S. African AIDS Expert Urges Circumcision
A South African AIDS expert Sunday advocated male circumcision as the best available "vaccine" against the virus in his country, where an estimated 6 million people are infected and more than 600 people die every day.
Francois Venter told a congress of health activists in the Treatment Action Campaign that a recent survey in the Soweto township indicated that circumcised men were 65 percent less likely to contract AIDS than those who had not been circumcised.
"We dream of a vaccine which has this efficacy," said Venter, clinical director of the Reproductive Health and HIV Research at the University of Witwatersrand. "The results are phenomenal."
The association between circumcision and a reduced risk of HIV was noted as early as 1987, when Dr. William Cameron of the University of Manitoba in Canada reported findings from a study in Kenya. Some researchers in early studies have said they believe cells in the foreskin may be particularly susceptible to infection.
Venter urged the Treatment Action Campaign, an influential movement of 13,000 activists, to consider promoting circumcision as a vital prevention tool, given that existing methods were failing to slow the spread of the epidemic.
South Africa has the highest number of people living with HIV/AIDS in the world. Nearly 30 percent of pregnant women are infected, according to a health department survey published in July, and in the hardest hit province of KwaZuluNatal this rises to 41 percent. The disease is now one of the main causes of death among young adults and infants.
Some traditional communities in South Africa practice circumcision, but there are calls for tighter medical controls to limit health risks from blunt and contaminated instruments.
"We don't want our men to go to the chop shop but have medical circumcision," said Zackie Achmat, an AIDS activist who said the congress — which meets every two years — would debate whether to encourage mass circumcision.
Achmat, who is HIV positive, said much more needed to be done on prevention. He said that even though government distribution of condoms increased from one million in 1994 to 40 million in 2004, this still only amounted to 35 condoms per sexually active male per year.
He said that 73 percent of young people without the virus believed that they were not at risk of catching, and 62 percent of young people with the virus also believed there was no risk.
Achmat criticized the government's record on treatment. Of the 500,000 people who need AIDS therapy, only 76,000 are currently receiving it through the public health sector. The World Health Organization has singled out slow progress in South Africa as one of the main reasons it will likely miss its target of putting 3 million people worldwide on therapy by the end of this year.
"We are dying. We are still dying," he said.
Achmat has for years attacked the government for doing too little too late against the AIDS epidemic. In a sign of the mutual antagonism, health ministry officials refused invitations to attend the congress.
"President Thabo Mbeki tragically still shows symptoms of AIDS denialism," said Achmat. Mbeki reputedly doubts the link between HIV and AIDS. Health Minister Manto Tshabalala-Msimang has repeatedly voiced doubts about the safety and efficacy of antiretrovirals, instead stressing the benefits of a diet heavy in garlic, lemon and olive oil.
The Soweto study, was conducted by French researchers between 2002 and 2005 with more than 3,000 healthy, sexually active males between 18 and 24. About half the volunteers were circumcised by medical professionals, and the rest remained uncircumcised.
All the men received counseling on AIDS prevention. But after 21 months, 51 members of the uncircumcised group had contracted HIV, the AIDS virus, while only 18 members of the circumcised group had gotten the disease.
The World Health Organization and UNAIDS welcomed the results of the study, released at a conference in Brazil in July, but says that more trials should be conducted before circumcision can be recommended as a preventive method.
A study conducted by the U.S. National Health Institute involving 5,000 individuals is now under way in Uganda.
Bones to Blame for Aging Face
Beauty, and age, is more than skin deep. In fact, it's bone-deep, a new study finds.
Researchers say shrinking facial bones play a major role in facial aging and that women experience this type of facial bone loss at a younger age than men.
"Many people believe that only gravity creates wrinkles; however, we have discovered the loss of volume in the face and changes in bone structure also contribute to making us look older," study co-author Dr. David Kahn said in a prepared statement.
"As we age, not only do we lose fat in our faces but our bones actually change in contour, often making us look older than we feel," Kahn said.
The findings were presented Sunday at a conference of the American Society of Plastic Surgeons in Chicago.
Kahn's team analyzed computed tomography scans of 30 women and 30 men ranging in age from 25 to more than 65 years old.
He and his colleagues found that, as individuals age, their facial bones dissolve, shrink and leave empty spaces. Since skin also loses elasticity as we age, it's not able to tighten around the spaces left by facial bone loss. Thus, we end up with drooping and wrinkles.
