RWANDA: Poverty, landlessness exacerbating impact of HIV

Plus News, 12 July 2006

Kigalai - More than 60 percent of Rwanda's eight million people get by on less than a dollar a day, but grinding poverty is an even greater threat to HIV-positive people.Rwanda, one of the world's poorest countries and the most populous in central Africa, has an estimated 340 people per square kilometre.

The land is also very unequally divided, with the majority having tiny plots or none at all to cultivate."Families that have to look after AIDS orphans have nowhere to grow food and nowhere to find money for their medical treatment. I am looking after my daughter's children but have no money for school fees and, sometimes, even for food," said Annette Nyiraneza, an elderly widow in the capital, Kigali.

According to the United Nations Children's Fund (Unicef), more than 800,000 Rwandan children have been orphaned by AIDS and the 1994 genocide that killed nearly a million people. Most of these children are being raised by relatives who are actually too poor to look after their immediate families.

The result is thousands of households headed by children, who are often forced to perform sexual favours to feed their families, making them even more vulnerable to HIV.Nyiraneza said her daughter used to help cultivate the family's tiny plot but fell ill, and she is too old and weak to work, so she and her grandchildren depend on handouts from nongovernmental agencies.

"When giving antiretroviral [ARV] drugs to HIV-positive people, especially in the rural areas, we try to give nutritional support as part of the package," said Shakilla Umutoni, executive secretary of Reseau Rwandais des Personnes Vivant avec le VIH/SIDA, an umbrella body for 800-plus organisations for people living with the virus. "One cannot expect people who cannot afford to buy food to adhere to their drugs [regimens]."

Umutoni, whose organisation is supported by the Global Fund for AIDS, Tuberculosis and Malaria, the US Agency for International Development and the British government's Department for International Development, said providing nutritional support was difficult.

"We have to ensure the whole family is well fed, because if they are not, they may all have to share the small portion of the HIV-positive person, or they could become malnourished and fail to look after their sick relative," she explained.

Persuading people to spend their money on medication rather than food was a constant challenge. "It is necessary to improve the quality of life of these people, so that they have the basic needs such as food, after which they can be taught the importance of taking their medicines in the correct dosage," she said.

The Rwandan government provides free antiretroviral drugs, but the health centres are often too far away - Unicef estimates that 88 percent of women have to walk for more than an hour to reach a health facility, an impossible journey for people with immune systems compromised by illness or malnutrition.

"Providing HIV services to people in Rwanda goes beyond giving people ARVs," Umutoni said. "They need food, they need education and sensitisation, and also need home care and follow-up."

Source: Plus News

G8 Leaders pledge to fight infectious diseases, prioritize HIV and AIDS treatment, vaccine research

By Vichitraweer Singh, Intern, AIDS-Care-Watch campaign

At the G8 Summit in St. Petersburg last month (15-17 July 2006), leaders from the eight wealthiest countries (G8) produced a lengthy document addressing the need to improve international cooperation on the surveillance and monitoring of infectious diseases, intensification of scientific research, building the capacity of health care systems in poor countries, and fulfillment of prior G8 promises.

Anders Nordstrom, the WHO acting director general, described the commitments put forth by the G8 nations as detailed, concrete, and putting them in a leading position to improve global health services.[E1]

However, during the past five years, very few of the G8’s previous commitments on health have been adopted by the leading economies of the world—clearly, for G8 leaders, making promises is much easier than keeping them. If G8 nations are now ready to keep their stated commitments, particularly related to HIV and AIDS, tuberculosis, and other infectious diseases, immediate action by them is warranted.

Given that forty million people are now living with HIV/AIDS, and over three million people died as a result of AIDS related conditions (TB being the number one killer) in 2005, the G8 must be held accountable. Further, as World Learning President Carol Bellamy, and Global Unions HIV/AIDS Programme Chair Alan Leather, recently suggested, G8 leaders should “take the long overdue steps to mainstream HIV/AIDS into overall G8 processes and create a permanent working group on HIV/AIDS.”[2]

RECOMMENDATIONS:
HIV/AIDS is often a disease of poverty. While vital, addressing the need for antiretroviral drugs (ARVs) should not be the only option associated with the concept of “universal access to treatment” for people living with HIV.

A wide range of care and treatment services is necessary to extend the lives of people living with HIV. Food security, access to medications to treat and prevent tuberculosis and other opportunistic infections, clean water, less stigma in health care settings, home and community care, among others are all part of an essential AIDS package.

For instance, in Rwanda, Shakilla Umutoni, executive secretary of Reseau Rwandais des Personnes Vivant avec le VIH/SIDA, an umbrella body for 800-plus organizations for people living with the virus was recently quoted in an IRIN news report stating, “Providing HIV services to people goes beyond giving people ARVs, They need food, they need education and sensitization, and also need home care and follow-up."[3]

AIDS-Care-Watch (ACW)—an international HIV/AIDS campaign with over 400 partners worldwide—strongly recommends that Ministries of Health and international agencies invest in a wide range of care, treatment and support options to enable people living with HIV to stay alive and healthy—especially for those still unable to access ARV treatment.

