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Thursday, December 14, 2006

Circumcision Halves H.I.V. Risk, U.S. Agency Finds - New York Times

Circumcision Halves H.I.V. Risk, U.S. Agency Finds - New York Times:
December 14, 2006

Circumcision Halves H.I.V. Risk, U.S. Agency Finds

Circumcision appears to reduce a man’s risk of contracting AIDS from heterosexual sex by half, United States government health officials said yesterday, and the directors of the two largest funds for fighting the disease said they would consider paying for circumcisions in high-risk countries.

The announcement was made by officials of the National Institutes of Health as they halted two clinical trials, in Kenya and Uganda, on the ground that not offering circumcision to all the men taking part would be unethical. The success of the trials confirmed a study done last year in South Africa.

AIDS experts immediately hailed the finding. “This is very exciting news,” said Daniel Halperin, an H.I.V. specialist at the Harvard Center for Population and Development, who has argued that circumcision slows the spread of AIDS in the parts of Africa where it is common.

In an interview from Zimbabwe, he added, “I have no doubt that as word of this gets around, millions of African men will want to get circumcised, and that will save many lives.”

Uncircumcised men are thought to be more susceptible because the underside of the foreskin is rich in Langerhans cells, sentinel cells of the immune system, which attach easily to the human immunodeficiency virus, which causes AIDS. The foreskin also often suffers small tears during intercourse.

But experts also cautioned that circumcision is no cure-all. It only lessens the chances that a man will catch the virus; it is expensive compared to condoms, abstinence or other methods; and the surgery has serious risks if performed by folk healers using dirty blades, as often happens in rural Africa.

Circumcision is “not a magic bullet, but a potentially important intervention,” said Dr. Kevin M. De Cock, director of H.I.V./AIDS for the World Health Organization.

Sex education messages for young men need to make it clear that “this does not mean that you have an absolute protection,” said Dr. Anthony S. Fauci, an AIDS researcher and director of the National Institute of Allergy and Infectious Diseases.

Circumcision should be used with other prevention methods, he said, and it does nothing to prevent spread by anal sex or drug injection, ways in which the virus commonly spreads in the United States.

The two trials, conducted by researchers from universities in Illinois, Maryland, Canada, Uganda and Kenya, involved nearly 3,000 heterosexual men in Kisumu, Kenya, and nearly 5,000 in Rakai, Uganda. None were infected with H.I.V. They were divided into circumcised and uncircumcised groups, given safe sex advice (although many presumably did not take it), and retested regularly.

The trials were stopped this week by the N.I.H. Data Safety and Monitoring Board after data showed that the Kenyan men had a 53 percent reduction in new H.I.V. infection. Twenty-two of the 1,393 circumcised men in that study caught the disease, compared with 47 of the 1,391 uncircumcised men.

In Uganda, the reduction was 48 percent.

Those results echo the finding of a trial completed last year in Orange Farm, a township in South Africa, financed by the French government, which demonstrated a reduction of 60 percent among circumcised men.

The two largest agencies dedicated to fighting AIDS said they would now be willing to pay for circumcisions, which they have not before because there was too little evidence that it worked.

Dr. Richard G. A. Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has almost $5 billion in pledges, said in a television interview that if a country submitted plans to conduct sterile circumcisions, “I think it’s very likely that our technical panel would approve it.”

Dr. Mark Dybul, executive director of President Bush’s $15 billion Emergency Plan for AIDS Relief, said in a statement that his agency “will support implementation of safe medical male circumcision for H.I.V./AIDS prevention” if world health agencies recommend it.

He also warned that it was only one new weapon in the fight, adding, “Prevention efforts must reinforce the A.B.C. approach — abstain, be faithful, and correct and consistent use of condoms.”

Researchers have long noted that parts of Africa where circumcision is common — particularly the Muslim countries of West Africa — have much lower AIDS rates, while those in southern Africa, where circumcision is rare, have the highest.

But drawing conclusions was always confounded by other regional factors, like strict Shariah law in some Muslim areas, rape and genocide in East Africa, polygamy, rites that require widows to have sex with a relative, patronage of prostitutes by miners, and men’s insistence on dangerous “dry sex” — with the woman’s vaginal walls robbed of secretions with desiccating herbs.

Outside Muslim regions, circumcision is spotty. In South Africa, for example, the Xhosa people circumcise teenage boys, while Zulus do not. AIDS is common in both tribes.

