With Cease-Fire Joy in Gaza, Palestinian Factions Revive Unity Pledges

GAZA — Palestinians erupted in triumphant celebrations here on Thursday, vowing new unity among rival factions and a renewed commitment to the tactic of resistance, while Israel’s leaders sought to soberly sell the achievements of their latest military operation to a domestic audience long skeptical of cease-fire deals like the one announced the night before.

After eight days of intense Israeli shelling from air and sea that killed 162 Gazans, including at least 30 militant commanders, and flattened many government buildings and private homes, people poured onto the bomb-blasted streets, beaming as they shopped and strolled under the shield of the cease-fire agreement reached Wednesday in Cairo. The place was awash in flags, not only the signature green of the ruling Hamas party but also the yellow, black and red of rivals Fatah, Islamic Jihad and the Popular Front for the Liberation of Palestine, a rainbow not visible here in years.

Despite the death and destruction, Hamas emerged emboldened, analysts said, not only because it had landed rockets near Tel Aviv and Jerusalem, but also from the unprecedented visits and support by Arab and Muslim leaders, potentially resetting the balance of power and tone in Palestinian politics, as leaders from various factions declared the peace process dead.

“The blood of Jabari united the people of the nation on the choice of jihad and resistance,” Ismail Haniya, the Hamas prime minister, declared in a televised speech, referring to the commander Ahmed al-Jabari, killed in an Israeli airstrike at the beginning of the operation last week. “Resistance is the shortest way to liberate Palestine.”

There were neither celebrations nor significant protests across the border in Israel, where people in southern cities passed the first day in more than a week without constant sirens signaling incoming rockets sending them to safe rooms. Instead, an uneasy, even grim calm set in. The military announced that an officer, Lt. Boris Yarmulnik, 28, had died from wounds sustained in a rocket attack the day before, bringing the death toll on the Israeli side to six, four of them civilians. The Israeli authorities announced several arrests, including an Arab Israeli citizen, for a bus bombing in Tel Aviv on Wednesday that revived memories of the violence from the last Palestinian uprising.

But there was collective relief in Israel as thousands of army reservists, sent to the Gaza border ahead of a possible ground invasion, gradually began returning home. With national elections eight weeks away, Israeli politicians tried to showcase accomplishments without raising expectations.

“It could last nine months or it could last nine weeks,” Defense Minister Ehud Barak said of the cease-fire. “When it does not last, we will know what to do. We see clearheadedly the possibility that we will have to do this again.”

And so it went on the day after the latest round in the decades-old Israeli-Palestinian conflict. What was widely heralded as a game changer by Palestinian politicians and independent analysts alike was viewed by Israeli officials and commentators as a maintenance mission that had succeeded in its stated goals: restoring quiet after months of intensifying rocket fire, and culling the weapons cache of Gaza’s armed groups.

Details of the cease-fire agreement announced Wednesday by Secretary of State Hillary Clinton and the Egyptian foreign minister remained unclear. Both sides pledged to stop the violence, and Palestinians say Israel will loosen its restrictions on fishing off Gaza’s Mediterranean coastline and farming along its northern and eastern borders. But the critical question of whether the border crossings would be open wide for people and commerce was not fully addressed, with only a vague promise that discussions would ensue after 24 hours. The exact agenda, time, location and even participants in these discussions have not been announced.

At the same time, Mustafa Barghouti, a West Bank leader who has spent the last several days in Gaza, said the Palestinian factions had agreed to meet in Cairo for another round of unity talks in the next few days, as President Mahmoud Abbas of the Palestinian Authority prepares to take his case for observer-state status to the United Nations next week. Though Hamas and Fatah, the party Mr. Abbas leads, have signed four reconciliation agreements in the five years since Hamas took control of Gaza after winning elections here, Mr. Barghouti said this time was different.

“Hamas is stronger, of course, and Abbas is having to change his line because negotiations failed,” he said after appearing with Mr. Haniya at a rally in front of the Parliament building. “This time Israel felt the heat of the Arab Spring, and Gaza was not isolated; the whole Arab world was here. The road is open for unity.”