In addition to the provision of ARV treatment, priority care services include:

• Voluntary HIV counseling and testing;
• Effective diagnosis and treatment of tuberculosis;
• Food security and micronutrient provision;
• Drugs, such as cotrimoxazole, to prevent/treat other opportunistic infections;
• Home- and community-based care services;
• Pharmacotherapy therapy for recovering injection drug users.

The AIDS-Care-Watch campaign calls upon the G8 and other donor countries to implement immediate action to ensure wider access to a broad range of affordable and readily available AIDS-related treatment, care and support services to extend the lives of people living with HIV and AIDS related conditions as they wait for expanded ARV treatment access.

Such action will lead to greater promotion of all the ways millions of people living with HIV today can be helped to stay alive. In particular, these measures will:

• Ensure widespread access to comprehensive services to help people discover their HIV status, delay progression to AIDS, and prevent and treat HIV-associated conditions and opportunistic infections.

• Improve health literacy among people living with HIV, particularly in relation to prevention, management, and treatment of ‘early’ HIV-associated conditions.

• Identify, diagnose and treat conditions that accelerate the development of AIDS related conditions, such as malnutrition and treatment of tuberculosis and other concurrent infectious diseases.

These measures significantly shorten the interval between initial HIV infection and the onset of AIDS-related conditions, and must be addressed with urgent priority.

**************
[1] Nordstrom Anders, July 17, 2006. G8 commitment on diseases to improve health security - WHO. Web: http://en.g8russia.ru/news

[2] Carol Bellamy and Alan Leather, July 14, 2006. AIDS: 25 years and no real action. Web: http://www.reformer.com/columnists.

[3]RWANDA: Poverty, landlessness exacerbating impact of HIV, International Regional Information Network (IRIN) report, Thursday July 20, 2006.

HIV and INDIA: From Problems to Solutions.

Haryana: HIV AIDS is one of he biggest threats posing thecountry today. India has the fastest growing HIV AIDSpopulation in the world and this makes the situation extremely grave.

Discarding the recent controversy between the UN and the HealthMinistry over whether India has the largest population of HIVinfected people, it would be safe to say that India has asubstantial population of infected people and whether it isthe largest or the second largest is really irrelevant.Compounding the problem is the lack of awareness regarding thedisease. Many people in our country have simply never heardabout the disease. They actually don't know what HIV AIDS is.Leaving aside this ignorant lot, there are those who probablyhave heard about the disease but choose vehemently to ignoreit. They either believe that the disease itself is a myth orif at all it exists then they are somehow immune to it. Thenthere are those thick heads who have a problem using condoms.

They believe it's not macho to use condoms and that real mendon't need to use one. Then there are genuine misconceptionsabout the disease. The people who fall under this categoryaccept the disease but due to their misconceptions think theycan somehow avoid it. Even though there are other ways thatAIDS can spread, such as through infected blood transfusionsor by sharing infected needles, in the course of this articleI shall focus on sexual transmission of AIDS as it is thelargest cause of the spread of the disease and accounts forthe majority of the cases.

So this is the situation that the country is faced with today.We have a large chunk of our population that is simplyignorant about the disease or it hurts their macho pride toaccept it. The question to be asked here is why is it so? Whyis India in such a grave scenario when it comes to HIV AIDS?Firstly, let us draw some parallels with South Africa, whichis the other country that has a huge HIV infected population.

The problem with South Africa is that it is riddled with mythsand utter misconceptions when it comes to HIV. There are mythssuch as if you are an HIV infected person then having sex witha virgin can rid you of the disease, then there is one whichsays how you can rid yourself of the disease by passing onyour blood to someone else, and then there is the mostlaughable one which says that having a bath after having sexcan prevent you from contracting the disease. What makes thesemyths even more outrageous and baffling is that people whobelieve in such myths in South Africa are not just yourilliterate, uneducated lot but infact it runs as high up asthe South African Health Ministry itself.

A recent UN report clearly indicated that the reluctance ofthe of the South African Heath Ministry to advocate usage ofcondoms is due to these very myths and misconceptions.

Now the problem in India is slightly different from SouthAfrica. Yes there are myths and misconceptions here as wellbut the nature of these are different from South Africa.Over here the misconceptions stem from a reluctance to openlytalk about sex and from male chauvinism/egoism. Lets take upthe first one. Sex, in India, is one of those things thatpeople somehow don't talk about openly. It is difficult togauge the reasons behind this, even though we are the land ofthe 'Kamasutra'. But somehow a majority of the people in ourcountry are reluctant to openly talk about sex and this goestrue not just in rural India but in urban India as well. Thisis where a majority of the misconceptions creep in. The onlyway to fight AIDS is through knowledge and awareness and nottalking about sex openly is probably the single most reasonwhy India has the fastest growing HIV numbers.

