Gonorrhoea 'may become untreatable', health experts warn

Jessica Green (PN)

The World Health Organisation (WHO) has said that the sexually transmitted disease gonorrhoea may become untreatable due to the improper use of antibiotics.
The disease, which increases the chances of gay men catching HIV, is usually treated with a course of antibiotics but doctors say that they are seeing increasing resistance to drugs in the eastern hemisphere.

According to WHO, cheaper, first-line antibiotics are losing their effectiveness and it will be a "matter of time" before gonorrhoea develops resistance to third-generation cephalosporin, which is usually the last drug used to treat infections.
Australia, Hong Kong and Japan have reported treatment failures with oral cephalosporin, the agency said.

Studies show that the overuse of antibiotics can render bacteria immune to them.
"We are dealing with a serious issue with the implication that gonorrhoea may become untreatable," said Dr Shin Young-soo, WHO regional director for the Western Pacific.
"This will have a major impact on our efforts to control the disease and will result in an increase in serious health-related complications."

If left untreated, gonorrhoea can result in infertility, pelvic inflammatory disease, ectopic pregnancy, infections in newborn children, urethral strictures and scrotal swelling.
It also increases the likelihood of acquiring and transmitting HIV infection, which disproportionately affects gay men.

Matthew Hodson, head of programmes at GMFA, the gay men’s health charity, said: “Hearing this report is a major concern. Not only can gonorrhoea have major health consequences, such as inflammation of the joints and septicaemia, but also it can considerably increase the likelihood of HIV being transmitted.

"HIV positive men with gonorrhoea will be more infectious. HIV negative men with gonorrhoea will be more vulnerable to HIV infection."

more from Bloomberg

Ways of attacking HIV

HIV has a complex life-cycle that involves several steps. Disease progression occurs when the virus replicates (reproduces) and infects new cells. The key goal of antiretroviral therapy is to slow – or ideally stop – HIV replication and enable recovery of the immune system.

Antiretroviral drugs, targeting different steps in the viral life-cycle, are the mainstay of HIV treatment. These include, but are not limited to:
Nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs and NtRTIs).
Non-nucleoside reverse transcriptase inhibitors (NNRTIs).
Protease inhibitors.
Integrase inhibitors.
Fusion inhibitors.
CCR5 inhibitors.

There are a number of other candidate drugs in clinical trials, including one in a class called 'maturation inhibitors', as well as innovations in immune-based strategies.
The standard of care for anyone on antiretroviral treatment is highly active antiretroviral therapy (HAART) using drugs with at least two different mechanisms of action (for example, two NRTIs plus either an NNRTI or a protease inhibitor). Over time, HIV can develop mutations that make it resistant to drugs. For this reason, people who have more treatment experience may need more drugs to construct an effective regimen.

By targeting multiple steps in the viral life-cycle simultaneously, the emergence of resistance can be slowed or prevented.
Researchers have also explored other approaches for treating HIV, such as inhibiting cellular factors the virus needs for its replication, gene therapy that protects cells from infection, and removal of cells that are already infected. Many of these approaches are experimental and some remain purely theoretical. But there is evidence that complementary therapies such as nutrient supplements – used in conjunction with antiretroviral therapy – can improve the overall health of people with HIV.

Since the advent of effective combination antiretroviral therapy in the mid-1990s, researchers have discovered much about how best to treat HIV, and treatment has shifted from managing opportunistic illness to suppressing the virus to the greatest extent possible. New studies are showing that even at CD4 cell counts between 350 and 500 cells/mm3, there is a greater risk of morbidity and mortality from non-AIDS illnesses.

While viral load suppression is considered an indicator of effective therapy, the ultimate goal of treatment is to preserve immune function, increase disease-free survival, and reduce mortality. Once HIV replication is controlled, a person’s CD4 cell count usually rises over time, but this occurs more slowly in some patients. Researchers are studying various ways to promote immune system reconstitution and HIV-specific immune response.

Effective antiretroviral therapy has dramatically improved survival and lowered the incidence of opportunistic illnesses and other conditions related to immune suppression in people with HIV. But much remains to be learned about long-term treatment, including whether it is possible to completely eradicate HIV from the body.

also see: How NRTIs and NtRTIs work

Bisexual concurrency, bisexual partnerships, and HIV among Southern African men who have sex with men study

Accepted 9 February 2010
Published Online First 21 April 2010

Abstract
Objectives
The sexual behaviour of men who have sex with men (MSM) in southern Africa has been little studied. We present here the first data on bisexual partnerships and bisexual concurrency among MSM in Malawi, Namibia and Botswana.

