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The case for taking one pill a day to prevent HIV

Opinion: Concerns about the newly approved drug Truvada for HIV prevention are unfounded. It’s worth prescribing, say health researchers at UCLA.
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A picture taken on May 11, 2012 shows a box of antiretroviral drug Truvada -- two months before the U.S. Food and Drug Administration (FDA) approved Gilead Sciences' Truvada as a preventative treatment for people who are at high risk of contracting HIV through sexual intercourse. (JOEL SAGET/AFP/Getty Images)

New global data overwhelmingly suggest that a pill to prevent HIV, approved by the United States’ Food and Drug Administration in July 2012, is safer and more effective than the medical community originally thought. Importantly, new models predict that when taken daily, the drug, called Truvada, can lower the risk of HIV transmission by 99 percent. Recent studies also show that a large-scale rollout of Truvada is unlikely to lead to increased antiviral drug resistance or risk-taking behavior, as some had feared.

But old concerns, even as they have been called into question, persist, and are hindering Truvada from being widely used for HIV prevention. This needs to change. 


Early-stage program saving mothers' lives in Uganda and Zambia

With a surge of cash from donors, maternal mortality has dropped by a third in Zambia and Uganda. Can the program be sustained?
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Thomas Frieden, director of the Centers for Disease Control and Prevention, speaks at a Saving Mothers, Giving Life event in Washington DC on January 9, 2013. (Center for Strategic and International Studies/YouTube)

Brenda Mweetwa was a janitor, not a nurse or a midwife. But she had heard her late husband, a doctor, talk about delivering babies. That was enough, in the understaffed health clinic where she worked in Mabombo, Zambia, to make her the most qualified candidate to help out when a pregnant 16-year-old showed up in labor.

Fortunately, she wasn’t on her own.

As part of a mentorship program administered by Boston University, a certified nurse midwife was standing by to talk Mweetwa through the two-hour delivery over the phone, said Donald Thea, the professor who heads up the effort. When, after producing a healthy, squawking set of twins, the mother started hemorrhaging, Mweetwa harkened back to a training session she’d attended just two days earlier. With a condom and a catheter, she cobbled together a device to stop the bleeding and saved the mother’s life. 


Plague highlights public health failings in Madagascar

Five serious outbreaks of the notorious slayer have spotlighted the perilous state of public health in this island nation, just as it is trying to emerge from a five-year crisis precipitated by a 2009 coup d’état.
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A woman carries water in 'La Reunionkely' area in Antananarivo, Madagascar. (Stephane de Sakutin/AFP/Getty Images)

ANTANANARIVO, Madagascar — Madagascar boasts some of the world’s rarest life forms. Eighty percent of its plants and animals are endemic to the island, including the beloved lemur.

It is also home to a distinctly less endearing organism: a bacteria called Yersinia pestis—or, in common parlance, plague.


How beer explains 20 years of NAFTA’s devastating effects on Mexico

Analysis: The North American Free Trade Agreement was the poster child for the wonders of free trade. The reality is another story.
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Employee Angel Rodriguez checks the beer during the bottling process in the Cervecería Calavera, on July 20, 2012, in Tlanepantla, Mexico State. Producers of handcrafted beer are making their way in Mexico following the emergence of new breweries in crowded neighborhoods of the capital and as large emporiums producing traditional brands like Corona stopped being Mexican-owned. (Ronaldo Schemidt/AFP/Getty Images)

Mexico’s largest agribusiness association invited me to Aguascalientes to participate in its annual forum in October. The theme for this year’s gathering was “New Perspectives on the Challenge of Feeding the World.”

But it was unclear why Mexico, which now imports 42 percent of its food, would be worried about feeding the world. It wasn’t doing so well feeding its own people.


7 wins for global child health in 2013

This year's most notable achievements in the field of child health.
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In the battle against child mortality, the global health community gained some ground in 2013. Here are seven political and scientific developments that gave us reason to hope this year.

1. Millions of lives saved. UNICEF’s annual report on child mortality published in September brought encouraging news: child deaths have declined by nearly 50 percent since 1990. Most of the 6.6 million children who die before age 5 die of preventable causes, but the global health community is making headway against the deadliest diseases. Deaths from diarrhea, which is responsible for 9 percent of child fatalities, have declined by 50 percent. Pneumonia and malaria deaths have dropped by a third.

Still, the world isn’t on pace to meet the Millennium Development Goal set by the United Nations, which aims to decrease child mortality by two thirds by 2015.


Why Madagascar's children have the most at stake in Friday's presidential election

Madagascar’s children have borne the highest costs of the nation's social and economic turmoil since the 2009 coup d'etat. And it will be up to the new president to refocus government priorities.
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Children carry bricks on December 19, 2013 in Antananarivo, ahead of the upcoming presidential election. (Alexander Joe/AFP/Getty Images)

ANTANANARIVO, Madagascar — As the east African island nation of Madagascar picks a president on Friday, five years after a coup d’état sent the country spiraling into crisis, the political dynamics will be closely scrutinized. Will there be post-election violence? How will the impasse between the toppled former president Marc Ravalomanana and his successor, Andry Rajoelina, resolve itself? Will the government shed its pariah status among the international community?