Jodi Rudoren reported from Gaza and Isabel Kershner from Jerusalem. Fares Akram contributed reporting from Gaza and Tamir Elterman from Sderot, Israel.

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National Dog Show Crowns Wire Fox Terrier Best in Show - Again

People Pets

By Alison Schwartz

11/22/2012 at 06:00 PM EST

It was a cute case of déjà vu at this year's National Dog Show, which gave top prize to a wire fox terrier again.

GCH Afterall Painting the Sky (a.k.a. Sky) was named the 2012 Best in Show winner on Thursday's Thanksgiving day broadcast. It's the first time that the same breed has consecutively won the top spot at a major competition since an English springer spaniel won Westminster in 1971 and 1972. (Think Eira, last year's wire fox terrier winner, wants her paw-tograph?)

After quickly becoming the top dog of the terrier group when the show was taped Saturday, Sky bested an affenpinscher, an American foxhound, a Great Dane, a Tibetan Spaniel, a bearded collie and a Field Spaniel to take home highest honors at the show, which featured more than 1,500 canine participants.

"Sky is a very beautiful wire fox terrier," handler Gabriel Rangel, who's now won the dog show three of the last four years, said post-victory. "She is a natural show dog with a short, well-balanced body. She has a beautiful head and her face is unbelievable."

Of course, Best in Show judge Vicki Abbott agreed, saying, "She has a keen expression and that dense, wiry coat. The handler let her show herself, and she performed."

Too busy with Turkey Day to watch the fur fly? The show will re-air Friday at 8 p.m. (all time zones) on NBC.

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Study finds mammograms lead to unneeded treatment

Mammograms have done surprisingly little to catch deadly breast cancers before they spread, a big U.S. study finds. At the same time, more than a million women have been treated for cancers that never would have threatened their lives, researchers estimate.

Up to one-third of breast cancers, or 50,000 to 70,000 cases a year, don't need treatment, the study suggests.

It's the most detailed look yet at overtreatment of breast cancer, and it adds fresh evidence that screening is not as helpful as many women believe. Mammograms are still worthwhile, because they do catch some deadly cancers and save lives, doctors stress. And some of them disagree with conclusions the new study reached.

But it spotlights a reality that is tough for many Americans to accept: Some abnormalities that doctors call "cancer" are not a health threat or truly malignant. There is no good way to tell which ones are, so many women wind up getting treatments like surgery and chemotherapy that they don't really need.

Men have heard a similar message about PSA tests to screen for slow-growing prostate cancer, but it's relatively new to the debate over breast cancer screening.

"We're coming to learn that some cancers — many cancers, depending on the organ — weren't destined to cause death," said Dr. Barnett Kramer, a National Cancer Institute screening expert. However, "once a woman is diagnosed, it's hard to say treatment is not necessary."

He had no role in the study, which was led by Dr. H. Gilbert Welch of Dartmouth Medical School and Dr. Archie Bleyer of St. Charles Health System and Oregon Health & Science University. Results are in Thursday's New England Journal of Medicine.

Breast cancer is the leading type of cancer and cause of cancer deaths in women worldwide. Nearly 1.4 million new cases are diagnosed each year. Other countries screen less aggressively than the U.S. does. In Britain, for example, mammograms are usually offered only every three years and a recent review there found similar signs of overtreatment.

The dogma has been that screening finds cancer early, when it's most curable. But screening is only worthwhile if it finds cancers destined to cause death, and if treating them early improves survival versus treating when or if they cause symptoms.

Mammograms also are an imperfect screening tool — they often give false alarms, spurring biopsies and other tests that ultimately show no cancer was present. The new study looks at a different risk: Overdiagnosis, or finding cancer that is present but does not need treatment.

Researchers used federal surveys on mammography and cancer registry statistics from 1976 through 2008 to track how many cancers were found early, while still confined to the breast, versus later, when they had spread to lymph nodes or more widely.

The scientists assumed that the actual amount of disease — how many true cases exist — did not change or grew only a little during those three decades. Yet they found a big difference in the number and stage of cases discovered over time, as mammograms came into wide use.