Methods
A cross-sectional probe of a convenience sample of 537 men who have ever reported anal sex with another man using a structured survey instrument and rapid-kit HIV screening.

Results
34.1% of MSM were married or had a stable female partner, and 53.7% reported both male and female sexual partners in the past 6 months. Bisexual concurrency was common, with 16.6% of MSM having concurrent relationships with both a man and a woman. In bivariate analyses, any bisexual partnerships were associated with lower education (OR 1.6, 95% CI 1.1 to 2.3), higher condom use (OR 6.6, 95% CI 3.2 to 13.9), less likelihood of having ever tested for HIV (OR 1.6, 95% CI 1.1 to 2.3), less likelihood of having disclosed sexual orientation to family (OR 0.47, 95% CI 0.32 to 0.67) and being more likely to have received money for casual sex (OR 1.9, 95% CI 1.3 to 2.7).

Bisexual concurrency was associated with a higher self-reported condom use (OR 1.7, 95% CI 1.0 to 3.1), being employed (OR 1.8, 95% CI 1.2 to 2.9), lower likelihood of disclosure of sexual orientation to family (OR 0.37, 95% CI 0.22 to 0.65) and having paid for sex with men (OR 2.0, 95% CI 1.2 to 3.2).

Conclusions
The majority of MSM in this study report some bisexual partnerships in the previous 6 months. Concurrency with sexual partners of both genders is common. Encouragingly, men reporting any concurrent bisexual activity were more likely to report condom use with sexual partners, and these men were not more likely to have HIV infection than men reporting only male partners.

HIV-prevention programmes focussing on decreasing concurrent sexual partners in the African context should also target bisexual concurrency among MSM. Decriminalisation of same-sex practices will potentiate evidence-based HIV-prevention programmes targeting MSM.

DOWNLOAD FULL PDF OF STUDY

'Taboo Yardies' documentary to hit the streets in November

Howard Campbell

A Jamaican film-maker's documentary about the country's indifference toward homosexuals is tentatively scheduled for a November release.

Taboo Yardies is the title of Selena Blake's project which looks at the intolerance of Jamaicans toward persons with an alternative lifestyle. The project is being produced by Blake's Maynov Productions.

"Hopefully, the film should be completed within the next two months. I think the buzz surrounding this project is human rights because it's never been told in this manner before," she said.

The Old Harbour-born Blake interviewed several persons in the Caribbean gay community in New York City, and travelled to Jamaica late last year for similar discussions with prime minister Bruce Golding, psychologist, Aggrey Irons, journalist, Beverley Anderson Manley, and the Jamaica Forum of Lesbians, All-Sexuals and Gays.

Significant assignment

The Golding assignment was significant. In a 2008 interview on the British Broadcasting Corporation television programme Hard Talk, the prime minister said there was no space for homosexuals in his administration.

Blake, 47, said it was difficult getting archival material in Jamaica.

"We knew it would be challenging trying to get footage from sources that are homo-intolerant but we managed to overcome the road blocks," she said.

Jamaicans have long shunned homosexuality, mainly on religious grounds. In recent years, many dancehall artistes have been targeted by gay advocates in Europe and North America for their anti-gay songs.

Taboo Yardies is the second film by Blake, a former model who has lived in New York City for more than 30 years. Her 2005 debut, Queensbridge: The Other Side, dealt with deteriorating conditions at the Long Island housing project of the same name where she once lived.

The Queensbridge scheme was built in 1939 and was once home to World War II veterans. NBA star Ron Artest and rapper Marley Marl grew up there.

That documentary got strong reviews including a thumbs-up from the New York Times. Blake hopes Taboo Yardies will also strike an emotional chord.

"I hope it will become a vehicle that will spur an open and honest conversation where homo-intolerance is concerned," she said. "I'm sure there are bigger issues facing Jamaica than same-sex relationships."

see also: A glimpse into the lives of Taboo Yardies


TABOO YARDIES, a documentary that examines Jamaica's indifference toward homosexuals, will have a screening at the General Theological Seminary in New York City next week.

Selena Blake, a 49 year-old Jamaican filmmaker who is producing Taboo Yardies, says persons attending the April 24 event will see 17 minutes of the film which is expected to be released in late 2009.

"I hope that the documentary will be a springboard in the way we as Jamaicans conduct ourselves in the name of God," Blake told The Gleaner this week from her home in New York.

Blake, who was born in Old Harbour, St Catherine, started work on Taboo Yardies in 2007. Through interviews with gay Jamaicans in the United States and Canada, she attempts to show the un-initiated a look at the prejudice homosexuals face in Jamaica.