But those with the most at stake will play no role in the political intrigue. Amid unprecedented social and economic turmoil since the 2009 coup, Madagascar’s children have borne the highest costs.

“It’s what you would see in countries like DRC,” says Steve Lauwerier, the UNICEF country director. Except, he adds, “We didn’t have a war. There was no big economic crisis. There was no reason that this should happen.”

What has happened is a peacetime humanitarian collapse of startling proportions. While other African nations have progressed rapidly in health and education, Madagascar has stagnated or regressed. Half of children under 5 suffer from chronic malnourishment, or “stunting,” the fourth-highest rate in the world. At least 1.5 million children do not attend school — which the world bank estimates could be an increase of 600,000 since 2009.


How patent rules could keep new hepatitis C drug from saving 'millions of lives'

While affordable medicine advocates in India prepare to fight the patenting of a new hepatitis C drug, the US works to strengthen pharmaceutical patents through an international trade deal.
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An Indian patient sits in a roadside make-shift shelter outside The Tata Memorial Hospital in Mumbai in April, 2013, after India's Supreme Court rejected a patent bid by Swiss drug giant Novartis in a landmark ruling that activists say will protect cheap generic drugs and save lives in developing nations. (Punit Paranjpe/AFP/Getty Images)

Doctors are calling Gilead Sciences’ new hepatitis C drug a “game changer.” The pill, called sofosbuvir, is more effective than comparable drugs, works more quickly and makes treatment less painful.

“Suddenly, it’s realistic to think we can cure most patients with hepatitis C,” said Dr. Greg Fitz, president of the American Association for the Study of Liver Diseases, in a news conference where Gilead presented research on sofosbuvir. 

But patient rights advocates argue that the drug’s price tag — an estimated $84,000 per treatment — puts sofosbuvir out of reach for many.

The Food and Drug Administration gave the go-ahead on Dec. 6. Gilead will own the market in the United States for at least 20 years before generic drug producers can get in the game and bring prices down.

But in India, advocates for affordable medicine are fighting to block the pharmaceutical company’s patent. If they win, the country will be able to crank out low-cost copies of the drug for millions in India and other developing countries.


Q&A: How a new healthcare model could save thousands of children in Mali

GlobalPost spoke with physician Ari Johnson, co-author of a new study that documents a rapid, tenfold decline in child mortality.
Community Health Workers learn to conduct rapid antigen diagnostic testing for malaria, in Yirimadjo, Mali, 2013. They are training to provide proactive Doorstep Health Care, which includes actively searching for patients door to door. (Muso/Courtesy)

With enough resources and the right approach, ending preventable child deaths may be attainable much sooner than expected, according to a newly released study conducted in Mali. 


Could treating drug companies like restaurants improve global health?

Academics consider the value of rating companies’ global health “footprints.”
A Manhattan restaurant rated with a Health Department 'A' grade on March 7, 2011 in New York City. (Mario Tama/GlobalPost)

BOSTON — If prominently displayed grades in restaurant windows in New York City and Los Angeles can lead to healthier kitchen practices, could similar ratings on products — say, a special label on a box of Advil — do the same for global health?


Female genital mutilation on the rise among Southeast Asian Muslims

More than 90 percent of women surveyed in Malaysia have been circumcised, and experts say increasing regional Islamic conservatism may be the reason why.
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(Emily Judem/GlobalPost)

Though World Health Organization reporting in 2011 indicated a decline in the practice of female genital mutilation — also known as female circumcision — experts say it is actually being practiced at much higher rates among Southeast Asian Muslims than previously thought.

The rise, they suggest, correlates directly to increasing conservative attitudes throughout the region.

On December 20, 2012, the United Nations General Assembly unanimously accepted a resolution on the elimination of female genital mutilation, saying that the practice affects between 100 and 140 million women and girls worldwide. But nearly a full year later, it appears the ban has had little to no effect in the southernmost tip of Southeast Asia.

More from GlobalPost: Debunking 5 misconceptions about female genital mutilation

A 2012 study conducted by Dr. Maznah Dahlui, an associate professor in Malaysia’s University of Malaya’s Department of Social and Preventive Medicine, found that 93.9 percent of Muslim women surveyed had been circumcised. In Indonesia, a 2010 Population Council study of six provinces indicated that between 86 and 100 percent of teenage girls had undergone the procedure. In both studies, 90 percent of Muslim women surveyed expressed support for the practice, claiming that it fulfills a religious obligation and fosters purity in women by controlling their sexual desire.

“Many people are doing it because they believe it is wajib or mandatory in Islam - a belief that was reinforced by a 2009 fatwa by Malaysia’s Islamic council that made it religious obligation,” said Suri Kempe, an activist from Muslim feminist organization, Sisters in Islam. “Yet there is nothing in the Qur’an that states that female circumcision is required. The bottom line is that Islam is not supposed to cause harm.”