typhoid bacilli rapidly penetrate the small intestinal mucosa by transcytosis through M cells and enterocytes, and are taken up by macrophages or diffuse into mesenteric lymph nodes. A primary bacteraemia follows and the pathogen rapidly attains intracellular haven throughout the reticuloendothelial system. This is followed by a sustained secondary bacteraemia associated with clinical illness. S. typhi also shows remarkable predilection for the gall-bladder, where infection tends to become chronic especially in individuals with a pathologic gall-bladder condition.

The disease is almost exclusively transmitted by food and water contaminated by the faeces and urine of infected people and those that are carriers. Polluted water is the most common source of typhoid transmission. In addition, shellfish taken from sewage-contaminated beds, vegetables fertilized with night-soil and eaten raw, contaminated milk and milk products also have been shown to be a source of infection. People can transmit the disease as long as the bacteria remain in their body; most people are infectious prior to and during the first week of convalescence, but 10% of untreated patients will discharge bacteria for up to 3 months. In addition, 2–5% of untreated patients will become permanent, lifelong carriers of the bacteria in their gall-bladder. Usually 10% of the cases can be reduced to less than 1% with appropriate antibiotic therapy. However, strains resistant to chloramphenicol and other recommended antibiotics (ampicillin, cotrimoxazole and even ciprofloxacin) have become prevalent in recent years.

Vaccine:

The two most commonly used are: - oral typhoid vaccine and a single-dose injectable vaccine. These two produces fewer side effects than the older two-dose injectable vaccines. Both vaccines are equally effective and offer 65% to 75% protection against the disease. It is also important to note that, at present no vaccine offers 100% immunity.

The oral vaccine (Vivotif) contains a live but weakened strain of the Salmonella bacteria that causes typhoid fever. The vaccine consists of four capsules that are taken every other day over a one-week period. The capsule protects the vaccine against stomach acid so it remains active when it reaches the intestine where the immunity develops. The oral vaccine can be given either as a first-time dose or as a booster dose. The protection should last about 5 years, at which time another booster dose may be needed. The oral vaccine is not recommended for children under 6 years old.

The single-dose injectable vaccine, (Typhim VI) contains capsular polysaccharide antigen given as a single 0.5 cc/ml intramuscular injection. Immunity is conferred seven days after vaccination and should last for 2 years. Subsequent booster doses are recommended at 2-year intervals. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. Side effects, while greater than those of the oral vaccine, are much less than those experienced with the old 2-dose injectable vaccine.

The safety of typhoid vaccine during pregnancy is unknown. If typhoid immunization is necessary during pregnancy, the injectable polysaccharide vaccine (Typhim Vi) is probably preferable, because it does not contain live bacteria. Oral typhoid vaccine is safe in HIV-infected individuals as long as their CD4 lymphocyte counts remain above 200.

Breastfeeding is probably protective against typhoid fever in infants.

Due to limited efficacy of the typhoid vaccine, and the fact that many other infections can be acquired from contaminated food and beverages, immunization against typhoid should not in any way limit the importance of following food and water precautions.

DEMOCRATIC PRIMARY' 08 FINAL

2008-06-08T16:31:00.000-07:00

FINAL UPDATE OF DEM'S PRESIDENTIAL PRIMARY OUTCOME(2008):

** super delegate numbers **

- Feb. 5: Clinton 260-170 Obama
- Feb. 28 (after Obama's winning streak of 11-straight contests): Clinton 254-204 Obama
- March 6 (after OH/TX/RI/VT): 254 Clinton-215 Obama
- March 14 (After Obama's wins in WY 3/8; MS 3/11): Clinton 253-217 Obama
- March 31: Clinton 255-222 Obama
- April 15: Clinton 257-231 Obama
- April 23 (the day after the PA primary): Clinton 263-239 Obama
- April 30: Clinton 268-248 Obama
- May 5: (day before Indiana/NC primaries): Clinton 272.5-256 Obama
- May 12: Obama 279-276.5 Clinton
- May 13:Clinton added 20(in West Virginia{28}): Obama added 8
- May 20 : (Kentucky:Clinton 37-14 Obama {51}: Oregon:Obama 31-21 Clinton {52}
-June 1 : (Puerto Rico:Clinton 38-17 Obama {55}
-June 3 : (Montana:Obama 9-7 Clinton {16}: South Dakota:Clinton 8-7 Obama {15})

Total number of delegates for 2008 primary:

Barack Obama-2,158.5(100% of the 2,118 needed)
Hillary Clinton-1,920(90.7% of the 2,118 needed)

**Florida and Michigan delegates fully seated, but with ONE-HALF voting power compromise due to Democratic Party rules violations**

***AND BARACK OBAMA MAKES HISTORY BY BECOMING THE WINNER TO REPRESENT THE DEMOCRATIC PARTY FOR 2008 WHITE HOUSE***

AMNESTY DEBATE IN KENYA

2008-06-01T14:43:00.000-07:00

It should be appalling to every Kenyan at this juncture that a culprit who planned -along with his friends/relatives, executed-like a six y/o would, but somehow succeeded in getting a way with one of the most heinous crime on Kenyan soil now has lectures to give. He and his group has the gall and chutzpah to lecture anyone about obeying the law...etcetera etcetera! what a world. President Kibaki is the wrong candidate to talk about law and order as far as Kenya is concerned. No one is that forgetful. Not long ago -some time towards the end of last year, the exact date would be Dec. 27, 2007. When kibaki and his ilk decided to do what they did and Kenyans and the world at large saw what happened shortly afterwards. Nobody needs to be reminded of it.

Among the buried in the piles are the recommendations that the kenya's multicultural groups reconcile and try to forge a way forward with a spirit of forgiveness, togetherness and start a new, a friendship in cases where this might have been severely damaged. For goodness sake! neighbors turned on to neighbors, friends alike and even brothers and sisters on to each other! no country want a scenario like this repeating itself. Now what should bother every kenyan is that it is this selective application of the law that were one of the raw and sour points that actually turned Kenya upside down. And nobody seems to have learned not one thing from the past few months.

It's been reported in the news media that a section of the coalition-government are opposed to what they term as blanket amnesty. Not forgetting that most of them if not all should have been in custody already ha' it that the law was being followed with the same yardstick. Make no mistake anybody who brakes the law should be punished accordingly. And that should apply across the board not selectively. Or in this extraordinary case, some kind of guidelines should be set to either forgive and reconcile so that the country can move forward. Or set some kind of parameters to guide the punishment for all those took part. STARTING from THE FIRST PERSON ON TOP to THE LAST PERSON at THE BOTTOM. And Not some brainwash/hogwash nonsense.

It was also reported that Kibaki ordered those who committed criminal acts during the political crisis earlier this year be punished. He also directed the police to conclude investigation on cases, saying those who engaged in criminal activities will face the full force of the law. The President announced his stand on the issue for the first time only minutes after Raila had said the Government would find a solution to the problem. Saying society should not spare those who unleashed mayhem.

Kibaki observed: "As a society, we should reject those who incite others to violence. We should not spare them or those who recruit the gangs that cause mayhem. Once investigations are complete, those found to be innocent will be released without undue delay. But those who committed murder of innocent citizens, engaged in reckless destruction of property or rape should not expect any mercy." He revisited the issue in his off-the-cuff address in Kiswahili. "Mtu hawezi kuleta fujo na kuchokoza jirani yake halafu aachiliwe hivyo hivyo. Hiyo hatuwezi. Hakuna mtu mwenye akili timamu atapenda hivyo (Nobody should be allowed to harm his or her neighbour and expect to go Scot-free. Nobody can reason that way)" he said.

He was speaking on Sunday at Nyayo National Stadium, Nairobi, where he led the nation in marking the 45th Madaraka Day celebrations. Those present were First Lady Lucy Kibaki Vice President Mr Kalonzo Musyoka, Prime Minister Mr Raila Odinga, Deputy Prime Minister Mr Musalia Mudavadi, Speaker of the National Assembly Mr Kenneth Marende, Chief Justice Mr Evans Gicheru and other Cabinet ministers. The President issued the directive a day after Police Commissioner Maj-Gen Hussein Ali said 12,000 cases were reported during the post-election chaos, of which 103 were capital offences involving 137 suspects now in remand. And another 550 suspects were being sought over 260 other capital offences. The police boss ruled out release of the suspects saying: "We do not know of any ‘youth’. We are talking of criminals.

Sharp differences have emerged in the Cabinet over the call for blanket amnesty for youths arrested following the violence that rocked the country in January after the December 30 announcement of disputed results of the presidential election. More than 1,000 people were killed and an additional 350,000 others uprooted from their homes during the two-month mayhem. On February 28, President Kibaki and Raila signed a power-sharing deal that saw the ODM leader named premier, bringing the violence to an end and hauling the country out of its worst political crisis since Independence. The controversial call for blanket amnesty for youths arrested during the violence seems to be the biggest issue that could split the Cabinet and threaten the fledgling Grand Coalition Government. While ODM ministers have demanded the unconditional release of their supporters, their PNU colleagues insist perpetrators of violence should answer for their crimes.

