For further information check the PrEPWatch Website.

Addressing poor condom use therefore is not a question of simply promoting them but a question of knowing and understanding these numerous factors, their interactions and additive effects and ultimately understanding what leads people to do what they do or can do in their individual situation with their own perspectives, understanding, resources and options.

This conceptual framework summarises only the biological factors that influence HIV transmission. When assessing the risk of infection, each should be considered in turn and as a whole.

Exposure alone is not enough to predict the risk of infection, viral load maters and though there is no direct correlation between viral load and infectiousness, a high viral load has been associated with higher infectiousness. However, a low viral load may not be underrated if exposure is direct through blood, like with IDUs.

When it comes to sex with an HIV-infected person or a person of unknown status, different levels of risk have been attributed to different sexual practices. But this does not mean that the risk is always the same for the same practice. Oral sex may be overall much safer than unprotected anal sex, but oral sex with bleeding teeth and rotten gum isn’t certainly safe!

By and large, there is no clear cut or definitive risk factor and often risk is what we estimate it to be and how we relativise it. The risk of HIV infection is dynamic and depends on many factors who weight differently. Though there is an agreement that some factors weight more than other this cartoon does not give a weight to each factor identified as this is open to debate and only add to the existing confusion around risk.

Knowing and understanding what these factors are and how they interact one with another to determine the overall level of risk of HIV infection when exposed to the virus, particularly during sexual intercourse, will help individual to assess the risk of being infected.

]]> http://www.rogertatoud.com/2009/05/24/hiv-prevention-an-overview/feed/ 0 http://www.rogertatoud.com/2007/09/13/32/ http://www.rogertatoud.com/2007/09/13/32/#comments Wed, 12 Sep 2007 23:00:01 +0000 Roger http://www.rogertatoud.com/?p=32 The academic year 2007 started with a “Time Bomb” uncovered by the Higher Education Policy Institute (HEPI): student in England are having it the easy way with an average of 26 hours a week spent studying compared to 30 in Ireland, 35 in France and 41 in Portugal. Variations are wide depending on the subject but with less than 15 hours of tuition a week, fears and concerns are raised that Higher Education is going down the drain and will have serious academic consequences for the future of Science in the UK.

Some object that quantity does not equate quality; however, content is not the only challenge the UK science base is facing. Science faces a continuum of challenges from school to university, from university to the public world. It is a challenge to teach and train people in science but also to publicise and exploit, commercially or not, the results of scientific research. In this article, I will introduce 5 major challenges that should inform education and science policies.

The first challenge: changing the image of science in the public and the scientific community.

Science does not have a good public image, particularly in the media. When it is not “mad” scientists developing Frankenfood or carelessly releasing food and mouth virus into the English countryside, we are inflicted with TV-boffins trivialising science.

It results that the public lack confidence in science (MMR) or engineering (nanotechnologies), does not understand what science is about or what scientists do and can’t judge if science is good or bad. Often in this situation, bad prevails. We know the problem stems from scientists being bad communicators but also that the public has received little science education. It is right to complain of the lack of science teachers or of the declining number of students taking science A-level, but let it be clear, for many young people a career in science does not sound a good career move. Studies are long, difficult, career prospects are uncertain and wages are not very good.

But science image-problem goes beyond the public and is manifest within the scientific community, where it originates as revealed by a report from the Council for Science and Technology in a recent report. Forsaken PhD students, badly managed Post-docs and scientists fed up that science is not at the heart of what they are doing, contribute to the feeling that the pain is not worth the game.

The situation could be improved by tackling the second major challenged faced by science, that of improving science administration and management.

Scientists are professional people trained in science, but they are often unaware of basic administration and management skills that they will need in their career. This is a problem because grants need to be administered, projects need to be managed, and crucially people need to be managed and mentored. Too often Ph.D. students are left on their own, post doctoral fellows do not get the professional support they need, and researchers spend more time doing paperwork and politics than research. The result is a waste of time and resources.

