WHO is seeking US$56m to battle Zika virus

THE World Health Organization says it requires an estimated US$56 million to implement its global Strategic Response Framework and Joint Operations Plan to guide the international response to the spread of mosquito-borne Zika virus infection and the neonatal malformations and neurological conditions associated with it.

The funds sought would be used  to fast-track vaccines, carry out diagnostics and research into how the virus spreads, as well as virus control. 
Possible links with neurological complications and birth malformations have rapidly changed the risk profile for Zika from a mild threat to one of very serious proportions, WHO Director-General Margaret Chan admitted in a strategy paper.
The funds sought to include $25 million for the Agency and its regional office and the rest for aid partners such as UNICEF. The WHO expects the money to come from states and other donors and in the meantime it has tapped a new emergency contingency fund for $2 million for initial operations.

A  breakdown shows that about US$25 million would be required to fund the WHO/AMRO/PAHO response and $31 million to fund the work of key partners of the strategy that focuses on mobilizing and coordinating partners, experts and resources to help countries enhance surveillance of the Zika virus and allied disorders.

Improvement of vector control, effective communication of risks, guidance and protection measures, provision of  medical care to those affected and fast-tracing research and development of vaccines, diagnostics and therapeutics are part of the expected package.

WHO has also activated an Incident Management System to oversee the global response and leverage expertise from across the organization to address the Zika virus crisis while tapping into a recently established emergency contingency fund to finance its initial operations.

WHO’s Regional Office for the Americas (AMRO/PAHO) has been working closely with affected countries and partner specialists to help health ministries detect and track the virus, contain its spread, advise on clinical management of Zika and investigate the spikes in microcephaly and Guillain-Barré syndrome in areas where Zika outbreaks have occurred.

WHO said it is issuing regular information and guidance on the congenital and neurological conditions associated with Zika virus disease, as well as related health, safety and travel issues.

Working with partners, WHO is also mapping efforts to develop vaccines, therapies, diagnostic tests and new vector control tactics and putting in place mechanisms to expedite data sharing, product development and clinical trials.

On 1 February 2016, based on recommendations of the International Health Regulations Emergency Committee, WHO declared the increasing cases of neonatal and neurological disorders, amid the growing Zika outbreak in the Americas, a Public Health Emergency of International Concern.

HIV contains copycat protein

HIV is a smart virus. It is also a copycat. It is smart because it actively evades detection so that it can cause AIDS by hijacking the body's immune cells. 
Researchers have deciphered how a small protein made by the Human Immunodeficiency Virus (HIV) that causes AIDS manipulates human genes to further its deadly agenda. 
Scientists have  long known that HIV  transforms ing them into HIV factories and killing other immune cells that normally fight disease. HIV also hides in cells and continues to undermine the host's immune system despite antiretroviral therapy that has improved the outlook of those with AIDS.

The findings, published in the online journal eLife, could aid in the search for new or improved treatments for patients with AIDS, or to the development of preventive strategies.

"We have identified the molecular mechanisms by which the Tat protein made by HIV interacts with the host cell to activate or repress several hundred human genes," said Dr. Iván D'Orso, Assistant Professor of Microbiology at UT Southwestern and senior author of the study. "The findings clearly suggest that blocking Tat activity may be of therapeutic value to HIV patients."

It has long been known that HIV causes AIDS by hijacking the body's immune cells, transforming them into HIV factories and killing other immune cells that normally fight disease. HIV also hides in cells and continues to undermine the host's immune system despite antiretroviral therapy that has improved the outlook of those with AIDS.

The latest data from the Centers for Disease Control and Prevention (CDC), in 2012, estimated 1.2 million Americans were living with HIV, including 156,300 whose infections had not been diagnosed. About 50,000 people in the U.S. are newly infected with HIV annually, the CDC projects. In 2013, the CDC estimated that over 26,000 Americans had the advanced form of HIV infection, AIDS.

Like all retroviruses, HIV has very few genes of its own and must take over the host's cellular machinery in order to propagate and spread throughout the body. Although the broad aspects of that cellular hijacking were known, the nuances remain to be explored, Dr. D'Orso said.