The documentary also has interviews with businesspersons who have suffered because of the anti-gay themes of some Jamaican dancehall acts. Businesspersons like show promoter D'Niscio Banks of the annual Carifest concert who was strongly criticised by New York Mayor Mike Bloomberg for inviting Buju Banton and Bounty Killer on that show last year.

Aljazeera Network carries Island of Music & Murder Story

Though not directly related to homophobic violence here is a damming piece by the Aljazeera Network in the middle east on our murderous trends specifically related to murdered DJ Kentucky Kid.

Click the image or here to see the video feed from their website.

More:
With 268 armed gangs or neighbourhood 'corner crews' locked in deadly turf wars, Jamaica is one of the most violent societies on earth.

With a population of less than three million people, police kill hundreds of people every year in what they claim are crime-related shootouts, making Jamaica's police force among the deadliest in the world.

Rights groups say that these shootings add up to a campaign of extra-judicial executions carried out by police who have taken the law into their own hands.

The official police response to these allegations cannot be recorded - the commissioner has issued standing orders which ban all officers from speaking to foreign journalists.

But, as reporter Simon Ostrovsky discovered, many others in Jamaica are prepared to speak out. One of them, Robert Hill, an entertainer, actually warned of his own impending death.

"Hello Jamaica. I'm Robert Hill AKA Kentucky Kid. I really don't know what is going on but all I know, police are covering up for each other and they're trying to kill me," Hill explained in a video message.

Robert Hill installed a video camera in his house because he was concerned about his safety

Hill went on to explain how his car had been hit by a police car that had passed through a red light.

Hills car was badly damaged in the incident and he was taken to the police station to give a written statement.

But after waiting for four hours, Hill was sent home and told to return within 24 hours to submit the statement.

When he returned the following day, the police told him that they could not take his statement.

"They told me that they could not take my statement, [and asked] why I did not give it [at] the time of the accident. I told them that Sergeant Gardener told me to return to give it," Hill explained.

When he refused to leave without providing a statement, Hill said he was physically forced out of the building.

"All I know is I can't get any justice. Who will fix my car? Who will take care of my health?" Hill asked in his video message.

Fearful

Kimmo Matthews, a reporter for the Jamaica Observer, says Hill was concerned for his safety.

"The first time he came in and spoke to us it was evident that he was really concerned. He had mentioned that police had threatened him at his home and they were intimidating him."

Hill saw a legal aid lawyer who advised him to install a camera in his house. He followed their advice.


Many Jamaicans are angered by police violence and corruption

"After installing the camera he came to me three days later showing me some video footage of what appeared to be police manhandling him along with his wife. It appeared they were holding him and pushing him around in a room and they were asking him questions," Matthews says.

Hills wife was eight months pregnant when she was beaten by police along with her husband.

Hill told Matthews that members of the police wanted him to drop his case and had resorted to intimidation and physical violence to make him do so.

When Hill took the video of the violence to the police high command, he said nobody was willing to help him.

"I can't get any justice from anyone in Jamaica. All I know is everywhere I go for justice in the police force there is someone there trying to kill me or someone there trying to set me up with the police," Hill said.

"So I would like the whole world to check this out, listen to this, and know that if I'm dead or anything happens to me, it's the Jamaican police that carry out that work or that order."

Shot dead

On December 8, 2009 Robert Hill was shot dead by the Jamaica Constabulary Force (JCF). The police report said they were forced to shoot because Hill had a gun.

Kumiko, Hill's wife, said Hill had received a call that night from someone who said they wanted to see a car that he was selling.

He told her he was going out to show it to them but would be right back.

His cousin accompanied him, but Hill had forgotten the car key and asked his cousin to return to the house for it.

"The Robert Hill case perhaps is a nadir for Jamaica because Robert went and caught the people on tape," says Carolyn Gomes, a medical doctor and the executive director of Jamaicans for Justice.

"You can see them, their faces, you can see them beating him and his wife. You can see them threatening him, and he took that tape to the police high command and they came back and killed him."

"It was too much. It was too much for me to bear. Up to this point I cannot believe that he is dead, that he is gone, just because of a car," says Hills mother, Caroline.

Robert Hill was one of 224 people killed in police shootings last year.

"In the last ten years, 1,900 of our Jamaican citizens, officially, have been killed by the police, more than 1,900. In that time, one policeman has been convicted of manslaughter and he has been freed on appeal," Gomes says.

Corruption and crime

Police blame Jamaica's high crime rates and gang violence.