Mammograms more than doubled the number of early-stage cancers detected — from 112 to 234 cases per 100,000 women. But late-stage cancers dropped just 8 percent, from 102 to 94 cases per 100,000 women.

The imbalance suggests a lot of overdiagnosis from mammograms, which now account for 60 percent of cases that are found, Bleyer said. If screening were working, there should be one less patient diagnosed with late-stage cancer for every additional patient whose cancer was found at an earlier stage, he explained.

"Instead, we're diagnosing a lot of something else — not cancer" in that early stage, Bleyer said. "And the worst cancer is still going on, just like it always was."

Researchers also looked at death rates for breast cancer, which declined 28 percent during that time in women 40 and older — the group targeted for screening. Mortality dropped even more — 41 percent — in women under 40, who presumably were not getting mammograms.

"We are left to conclude, as others have, that the good news in breast cancer — decreasing mortality — must largely be the result of improved treatment, not screening," the authors write.

The study was paid for by the study authors' universities.

"This study is important because what it really highlights is that the biology of the cancer is what we need to understand" in order to know which ones to treat and how, said Dr. Julia A. Smith, director of breast cancer screening at NYU Langone Medical Center in New York. Doctors already are debating whether DCIS, a type of early tumor confined to a milk duct, should even be called cancer, she said.

Another expert, Dr. Linda Vahdat, director of the breast cancer research program at Weill Cornell Medical College in New York, said the study's leaders made many assumptions to reach a conclusion about overdiagnosis that "may or may not be correct."

"I don't think it will change how we view screening mammography," she said.

A government-appointed task force that gives screening advice calls for mammograms every other year starting at age 50 and stopping at 75. The American Cancer Society recommends them every year starting at age 40.

Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer, said the study should not be taken as "a referendum on mammography," and noted that other high-quality studies have affirmed its value. Still, he said overdiagnosis is a problem, and it's not possible to tell an individual woman whether her cancer needs treated.

"Our technology has brought us to the place where we can find a lot of cancer. Our science has to bring us to the point where we can define what treatment people really need," he said.

___

Online:

Study: http://www.nejm.org/doi/full/10.1056/NEJMoa1206809

Screening advice: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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At Moorpark College, he has big plans — and fans — on campus

As Jon Foote walked through the tidy grounds of Moorpark College, one student after another called out his name.

To one, he offered directions to a new classroom; to the next, suggestions on an essay about faith; to another, a high-five on a calculus test score. He is 33 years old, not so unusual at a community college — "my only chance," as he puts it, "at a second chance."

Foote arrived at Moorpark determined to show his gratitude by investing in campus life and the school's 14,500 students. He launched Foote's Books, a free, Craigslist-style website to save students money on textbooks, and arranged to bring hybrid and electric vehicles to campus for an exhibit.

When he ran for student body president in the spring of 2011, he seemed to be the only person surprised by his victory.

Foote's second chance, though, has nearly been his undoing. Over the last year, he has been accused of inappropriate behavior — and kicked out as student body president by the college administration. He and his supporters, including prominent faculty members, believe he was targeted because he questioned how the school spent its money.

"It's a public institution," said Robert Keil, chairman of Moorpark's chemistry program. "Yet knowing where your money goes is not always as obvious as it should be. Jon said that students need that information. He butted into an institutional parochialism: 'You're a student. Why don't you just shut up?'"

Administrators declined to comment.

::

Foote grew up in Camarillo and the San Fernando Valley. After earning his high school GED, he bounced from job to job, often clashing with co-workers.

"You have to deal with people around you, whether you like them or not," said his father, Robert Foote, an attorney in Ventura. "He was not very amenable to that."

Foote struggled in the recession. "The world thought I was a failure," he said. "And I was."

Community college, Foote said, was the one place he could start over. He enrolled at Moorpark in 2010. Passionate about the environment and technology, he is studying environmental engineering. He was a model student, several instructors said, with interests beyond the classroom.

"I have never seen a student as devoted to serving the needs of the student community as Jon Foote," Lori Clark, a professor of environmental science, wrote to the administration. "Jon is not a conventional student."