"We observed that HIV methodically and precisely manipulates the host's genes and cellular machinery. We also observed that HIV rewires cellular defensive pathways to benefit survival of the virus," he added.

The study provides insights into HIV's ability to survive despite antiretroviral therapy, findings that could lead to new therapeutic targets or ways to make current therapies more effective, he said.

"Our study indicates that this small viral protein, Tat, directly binds to about 400 human genes to generate an environment in which HIV can thrive. Then, this protein precisely turns off the body's immune defense. It is striking that such a small viral protein has such a large impact," Dr. D'Orso said. "The human genes and pathways that Tat manipulates correlate well with symptoms observed in these patients, such as immune system hyperactivation, then weakening, and accelerated aging," Dr. D'Orso said, describing the situation in which HIV infection leads to AIDS.

Italy's National Institute of Health in Rome recently completed a phase II clinical trial of an experimental vaccine that targets the Tat protein. That trial, which followed 87 HIV-positive patients for up to three years, reported that the vaccine was well-tolerated without significant side effects. However, it will take several years to determine if the vaccine works, Dr. D'Orso said.

Although someone can have HIV for years without showing symptoms, AIDS occurs when HIV blocks the body's ability to fight off illness. The person then becomes overrun by the opportunistic infections and specific cancers that are hallmarks of AIDS.

Zero tolerance for the scar of a lifetime

The day Folake, 13, was circumcised, she had no idea what was about to happen. She had gone to bed the previous evening only to be woken in the dead of the night by a loud bang on the door of the room where she and her 10-year-old sister slept.

The room was in inky darkness as the door crashed open and before Folake could move, she felt a large hand covering her mouth and nose while another strong hand lifted her off the bed and dragged her out of the room into the passage.

In shock and unable to protest or wriggle free, Folake  heard her sister screaming in the background, but under the pale, moon-lit night, as she was dragged out of the back door into the compound and onto the footpath leading to the main road, she  quickly became aware of some figures standing by the house.

She recognized one of those figures as her mother’s and made a vain attempt to call out to her. She was surprised that her mother made no move to rescue her from the assailant. Tears came to her eyes when she heard her mother whisper “Folake, you are going to be cut. It’s your turn.”

The rest of the events after that went by in a blur. Folake practically passed out as a result of the choking grip on her mouth and nose. When she came to, she found herself naked and spread-eagled on the floor in an unknown room.

A candle burned unsteadily nearby as she struggled hopelessly to get up, but was pinned onto floor by four women. A fifth woman knelt between her legs, bent over her lower abdomen with a razor blade in her right hand , urged her to stop struggling. “You won’t feel it. It's not going to be painful, the woman remarked.

But Folake felt it. As her flesh was being cut off, white-hot pain enveloped her entire being. The pain was more intense than she ever imagined. She bled a lot. For many days thereafter, she was in agony. She felt abused, violated and disenchanted.

Why, why? She kept asking. But there were no answers. She had gone through Type 3 form of Female Genital Mutilation and Cutting and did not know why.

Slowly she healed and time passed. She thought her ordeal was, but only became aware of how much she’d been affected psychologically and physiologically when she fell pregnant.

Folake was severely depressed and hated being vaginally examined. It was her worst nightmare.Her gynaecologist could not understand why she was so averse and so scared?

Folake did not know it, but her body was experiencing flashbacks - a reminder of what had happened to her when I was 13.

There are millions of girls and women like Folake that are victims of FGM/C. February 6, the International Day of Zero Tolerance for Female Genital Mutilation and Cutting, FGM/C, is  an awareness campaign to end the harmful practice that violates girls’ and women’s rights.

The World Health Organisation, WHO, describes female genital mutilation and comprising all procedures that involve altering or injuring the female genitalia for non-medical reasons. The practice is recognized internationally as a violation of the human rights of girls and women.  

In Nigeria and some other parts of the developing world, this practice has been described as reflecting deep-rooted inequality between the male and female sexes, and constituting an extreme form of discrimination against women and girls.

The practice also violates their rights to health, security and physical integrity, their right to be free from torture and cruel, inhuman or degrading treatment, and their right to life when the procedure results in death.

Although the practice of FGM cannot be justified by medical reasons, in many countries it is being executed more and more often by medical professionals, which constitutes ones of the greatest threats to the abandonment of the practice. 