Raila told a lawyers’ forum on Thursday that the youths should be released unconditionally "because they committed no crime. Is it a crime to fight for your democratic rights? Is it a crime to stand and say that last year’s elections were rigged?" posed the Prime Minister. On the same day, Internal Security minister, Prof George Saitoti, said those linked to the violence should be prosecuted to promote peace and to discourage impunity. He ordered police to speed up investigations and prosecutions of the remaining cases, and particularly those linked to capital and other serious offenses. Justice and Constitutional Affairs minister, Ms Martha Karua, has maintained that the law must be allowed to take its course. The number of youths in custody has been difficult to ascertain, with police saying only 137 were in remand, while some leaders, including Agriculture minister Mr William Ruto saying the figure runs into thousands.

DEMOCRATS' 08

2008-05-20T00:22:00.000-07:00

** A time line of super delegate numbers**

- Feb. 5: Clinton 260-170 Obama
- Feb. 28 (after Obama's winning streak of 11-straight contests): Clinton 254-204 Obama
- March 6 (after OH/TX/RI/VT): 254 Clinton-215 Obama
- March 14 (After Obama's wins in WY 3/8; MS 3/11): Clinton 253-217 Obama
- March 31: Clinton 255-222 Obama
- April 15: Clinton 257-231 Obama
- April 23 (the day after the PA primary): Clinton 263-239 Obama
- April 30: Clinton 268-248 Obama
- May 5: (day before Indiana/NC primaries): Clinton 272.5-256 Obama
- May 12: Obama 279-276.5 Clinton
- May 13:Clinton added 20(in West Virginia{28}): Obama added 8
- May 20 : (Kentucky {51}/Oregon{52})
-June 1 : (Puerto Rico{55})
-June 3 : (Montana {16}/South Dakota{15})

Total of delegates as of May 20,2008:

Barack Obama-1,913.5(94.4% of the 2,026 needed)
Hillary Clinton-1,715(84.6% of the 2,026 needed)

**Florida and Michigan tallies not included due to party Democratic Party rules violations**

TB (TUBERCULOSIS)

2008-05-15T22:55:00.000-07:00

TUBERCULOSIS (TB)

What is TB (tuberculosis infection)?

TB or tuberculosis is a disease caused by a bacterium called Mycobacterium tuberculosis. Mycobacterium tuberculosis belongs to the sub group mycobacterium tuberculosis complex, in this group there are other members, and of notice are- (M. bovis, M. Africanum and M. bovis BCG). The bacteria can attack any part of the body, usually affecting the lungs (pulmonary TB). Other parts of the body can also be affected, for example lymph nodes, kidneys, bones, joints, etc. (extra pulmonary TB).

How TB Spread (route of transmission):

The TB’s primary route of transmission is through person to person by inhalation of droplet nuclei that contain the organism (infectious aerosols, 1-5um) that are produced when infected individuals with pulmonary TB cough, sneeze, speak, or sing; infectious aerosols maybe also produced by manipulations of lesions or processing clinical specimens in the laboratory. The droplets are so small that the air currents keep them air-borne for long periods of time and once inhaled, they are small enough to reach the lung’s alveoli.

TB in other parts of the body, such as the kidney or spine, is usually not infectious. People with TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and coworkers.

Signs and symptoms:

TB may mimic other diseases such as pneumonia, neoplasm, or fungal infections. In addition, clinical manifestations of patients infected with TB complex may range from asymptomatic to acutely symptomatic. Patients who are asymptomatic can still have systemic symptoms, pulmonary signs and symptoms and signs and symptoms that are related to other organ involvement (e.g., kidney) or a combination of these features. Of note, cases of pulmonary disease caused by M.tuberculosis complex organisms are clinically, radiologically and pathologically indistinguishable.

Common presenting signs and symptoms:

TB mainly affects the lungs (pulmonary tuberculosis), and coughing is often the only indication of infection initially.

Signs and symptoms of active pulmonary TB include:

A cough lasting three or more weeks that may produce discolored or bloody sputum (normally referred to as positive sputum) Unintended weight loss, Fatigue, Slight fever (low-grade fever), Loss of appetite(anorexia), Pain with breathing or coughing (pleurisy). Tuberculosis also can target almost any part of your body, including your joints, bones, urinary tract, central nervous system, muscles, bone marrow and lymphatic system.

When TB occurs outside your lungs, signs and symptoms vary, depending on the organs involved. For example, tuberculosis of the spine may result in back pain, and tuberculosis that affects your kidneys might cause blood in your urine. Tuberculosis can also spread through your entire body, simultaneously attacking many organ systems. It should be noted that immunocompromised patients i.e. the elderly and more so individuals infected with HIV are particularly susceptible to developing active TB. They are more likely to have rapidly progressive primary disease instead of the sub clinical infection. Of further concern is the diagnosis of TB which becomes more difficult in persons with HIV, because the chest radiographs of pulmonary disease often lack specificity and frequently the patients are allergic to tuberculin skin testing, a primary means to identify individuals infected with TB. The TB test or PPD (purified protein derivative) test is based on the premise that following infection with M.tuberculosis, a patient will develop a delayed hypersensitivity cell-mediated immunity to certain antigenic components of the organism. To determine whether a person has been infected with M.tuberculosis, a culture extract of M.tuberculosis (i.e. PPD of tuberculin) is intravenously injected. After 48-72 hours, a person who has been infected will exhibit a delayed hypersensitivity reaction to the PPD; this reaction is characterized by erythema (redness) and most important, induration (firmness as a result of influx of immune cells). The diameter of induration is measured and then interpreted as whether the patient has been infected or not. Different criteria exist for different patient populations (e.g., immunosuppresed persons, such as those infected with HIV). It is also important to bear in mind that the test is not 100% sensitive or specific, and positive reaction to the skin does not necessarily signify the presence of the disease.

Treatment:

Treating TB infection (asymptomatic)

If tests show that you have TB infection but not active disease, your doctor may recommend preventive drug therapy to destroy dormant bacteria that might become active in the future. In that case, you're likely to receive a daily dose of the TB medication isoniazid (INH). For treatment to be effective, you usually take INH for six to nine months. Long-term use can cause side effects, including liver disease-hepatitis. For that reason, your doctor will monitor you closely while you're taking INH. During treatment, avoid using acetaminophen (Tylenol, others) and avoid or limit alcohol use. Both greatly increase your risk of liver damage.

Treating active TB disease (symptomatic)

If you're diagnosed with active TB, you're likely to begin taking four medications - isoniazid, rifampin (Rifadin, Rimactane), ethambutol (Myambutol) and pyrazinamide. This regimen may change if susceptibility tests later show some of these drugs to be ineffective. Even so, you'll continue to take several medications. Depending on the severity of your disease and whether there is drug resistance, one or two of the four drugs may be stopped after a few months. Sometimes the drugs may be combined in a single tablet such as Rifater, which contains isoniazid, rifampin and pyrazinamide. This makes your therapy less complicated while ensuring that you get the different drugs needed to completely destroy TB bacteria. Another drug that may make treatment easier is rifapentine (Priftin), which is taken just once a week during the last four months of therapy. Sometimes you may be hospitalized for the first two weeks of therapy or until tests show that you're no longer contagious. Completing treatment is essential.

Because TB bacteria grow slowly; treatment for an active infection is lengthy - usually six to 12 months. After a few weeks, you won't be contagious and may start to feel better, but it's essential that you finish the full course of therapy and take the medications exactly as prescribed by your doctor. Stopping treatment too soon or skipping doses can create drug-resistant strains of the disease that are much more dangerous and difficult to treat. Drug-resistant strains that aren't treated can quickly become fatal, especially in people with impaired immune systems. In an effort to help people stick with their treatment regimen, some doctors and clinics use a program called directly observed therapy short-course (DOTS). In this approach, a nurse or other health care professional administers your medication so that you don't have to remember to take it on your own.

Treatment side effects:

Side effects of TB drugs aren't common, but can be serious when they do occur. All TB medications can be highly toxic to your liver. Rifampin can also cause severe flu-like signs and symptoms - fever, chills, muscle pain, nausea and vomiting. When taking these medications, call your doctor immediately if you experience any of the following:

Nausea or vomiting, Loss of appetite, A yellow color to your skin (jaundice), A fever lasting three or more days that has no obvious cause, such as a cold or the flu, Tenderness or soreness in your abdomen, Blurred vision or colorblindness.