As student body president, Foote focused on Moorpark's budget at a time when California's community colleges were being decimated by cuts, with course offerings slashed by a quarter. Moorpark administrators were shutting the cafeteria and eliminating staff positions, and students were struggling to get into crowded classes.

"Politics disgust me," Foote said. "But I also don't believe in playing patty-cake when something is so clearly wrong."

Foote began to investigate the college's budget choices. Why did the school spend thousands of dollars to fly a small number of students to Washington, D.C., every year? Why had the pay for some student employees risen so quickly? What if entire athletic programs were eliminated and the savings funneled into academics?

"They are slicing courses left and right," Keil said. "We're firing instructors. If you're going to cut core English classes, should you really have a football team? Maybe the answer is 'yes' — but people can't even have an informed discussion."

::

Foote began clashing regularly with administrators, who he said refused to turn over detailed financial accounts.

The college has begun releasing some of that information to The Times in response to public records requests. The records show, for instance, that the Washington trip cost about $15,500 and indicate that wages paid to student workers in the student government office have nearly tripled since 2008, to more than $18,000.

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Cease-Fire Between Israel and Hamas Takes Effect

CAIRO — Israel and Hamas agreed to a cease-fire on Wednesday, the eighth day of lethal fighting over the Gaza Strip, in a deal completed under strong American and Egyptian diplomatic pressure that quieted an aerial battle of rockets and bombs and forestalled — for now — an escalation into an Israeli invasion.

The cease-fire, which took effect at 9 p.m. local time (2 p.m. Eastern), was formally announced by Secretary of State Hillary Rodham Clinton and Foreign Minister Mohamed Amr of Egypt after intensive negotiations in Cairo. It was welcomed by all sides, but whether the cease-fire could hold was uncertain.

Even in the minutes leading up to the effective start time, the antagonists were firing at each other, and the Israeli authorities reported at least five Palestinian rockets were lobbed into southern Israel shortly after the cease-fire had begun. But no damage or injuries were reported and the rocket fire seemed to end in the second hour. In Gaza, thousands of residents came outside to celebrate.

“This is a critical moment for the region,” Mrs. Clinton, who rushed to the Middle East late Tuesday in an intensified effort to halt the hostilities, told reporters in Cairo. She thanked Egypt’s president, Mohamed Morsi, who played a pivotal role in the negotiations, for “assuming the leadership that has long made this country a cornerstone of regional stability and peace.”

Mrs. Clinton also pledged to work “with our partners across the region to consolidate this progress, improve conditions for the people of Gaza, provide security for the people of Israel.”

Mr. Amr said Egypt’s role in reaching the agreement reflected its “historical commitment to the Palestinian cause” and Egypt’s efforts to “bring together the gap between the Palestinian factions.”

The top leader of Hamas, Khaled Meshal, also had strong words of praise for the Egyptian leader, a former official in the Muslim Brotherhood, in which Hamas has roots. At a news conference in Cairo, Mr. Meshal thanked Egypt for its role and said Israel had “failed in all its objectives.”

The negotiators reached an agreement after days of nearly nonstop Israeli aerial assaults on Gaza, the Mediterranean enclave run by Hamas, and the firing of hundreds of rockets into Israel from an arsenal Hamas had been amassing since the three-week Israeli invasion four years ago.

Under the terms distributed after the cease-fire was announced, Israel agreed to stop all land, sea and air hostilities in Gaza, including the “targeting of individuals” — a reference to militants of Hamas and its affiliates who have been killed. The cease-fire also called on the Palestinian factions in Gaza to stop all hostilities against Israel, including rocket attacks and attacks along the border.

But the terms also state that underlying grievances of Gazans, most notably the border restrictions Israel has imposed that impede the movement of people and goods through Gaza, will be addressed starting 24 hours after the cease-fire is in effect. Precisely how they will be addressed was left unclear.

Also left unclear was how the agreement would be enforced, but the terms stated that “each party shall commit itself not to perform any acts that would breach this understanding.”

The agreement came despite a bus bombing in Tel Aviv earlier in the day, applauded by Hamas and other Palestinian militant groups, which invited Israeli reprisals and threatened to derail the talks. Also complicating the path to the cease-fire were Israeli strikes overnight on Gaza.