Recent analysis of existing data shows that more than 18 percent of all girls and women who have been subjected to FGM have had the procedure performed by a health-care provider and in some countries this rate is as high as 74 percent. 

The situation of FGM/C in Nigeria according to NDHA 2013 reveals that due to its large population, Nigeria has the third highest absolute number of women and girls (19.9 million) who have undergone FGM/C worldwide (after Egypt and Ethiopia).

In it’s clinical description of FGM/C, the WHO describes it as comprising four types:  Type1: Clitoridectomy: partial or total removal of the clitoris and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris). Type2: Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia; Type3: Infibulation: narrowing of the vaginal opening through the creation of a covering seal. Type IV (Unclassified): all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

The National President, Inter-African Committee on FGM, Professor Modupe Onadeko, argues that the sensitisation against FGM/C  is now in the nurses’ curriculum at the University College Hospital, UCH, Ibadan, observes that we should not allow even one  girl to be mutilated again.

Onadeko  who argues that female circumcision is not the equivalent of male circumcision, said globally it is a violation of the girl child and the woman and has drawn criticism because of the hazards of health and complications.

“Female Genital Mutilation/Cutting has been with us for a long time. It is an accepted practice in so many cultures and it has been justified as to why it should go on, as the rites of the passage for preparing a girl to womanhood.

“I have researched and have not come across one good that comes out of FGM/C but there are numerous disadvantages.”   

Data from NDHS 2013, shows that 27 percent women 15-49 have been cut. It happens mainly before the 8th day or early teenage, during labour. An estimated 19.9 million Nigerian women have undergone FGM/C meaning that approximately 16 percent of the 125 million FGM/C survivors worldwide are Nigerians.

From left: Programme Officer, UNFPA Nigeria, Damilola 

Obinna; National President, Inter-African Committee on

 FGM, Professor Modupe Onadeko, and UNICEF Chief 

Communications Officer, Douane Porter. 

Programme Officer, UNFPA Nigeria, Damilola Obinna, notes that there are three sorrowful milestones for the girl child – the day of circumcision, the wedding night  (the fear of painful sexual intercourse) and  the day she would be having her baby. “We need to stop this practice.

Studies show that FGM/C is more prevalent in the southern zones than in the northern zones.  States with the highest prevalence include Osun (77 percent), Ebonyi (74 percent) , Ekiti (72 percent), Imo (68 percent ) and Oyo  (66 percent).

There is a Federal law outlawing the practice of FGM/C in Nigeria, the Violence Against Persons

(Prohibition) Act (VAPP), 2015, the practice continues.  

Eight states of the Federation have laws prohibiting FGM/C viz: Lagos, Osun, Ondo, Ekiti, Bayelsa, Edo, Cross River and Rivers. The Child Rights Act (CRA) 2004 also prohibits FGM/C

Reasons adduced for continuation of the practice range from tradition to preserving and continuing a set of values and rituals in a community, rite of passage from girlhood into womanhood, etc.

Child Protection Specialist, UNICEF, Maryam Enyiazu, FGM/C says is performed in Nigeria for cultural aesthetic reasons. In some communities, normal female genitals are considered ugly, unclean and unattractive unless they are subjected to FGM.

She says in some communities, it is believed that the clitoris contains powers strong enough to damage a man’s penis or to kill a baby during childbirth.

Solely focusing on the medical reasons has not helped. Medicalisation leads to legitimisation of the practice. But with collective support, FGM/C can be abandoned in this generation. That is the message today and every day.

Medic recommends clitoral reconstruction for women living with FGM/C

ON the heels of calls by the UN and human rights organizations for complete ban of the practice of Female Genital Mutilation and Cutting, an Obstetrician and Gynaecologist, Dr Jasmine Abdulcadir, of the University Hospitals of Geneva (HUG), Switzerland, says women living with FGM/C should consider undergoing clitoral reconstruction.

Abdulcadir who specializes in providing services for women who have experienced FGM/C,  urges them to consider this surgery for  reasons ranging from reduction of chronic clitoral pain or to improve sexual pleasure. 