Treating drug-resistant TB:

Multi-drug-resistant TB (MDR-TB) is any strain of TB that can't be treated by the two most powerful TB drugs, isoniazid and rifampin. Extensive drug-resistant TB (XDR-TB) is a newly developed strain of TB that's resistant to the same treatments that MDR-TB is, and additionally XDR-TB is resistant to three or more of the second-line TB drugs. Both strains develop as a result of partial or incomplete treatment - either because people skip doses or don't finish their entire course of medication or because they're given the wrong treatment regimen. This gives bacteria time to undergo mutations that can resist treatment with first-line TB drugs. MDR-TB can be treated. But it requires at least two years of therapy with second-line medications that can be highly toxic. Even with treatment, many people with MDR-TB may not survive.

And when treatment is successful, people with this form of TB may need surgery to remove areas of persistent infection or repair lung damage. Treating these resistant forms of TB is far more costly than treating nonresistant TB, making therapy unaffordable in many parts of the world. Because these resistant infections are spreading and could potentially make all TB incurable, some experts believe that ineffective treatment is ultimately worse than no treatment at all.

Treating people who have HIV/AIDS:

Treating people who are co-infected with TB and HIV is a particular challenge. HIV-positive people are especially likely to develop MDR-TB and to rapidly progress from latent to active infection. What's more, the most powerful AIDS drugs - protease inhibitors - interact with rifampin and other drugs used to treat TB, reducing the effectiveness of both types of medications. To avoid interactions, people living with both HIV and TB may stop taking protease inhibitors while they complete a short course of TB therapy that includes rifampin. Or they may be treated with a TB regimen in which rifampin is replaced with another drug that's less likely to interfere with AIDS medications. In such cases, doctors carefully monitor the response to therapy, and the duration and type of regimen may change over time. Without treatment, most people living with both HIV and TB will die, often in a matter of months. In such cases, the primary cause of death is TB, not AIDS.

Prevention:

In general, TB is a preventable disease. From a public health standpoint, the best way to control TB is to diagnose and treat people with TB infection before they develop active disease and to take careful precautions with people hospitalized with TB. But there are also measures you can take on your own to help protect yourself and others:Keep your immune system healthy. Make sure you eat plenty of healthy foods, get adequate amounts of sleep and exercise regularly to keep your immune system in top form.Get tested regularly. Experts advise getting a skin test annually if you have HIV or another disease that weakens your immune system, live or work in a prison or nursing home, are a health care worker, or have a substantially increased risk of exposure to the disease.Consider preventive therapy. If you test positive for latent TB infection, but have no evidence of active TB, talk to your doctor about therapy with isoniazid to reduce your risk of developing active TB in the future. A vaccine, BCG, is available and has been of some benefit in preventing TB. It is more commonly administered in countries where TB is more common. The vaccine isn't very effective in adults, although it can prevent TB from spreading outside the lungs in infants. Vaccination with BCG also causes a false-positive result on a Mantoux skin test and for that reason, isn't recommended for general use in some countries like US.

Researchers are working on developing a more effective TB vaccine. Either way, finish your entire course of medication. This is the most important step you can take to protect yourself and others from TB. When you stop treatment early or skip doses, TB bacteria have a chance to develop mutations that are resistant to the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat.

To help keep your family and friends from getting infected if you have active TB:

Stay home. Don't go to work or school or sleep in a room with other people during the first few weeks of treatment for active TB. Ensure adequate ventilation. Open the windows whenever possible to let in fresh air. Cover your mouth. It takes two to three weeks of treatment before you're no longer contagious. During that time, be sure to cover your mouth with a tissue any time you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away. Also, wearing a mask when you're around other people during the first three weeks of treatment may help lessen the risk of transmission.

Coping skills:

Undergoing treatment for TB for a long period of time can be complicated, yet sticking with therapy is the only way to cure the disease. You may find it helpful to have your medication administered by a nurse or other health care professional so that you don't have to remember to take it on your own. In addition, try to maintain your normal activities and hobbies and stay connected with family and friends. Keep in mind that your physical health can directly impact your mental health. Denial, anger and frustration are not uncommon when you learn life has dealt you something difficult and unexpected. At times, you may need more tools to deal with these or other emotions. Professionals, such as therapists or behavioral psychologists, may help you put things in perspective.

KENYA POLITICIANS AND "MUDUS OPERANDI"

2008-05-03T19:57:00.000-07:00

CUT AND PASTE-protocol war?

Editorial Cartoon [ Sunday, May 04, 2008 ]

THE KENYAN POLITICS

2008-04-20T20:31:00.000-07:00

There are voices who, rightly point out that ODM was short changed in the sharing of Cabinet positions. With most people citing the beefy positions that went to a PNU clique from the Mount Kenya region.

And then there are also these grumblings of south rift leaders threating to form their on party because they felt short changed? I am not sure, but maybe Kenyans might as well give each VILLAGE CHIEF a ministerial position, full with assistant minister-in tow and Ps! or something of that sort, if this is where we are headed.

The story that five MPs and more than 100 councillors were threatening to withdraw their support for ODM over Cabinet appointments was a cheap blackmail attempt by these so called leaders to say the least. The current and former MPs from the South Rift accused Prime Minister, Mr Raila Odinga, of sidelining the Kipsigis. "The community got a raw deal in the appointments," they said in a statement read by Chepalungu MP, Mr Isaac Ruto.

Speaking at Tea Research Foundation, Kericho, on Saturday, they called for a political party for the community. The Konoin MP, Dr Julius Kones, said the community would use the by-elections in Ainamoi and Trans Mara to stamp their authority. Among the MPs at the meeting were Mr Franklin Bett (Buret), Mr Magerer Lang’at (Kipkelion), Mr Zakayo Cheruiyot (Kuresoi)and former MPs, Mr Paul Sang and Mr John Terer.

These leaders said they held Raila responsible for shortchanging the community.In the region, only Bomet MP, Mr Kipkalya Kones, is a cabinet minister (Roads), while Mr Charles Keter (Belgut) and his Sotik counterpart, Mrs Lorna Laboso, were appointed assistant ministers in the ministry of Energy and office of the Vice-President respectively. On Thursday, ten MPs from the Rift Valley raised concern over Cabinet appointments, saying they were shortchanged.

Meanwhile, Budalang’i MP, Mr Ababu Namwamba, has asked Raila to contact ODM MPs who missed the appointments and assure them that all was not lost. "We have many other opportunities and all is not lost for the MPs who missed Cabinet appointments. That is what our PM should tell them now," said Namwamba.

Back to the accord-the National Reconciliation Act provides for a sharing of executive authority between Kibaki and Raila. The President remains the Head of State, but the responsibility of running the country is clearly shared between the two. This is a salient point which needs to be fore grounded in any discussion about the power sharing deal for it has far reaching implications on how the country will be managed henceforth.

That is why it is important for all Kenyans to know that for once we have a governance arrangement where the President will not enjoy the sweeping powers that have traditionally been associated with his office. The sweeping presidential powers have been the cause of many of our problems. The existence of a Prime Minister who the Constitution now fully recognizes as holding executive power means that the President’s sole imperial responsibility of running the State and Government has been moderated.

African states have failed in the past to institutionalize democracy due to the imperial powers held by those in the presidency. The provisions of the National Reconciliation Act have undoubtedly given Kenya an unprecedented opportunity to strengthen democracy, accountable leadership and to take a lead role in showing Africa that new beginnings are possible. Additionally, the Act gives this country a new impetus to move a way from the impunity of the past while introducing measures for a fair system of rule where the President will directly account to some other authority by way of consultation and teamwork.

Africa’s history is full of fine examples of leaders who hold unfettered power, which they have tended to use in ways that have brought disrepute, suffering and reduced freedoms to their peoples. This is what has led to the ills of cronyism and patronage. Presidents have tended to use their powerful positions to reward and punish according to their whims thus stifling alternative voices of reason.

The creation of the premier’s office provides real possibilities for minimizing unaccountable leadership and fostering openness and consultation as a vital process in governance. This way of running Government business does provide for automatic checks and balances in the decision making and governance processes thus eliminating despondency.

Another point to make is that, although PNU took the politically strategic ministries of Defence, Finance and Justice, this does not necessarily make the party privileged. ODM’s haul of infrastructural and service oriented positions of Agriculture, Local Government, Tourism, Water, Roads and Public Works, indeed does put it in better stead to push a strong development agenda based on equity and fair distribution and utilization of national resources for the benefit of a majority of Kenyans.

Also another factor to consider is the aggregate annual budgetary allocations to the ministries taken by ODM against those with PNU. There is negligible difference in this regard, meaning that none of the parties was handed a raw deal. This is an important point considering that both parties would want to have a direct say on how and where Government resources are used.

It is only fair and correct to say that real power sharing is not exactly in the sharing of Cabinet positions. The real power sharing is in the possibilities for responsibility sharing between the Prime Minister and the President.

The debate around Cabinet appointments did miss these points, yet these are precisely what has redefined the country’s political and governance landscape.