Prime Minister Benjamin Netanyahu of Israel, who had been threatening to start another ground invasion if the Gaza rockets did not stop, said in a statement that he was satisfied, for the moment, with the outcome. But he left open the possibility of more military action.

The statement issued by his office said Mr. Netanyahu had spoken with President Obama and “responded positively to his recommendation to give a chance to the Egyptian proposal for a cease-fire and to allow an opportunity to stabilize the situation and to calm it down before there is a need to use much greater force.”

An agreement had been on the verge of completion on Tuesday, but was delayed over a number of issues, including Hamas’s demands for unfettered access to Gaza via the Rafah crossing into Egypt and other steps that would ease Israel’s economic and border control over other aspects of life for the more than one million Palestinian residents of Gaza, which Israel vacated in 2005 after 38 years of occupation.

David D. Kirkpatrick reported from Cairo, Ethan Bronner from Jerusalem and Rick Gladstone from New York. Reporting was contributed by Jodi Rudoren and Fares Akram from Gaza, Isabel Kershner from Jerusalem, Alan Cowell from London, Andrea Bruce from Rafah and Christine Hauser from New York.

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Mayim Bialik and Michael Stone Divorcing

By Mike Fleeman

11/21/2012 at 05:00 PM EST

After "much consideration and soul-searching," Mayim Bialik announced Wednesday that she and husband Michael Stone are divorcing after nine years of marriage.

The Big Bang Theory star, who has sons Miles, 7, and Fred, 4, with Stone, cites "irreconcilable differences" for the split, which she revealed in a statement on her Kveller.com parenting blog.

"Divorce is terribly sad, painful and incomprehensible for children. It is not something we have decided lightly," she writes.

The former star of TV's Blossom, 36, also says that the split is not due to the attachment parenting she discusses in her book Beyond the Sling. "Relationships are complicated no matter what style of parenting you choose," she says.

"The main priority for us now is to make the transition to two loving homes as smooth and painless as possible," Bialik, 36, continues. "Our sons deserve parents committed to their growth and health and that’s what we are focusing on. Our privacy has always been important and is even more so now, and we thank you in advance for respecting it as we negotiate this new terrain."

She concludes by saying, "We will be ok."

The couple were married in August 2003 in Pasadena, Calif.

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LAPD plans major presence for Black Friday

Black Friday is a day for burning off those Thanksgiving calories with some intense Christmas shopping. But for the Los Angeles Police Department, it's become a day of surveillance, crowd control and crime-suppression tactics.

Helicopters will buzz above some shopping centers, and below, a cavalry of LAPD officers will patrol on bikes and horses. From store rooftops, officers will scan the crowds below looking for unruly behavior. Electronic signs near stores will warn customers about becoming victims of theft as they navigate the mass of humanity looking for bargains.

The deployments are part of a new strategy by the LAPD to deal with the retail roller derby that comes after Thanksgiving. In addition to stationing officers around shopping centers, the LAPD has been visiting stores across the city this week, talking to managers about the psychology of the frantic shopper.

Officials said the push was prompted by a series of incidents at Black Friday sales, notably one last year at a Porter Ranch Wal-Mart in which two dozen people were injured when a woman unleashed pepper spray during a frantic battle for some discounted video games.

LAPD Cmdr. Andy Smith said he hopes people will behave. But "like Chief [Charlie] Beck says, we are not in the optimism business."

The LAPD would not say exactly how many officers it will deploy Friday, but the number is expected to be considerable. In the Valley division, for example, officials have put together detailed tactical plans for each major shopping center, using mobile command posts and both officers and cadets.

"For some people, shopping is a competitive sport," Smith said. "But it should not be a contact sport."

Even some big retailers — which for years fueled the shopping frenzy with aggressive marketing and deep discounts — are trying to rein in some of the excitement they create this year.

Fernando Reyes, manager of the Wal-Mart in Porter Ranch where the pepper spray incident occurred, said his main goal is to avoid a repeat of the chaos. He has met with the LAPD and plans new crowd-control strategies, including setting up special check-out lines for some sales items.