Nelson Mandela’s autobiography, “Long Walk to Freedom,” contains an unnerving but hilarious account of his own Xhosa circumcision, by spear blade, as a teenager. Although he was supposed to shout, “I am a man!” he grimaced in pain, he wrote.

But not all initiation ceremonies are laughing matters. Every year, some South African teenagers die from infections, and the use of one blade on many young men may help spread AIDS.

In recent years, as word has spread that circumcision might be protective, many southern African men have sought it out. A Zambian hospital offered $3 circumcisions last year, and Swaziland trained 60 doctors to do them for $40 after waiting lists at its national hospital grew.

“Private practitioners also do it,” Dr. Halperin said. “In some places, it’s $20; in others, much more. Lots of the wealthy elite have already done it. It prevents S.T.D.’s, it’s seen as cleaner, sex is better, women like it. I predict that a lot of men who can’t afford private clinics will start clamoring for it.” (S.T.D.’s are sexually transmitted diseases.)

Male circumcision also benefits women. For example, a study of the medical records of 300 Ugandan couples last year estimated that circumcised men infected with H.I.V. were about 30 percent less likely to transmit it to their female partners.

Earlier studies on Western men have shown that circumcision significantly reduces the rate at which men infect women with the virus that causes cervical cancer. A study published in 2002 in The New England Journal of Medicine found that uncircumcised men were about three times as likely as circumcised ones with a similar number of sexual partners to carry the human papillomavirus.

The suspected mechanism was the same — cells on the inside of the foreskin were also more susceptible to that virus, which is not closely related to H.I.V.

Monday, December 11, 2006

About.com: http://news.yahoo.com/s/usatoday/20061205/cm_usatoday/52yearslaterintegrationfacesnewsupremecourttest

About.com: http://news.yahoo.com/s/usatoday/20061205/cm_usatoday/52yearslaterintegrationfacesnewsupremecourttest

52 years later, integration faces new Supreme Court test

Tue Dec 5, 6:32 AM ET

Since the historic 1954 ruling in Brown v. Board of Education began dismantling separate schooling for black and white children, the Supreme Court has spent a half-century painstakingly working out a fair way of making America's classrooms more racially diverse.

The results can be seen nearly everywhere you look. African-Americans head major companies. The two most recent secretaries of State are black. A vibrant, educated black middle class has sprung up, and colleges actively seek black students to enrich their campuses, expanding that middle class further.

So it was ominous Monday to hear Supreme Court justices sounding hostile to voluntary - and popular - desegregation plans in Seattle and Louisville. If the justices rule them unconstitutional, the tenuous advance of equal opportunity could be undermined or even reversed.

As with anything involving race, the system of desegregation and affirmative action that has evolved under the court's watchful eye is controversial. Whites sometimes feel slighted, and it is whites who brought the Seattle and Louisville cases to court.

Both cities assigned students to schools in part to ensure that the schools are racially diverse, and parents whose children were temporarily denied admission to the schools they preferred sued, claiming racial bias.

Lower courts ruled against them, and just a year ago, the issue seemed settled. The court refused to hear a challenge to a desegregation plan in Lynn, Mass., that is similar to the Louisville plan.

But then Justice Sandra Day O'Connor retired and was replaced by Justice Samuel Alito, who civil rights advocates fear is the crucial fifth vote to undo the two plans - and others in hundreds of school districts that follow similar guidelines to achieve diversity.

In 2003, O'Connor was the fifth vote in a pivotal 5-4 decision that said the University of Michigan Law School could consider race as a factor in admissions, as long as there was no explicit quota for admitting black applicants. The court noted that diversity promotes "cross-racial understanding and the breaking down of racial stereotypes" and gives students invaluable skills that "can only be developed through exposure to widely diverse people, cultures, ideas, and viewpoints."

That is the reason Louisville and Seattle tried to diversify their schools. Another reason was that students in overwhelming black or Hispanic schools consistently underperform.

The plans of both cities are complex, trying to balance family preferences against diversity and other non-racial considerations, but they are widely accepted in those communities, and they work.

But they appear far less popular at the court. Court watchers came away thinking the school diversity plans will be in trouble when the court rules early next year. Justice Anthony Kennedy, the likely swing vote now, said at one point that Seattle's plan seems to hinge in some cases "solely on skin color … it's like saying everybody can have a meal, but only (certain people) can get the dessert."

More telling was the answer to a question Kennedy asked about what has happened to Seattle schools since the school board suspended the plan after an adverse court ruling in 2001. Kennedy wondered whether the schools had integrated on their own.