PS:We need to remind the idler-MPs that, there lie a head a daunting task of rebuilding a new Kenya's socio-economic, infrastructure, tackle unemployment, correct the historical injustices over land/resources distribution, resettlement of the IDPs et cetera et cetera. The time to start working was yesterday! Instead of throwing tantrums and issuing meaningless press reports lets come together for the good of the nation. These are distractions we can ill afford at this juncture.

KENYA'S NEW "SHARED" COALITION SWORN IN

2008-04-17T10:47:00.000-07:00

Nearly three months after Kenya's disputed elections, the country's new power-sharing cabinet has been sworn in, including ODM's leader Raila Odinga as a Prime Minister.

As he was being sworn-in in front of dignitaries including Kofi Annan, the former UN chief who brokered the power-sharing deal with President Mwai Kibaki, Mr Odinga not only began a new phase of his political career, but a new era for Kenya.

"We will ensure that power, wealth and opportunity are [in] the hands of many, not the few," he said after taking his oath of office as Prime Minister. He becomes the second Prime Minister in the country's history.

At a lengthy ceremony in the capital, Nairobi, Kenya's 42 ministers and 50 assistant ministers - half belonging to or aligned with President Mwai Kibaki's Party of National Unity, and half from Prime Minister Raila Odinga's Orange Democratic Movement - took office.

The event officially puts in place the power-sharing government agreed upon by President Kibaki and Mr. Odinga in an agreement mediated by former U.N. Secretary General Kofi Annan in late February.

Mr. Annan was on hand for the event and urged support for the new government, despite concerns that the large number of ministers, the most in Kenya's history, is a waste of resources.

"I know there has been some debate as to the size of the government, but what is important is that we do have a government," he said. "We have an opportunity to put Kenya back on track and build a stronger Kenya and it is essential that you all support the leaders and the government."

Ugandan president Yoweri Museveni, Prime Minister Odinga, and President Kibaki also delivered speeches. President Kibaki sounded an optimistic note on moving forward.

KENYA NAMES A COALITION CABINET

2008-04-13T11:32:00.000-07:00

Mwai Kibaki announced the cabinet on April 13th, 2008.

Mr Kibaki called for politics to be set aside and real work to start, while announcing the new power-sharing cabinet following a deal that the two brokered during the latest secrete meeting at sagana lodge to end the long-running political crisis.

Kibaki officially named Raila Odinga as the new prime minister, after the pair agreed the deal on Saturday in their secret talks.

The crisis was sparked by presidential elections in December that triggered violence in which over 3,500 people died and more than 600,000 displaced.

The deal overcame a row over how the cabinet posts would be divided.

Local and international pressure:

Mr Kibaki said in a live televised speech alongside Mr Odinga: "My challenge to the new cabinet members and the entire national leadership at all levels is: let us put politics aside and get to work."As both the local and international pressure pilled on the two leaders.

KEY POSTS:

Office of the Prime Minister:

Prime Minister: Raila Amollo Odinga
Assistant Minister: Alfred Khang’ati

Office of Vice-President and Home Affairs:

Vice President and Minister for Home Affairs:Stephen Kalonzo Musyoka
Assistant Minister: Lorna Laboso

Office of the Deputy Prime Minister and Ministry of Local Government:

Deputy PM and Minister for Local Government: Wycliffe Musalia Mudavadi
Assistant Minister: Robison Njeru Githae

Deputy Prime Minister and Minister for trade:Uhuru Kenyatta
Assistant Minister: James Omingo Magara

Kibaki added: "Let us build a new Kenya where justice is our shield and defender, and where peace, liberty and plenty will be found throughout our country."

Two deputy prime ministers were named - Uhuru Kenyatta of Mr Kibaki's Party of National Unity and Musalia Mudavadi of Mr Odinga's Orange Democratic Movement.

Finance Minister Amos Kimunya retained his post and the ODM's William Ruto becomes agriculture minister.

A total of 40 posts were named in an even split between ODM and the PNU and its allies.

Even though Kenyans had protested and argued the country could not afford so many posts with the looming food crisis and future socio-economic appearing bleak as over 600,000 people are still displaced while more than 3,500 lost their lives, the kibaki train took no such notice and stuffed a bloated cabinet nonetheless.

It is also clear that, with the exception of local government the key posts remain with PNU's close followers.

Although its apparent that the cabinet appeared unreasonably large, Kibaki said, many Kenyans will breath a collective sigh of relief that perhaps the country can now move forward.

It is understood that the cabinet will work on framing a new constitution over the next year that will tackle long-standing grievances over land, wealth and power.

The two leaders had come under intense international pressure to achieve a breakthrough.

The deal on power-sharing had been brokered by former UN secretary general Kofi Annan in February and a cabinet was scheduled to be announced on 6 April.

But the talks seemed to break down this week as Mr Odinga held out for the 50-50 split in cabinet posts following the signed accord.

The country,needless to say is still on a cliff hanger given the over 3,500 who died and more than 600,000 who were displaced during the election crisis. Many thousands have yet to return to their homes.

Full Cabinet list:

1)Ministry of State for Provincial Administration and Internal Security

Minister: Prof George Saitoti
Assistant Ministers: Simon Lesirma and Joshua Orwa Ojode

2)Ministry of State for Defence

Minister: Yusuf Haji
Assistant Ministers: David Musila and Joseph Nkaisserry

3)Ministry of State for Immigration and Registration of Persons

Minister: Gerald Otieno Kajwang’
Assistant Minister: Francis Baya

4)Ministry of State for National Heritage & Culture:

Minister: William ole Ntimama
Assistant Minister: Joel Onyancha Omagwa

5)Ministry of State for Planning, National Development and Vision 2030:

Minister: Wycliffe Ambetsa Oparanya
Assistant Minister: Peter Kenneth

6)Ministry of State for Public Service:

Minister: Dalmas Anyango Otieno
Assistant Minister: Aden Ahmed Sugow

7)Office of Deputy Prime Minister and Ministry of Trade:

9)Ministry of East African Community

Minister: Amason Kingi Jeffah
Assistant Minister: Peter Munya

10)Ministry of Foreign Affairs

Minister: Moses Wetangula
Assistant Minister: Richard Momoima Onyonka

11)Ministry of Finance

Minister: Amos Kimunya
Assistant Minister: Dr. Oburu Oginga

12)Ministry of Justice, National Cohesion and Constitutional Affairs
Minister: Martha Karua
Assistant Minister: William Cheptumo Kipkorir

13)Ministry of Nairobi Metropolitan Development

Minister: Mutula Kilonzo
Assistant Minister: Elizabeth Ongoro Masha

14)Ministry of Roads

Minister: Kipkalya Kones
Assistant Ministers: Wilfred Machage and Lee Kinyanjui

15)Ministry of Public Works

Minister: Chris Obure
Assistant Minister: Dickson Wathika Mwangi

16)Ministry of Transport

Minister: Chirau Ali Makwere
Assistant Minister: John Harun Mwau

17)Ministry of Water and Irrigation

Minister: Charity Kaluki Ngilu
Assistant Minister: Mwangi Kiunjuri

18)Ministry of Regional Development Authorities

Minister: Fredrick Omulo Gumo
Assistant Minister: Judah Katoo ole Metito

19)Ministry of Information & Communications

Minister: Samuel Poghisio
Assistant Ministers: George Munyasa Khaniri and Dhadho Godhana

20)Ministry of Energy

Minister: Kiraitu Murungi
Assistant Ministers: Charles Keter and Maalim Mohamud Mohamed

21)Ministry of Lands

Minister: Aggrey James Orengo
Assistant Ministers: Silvester Wakoli Bifwoli and Samwel Gonzi Rai

22)Ministry of Environment and Mineral Resources

Minister: John Michuki
Assistant Ministers: Ramadhan Seif Kajembe and Jackson Kiplagati Kiptanui

23)Ministry of Forestry and Wildlife

Minister: Noah Wekesa
Assistant Minister: Josphat Koli Nanok

24)Ministry of Tourism

Minister: Mohamed Najib Balala
Assistant Minister: Cecily Mtito Mbarire

25)Ministry of Agriculture

Minister: William Samoei Ruto
Assistant Ministers: Japhet Kareke Mbiuki and Gideon Musyoka Ndambuki

26)Ministry of Livestock Development

Minister: Mohamed Abdi Kuti
Assistant Minister: Bare Aden Duale

27)Ministry of Fisheries Development

Minister: Paul Nyongesa Otuoma
Assistant Minister: Mohamed Abu Abuchiaba

28)Ministry of Development of Northern Kenya and other Arid Lands

Minister: Ibrahim Elmi Mohamed
Assistant Minister: Hussein Tarry Sasura

29)Ministry of Cooperatives Development

Minister: Joseph Nyagah
Assistant Minister: Linah Jebii Kilimo

30)Ministry of Industrialisation

Minister: Henry Kiprono Kosgey
Assistant Minister: Ndiritu Murithi

31)Ministry of Housing

Minister: Peter Soita Shitanda
Assistant Minister: Bishop Margaret Wanjiru Kariuki