The store also plans to give out vouchers to shoppers for "door buster" merchandise to avoid people jockeying for the limited supplies. If a customer did not get such a voucher, Reyes said there should be a "reasonable expectation" that they won't get the sales item.

The LAPD has talked to other retailers about creating "time-specific entry passes" that would stagger the number of shoppers who are inside the store at any given time. In a flier the department is handing out to store managers, officials note that "this process has been very successful at many of the major theme parks and can help to ensure organized, safe entry into your business."

The LAPD has also suggested that retailers avoid stacking sales items on pallets "to mitigate crowd aggression."

Despite all the headlines, Black Friday misbehavior is still relatively rare. Police report a scattering of brawls, assaults and various larcenies each year. But it's the headlines that people remember. A few years ago, gunfire erupted in a crowded Palm Desert Toys R Us, killing two people. Four years ago, a Long Island, N.Y., Wal-Mart employee was trampled to death by a crush of customers who toppled large glass doors.

Aimee Drolet Rossi, a consumer psychologist at UCLA's Anderson School of Management, said it should not be surprising that some people act out on Black Friday. Research on rats and monkeys has shown that they become more aggressive when placed in a crowded situation, and Rossi said humans are no different.

"Crowding leads people to behave less altruistically, in part because people's sense of responsibility lags when a lot of other people are around," she said. "People assume that other people will step up to help someone who is in distress."

She also said research shows that people are less likely to make eye contact with people in crowded situations, and this can cause them to make bad decisions.

Retailers bear some of the responsibility for what's happened, she said.

"They set up this environment that encourages this competitive shopping ...." Rossi said. "They offer only 10 TV sets at the ridiculously low price. It's really no surprise people get upset when they don't get one."

This year, some stores are actually opening on Thanksgiving Day, and people are already lined up.

Tony Juarez, a 30-year-old North Hollywood resident, has been camping outside the Porter Ranch Best Buy for a week. It's been an eight-year tradition for Juarez and his friends, who set up a makeshift campsite with portable chairs, blankets and a heater. A few feet away, other campers actually brought tents.

This year, Juarez is hoping to score some cut-priced TVs and laptops. A few years ago, he got a $200 Toshiba laptop and is still crowing about the bargain.

He was at the Best Buy when the pepper spray incident occurred at the Wal-Mart next door. He watched, stunned, as a stampede of shoppers streamed out of the store and scores of police arrived.

This year, he's definitely noticed more police presence at the shopping center, and that has been comforting.

"We are seeing an LAPD car every five minutes. It's definitely safer," he said.

But more police isn't enough for South L.A. resident Lynnette Jordan, who plans to stay away from the Baldwin Hills Crenshaw mall on Friday.

"You are still going to deal with folks basically fighting to get into the door to get the item they so desperately want," Jordan said. "No matter what, some people will act the fool because that's what they do."

andrew.blankstein@latimes.com

hector.becerra@latimes.com

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New H.I.V. Cases Falling in Some Poor Nations, But Treatment Still Lags

New infections with H.I.V. have dropped by half in the past decade in 25 poor and middle-income countries, many of them in Africa, the continent hardest hit by AIDS, the United Nations said Tuesday.

The greatest success has been in preventing mothers from infecting their babies, but focusing testing and treatment on high-risk groups like gay men, prostitutes and drug addicts has also paid dividends, said Michel Sidibé, the executive director of the agency U.N.AIDS.

“We are moving from despair to hope,” he said.

Despite the good news from those countries, the agency’s annual report showed that globally, progress is steady but slow. By the usual measure of whether the fight against AIDS is being won, it is still being lost: 2.5 million people became infected last year, while only 1.4 million received lifesaving treatment for the first time.

“There has been tremendous progress over the last decade, but we’re still not at the tipping point,” said Mitchell Warren, the executive director of AVAC, an advocacy group for AIDS prevention. “And the big issue, sadly, is money.”

Some regions, like Southern Africa and the Caribbean, are doing particularly well, while others, like Eastern Europe, Central Asia and the Middle East, are not. Globally, new infections are down 22 percent from 2001, when there were 3.2 million. Among newborns, they fell 40 percent, to 330,000 from 550,000.