Not talking about sex and not discussing things like safe sexand AIDS and other sexually transmitted diseases is absolutelycriminal. One should definitely foster an environment wherebythings like safe sex and AIDS can openly be discussed in theclassrooms in schools/colleges, between friends and familymembers. That is the only way we would have a shot at fightingthis dreaded disease. So to sum up, talk sex. Secondly, thepoint about male chauvinism or egoism. There are men out therethat are fully aware of HIV AIDS but choose to ignore it.

They are somehow blinded by male egoism and believe that realmen can't have AIDS and therefore don't take any precautions.A classic group of such people are the truck drivers in ourcountry, who go from town to town, sleeping with variousprostitutes in different places. These people will tell youthat AIDS is something that can only happen to those who arenot man enough and probably weak in sex. So they being realmen don't exactly have to worry about things like AIDS. Afterall they do have a robust sex life.

Misconceptions like these are what makes truck drivers andother similar individuals with similar thinking, a high-riskgroup as far as HIV AIDS is concerned. For HIV AIDS canhappen to anyone if one is not careful and doesn't takeprecautions during sex.

Lastly I would like to highlight another group of individualsin our society who believe that AIDS can't happen to thembecause of cultural reasons. They believe that culturallythey are so different from the rest of the world that there isno way things like AIDS can happen to them. Their answer tofighting AIDS is 'abstinence'. I cannot express in words asto how much I despise these people from the very core of myheart. Not only are these people simply morons but also theirunderstanding of the society is so utterly ridiculous that itmakes my blood boil.

Thankfully the present government seems to have their factsright about HIV AIDS and seems to be going about the ant-AIDScampaign in the right manner. But more needs to be done. Thereshould be many more public campaigns and projects regardingthis issue and the society as a whole should be a part ofthese. School and college children are the most receptive inthis regard and the government should tap the potential thatthey have to offer. Make HIV AIDS education a priority. Gofrom door to door spreading awareness and information and talkfreely about it. Then only do we stand a chance.

This is a fight that we as a nation cannot afford to lose. Letas all strengthen our resolve to fight AIDS. Fight AIDS beforeit gets you.

Source:// indiaenews.com, July 04, 2006.
http://indiaenews.com/2006-07/13645-hiv-india.htm

HIV epidemic could hit Asia-Pacific drug users: UN.

Kuala Lumpur: Asia-Pacific countries risk a full-blown HIVepidemic among drug users unless governments do more to keepyouths off drugs and make clean needles available, a UNofficial said today.Injecting drug use or IDU fuels at least 70 per cent of HIVtransmission in places such as China, Indonesia, Malaysia,Myanmar and Vietnam, said Prasada Rao, Asia-Pacific directorof UNAIDS, the UN body fighting HIV/AIDS.Those countries, and others including Bangladesh, India, Nepaland Pakistan, "have a very severe IDU epidemic almost in theoffing, about to break out in the open," Rao said in aninterview at the start of a two-day UNAIDS meeting here.The forum involved drug abuse and disease preventionauthorities from more than 40 countries."We want to caution the countries not to take an IDU epidemiclightly".Countries such as India, where IDU-related infections areconcentrated in specific zones, could contain the problem ifthe national leadership ensures strategies are properlycarried out in affected provinces, Rao said."China has a much bigger challenge, because that (IDU) iswhat's driving the infections, much more compared to India,"he said.India had about 5.7 million HIV/AIDS-infected people last year,more than two-thirds of the Asia-Pacific total. The problemthere is largely sparked by the sex trade, except in placessuch as the country's northeast, where most transmissionscome from needles shared by heroin addicts.UNAIDS estimates that some 1 million of the 8.3 millionpeople living with HIV last year in the Asia-Pacific regionwere infected because of IDU.

Source://The Hindu, July 04,2006

http://www.hindu.com/thehindu/holnus/001200607041442.htm

India: Anguished young voices

by, NITIN JUGRAN BAHUGUNA, The Hindu, July 2, 2006

Sixty children affected by HIV from all over India get together to express their views and demands.

India: WITH the cheerfulness that characterises children, they fantasise about glory and wealth, saving lives as doctors, designing high-rise buildings as architects, seeing the world as pilots or spreading awareness as teachers.

But these children have other, more urgent, demands too — "I want to have a lot of good food"; "I want my mother always healthy"; "I want good orphanage homes to be opened in different places for HIV-affected children"; "I need to earn money for my younger sister's education"; "I want a good education"; "We need good counsellors and regular treatment". These are just some of the yearnings of children affected and infected with HIV/AIDS across India.