For the last two years, she has supported the work of WHO/RHR in development and implementation of a research agenda that aims to address the needs of women and girls who are at risk of and who live with FGM towards improving the evidence-base for effective policies, and their implementation.  Several women that have been cut see clitoral reconstruction as a way to improve their body image and female identity. 

"They may want to reverse a procedure that was performed without their consent or to regain a genital appearance similar to uncut women," she argues.

On what can women expect from the surgery, she says: "When FGM involves the cutting of the clitoris, it affects the clitoral glans (the visible and more external part of the organ). The majority of the clitoris (the body and crura) lies anatomically deeper and is therefore not affected by the procedure. 

"Additional structures responsible for sexual pleasure, such as the bulbs, also remain intact. This explains why women who have undergone FGM, and do not have psychosexual or other long term physical health complications, may still experience orgasm and sexual pleasure."

Abdulcadir describes clitoral reconstruction as a surgery that consists of re-exposing the clitoral body that is hidden beneath the scar tissue and recreating a more accessible clitoral glans, which can facilitate its stimulation.

"Reduction of clitoral pain and improvement of sexual function are chief among reported positive outcomes. However, the surgery is not without its complications: hematoma, wound breakdown, and post-operative decreased sexual function have been reported in the literature. The rate at which these complications occur ranges from 5.3% to 40%.

On implications for women considering clitoral reconstruction and their providers, she says there is still much unknown about the outcomes of clitoral reconstruction and urged health providers to make women who consider the surgery aware of this scarcity of scientific evidence.

"Whether considering the surgery or not, women should be offered comprehensive, multidisciplinary care including health education on female anatomy, physiology and sexuality, as well as psychosexual therapy. 

"Often, adequate psychosexual care and counselling can improve women's sexual function, body-image and identity with no need for more invasive interventions. Female sexual function is multifactorial and depends on more than the genital anatomy."

Abdulcadir says prior to undergoing any surgery, it is crucial to explore women's pre-operative symptoms, expectations, beliefs and misconceptions on the clitoris, their anatomy and sexuality. "Other possible psychological or physical comorbidities that can affect sexual function should also be screened and treated. If possible, partners should also be included in the care.

"Alternative therapies for improving the sexual health and wellbeing of women living with FGM/C

Women with FGM type III (infibulation) can suffer from superficial dyspareunia (pain during intercourse) and should be offered deinfibulation, a procedure to re-open the vaginal opening after infibulation has been performed. 

"This helps facilitate penetration during sexual activity, hence reducing painful intercourse. It also facilitates urination, menstruation and childbirth. Health education focusing on cultural myths on the clitoris, women's anatomy and physiology, and FGM, as well as associated psychosexual therapy are alternative and effective therapies to improve sexual health that can be proposed to women living with FGM and their partners," she argued.

We can stop FGM/C in our time, says Aishat Buhari

WIFE of the Nigerian President, Mrs Aisha Buhari, has said that the practice of Female Genital Mutilation/Cutting (FGM/C) can be ended within a generation. 

Buhari, who spoke in Abuja, at the formal launch the national response to eliminate the practice, in Nigeria urged the wives of Governors of states where the harmful practice is rampant, to be the voice of the campaign to end FGM/C in their various states.

The event was a collaboration between the Federal government and the Joint UNFPA/UNICEF Programme on FGM/C Abandonment, in partnership with several civil society organizations.

“We are mothers and women and have the primary role to use our privileged positions to make lives better for Nigerians, especially women and girls.

“I urge you to be vocal on the need for FGM/C to end in Nigeria and take action that will enable this to happen,” Buhari noted.

FGM/C is an extremely harmful traditional practice, documented in 28 countries in Africa, Asia and the Middle East.

 It comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.

The practice exposes girls and women to severe and sometimes life-threatening health complications, including hemorrhage, tetanus, sepsis, urine retention, sexual dysfunction and infertility; women who have undergone FGM/C are twice as likely to die during childbirth, and their babies are more likely to during or just after birth. 

UNICEF Nigeria Representative, Jean Gough, stated: “Not one of the myths surrounding this practice has any basis in truth. The only truth is that on every level this is a harmful and brutal practice that has a detrimental impact on the health and the human rights of women and girls.”

Also speaking, UNFPA Nigeria Representative, Mrs. Ratidzai Ndhlovu described FGM as an       extreme form of violence against women and girls.