The facts should sober him. In 2000, white enrollment at predominantly non-white Franklin High School was 25%; by 2005 it was down to 10%. Without the plan, Seattle's schools have gone backwards. The high court shouldn't lead a charge to ensure similar results around the nation.

Taliban and Allies Tighten Grip in North of Pakistan - New York Times

Taliban and Allies Tighten Grip in North of Pakistan - New York Times:
December 11, 2006

Taliban and Allies Tighten Grip in North of Pakistan

PESHAWAR, Pakistan — Islamic militants are using a recent peace deal with the government to consolidate their hold in northern Pakistan, vastly expanding their training of suicide bombers and other recruits and fortifying alliances with Al Qaeda and foreign fighters, diplomats and intelligence officials from several nations say. The result, they say, is virtually a Taliban mini-state.

The militants, the officials say, are openly flouting the terms of the September accord in North Waziristan, under which they agreed to end cross-border help for the Taliban insurgency that revived in Afghanistan with new force this year.

The area is becoming a magnet for an influx of foreign fighters, who not only challenge government authority in the area, but are even wresting control from local tribes and spreading their influence to neighboring areas, according to several American and NATO officials and Pakistani and Afghan intelligence officials.

This year more than 100 local leaders, government sympathizers or accused “American spies” have been killed, several of them in beheadings, as the militants have used a reign of terror to impose what President Pervez Musharraf of Pakistan calls a creeping “Talibanization.” Last year, at least 100 others were also killed.

While the tribes once offered refuge to the militants when they retreated to the area in 2002 after the American invasion of Afghanistan, that welcome is waning as the killings have generated new tensions and added to the region’s volatility.

“They are taking territory,” said one Western ambassador in Pakistan. “They are becoming much more aggressive in Pakistan.”

“It is the lesson from Afghanistan in the ’90s,” he added. “Ungoverned spaces are a problem. The whole tribal area is a problem.”

The links among the various groups date to the 1980s, when Arabs, Pakistanis and other Muslims joined Afghans in their fight to drive the Soviet Union out of Afghanistan, using a network of training camps and religious schools set up by the Pakistani intelligence agency and financed by the C.I.A. and Saudi Arabia.

The training continued with Pakistani and Qaeda support through the 1990s, and then moved into Afghanistan under the Taliban. It was during this time that Pakistanis became drawn into militancy in big numbers, fighting alongside the Taliban and hundreds of foreign fighters against the northern tribes of Afghanistan. Today the history of the region has come full circle.

Since retreating from Afghanistan in 2002 under American military attacks, the Taliban and foreign fighters have again been using the tribal areas to organize themselves — now training their sights on the 40,000 American and NATO troops in Afghanistan.

After failing to gain control of the areas in military campaigns, the government cut peace deals in South Waziristan in 2004 and 2005, and then in North Waziristan on Sept. 5. Since the September accord, NATO officials say cross-border attacks by Pakistani and Afghan Taliban and their foreign allies have increased.

In recent weeks, Pakistani intelligence officials said the number of foreign fighters in the tribal areas was far higher than the official estimate of 500, perhaps as high as 2,000 today.

These fighters include Afghans and seasoned Taliban leaders, Uzbek and other Central Asian militants, and what intelligence officials estimate to be 80 to 90 Arab terrorist operatives and fugitives, possibly including the Qaeda leaders Osama bin Laden and his second in command, Ayman al-Zawahri.

The tightening web of alliances among these groups in a remote, mountainous area increasingly beyond state authority is potentially disastrous for efforts to combat terrorism as far away as Europe and the United States, intelligence officials warn.

They and Western diplomats say it also portends an even bloodier year for Afghanistan in 2007, with the winter expected to serve as what one official described as a “breeding season” to multiply ranks.

“I expect next year to be quite bloody,” the United States ambassador in Afghanistan, Ronald Neumann, said in a recent interview. “My sense is the Taliban wants to come back and fight. I don’t expect the Taliban to win, but everyone needs to understand that we are in for a fight.”

Foreign Influence

One of the clearest measures of the dangers of this local cross-fertilization is the suicide bombings. Diplomats with knowledge of the area’s Pashtun tribes say they have little doubt the tactic emerged from the influence of Al Qaeda, since such attacks were unknown in Pakistan or Afghanistan before 2001.

This year suicide attacks have become a regular feature of the Afghan war and have also appeared for the first time in Pakistan, including two in this frontier province in recent weeks, indicating a growing threat to Pakistan’s security.