At the recent "National Consultation for Children Affected by HIV/AIDS" — the first of its kind — about 60 children from across the country gathered in Manesar, Haryana, to voice their views, concerns and feelings vis-à-vis their proximity to a disease that continues to strike terror in the community at large. The predominant feeling among them was a sense of isolation from the community, stigma and discrimination at schools, and lack of good, nutritious food and child-friendly medical services in hospitals.

"Why are we not getting seats in good schools?"; "Why are we not getting treatment like normal children?"; "Why are we thrown out from society?"; "Why are they separating us from our family? Why can't we live with our brothers and sisters?" These and many more anguished queries came from the young but articulate gathering.

Similar experiences
"I am an orphan", says Chingkheihunbi, 12, of Manipur matter-of-factly. By now, she has become inured to the loathing meted out to her by her uncle with whom she stays and just tunes out his verbal lashings. "My aunt, who is my father's sister, is kind to me, but my uncle is always scolding me," she says with a shrug. Her objective is to escape her present surroundings and put as much distance as possible between her uncle and herself. "I am studying in class VI. I hope to become a doctor one day," she vows.

Murugesh, 16, of Bangalore, remembers his uncle taking him away from his native Surynalli village near the Kerala-Tamil Nadu border and placing him in an orphanage after his parents died. At the orphanage, he began to get severe headaches and fever. "After a blood check, it was discovered that I was HIV+. Soon afterwards, the orphanage threw me out," he says.

He had his first stroke of luck two years later in 1999, when a Bangalore-based NGO learnt of his plight and offered him a home. At Freedom Foundation, an organisation providing medical and other livelihood support to People Living with HIV/AIDS (PLWHA), Murugesh got another chance at life. "They enabled me to enrol in a school here and I am now studying in class IX," he says proudly.

But the new life is not without its challenges. "Only my teachers and the Principal know of my HIV status. I'm scared to tell my friends in case their parents protest and force me to leave school."

But the lad believes in a positive approach, his hope strengthened by the astonishing care and support given to him by his teachers. His deepest desire now is to study law. "I want to fight for the rights of HIV+ people. I also dream of going abroad for higher studies," he confesses with a smile.

Having a say in policy
The four-day workshop from May 24 to 27 was organised by the Positive Women Network (PWN+), headquartered in Chennai, Tamil Nadu. Children from the States of Andhra Pradesh, Gujarat, Maharashtra, Manipur, Nagaland, Orissa and Tamil Nadu attended.

P Kousalya, PWN+ President, describes the network as an organisation affiliated to the Indian Network of People Living with HIV/AIDS (INP+). It has been exclusively working with women affected by HIV/AIDS over the past eight years and with children for two years, she informs.

According to Kousalya, the purpose of the consultation was to "hear the voices of children directly affected and infected by HIV/AIDS", and get from them suggestions and recommendations for their welfare. Children affected by HIV are major stakeholders in any debate on HIV policy and so their voices must be heard, she stresses.

"We have forwarded the children's recommendations to the National AIDS Control Organisation (NACO). We hope they will find a presence in the third phase of the Government's National AIDS Control Programme, called NACP III, which is in the process of being finalised," Kousalya adds.

The issues surrounding children orphaned or made vulnerable by HIV/AIDS have been highlighted at two Special Sessions of the UN General Assembly — one on HIV/AIDS in June 2001 and the other on Children in May 2002. According to UNICEF's latest yearly child update,

"The State of the World's Children 2005", every day about 1,700 children are infected with HIV. There are an estimated 2.1 million children worldwide under 15 years currently living with HIV, it says.

Preventing HIV infection in women of reproductive age is the most effective way of decreasing the number of young children infected with HIV. But, as the report points out, in the absence of antiretroviral (ARV) drug prophylaxis for pregnant women (literally, preventive treatment; here, short-term ARV treatment for pregnant women), the estimated rates of mother-to-child HIV transmission in developing countries range from 25 to 45 per cent.

Providing ARV prophylaxis to pregnant women and to babies at birth can reduce the risk of transmission by half, the UNICEF report adds.

Urgent needs
Strong on the list of the 60 children converging here was to make available testing facilities as well as treatment and drugs for all opportunistic infections (infections due to reduced immunity caused by HIV infection, like tuberculosis or bacterial infections). They also called for child-friendly hospitals with sensitised medical personnel and child counsellors.

Other significant recommendations proposed by the children are: the need for children's support groups to be established at the district level, facilitated by positive women's groups; a revisit and re-designing of the existing guidelines for counselling to address needs of children affected by HIV; linkages for parents of affected children with the Rural Employment Guarantee Scheme; schemes for homeless women; vocational training for girl children and various other support schemes; and the setting up of an expert committee to monitor the quality of facilities for orphaned children.

Courtesy: Women's Feature Service

Source: The Hindu