32)Ministry of Special Programmes

Minister: Dr. Naomi Namsi Shabani
Assistant Minister: Mohamed Muhamud Ali

33)Ministry of Gender and Children Affairs

Minister: Esther Murugi Mathenge
Assistant Minister Atanas Manyala Keya

34)Ministry of Public Health and Sanitation

Minister: Beth Wambui Mugo
Assistant Minister: Dr. James Ondicho Gesami

35)Ministry of Medical Services

Minister: Prof. Peter Anyang’ Nyong’o
Assistant Minister: Danson Buya Mungatana

36)Ministry of Labour

Minister: John Kiyonga Munyes
Assistant Minister: Sospeter Ojamaa Ojamong’

37)Ministry of Youth and Sports

Minister: Dr. Helen Jepkemoi Sambili
Assistant Ministers: Wavinya Ndeti and Kabando wa Kabando

38)Ministry of Education

Minister: Samson Kegeo Ongeri
Assistant Ministers: Prof. Patrick Ayiecho Olweny and Andrew Calist Mwatela

39)Ministry of Higher Education, Science and Technology

Minister: Dr. Sally Jepngetich Kosgey
Assistant Ministers: Kilemi Mweria and Asman Abongotum Kamama

40)Office of the Attorney General
Attorney General: Amos Wako

MADE IN KENYA

2008-04-06T14:11:00.000-07:00

Countries world over promote themselves with the label's such as MADE IN CHINA,MADE IN SINGAPORE,MADE IN MALAYSIA,MADE IN JAPAN,MADE IN S.KOREA, MADE IN USA,MADE IN VENEZUELA,MADE IN MEXICO,MADE IN GREAT BRITAIN,MADE IN RUSSIA,MADE IN BRAZIL,MADE IN COLOMBIA,MADE IN INDIA,MADE IN SOUTH AFRICA,MADE IN THE PHILIPPINES... et cetera et cetera...This, in actual sense means that these countries are proud to be associated with the products/and or what they make and are. But in Kenya,things are different...there is a unique taste into what they make.

It is in Kenya that a general election can be bungled to a point where one is left wondering whether the people involved really live in that same country. Or whether they have any afterthought of the future.In Kenya, electoral commission can chose to completely ignore the constitution or pick parts of it to side step.this is the same constitution on which they are supposedly formed or to operate under, without anybody raising a finger or ever being taken to court of law for the mismanagement.

It is not a surprise to find out that its only in Kenya that a sitting president can organize, steal-(in abroad daylight-ask a small kid, he/she will tell you....yes he stole and everyone knows it- kind)the election and put on a brave face and say to the world that "I am the duly elected president of Kenya" without giving it much thought! It is only in this country that not only can one steal the election, over 3000 innocent lives and more than a quarter of a million people be refugees in their own country, the perpetrators can actually get a way with it-NO QUESTIONS ASKED.

It is also in Kenya that a sitting president can bungle the election and still be in the coalition government where a staggering 40 plus cabinet ministers and unspecified or similar numbers of assistant ministers are proposed and justified to be a good number even though the country is in a bleak economic/social and political times. And the issue of almost 90% of the populace living under ksh 60.00/day do not arise.THIS IS A TRUE KENYAN MADE!

Yes it's only in Kenya where politicians can buy themselves into the parliament, once there, they can get to appoint themselves into the cabinet and cherry-pick which posts massages their ego better and fight/throw tantrums to get.They also can fix their salaries at will- making sure that they get paid/or pay themselves the highest in the world...given the country's GDP. And while at it, also make sure that they are in apposition to grab anything-everything as much as they can.

It is also in Kenya where major scandals such as angloleasings, goldenburgs, Ndung'us, krolls types..among numerous others not to forget to mention the mobiteleas can be conceptualized-executed and continue to thrive without loosing any sleep over it. OOOh and the IPO?

Abdulahi Ahmednasir said this much on his article to the standard:

Eight years after conception, the riddle that is Mobitelea remains unresolved. With the floatation of Safaricom shares in the Nairobi Stock Exchange next month, the long drawn saga of Mobitelea will officially end. Like other grand scams that litter our landscape, Mobitelea will then be buried without any rituals among the haunting ghosts of Anglo Leasing and Goldenberg. Mobitelea costs the taxpayer a staggering Sh10 billion according to the current valuation of Safaricom. How can a scam of this magnitude be conceptualised, successfully executed, and its fruits so publicly eaten, while no one in power raises a finger? Please read the bewildering narrative that is Mobitelea.

In May, 2000 Vodafone, a blue chip British enterprise finally realised its long cherished dream of buying for a song a sizeable stake in Safaricom. It has been trying to do for a long time. To realise the goal, Vodafone enlisted the service of Mobitelea, a company solely created for that task, and which in turn, ordered four important institutions in Kenya to do its bidding.

So how did Vodafone and Mobitelea pull the transaction? Mobitela offered its service to Vodafone and guaranteed that it can force Kenyan officials to sell Safaricom shares to Vodafone at a price determined by the later.

Vodafone, as many European companies do, tried to pay off Mobitelea in one cash transaction for the services rendered. Mobitelea resisted this and insisted on being given a percentage of the shares Vodafone wanted to buy in Safaricom.

Further negotiations between the parties ensured. Mobitelea, on condition that it will be allotted some of the shares of Vodafone, was additionally mandated to ensure that there should be no independent valuation of the Safaricom shares.

The price Vodafone paid was solely agreed between Vodafone and Mobitelea. That explains the generosity of the British company. Both parties shook hands. Mobitelea became the rich owner of 10 per cent of Safaricom.

In executing its task, Mobitelea did pull four important strings. First, it forced the Finance ministry to approve the sale of Safaricom shares to Vodafone. Only the Minister of Finance had the legal power to allow Telkom Kenya, which was the parent company of Safaricom, to sell its shares to a foreign company.

The Finance minister in May 2000 is thus a material witness to this saga for he knew the human faces behind Mobitelea.

Second, who was the Minister in charge of Transport and Telecommunication in May 2000? That ministry was in charge of Telkom Kenya and its subsidiary, Safaricom. It is impossible for Telkom Kenya, as a wholly owned parastatal, to sell its equity in Safaricom without being sanctioned by the minister in charge of this docket. He, too, knows the human faces behind Mobitelea.

Third, the management and board of directors of Telkom Kenya in May 2000 were the foot solders of Mobitelea. They have all the details of the transaction.

Four, before any transaction of the magnitude of Mobitelea can join the big league of Kenya’s scams, the State Law Office must legally sanction it. A legal opinion validating the transaction must be lying somewhere in the State Law Office.

Political compromise

The narrative goes on. In 2002 when the National Rainbow Coalition government came to power, powerful individuals in government came after Mobitelea threatening that the authorities will repossess Mobitelea’s shares in Safaricom. Both the owners of Mobitelea and those making the threat being members of the same political elite struck a compromise. One to two per cent of Mobitelea’s shares in Safaricom were given to the new kids on the block and Mobitelea retained the rest. That is the end of the narrative.

The Mobitelea saga raises disturbing questions on a number of fronts. This is yet another instance when billions of shillings jointly stolen by our leaders and friendly foreigners. I think it is in order for the British High Commissioner to Kenya Mr Adam Wood to address the ethics of a British corporation in one of his forthcoming lectures. What is his government doing about this Imperial British East African Company?

Kenyans must appreciate that the sale of Safaricom shares to Vodafone was not a backroom deal. It was officially sanctioned at all levels of government. There is even a possibility that the Cabinet gave the seal of approval. Further, the Kenya Anti-Corruption Commission and the Attorney General have all the details of the transaction. They know the details of who the original owners, how the transaction was negotiated, who signed what documents, and who received what amount. They also know who in government was given shares in Mobitelea in exchange for political protection. Of course, Kenyans are not too foolish to expect these two offices to go after their political masters.

Even though it will be difficult to trace the Mobitelea shares once it is off loaded in the stock exchange, Kenyans still have a good recourse. The weakest link in this corrupt transaction is the shares of Vodafone in Safaricom. A viable legal challenge can be mounted against Vodafone to invalidate the transaction and return all the shares to the Government. This is because the underlying basis of the entire transaction was a bribe to induce the Government to offload its 40 per cent stake in Safaricom.

Lest we forget, some of the ministers who in 2000 sanctioned the Mobitelea scandal will be among the 40 ministers to be appointed today. The more we think we have changed, the more we remain the same.

KENYA'S COALITION CABINET READY?

2008-04-03T10:07:00.000-07:00

The much a waited Cabinet is finally here?

The reports are trickling in that PNU and ODM are ready to form the new cabinet.
After haggling for almost a month about every little things imaginable and PNU brigades with their usual antics showing their true colours and how myopic they really can be/are, Kenyans had been reduced to mere spectators save for their fate being in the precipice.