“It violates her reproductive rights and her bodily integrity. To end this harmful practice, we must understand not only where and how it is practiced, but also the social dynamics that perpetuate it, so we can use that knowledge to persuade practitioners to end the practice,” she argued. 

The national response to accelerate change and eliminate the practice within a generation – estimated at 20 years – will be based on information gathered in a study on the beliefs, knowledge, and practices of FGM/C that was conducted last year by UNICEF, UNFPA and partners in six high-prevalence states: Ebonyi, Ekiti, Imo, Osun, Oyo and Lagos.

The findings of the study highlight the need for sustained communication with communities and collaboration with the media to promoting the social change needed for FGM/C abandonment.

Data from the National Demographic Health Survey 2013, shows 25 percent of women in Nigeria have undergone FGM/C, although the practice is slowly declining. 

Little is known about the origin of FGM/C, which predates contemporary world religions. It is widely practiced in Nigeria, where an estimated 19.9 million Nigerian women have undergone the procedure. 

A new global target and call to action to eliminate Female Genital Mutilation (FGM) by 2030 was launched on February 6, International Day of Zero Tolerance for FGM by UNFPA Executive Director, Prof. Babatunde Osotimehin, and UNICEF Executive Director, Anthony Lake.

Zika virus: Restricting pregnancy is discriminatory

Don't restrict women's access to sexual and reproductive health services in contravention of international standards, the UN High Commissioner for Human Rights, Zeid Al Hussien, warned last week in New York.

The UN is averse to the advice to women to delay getting pregnant due to the possible link between the rampaging Zika virus and neurological disorders affecting newborns.

It says upholding women’s human rights was essential if the response to the Zika health emergency would be effective.

Telling women to delay getting pregnant ignores the reality that many women and girls simply cannot exercise control over when they become pregnant, especially in environments where sexual violence is so common.

For instance, in situations where sexual violence is rampant and sexual and reproductive health services are unavailable, efforts to halt Zika crisis will not be enhanced by stopping women from getting pregnant.

The UN says amid the continuing spread of the virus, authorities must ensure that their public health responses were pursued in conformity with human health-related rights obligations.

It wants governments ensure that women, men and adolescents have access to comprehensive and Health services must be delivered in a way that ensures the woman’s informed consent, respect for her dignity and the guarantee of her privacy.

`Laws and policies that restrict her access to these services must be urgently reviewed in line with human rights obligations in order to ensure the right to health for all in practice.

WHO's roadmap for Zika vaccine development

The World Health Organisation, WHO, has begun mapping existing Research & Development efforts for Zika in order to prioritize medical products and approaches that should be fast-tracked into development.

The global health body said such products will be reviewed by expert advisory committees as soon as possible.

At least 12 groups working on Zika vaccines all in the early stages of development, but availability of licensed products could take a few years.

Currently, most research that could be useful for Zika has been carried out on other flaviviruses – such as dengue or yellow fever.

The WHO had earlier invited interested companies to submit potential products to its Emergency Assessment and Listing procedure.

Diagnostics are a top urgency in order to ascertain the presence of the Zika virus as opposed to other similar diseases caused by flaviviruses with mosquito vectors.

This procedure, once a product has been accepted, guarantees acceptable levels of quality and performance and allows UN agencies, NGOs and countries to procure the product with confidence.

Some studies are being carried out on prophylactic therapeutics that would work in the same way as prophylaxis for malaria.

WHO is also working on establishing regulatory support networks to fast-track approval of clinical trials in countries.

Advocacy on timely samples and data sharing among groups undertaking R&D studies on Zika, to ensure the best science is brought to bear on research and development.

The  WHO’s R&D efforts on Zika are part of the overall work on a roadmap – the R&D Blueprint - for better R&D preparedness based on the experience of the R&D work carried out during the West-Africa Ebola outbreak.

The roadmap will enable roll-out of an emergency R&D response as early and as efficiently as possible for emerging diseases for which there are no, or few, countermeasures. In December 2015, WHO held a consultation to identify a short-list of pathogens to be prioritized immediately for R&D preparedness. Zika was identified as a serious risk, needing further action as soon as possible.