The two most important financial forces in the fight, the multinational Global Fund for AIDS, Tuberculosis and Malaria and the domestic President’s Emergency Plan for AIDS Relief, were both created in the early 2000s and last year provided most of the $16.8 billion spent on the disease. But the need will soon be $24 billion a year, the groups said.

“Where is that money going to come from?” Mr. Warren asked.

The number of people living with H.I.V. rose to a new high of 34 million in 2011, while the number of deaths from AIDS was 1.7 million, down from a peak of 2.3 million in 2005. As more people get life-sustaining antiretroviral treatment, the number of people living with H.I.V. grows.

Globally, the number of people on antiretroviral drugs reached 8 million, up from 6.6 million in 2010. However, another 7 million are sick enough to need them. The situation is worse for children; 72 percent of those needing pediatric antiretrovirals do not get them.

New infections fell most drastically since 2001 in Southern Africa — by 71 percent in Botswana, 58 percent in Zambia and 41 percent in South Africa, which has the world’s biggest epidemic.

But countries with drops greater than 50 percent were as geographically diverse as Barbados, Cambodia, the Dominican Republic, Ethiopia, India and Papua New Guinea.

The most important factor, Mr. Sidibé said, was not nationwide billboard campaigns to get people to use condoms or abstain from sex. Nor was it male circumcision, a practice becoming more common in Africa.

Rather, it was focusing treatment on high-risk groups. While saving babies is always politically popular, saving gay men, drug addicts and prostitutes is not, so presidents and religious leaders often had to be persuaded to help them. Much of Mr. Sidibé’s nearly four years in his post has been spent doing just that.

Many leaders are now taking “a more targeted, pragmatic approach,” he said, and are “not blocking people from services because of their status.”

Fast-growing epidemics are often found in countries that criminalize behavior. For example, homosexuality is illegal in many Muslim countries in the Middle East and North Africa, so gay and bisexual men, who get many of the new infections, cannot admit being at risk. The epidemics in Eastern Europe and Central Asia are driven by heroin, and in those countries, methadone treatment is sometimes illegal.

Getting people on antiretroviral drugs makes them 96 percent less likely to infect others, studies have found, so treating growing numbers of people with AIDS has also helped prevent new infections.

Ethiopia’s recruitment of 35,000 community health workers, who teach young people how to protect themselves, has also aided in prevention.

Mr. Sidibé acknowledged that persuading rich countries to keep donating money was a struggle. The Global Fund is just now emerging from a year of turbulence with a new executive director, and the American program has come under budget pressures. Also, he noted, many countries like South Africa and China are relying less on donors and are paying their own costs. The number of people on treatment in China jumped 50 percent in a single year.

Mr. Warren’s organization said in a report Tuesday that the arsenal of prevention methods had expanded greatly since the days when the choice was abstain from sex, be faithful or use condoms. Male circumcision, which cuts infection risk by about 60 percent, a daily prophylactic pill for the uninfected and vaginal microbicides for women are in use or on the horizon, and countries need to use the ones suited to their epidemics, the report concluded.

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Leonor Varela Welcomes a Son

Mom & Babies
Celebrity Baby Blog

11/20/2012 at 07:00 PM ET

David Livingston/Getty

Leonor Varela‘s days as villainous vixen may be over, but her role in motherhood has only just begun.

The former Dallas actress, 39, and producer Lucas Akoskin have welcomed their first child together, the new mom announced on Twitter Tuesday.

“Matteo V. Akoskin is finally in our arms!” Varela writes, keeping any further details under wraps.

Confirming the pregnancy in July, Varela and Akoskin were elated to be starting a family together. “The couple are over the moon,” her rep told PEOPLE at the time.

Courtesy Leonor Varela

– Anya Leon

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OB/GYNs back over-the-counter birth control pills

WASHINGTON (AP) — No prescription or doctor's exam needed: The nation's largest group of obstetricians and gynecologists says birth control pills should be sold over the counter, like condoms.

