Questioning the value of GeneXpert, Nigeria’s anti-gay law, and myths about the poor: What we’re reading

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Point-of-care diagnostics for tuberculosis elimination? – In this commentary published in The Lancet, Christian Wejse cites a recent randomized trial comparing point-of-care GeneXpert with smear microscopy in the management of TB to argue that instead of investing heavily to provide all peripheral health facilities in the world with GeneXpert, the same investment could ensure that health facilities have high quality sputum smear fluorescence microscopy and quality radiography setups available. “That approach is likely to promote the necessary shift towards building health care in general,” he writes. The study in reference showed that patients in the Xpert arm started treatment initiation earlier than the patients in the microscopy arm, but over a period of time, the proportion of patients given treatment was not higher in the Xpert arm, and mortality was the same 8 percent in both arms.  “Considering the findings of Theron and colleagues, the substantial financial burden of Xpert MTB-RIF rollout needs to be reassessed to see if it provides value for the cost,” Wejse writes.

The imminent danger of Nigeria’s latest anti-gay legislation – Nigerian advocate Ajibola Adigun offers his view of why President Goodluck Jonathan signed the Same Sex Marriage Prohibition Act, which not only criminalizes homosexual sex, but penalizes gay rights organizations, and even threatens people researching indigenous homosexual practices with imprisonment. “The present administration seems bent on cocooning themselves from angry citizens who are disappointed by their dismal performances in office and scoring cheap points passing policies that help no one under the guise of protecting the body politic.” This isn’t the first time, he writes: “Late last year, in a bid to preempt social media dissent that might spark an Arab Spring-like rebellion, the Nigerian Senate proposed seven year jail terms for social media critics whose activities are seen as inciting people against the government,” he wrote.  As Nigeria has the second-largest HIV epidemic globally, with an estimated 3.4 million people living with HIV, this law will severely limit HIV services access for the LGBT community, Adigun writes.

Myths that block progress for the poor – In this excerpt from Bill and Melinda Gates’ 2014 Annual Letter, the duo make a bold and ambitious prediction: by 2035, there will be almost no poor countries left in the world. They write, “Specifically, we mean that by 2035, almost no country will be as poor as any of the 35 countries that the World Bank classifies as low-income today, even after adjusting for inflation.” One of the ways this will be achieved is by disproving myths about the poor that many people believe, which serve to hamper progress. “The most damaging myths are that the poor will remain poor, that efforts to help them are wasted, and that saving lives will only make things worse,” they write. The Gates’ point out that incomes and other measures of human welfare are rising almost everywhere, including in Africa, where per person income has risen by two-thirds since the debt crisis of the 1980s, and where women’s life spans have gone up from 41 to 57 years since 1960, despite the HIV epidemic. “You should look skeptically at anyone who treats an entire continent as an undifferentiated mass of poverty and disease,” they add.

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