Kahn said the fact that women tend to experience facial bone loss at a younger age than men may explain why women are more likely to seek facial cosmetic enhancement at a younger age than men.
In some cases, cosmetic enhancement can restore lost volume, he said. "By using fillers, along with other cosmetic plastic surgery techniques such as forehead lifts and soft tissue repositioning, plastic surgeons can recreate volume loss caused by dissolving or shrinking bone and lift the skin to create better, more refined results for patients," he said.
Lead Exposure Plus Hypertension May Cause Cognitive Decline
Exposure to lead in childhood and adolescence may contribute to high blood pressure-related problems that can harm cognitive abilities later in life, a new study finds.
Lead exposure and high blood pressure are associated with cognitive impairments in older adults. And being exposed to lead early in life may have a long-term effect on cognitive ability and motor function that carries through to adulthood, the researchers suggest.
The study results were to be presented Saturday at the American Heart Association's annual high blood pressure conference, in Washington, D.C.
"Many of the things that happen with age are not just a byproduct of age," said lead author Dr. Domenic Sica, a professor of medicine and pharmacology at Virginia Commonwealth University. "Your catalog of diseases and exposures comes back to haunt you over time. Lead exposure probably carries a long-term determinative function on some of the changes that occur with hypertension" -- another name for high blood pressure.
Lead is associated with a greater risk of hypertension and also with a greater tendency to chronic kidney disease, Sica said.
Using data from the Third National Health and Nutrition Survey (NHANES III), Sica's team found that lead exposure early in life, combined with high blood pressure in working-age adults, may lead to diminishing cognitive abilities in later life.
NHANES III involved 4,835 people ages 20 to 59. Of these, 51 percent were female, 35.4 percent were white, 31.4 were percent black and 29.7 percent were Hispanic.
The researchers looked at the relationships involving pulse pressure, blood lead level and C-reactive protein -- a marker of inflammation. They also looked at the results of neurobehavioral tests and simple reaction-time tests.
There was a correlation between blood pressure and these measures, Sica said. In neurobehavioral tests, which included measures of reaction time, the researchers found slower and less stable reaction time associated with increases in pulse pressure and blood lead levels.
"We have to be more careful in understanding the impact of blood lead levels," Sica said.
One expert finds the study results too preliminary to draw definitive conclusions.
"It may be that environmental conditions conducive to lead exposure independently harm brain function," said Dr. David L. Katz, an associate professor of public health and director of the Prevention Research Center at Yale University School of Medicine. "Such conditions might include poverty during childhood or adverse environmental conditions."
More work is needed to determine if lead exposure and blood pressure combine to form a unique threat to the brain, Katz said. "Given the prevalence of these exposures and the intense public interest in strategies to forestall dementing diseases, such efforts will be awaited with impatience."
Another expert thinks the findings point to a serious public health problem.
The impact of lead on cognitive function has been well known, and the impact of high blood pressure on cognitive function is also well known. "The fact these two may be synergistic is not a surprise," said Hillel W. Cohen, an associate professor of epidemiology and public health at Albert Einstein College of Medicine in New York City.
"This is more evidence to address lead in the environment and blood pressure as well," he said.
When Job Ups Blood Pressure, Spouse Can Help
A supportive spouse can help soothe the negative effects of job stress on blood pressure, new research shows.
The year-long study of 216 men and women found that a combination of job stress and lack of spousal support was associated with an increase of 2.8 mm Hg in systolic blood pressure.
However, study volunteers who experienced job stress but had a supportive spouse showed a decrease in their hypertension of 2.5 mm Hg in systolic blood pressure.
Spousal support means talking things over on a daily basis, and it's a key component of what the researchers called "marital cohesion," researcher Dr. Sheldon Tobe, assistant professor of medicine, University of Toronto, said in a prepared statement. "Did partners talk about their daily activities? Did one partner pay attention and sympathize when the significant other had a stressful day? Did the partners spend time together?"
Tobe said that people with high job stress and/or low marital cohesion should see their family doctor for a blood pressure check. He also advised people to get their blood pressure checked if they're in a formerly harmonious relationship that's deteriorated.
"The medical model of healthcare does not include job strain, but stress at work and at home can modify the health of patients," Tobe said.
The findings were presented Saturday at the American Heart Association's annual fall High Blood Pressure Research meeting in Washington, D.C.
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