Tuesday's surprise opinion from these gatekeepers of contraception could boost longtime efforts by women's advocates to make the pill more accessible.

But no one expects the pill to be sold without a prescription any time soon: A company would have to seek government permission first, and it's not clear if any are considering it. Plus there are big questions about what such a move would mean for many women's wallets if it were no longer covered by insurance.

Still, momentum may be building.

Already, anyone 17 or older doesn't need to see a doctor before buying the morning-after pill — a higher-dose version of regular birth control that can prevent pregnancy if taken shortly after unprotected sex. Earlier this year, the Food and Drug Administration held a meeting to gather ideas about how to sell regular oral contraceptives without a prescription, too.

Now the influential American College of Obstetricians and Gynecologists is declaring it's safe to sell the pill that way.

Wait, why would doctors who make money from women's yearly visits for a birth-control prescription advocate giving that up?

Half of the nation's pregnancies every year are unintended, a rate that hasn't changed in 20 years — and easier access to birth control pills could help, said Dr. Kavita Nanda, an OB/GYN who co-authored the opinion for the doctors group.

"It's unfortunate that in this country where we have all these contraceptive methods available, unintended pregnancy is still a major public health problem," said Nanda, a scientist with the North Carolina nonprofit FHI 360, formerly known as Family Health International.

Many women have trouble affording a doctor's visit, or getting an appointment in time when their pills are running low — which can lead to skipped doses, Nanda added.

If the pill didn't require a prescription, women could "pick it up in the middle of the night if they run out," she said. "It removes those types of barriers."

Tuesday, the FDA said it was willing to meet with any company interested in making the pill nonprescription, to discuss what if any studies would be needed.

Then there's the price question. The Obama administration's new health care law requires FDA-approved contraceptives to be available without copays for women enrolled in most workplace health plans.

If the pill were sold without a prescription, it wouldn't be covered under that provision, just as condoms aren't, said Health and Human Services spokesman Tait Sye.

ACOG's opinion, published in the journal Obstetrics & Gynecology, says any move toward making the pill nonprescription should address that cost issue. Not all women are eligible for the free birth control provision, it noted, citing a recent survey that found young women and the uninsured pay an average of $16 per month's supply.

The doctors group made clear that:

—Birth control pills are very safe. Blood clots, the main serious side effect, happen very rarely, and are a bigger threat during pregnancy and right after giving birth.

—Women can easily tell if they have risk factors, such as smoking or having a previous clot, and should avoid the pill.

—Other over-the-counter drugs are sold despite rare but serious side effects, such as stomach bleeding from aspirin and liver damage from acetaminophen.

—And there's no need for a Pap smear or pelvic exam before using birth control pills. But women should be told to continue getting check-ups as needed, or if they'd like to discuss other forms of birth control such as implantable contraceptives that do require a physician's involvement.

The group didn't address teen use of contraception. Despite protests from reproductive health specialists, current U.S. policy requires girls younger than 17 to produce a prescription for the morning-after pill, meaning pharmacists must check customers' ages. Presumably regular birth control pills would be treated the same way.

Prescription-only oral contraceptives have long been the rule in the U.S., Canada, Western Europe, Australia and a few other places, but many countries don't require a prescription.

Switching isn't a new idea. In Washington state a few years ago, a pilot project concluded that pharmacists successfully supplied women with a variety of hormonal contraceptives, including birth control pills, without a doctor's involvement. The question was how to pay for it.

Some pharmacies in parts of London have a similar project under way, and a recent report from that country's health officials concluded the program is working well enough that it should be expanded.

And in El Paso, Texas, researchers studied 500 women who regularly crossed the border into Mexico to buy birth control pills, where some U.S. brands sell over the counter for a few dollars a pack. Over nine months, the women who bought in Mexico stuck with their contraception better than another 500 women who received the pill from public clinics in El Paso, possibly because the clinic users had to wait for appointments, said Dr. Dan Grossman of the University of California, San Francisco, and the nonprofit research group Ibis Reproductive Health.

"Being able to easily get the pill when you need it makes a difference," he said.

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Online:

OB/GYN group: http://www.acog.org

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