In recent weeks, Afghan officials say they have uncovered alarming signs of large-scale indoctrination and preparation of suicide bombers in the tribal areas, and the Pakistani minister of the interior, Aftab Khan Sherpao, publicly acknowledged for the first time that training of suicide bombers was occurring in the tribal areas.

The Afghan intelligence service said last week in a statement that it had captured an Afghan suicide bomber wearing a vest filled with explosives. The man reportedly said he had been given the task by the head of a religious school in the Pakistani tribal region of Bajaur, and that 500 to 600 students there were being prepared to fight jihad and be suicide bombers.

The bomber said that the former head of Pakistani intelligence, Gen. Hamid Gul, was financing and supporting the project, according to the statement, though the claim is impossible to verify. Pakistani intelligence agencies have long nurtured militants in the tribal areas to pressure the rival government in Afghanistan, though the government claims to have ceased its support.

So numerous are the recruits that a tribal leader in southern Afghanistan, who did not want to be named because of the threat of suicide bombers, relayed an account of how one would-be suicide bomber was sent home and told to wait his turn because there were many in line ahead of him.

American military officials say they believe much of the training in Waziristan is taking place under the aegis of men like Jalaluddin Haqqani, once one of the most formidable commanders of the anti-Soviet mujahedeen forces who joined the Taliban in the 1990s.

He has had a close relationship with Arab fighters since the 1980s, when Waziristan was his rear base for fighting the Soviet occupation. Arab fighters had joined him there in the struggle, among them Mr. bin Laden.

Mr. Haqqani later became the Taliban’s minister of tribal affairs and was the main protector for the foreign fighters on their exodus from Afghanistan in 2001 and 2002. He and his son, Sirajuddin Haqqani, remain the most important local partners for Al Qaeda in Waziristan.

Mr. Haqqani bases himself in North Waziristan and has a host of other Taliban and foreign commanders, in particular Uzbeks, who are loyal to him, United States military officials say.

Money continues to flow in from religious supporters at home and in the Persian Gulf, as well as from a range of illicit activities like a lucrative opium trade, smuggling and even kidnapping, said diplomats, United Nations analysts and local journalists.

“There are clearly very substantial training facilities that are still operating in Waziristan, both north and south, and other parts of FATA and Baluchistan,” said a diplomat in Kabul, referring to the region by the acronym for its formal name, the Federally Administered Tribal Areas.

“Even more worrying is the continued presence of the Taliban and Haqqani leadership networks,” the diplomat said, dismayed at what he characterized as Pakistani passivity in breaking up the networks.

“They haven’t been addressed at all on the Pakistani side,” he added. “They haven’t been pursued.”

The diplomat also singled out Saddique Noor, a Pakistani militant commander in his mid-40s who he said was training suicide bombers in Waziristan and sending them into Afghanistan. Mr. Noor fought in Afghanistan alongside the Taliban in the 1990s and is a determined opponent of the American and NATO presence in Afghanistan.

Another commander, Beitullah Mehsud, about 40 and also from the region, is now probably the strongest Pakistani Taliban commander and may also be dispatching suicide bombers. He also fought in Afghanistan under the Taliban and claims to have 15,000 fighters under him now.

Both men are loyal to Mr. Haqqani, whom Western diplomats consider one of the most dangerous Taliban commanders because of his links to Al Qaeda and his strong local standing.

The other, for the same reason, is Mullah Dadullah, a ruthless Taliban commander from southern Afghanistan, who has emerged as the main figure in the resurgence of the Afghan Taliban.

The one-legged Dadullah — he lost a leg in fighting — has a flamboyant if cruel reputation. He narrowly escaped capture in northern Afghanistan in 2001, often gives boastful interviews to news agencies, and is known to have personally ordered the killings of aid workers. His latest announcement, made in a phone call to Reuters, was that the Taliban had infiltrated suicide bombers into every Afghan city.

He is widely thought to be based in or around the southern Pakistani town of Quetta but is reported to be constantly on the move. He visited various areas of southern Afghanistan this year and has traveled to Waziristan repeatedly, in particular as the tribes of North Waziristan negotiated their Sept. 5 peace deal with the government, which he sanctioned, according to local reporters and intelligence officials.

Push for Order

The increasingly urgent question for Pakistani, Afghan, American and NATO officials is what can be done to bring the region under control. The Pakistani government’s latest attempt was the Sept. 5 peace accord in North Waziristan.

Under the deal, both the government and militants agreed to cease attacks, and the militants agreed to end cross-border help for the Afghan insurgency, the killings of tribal leaders and accused government sympathizers, and to cease the “Talibanization” of the area.