Addressing reporters after talks, Mr Odinga said the agreement has been reached and that the new cabinet will be formally announced on 6 April. "We have agreed to announce the cabinet on Sunday and that the cabinet will be sworn in on [the following] Saturday," Mr Odinga said.

A statement from President Kibaki said both parties were pleased with the outcome of the discussions in the spirit of give and take. The long consultations were necessary to enable there be an agreement that is amicable and good for the country, the statement added. Civil society groups have called on the leaders to appoint a lean cabinet with untainted personalities.

Early this week, the activists lead by Nobel Prize winner Wangari Maathai were tear-gassed by police when they held a demonstration against proposals by President Kibaki to raise the cabinet positions from the present 34 to 44. And Transparency International chairman Richard Leakey warned that the continued delay in appointing the cabinet was creating room for corruption to thrive in government.

CHOLERA AND KENYA'S IDPS

2008-03-30T18:33:00.000-07:00

What is cholera?

Cholera is an acute diarrheal infection of the intestine caused by ingestion of the bacterium Vibrio cholerae;(v.cholerae is responsible for releasing the toxin called cholerae toxin or {CT}which in turn is responsible for causing the mucosal cells to hypersecrete water and electrolytes into the lumen of the gastrointestinal tract. The result is profuse watery diarrhea, leading to dramatic fluid loss "rice water stools"is its hallmark)- which is fluids and mucous flecks.

Transmission occurs through direct faecal-oral route/ contamination or through ingestion of contaminated water and food and not limited to exposure of disrupted skin and mucosal surfaces to contaminated water. The disease is characterized in its most severe form by profuse watery diarrhea, vomiting, and leg cramps. In these persons, rapid loss of body fluids leads to dehydration and hypotention leading to shock. Without treatment, death can occur within hours due to severe dehydration and kidney failure.

The extremely short incubation period - two hours to five days - enhances the potentially explosive pattern of outbreaks, as the number of cases can rise very quickly. About 75% of people infected with cholera do not develop any symptoms. However, the pathogens stay in their faeces for 7 to 14 days and are shed back into the environment, potentially infecting other individuals. Cholera is an extremely virulent disease that affects both children and adults. Unlike other diarrhoeal diseases, it can kill healthy adults within hours. Individuals with lower immunity, such as malnourished children or people living with HIV and the elderly are at greater risk of death if infected by cholera.

How does a person get cholera?

Two serogroups of V. cholerae - O1 and O139 - can cause outbreaks. The main reservoirs are human beings and aquatic sources, often associated with algal blooms (plankton). Recent studies indicate that global warming might create a favourable environment for V. cholerae and increase the incidence of the disease in vulnerable areas. V. cholerae O1 causes the majority of outbreaks worldwide. The serogroup O139, first identified in Bangladesh in 1992, possesses the same virulence factors as O1, and creates a similar clinical picture. Currently, the presence of O139 has been detected only in South-East and East Asia, but it is still unclear whether V. cholerae O139 will extend to other regions. Careful epidemiological monitoring of the situation is recommended and should be reinforced. Other strains of V. cholerae apart from O1 and O139 can cause mild diarrhoea but do not develop into epidemics. A person may get cholera by drinking water or eating food contaminated with the v. bacterium. In an epidemic, the source of the contamination is usually the feces of an infected person. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water.

The v. bacterium may also live in the environment in brackish rivers and coastal waters. Under cooked sea food e.g. Shellfish if eaten raw have been reported as a source of cholera. The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not at risk of becoming ill. However, eating in one plate or preparing meals with persons who are carriers and failed to wash their hands after a long visit to the bathroom/latrine is deemed unsafe.

ALL in all- Cholera is mainly transmitted through contaminated water and food and is closely linked to inadequate environmental management. The absence or shortage of safe water and sufficient sanitation combined with a generally poor environmental status are the main causes of spread of the disease. Typical at-risk areas include peri-urban slums, where basic infrastructure is not available, as well as camps for internally displaced people or refugees, where minimum requirements of clean water and sanitation are not met.

However, it is important to stress that the belief that cholera epidemics are caused by dead bodies after disasters, whether natural or man-made, is false. Nonetheless, rumours and panic are often rife in the aftermath of a disaster. On the other hand, the consequences of a disaster -- such as disruption of water and sanitation systems or massive displacement of population to inadequate and overcrowded camps -- can increase the risk of transmission, should the pathogen be present or introduced.
What to do to avoid getting cholera when you are a way from home?

Drink only water that you have boiled or treated with chlorine or iodine. Other safe beverages include tea and coffee made with boiled water.
Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself. Avoid undercooked or raw fish or shellfish, including ceviche.Make sure all vegetables are cooked avoid salads. Avoid foods and beverages from street vendors-the likes of Muturas.
A simple rule of thumb is "Boil it, cook it, peel it, or forget it"

Is a vaccine available to prevent cholera?
Oral cholera vaccines:

The use of the parenteral cholera vaccine has never been recommended by World health organization due to its low protective efficacy and the high occurrence of severe adverse reactions. An internationally licensed oral cholera vaccine (OCV) is currently available on the market and is suitable for travellers. This vaccine was proven safe and effective (85–90% after six months in all age groups, declining to 62% at one year among adults) and is available for individuals aged two years and above. It is administered in two doses 10-15 days apart and given in 150 ml of safe water. One such example of recently developed oral vaccine for cholera is Dukoral from SBL Vaccines. It is licensed and available. The vaccine appears to provide somewhat better immunity and have fewer adverse effects than the previously available vaccine.

Prevention and control of Cholera outbreaks:

Among people developing symptoms, 80% of episodes are of mild or moderate severity. Among the remaining cases, 10%-20% develop severe watery diarrhoea with signs of dehydration. If untreated, as many as one in two people may die. With proper treatment, the fatality rate should stay below 1%.

Measures for the prevention of cholera have not changed much in recent decades, and mostly consist of providing clean water and proper sanitation to populations potentially affected. Health education and good food hygiene are equally important. In particular, systematic hand washing should be taught. Once an outbreak is detected, the usual intervention strategy is to reduce mortality by ensuring prompt access to treatment and controlling the spread of the disease.

The majority of patients - up to 80% - can be treated adequately through the administration of oral rehydration salts- repackaged mixture of sugar and salts to be mixed with water and drunk in large amounts (standard sachets). Very severely dehydrated patients are treated through the administration of intravenous fluids, preferably Ringer lactate. Appropriate antibiotics can be given to severe cases to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed and shorten the duration of vibrio excretion. Routine treatment of a community with antibiotics, or "mass chemoprophylaxis", has no effect on the spread of cholera and can have adverse effects by increasing antimicrobial resistance. In order to ensure timely access to treatment, cholera treatment centres should be set up among the affected populations whenever feasible.The provision of safe water and sanitation is a formidable challenge but remains the critical factor in reducing the impact of cholera outbreaks.

Recommended control methods, including standardized case management, have proven effective in reducing the case-fatality rate. Comprehensive surveillance data are of paramount importance to guide the interventions and adapt them to each specific situation. In addition, cholera prevention and control is not an issue to be dealt by the health sector alone. Water, sanitation, education and communication are among the other sectors usually involved. A comprehensive multidisciplinary approach should be adopted for dealing with a potential cholera outbreak.

CAN KIBAKI RENEGE ON POWER-SHARING DEAL?

2008-03-28T21:23:00.000-07:00

National Accord and Reconciliation Act, No 4 of 2008 and the Constitution of Kenya (Amendment) Act, 2008, were passed and given assent by the President and became effective on March 20.The Acts demand that there be a Prime Minister and that the coalition Government reflect the parliamentary strength of the respective parties and that there be “…portfolio balance.”

As the new law states, the Prime Minister is automatically the parliamentary leader of the largest political party.

Therefore, the coalition government is based on the pro rata parliamentary strength of each political party forming the coalition. The coalition comprises ODM, PNU, ODM Kenya and Kanu, their shares in the coalition in the same descending order and including portfolio balance. ODM is therefore the senior partner.....

DONALD B. KIPKORIR has this in details in his DN article

REACTION TO OBAMA'S SPEECH A WEEK AFTER IT WAS GIVEN

2008-03-24T09:30:00.002-07:00

Tananarive Due and Steven Barnes wrote in huffingtonpost about sen.Barack Obama's speech a week after it was given and explores its deeper meaning.

What a difference a week makes.....

The Friday before Good Friday, I began my weekend with a sick feeling in my stomach that returned every time I switched on the news. Barack Obama's pastor, Rev. Jeremiah A. Wright, was everywhere. The pastor's incendiary remarks were being played and replayed, and I knew instantly that of all the threats to Barack Obama's candidacy thus far, none had been so potent--nor so utterly personal.