Resources and in particular funding could be a challenge in itself, but because it is a pervasive issue, I’ll only underline the commercialisation of science and the funding priorities. It is nowadays common for senior scientists to be involved in a biotech company. Public/Private partnerships are becoming a necessity because research is costly and also because there is a political will to develop these collaborations. Such ventures influence the direction scientific research is taking as well as how it is administered and managed. It is important to ensure that the private sector does not dictate what science should be about as it is also important for research councils not to constrain research to what they are willing to fund.

If administration and management are new essential skills needed by scientists, they also need more scientific skills. Science has benefited for fast engineering development leading to the next challenge which, to borrow from Thomas Homer Dixon who wrote extensively about it, is the Ingenuity Gap challenge.

Dixon describes a world where complexity increases very quickly but where our ability to manage and comprehend it does not follow as quickly, hence an “ingenuity gap”. During the last 30 years, science had made tremendous technical progresses allowing us to do research at a very different scale. There are two major problems with the speed and breadth of these developments.

First the data collected can be so vast or so new (such as generated by genomic or metabonomic study) that scientists don’t always know how to handle them. Often people do not have the skills needed, in particular statistical skills, to analyse the data and new mathematical model need to be developed before sense can be make out of numbers. More often, the problem is that of 21st century science analysed with a 20th century mindset and of the nature and immensity of data confronting our inability to fathom it.

Second, these methodologies and equipment require specialist technicians to handle them, but technicians are not common in science; university does not produce them. Post doctoral fellow can be reluctant to accept a position where they will have limited input in the scientific work and little prospect for first author publication that they would need to progress in their career.

But the problem of analytical skills goes far beyond analysing complex data. There is a general problem of numeracy and literacy amongst the population that also affect science students and that seriously challenge their future ability to do research.

Unfortunately, this increased complexity is not happening in isolation but in a wider context leading to the next challenge, that of the globalisation of science.

5% of the world research is done in the UK. Students come from all over the world to study here, the UK counts four universities in the top 25 world universities.

But this should not hide the fact that less than 30% of the post graduates comes from the UK, that China is producing 2 millions graduates a year, that South Korea’s R&D public budget will match that of the UK this year and that the situation worldwide is changing. The report from the HEPI indicates that some foreign students are not satisfied with the value they get for their money and that they now prefer to go to the US where there are more facilities and more scholarships.

Foreign students do not only contribute financially to UK science by paying heavy university fees, but they also sustain UK science. The truth is not that the UK cannot deliver good science but that other countries are able to do so and not only the US.

The challenge of globalisation also impacts on the scientist ability to conduct their work. The recent outburst from Lord Winston who was denied the possibility to carry on with a research work on humanised pig and decided to move this research to the US is an example of how red tape and policy can be an obstacle to research in the UK. Withholding judgement, this highlights a need to review processes and policies.

Falling standard, inadequate training, worldwide competition, and a bad press, is UK public science doomed? That would be painting too much a dark picture of a still thriving sector. The last challenge may give a new direction and provide innovative and relevant answers.

Mainstreaming science and empowering scientists

Although students and scientists organisations and Trade Unions have made impressive achievements, the policy-making process seems often in the hand of distant policy makers and the scientific establishment. It is fundamental to engage more students and scientists into the governance and political process and to value their day-to-day experience of science when drawing new policies. It is also important for these organisations to be representative of their base. And move the process “closer to the bench”.

Moreover, because so many aspects of our life today are connected to scientific or engineering issues, from health to personal freedom, mainstreaming science is a necessity. Science can not anymore be considered the exclusive domain of the white-coat-clad scientist who knows better. The challenge is to bring scientists and their science out into the public domain and into the political process and to make scientists the agents of science policy.

There is a long journey ahead to make science more relevant for public policies, less nebulous in the public eye and more considerate for science students and academics. But scientists are overall passionate people and it is possible to channel some of this passion into the social and political process.

© Roger TATOUD.