The national security ministry estimates that there are 268 gangs active in Jamaica.


Jamaican police kill hundreds each year in what they claim are crime-related shootouts

Horace Levy of the Peace Management Initiative says that the police often treat corners crews in the same way as criminal gangs and that it is the black people in the inner cities of Jamaica who are dying at the hands of the police.

"Each time we keep hearing the same reports. Police engaged a man in a shootout, firearm was recovered, a revolver, three live rounds. It's always amazing how when you hear of the incidents the residents always have a story totally different from what the police are saying," Matthews says.

Levy says that many of the police are frustrated because known criminals are being released back onto the streets after just weeks or months in prison.

"The fact is that this is probably one of the most difficult and dangerous places to police in the world because the number of illegal firearms that are on the streets is enormous. And that's a situation that's developed over the past 30 years," Mark Shields, the former deputy commissioner of police, says.

"We have to acknowledge that the JCF is rivven with corruption and crime and we have to make some very difficult decisions around well what we going to do about it? How are we going to protect the citizens of the country, how are we going to protect the good police, the good civilians who work with the police. How can we make their job easier and how can we make the public trust the good police?"

Gomes and Jamaicans for Justice believe that the current police force should be disbanded and that a new service should be created to protect Jamaica's citizens.

"If you gave them equipment, if you gave them the laws and they were not reformed, they continue to be corrupt, than obviously it's time that you dismantle and abandon that police force and form a new one," says Reneto Adams, a former senior superintendent of the JCF.

Eight months after Robert Hill gave the video tape showing him and his wife being beaten to the police high command, and three months after he was killed, no action had been taken against the officers involved and investigations were still in progress.

UK 'breaching UN rules' on returning gay Iraqi asylum seekers

An Amnesty International report claims that the UK and several other European countries are breaching United Nations rules on returning vulnerable Iraqi asylum seekers.
According to the report, women, ethnic minorities and gays, or those perceived to be gay, are most likely to be at risk of violence and persecution in the country.

More than 100 civilians died in the first week of April.

Amnesty accused the UK, along with several other countries, of forcibly returning "scores" of Iraqis to dangerous areas in the country, breaking international rules.

The report said: "Despite the ongoing violence in Iraq, several European governments continue to forcibly return rejected Iraqi asylum-seekers to Iraq.

"In 2009, the authorities in Denmark, the Netherlands, Norway, Sweden and the UK forcibly returned scores of Iraqis to unsafe parts of Iraq, such as central Iraq, in breach of UNHCR guidelines."

It recommended that all forcible returns should cease and resume only when the security situation in the country has stabilised.

Amnesty said that gay people in Iraq were living under a "constant threat" and that Muslim clerics were making frequent public statements condemning homosexuality.

Homosexuality is not illegal in Iraq but it is frowned upon.

In the first few months of 2009, an estimated 25 men and boys were killed in Baghdad because they were thought to be gay. The killings are thought to have been carried out by militia groups.

In some cases, the report said, there was evidence that members of the security forces and other authorities were encouraging the targeting of people suspected to be gay.

The report added that killers of gay men could find protection under the law, as it offers lenient sentences for those committing crimes with an “honourable motive”.

It said that Iraqi courts were continuing to interpret provisions of Article 128 of the Penal Code as justification for giving "drastically reduced" sentences to defendants who have attacked or killed gay men they are related to if they say that they acted to “wash off the shame”.

UK campaigners have complained in recent years that gay asylum seekers from around the world are being deported by UK authorities on the grounds that they will be safe in their home countries if they are "discreet".

Ali Hili, the head of London-based Iraqi LGBT, told PinkNews.co.uk that the British government was "failing Iraqi lesbians and gays".

He said: "We welcome the report. We continue to receive reports of killings and now have over 738 documented.

"Within the last fortnight two young gay men were taken by men in police uniforms and their graffitied bodies displayed in one of Baghdad's main squares.

"We have and will continue to try to get people to safety but the British government must do more. It is wrong to tell Iraqi asylum seekers that it is safe to return if only they are 'discreet', which they have done."

Amnesty International Middle East director Malcolm Smart said: “Iraqis are still living in a climate of fear, seven years after the US-led invasion. The Iraqi authorities could do much more to keep them safe, but over and over they are failing to help the most vulnerable in society.

“The continuing uncertainty as to when a new government will be formed following last month’s election could well contribute to a further increase of violent incidents of which civilians are the main victims.

“The uncertainty is threatening to make a bad situation even worse. Both the Iraqi authorities and the international community must act now to prevent more unnecessary deaths.”