What was Obama to do? Having attended black churches myself (and having been raised by civil rights activists), I understood the cultural context of his pastor's remarks--even those I did not agree with. Having read Obama's memoir, Dreams from My Father, I had some knowledge of Wright's place in Obama's heart. Wright had guided Obama's path to Christianity. How can that relationship be put into words? How can you convincingly disavow someone who, despite his flaws, has meant so much to you?
Read the rest of the article

REACTION TO OBAMA'S SPEECH ON RACE IN AMERICA

2008-03-21T01:21:00.000-07:00

This is a follow-up to the speech that sen. Barack Obama gave in Philadelphia on Tuesday March 18,2008. This afternoon on NPR'S talk of the nation by Neal Conan, I happened to switch on the radio on my way to work and i found the program to be very interesting.

Here we go:

......Sen. Barack Obama spoke on Tuesday about the role race has played in the presidential campaign and addressed the racially charged remarks made by his longtime pastor, the Rev. Jeremiah Wright. Guests and callers weigh in on the ways in which Americans talk about race in public and in private.

Guests:

1)Erin Aubry Kaplan, columnist for The Los Angeles Times, author of the op-ed "Black Isn't Enough"

2)Robert Jensen, professor of journalism at the University of Texas; author of The Heart of Whiteness: Confronting Race, Racism and White Privilege

3)Michael Meyers, executive director of the New York Civil Rights Coalition; author of the Los Angeles Times op-ed "Obama Blew It"

4)Gustavo Arellano, writer of the Ask a Mexican column....

HERE IS THE AUDIO PART

OBAMA'S SPEACH ON "RACE" IN AMERICA

2008-03-18T10:00:00.000-07:00

There is a seven page text making rounds that's been prepared for delivery by Senator Barack Obama in Philadelphia.The speech is about race in America. It is understood that this is in response to the Rev. Wright's controversy.

TRANSCRIPT:

“We the people, in order to form a more perfect union.”

Two hundred and twenty one years ago, in a hall that still stands across the street, a group of men gathered and, with these simple words, launched America’s improbable experiment in democracy. Farmers and scholars; statesmen and patriots who had traveled across an ocean to escape tyranny and persecution finally made real their declaration of independence at a Philadelphia convention that lasted through the spring of 1787..... READ MORE HERE

LET ALL MPS JOIN HANDS IN PREACHING PEACE

2008-03-16T19:14:00.000-07:00

There are some good news coming from a section of politicians who now appear to understand the magnitude of the aftermath of the Dec.27, 2007 disputed/discredited elections. Of note are the statements of Mr. William Ruto and Mr. Najib balala among others.

This weekend Ruto made statements that many will term as positive and headed in the right direction. “The Government we are about to form will not be pegged on sharing positions. Those out for positions should do so quickly and give us ample time to get down to real business,” he said.

He also supported Musalia Mudavadi for the post of deputy prime minister in the proposed coalition Government-this is after there appeared to be some frictions already beginning to show within the ODM ranks when three ODM MPs – Mr Kipkalya Kones, Mr Franklin Bett and Dr Julius Kones – said the sharing of power within ODM should be based on the voting pattern in the December election.

"If we gave more votes than the North Rift, we the Kipsigis should get the bigger portion,’’ Bett said. Dr Julius Kones added: "We support the power deal but not just on the horizontal basis between Kibaki and Raila, ODM and PNU, but we need to let it trickle down to the grassroots. This is ODM’s greatest test.’’It is understood that Ruto's statements were aimed at such stances while clarify and showing the bigger picture of what lies a head.

And while at it, he(Ruto) appealed to leaders to stop arguing over political positions and instead concentrate on fulfilling promises made to the people. The Eldoret North MP warned politicians not to reduce the sacrifices made in the past few months to a scramble for positions.

“Life and property have been lost. Let’s not talk about positions when many people are still living in camps as refugees in their own country,” he said.

The MP added: “Kenyans should pull up their socks, tighten their belts, roll up their sleeves and deal with various historical injustices, marginalization problems and tribalism that is tearing the country apart.” He added “it’s time for us to make sacrifices, like other Kenyans, in order to begin in earnest to solving problems affecting Kenyans instead arguing about positions”.

Balala on his part together with other MPs urged coastal communities to promote peace following the political crisis that rocked the country after the disputed polls. Lets hope that these are not mere empty isolated statements aimed at achieving cheap political mileage but, a true change of heart and a willingness to put the country before personal interests.And shall we demand that, the rest join-hands and together in unison to lift this country up.

MUTHAURAS OF KENYA NEED TO BE PUT ON NOTICE

2008-03-14T15:08:00.000-07:00

It was refreshing to read an accurate take on the Muthaura's last week's press conference.
D. KIPKORIR said this much...

On Monday(03/10/2008), the head of public service, Mr Francis Muthaura, with Government spokesman Alfred Mutua in tow, called a press conference and, with the national flag in the background, told Kenyans what he called the Government’s understanding of the power-sharing agreement signed by President Kibaki and ODM leader Raila Odinga.

In particular, he said the pact was restricted to assigning Mr Odinga the title of prime minister, maybe a security escort and half the Cabinet, and that is all. With respect to Mr Muthaura, his understanding of the deal is pedestrian, off-course and misleading.

The National Accord and Reconciliation Bill, 2008, and the Constitution of Kenya (Amendment) Bill, 2008, were published on March 6, setting in motion the legislative process to enact them into law.

The Reconciliation Bill sets out the details of the power-sharing agreement and, once enacted, will be an ordinary statute. The constitutional Bill merely intends to embed the statute in the Constitution and thus make the pact constitutional.

Dual process

The dual process of having a statute with the details, and then a mere insertion in the Constitution that says that the statute is part and parcel of the Constitution, is novel and precedent-setting in our constitutional jurisprudence. I guess the exigency of the moment was an inspiration to the people who drafted the Bills.

But drafting was the only point of convergence of ODM of Mr Odinga and President Kibaki’s PNU.

The heart and gist of the Reconciliation Bill states that the prime minister, who shall come from the largest political party in Parliament, shall “ … coordinate and supervise … the affairs of the Government, including those of ministries …”

The Constitution Bill will amend Sections 3, 15 and 17 of the Constitution to make the Reconciliation Bill part of the supreme law and make it supersede all other provisions of the Constitution and Acts of Parliament that shall be inconsistent with it.

What then are the true meanings of the two Bills? Before attempting to understand them one needs to know two things — that they are in law called enabling statutes as they are intended to create new offices and powers, and it is the exclusive province of Parliament to make laws and for courts to interpret them when there is a conflict.

In interpreting statutes, one has to look at several established parameters and principles. And of paramount importance is to give effect and efficacy to the intention of Parliament in legislating them.

The preamble to the two Bills, to which President Kibaki and Mr Odinga appended their signatures, is clear and states: “The crisis triggered by the 2007 disputed presidential elections …threatens the very existence of Kenya … neither side can … govern the country without the other. There must be real power sharing …”

Any interpretation of the Bills must, therefore, never contradict the intentions and objectives of what the President and Mr Odinga signed.

Both leaders have a duty to give Kenyans a joint statement of what they meant, and one side should not give a disputed position. As ODM has rejected Mr Muthaura’s statement, it must be taken that his statement was a personal view.

Further, meanings of Bills must be unambiguous and mean what they say as well as create consistency.

Every person is free to consult their dictionaries to get the meanings of the operative words that create the office of and give powers to the prime minister.

If words used in a Bill are meaningless or give contradictory and ambiguous dictionary meanings, it behoves Parliament to correct them.

The Bills say that the prime minister shall have “… authority to coordinate and supervise …” functions and affairs of the Government, including ministries.

The simplest dictionary meaning of this is that the prime minister shall have power — real power — to superintend and oversee all powers of government and ministries to create order, harmony and organization. The words cannot have a clearer meaning.

Government and ministries mean what they say; this is the entire Executive arm. The other arms of the State are the Legislature and the Judiciary.

Government and ministries include the entire civil service, the armed forces, the provincial administration, the diplomatic corps and the parastatals.

Supervisory role

The prime minister will thus have the overall supervisory and coordinating role over the entire Executive to its fullest extent as long as this does not conflict with the overall powers of the President as set out in sections 23 and 24 of the Constitution.

As the creation of the office and the powers of the prime minister was by President Kibaki’s agreement, we must take it to mean that their powers shall be seamless.

My understanding is that the prime minister shall be a co-president. The premier will, therefore, exercise all executive powers, except that of being commander-in-chief of the armed forces and receiving diplomatic accreditations.

The other interpretations of statutes are more scientific and are the preserve of the courts. Meanings beyond the clear, ordinary and unambiguous are left to the courts.

This interpretation is to create logic and consistency in the entire legal body to remove any unintended consequences. However, the power of the courts leaves it to the individual persuasion, philosophy and, tragically in Kenya, the judge’s tribe.

However, the judges will still be guided by history, context and public policy in their interpretation. The two Bills are, as admitted in the preamble, caused by the ineptitude and incompetence of the Electoral Commission which left Kenyans in doubt as to who the president is.