Taliban commanders sanctioned the deals, arguing that the militants should concentrate their efforts on the foreign armies in Afghanistan and not waste their energies on clashing with the Pakistani military, journalists working in Waziristan say.

Critics say that the agreement is fatally flawed since it lacks any means of enforcement, and that it has actually empowered the militants. In a report to be released on Dec. 11, the International Crisis Group, a Brussels-based research organization, brands it as a policy of appeasement.

The government has taken down checkpoints, released detainees, returned confiscated weapons and vehicles and issued an amnesty. But the militants have increased their activities, benefiting from the truce with the Pakistani military, the groups said.

“From the start the agreement was not good because there are too many concessions and no clauses that are binding,” said Brig. Mahmood Shah, who served as secretary of the Federally Administered Tribal Areas until 2005. “This agreement is not going to work, and if it is working, it is working against the government interest.”

Afrasiab Khattak, a local politician and spokesman for the Awami National Party in Peshawar, also criticized the agreement. The militants rather than the traditional tribal leaders have the power now, he said.

“They have imposed a new elite in Waziristan,” he said. “More than 200 tribal chiefs have been killed, and not a single culprit brought to justice.”

Still, Javed Iqbal, the newly appointed Pakistani secretary of the tribal areas, defended the North Waziristan accord as an effort to return to the traditional way of running the tribal areas, through the tribal chiefs. That system, employed by the British and Pakistani rulers alike, was eroded during the military campaigns of the last few years.

“We have tried the coercive tactic, we did not achieve much,” he said in an interview in Peshawar. “So what do you do? Engage.”

He said the government had let down the tribal elders in Waziristan who had wanted dialogue with the government, but were murdered one after another by the militants. But the big turnout of some 500 to 600 tribal elders at a meeting in Miramshah in North Waziristan in November was encouraging, he said, and showed that the tribes wanted to engage. “We are back in business,” he said.

Loss of Control

Some Pakistani officials admit they have made a serious mistake in allowing the militants so much leeway, but only if they will not be quoted publicly.

Afghan and Pakistani Taliban leadership networks run training camps in various parts of the 500-mile length of the tribal areas, from Baluchistan in the south to the hub of North and South Waziristan, and farther north to Bajaur, said a Western diplomat in Kabul.

A diplomat who visited Wana, the capital of South Waziristan, said the government had almost no control over either of the Waziristans.

“They are absolutely not running the show in North Waziristan, and it runs the risk of becoming like South Waziristan,” he said. “In South Waziristan the government does not even pretend to have a remit that runs outside of its compounds.”

The fundamentalists’ influence is seeping outward, with propaganda being spread on private radio stations, and through a widening network of religious schools and the distribution of CDs and DVDs. It can now be felt in neighboring tribal departments and the settled areas of the North-West Frontier Province. In recent months, Pakistani newspapers have reported incidents of music and barber shops being closed, television sets burned and girls’ schools threatened.

The militants are more powerful than the military and the local tribal police, kill with impunity and shield criminals and fugitives. Local journalists say people blame the militants for a rising tide of kidnappings, killings, robberies and even rapes.

The brutality of some foreign militants has led to rising discontent among their Pakistani hosts, many of whom are also armed and militant, making the region increasingly volatile and uncontrollable.

“Initially, it was sympathy,” one Pakistani intelligence official said. “Then came the money, but it was soon followed by fear. Now, fear is overriding the other two factors, sympathy and money.”

For now, however, the Taliban commanders and the Pakistani militants under them remain unswervingly loyal to jihad in Afghanistan and, despite the tensions, still enjoy local support for the cause, officials and local journalists say.

The failed government military campaigns of recent years, which are seen as dictated by the United States, have further radicalized the local population, many in the region say.

As a potential indicator of local support, the families of two suicide bombers sent to Afghanistan from Waziristan gained renown in the community, according to a local journalist.

“The people support the militants because they are from their own tribe, they are family,” said the journalist, who asked not to be named out of fear of the militants.

Morale is high among the resurgent Taliban after their revival in Afghanistan this year, one Pakistani security official said. That will lead to still more recruitment and better organization and planning in the year ahead.

Fighting traditionally dies down in winter because of the inhospitable conditions in the mountains.

But the new fighting season in the spring will be even bloodier, a Western diplomat in Kabul said. “We have to assume that things will be bad again,” he said, “because none of the underlying causes are being addressed.”