It will take a very unpatriotic and completely incompetent judge to give a meaning that is contrary to this history, context and public expectations.

Kenya needs to heal and move forward, and it is evident that the President and Mr Odinga know what we expected, and do expect, of them.

In the next one week or so Parliament, through a guillotine process, will enact the two Bills into law. The House is wholly empowered to have short-cuts in its procedure when there is cause, and isn’t there one now?

The Reconciliation Bill needs a simple majority of Parliament to be passed, whereupon it will be gazetted and assented to by the President.

The Constitutional Bill needs 65 per cent of all MPs and, once passed, automatically becomes law without the presidential assent. Parliament and the attorney-general need, therefore, to work in sync to bring both Bills into operation at the same time and seamlessly.

In the meantime, Mr Muthaura and like-minded officers should stay clear of the roles of the AG and the courts.

Interpreting the law is not part of the duties of a civil servant, and I am surprised that Mr Moses Wetang’ula and Mr Mutula Kilonzo, lawyers of impeccable record, will want to acquiesce to Mr Muthaura’s amorphous and non-existent duty.

Besides, the office of the head of public service being non-constitutional, will be subservient and answerable to the prime minister. Section 19 of the Public Officer Ethics Act, 2003, makes it a criminal offence for a civil servant to give false or misleading statement to the public.

Our prefects, AG Amos Wako and the head of the Kenya Anti-Corruption Authority, Mr Justice Aaron Ringera, should read and enforce it.

As our nation-state is trying to heal, we must stand up against people who want to derail the process.

Kenya is bigger than individuals, and our objective is to move forward according to the road map given by the mediation chief, former UN secretary-general Kofi Annan, and his team.

We must go through all the agreed processes. Some people will have to lose power and others gain it, but Kenya must stand united.

TIME FOR CHANGE IS NOW

2008-03-14T14:33:00.000-07:00

Kenyans, lets all join hands and say -enough already!... with the likes of Muthauras, Mutuas, Michukis, Karuas-(even though she's tried very hard to tone down her hardliner position for the last three days), Thuos, Muhohos, Kilonzos, Kimunyas, Wetangulas among others. Apparently it hasn't dawned on them that it's not going to be business as usual again in Kenya-never!.....

THIS MUCH IS TRUE:

By Emeka-Mayaka Gekara.....

The public service is the fulcrum on which government development programmes revolve. But given the recent election-related violence, the poisoned ethnic atmosphere and a torn national fabric, Kenya now requires a creative, clean and representative civil service to pull it from the brink. To achieve this goal, it must enjoy the goodwill of all Kenyans more than ever before.

Since independence, the ruling elite has been using patronage to reward cronies with positions in the public service, provincial administration and parastatals.

Presidents Kenyatta, Moi and Kibaki have all used the positions to pay back for the loyalty of their people. These include positions of permanent secretaries, provincial and district commissioners, State corporation chairmen and envoys.

Communities whose elites dominate government echelons reap a chunk of public service posts through a trickle down effect. Conversely, communities that are not represented feel marginalized, thereby causing ethnic resentment.

This discontent was partly to blame for the collapse of Narc, the coalition which won the 2002 election. The coalition collapsed after some ethnic groups felt short-changed in the allocation of positions in the public sector on the basis of the infamous MoU.

Central Kenya where President Kibaki comes from, was perceived to have received key posts in both the Cabinet and civil service.

According University of Nairobi political scientist Karuti Kanyinga who has carried research on governance institutions and inequalities in Kenya, it is through ethnicity that elites fence off those likely to oppose those competing against them.

“An inequality in the ethnic composition of influential positions therefore derives from conscious and deliberate efforts of the governing elite. Elites from ethnic groups associated with opposition groups are locked out of influential positions to ensure a structured form of inequalities and therefore a structured form of political domination.”

The civil service, by its very composition, played both a divisive and unifying role.

While some villages harvested more than two slots of permanent secretaries and a host of high commissioners and judges, some constituencies felt left out.

While one womb was rewarded with two posts of PS, thousands others in some parts of the country got not even a DO.

Those rewarded with the posts rallied around the President while the other group tilted away disenchanted. No wonder, the Narc coalition split within three years.

The Annan peace accord signed on February 28 has highlighted the mistake and argued a potent case for national unity which should be reflected at all levels of government — from the village chief to the President. If the late Kijana Wamalwa was to resurrect and attend a PNU/ODM Cabinet, he’ll only probably be concerned about the absence of Moody Awori and his North Rift neighbour Kipruto Kirwa.

At the sight of William Ruto, Musalia Mudavadi and Uhuru Kenyatta, he will think the politicians crossed over and joined Narc because the peace agreement has reassembled the original Narc and added Kanu to the mix for good measure.

It should not be split again.

But if history is anything to go by, the sharing of power should go beyond the Cabinet to other spheres of government, including the civil service. In fact, real sharing of government is the heartbeat of the Annan Accord.

Equitable distribution of key positions along regional lines should help foster a sense of inclusion and redistribution of resources at the top.

If the system does not work, the alternative would be to weed out the key civil servants standing in the way of reforms and replace them with those who will oil the wheels of change.

Like President Kibaki and Mr Raila Odinga, professionals across the political divide should team up as patriots in the public service to implement the coalition manifesto.

A young, competent and energized public sector picked on merit and which represents the face of country’s diversity will also boost a sense of national ownership of the shared government.

New dispensation

Besides, a public sector for the coalition must resonate and be fully reconciled with the new dispensation for it to implement the agenda of the parties and their leaders.

It is futile to have a Cabinet which represents the face of the alliance whose policies are implemented by a public service skewed in favour of one of the parties.

That is why, for instance, a number of us expect a new spokesman, probably woman, for the grand alliance.

Secondly, top civil servants, especially permanent secretaries, high commissioners and provincial administrators, play a significant political role because they are used to facilitate control and execution of power. This is why both PNU and ODM will need to have representation in them.

According to Prof Kanyinga, whenever governments change, “incoming elites feel insecure to govern using a framework they have little control of.”

This explains why Head of Public Service Francis Muthaura’s comments on the power-sharing agreement attracted the rough edge of the ODM tongue.

In his interpretation of the deal, Mr Muthaura said the civil service will not be subject to the power-sharing deal.

He also said that appointments to the public service, parastatals and other constitutional bodies were not subject to the agreement.

According to him, such appointees were expected to serve all Kenyans equally and their jobs could not be politicised.

Mbooni MP Mutula Kilonzo, who appears to be positioning himself for a key role in the alliance, supported Mr Muthaura saying he was executing the administrative part of the deal. But ODM reckons that the Secretary to the Cabinet was unqualified to interpret the agreement.

Out of tune

Mr Muthaura’s views projected him as the voice of a clique which has not learnt from history and is largely out of tune with the reality on the ground.

It is also curious that his sentiments were captured in a mysterious document circulated to MPs earlier this week.

Secondly, it portrayed him as the face of a frightened section of senior civil servants fighting to retain their jobs.

For real power-sharing, a shake-up of the service is inevitable.

Kenyans expect the typewriter generation of civil servants – of which Mr Muthaura is prominent member – to give way to new blood. Nobody had better advice for the Muthaura than former Knut chairman Joseph Chirchir.

Reacting to what he termed as the Head of Public Service’s “unfortunate remarks”, the retired unionist said: “Muthaura has outlived his usefulness in the civil service and should step aside for young people.”

US DEMOCRATIC RACE CONTINUES

2008-03-12T09:30:00.000-07:00

Barack Obama's victory in Mississippi last night along with his weekend win in Wyoming has enabled him to erase the gains Hillary Clinton made with wins in high-profile races in Ohio and Texas last week.

With the win in Mississippi, he has now won 29 contests compared to 15 for Clinton. In overall votes Obama has about 13.3 million to 12.6 million for Clinton, based on unofficial returns which don't include the Michigan and Florida contests.

Obama beat Clinton 61 percent to 37 percent with 99 percent of the precincts reporting in Mississippi state. With the victory, Obama added 17 delegates to his total while Clinton picked up 11, according to the estimates.

The Mississippi win was Obama's second win in a row, having won the Wyoming caucuses Saturday. He's also projected to be the winner of the Texas Democratic caucuses that occurred March 4. Obama will be awarded 38 of Texas's delegates, while Clinton will win 29 delegates as a result of the caucuses.

Clinton beat Obama 51 percent to 47 percent in the Texas primary that was also held on March 4, but Obama was expected to win a majority of the 228 Texas delegates due to his caucus win. Two-thirds of the state's 193 delegates were at stake at the primary, while the remaining third were decided by the caucuses.

Counting the wins in Mississippi and Texas, Obama now leads Clinton 1,608 to 1,478 in the total delegate count. Neither candidate is expected to obtain the 2,025 delegates needed to win the nomination outright before the national convention in August.