AIDS Care Watch

Monday, October 30, 2006

ZIMBABWE: Homophobia raises HIV risk for gays

By, IRIN PlusNews, October 30, 2006

HARARE, 26 October (PLUSNEWS) - Efforts to address the HIV/AIDS epidemic among Zimbabwe's homosexual population are being frustrated by homophobia in the government and society.

This is according to the Gays and Lesbians of Zimbabwe (GALZ), a national network of 6,000 gay men and women formed in 1989 to champion and protect the interests of the gay community in Zimbabwe.

Men who have sex with men are at high risk from HIV/AIDS, but Samuel Madzikure, GALZ programme manager for health, said the government's attitude towards homosexuals had made it extremely difficult for his organisation to target the gay community with prevention messages.

Zimbabwe's Sexual Offences Act forbids homosexuality and President Robert Mugabe has lambasted gays and lesbians on several occasions, describing them as "worse than pigs and dogs".

"Our government is rabidly anti-gays, and this makes it almost impossible for us to reach out to our membership, some of whom would not want to be known because of the pervasive anti-gay sentiments in government and society in general," said Madzikure.

Tongai (last name withheld), an HIV-positive member of GALZ, said he had experienced great difficulty in accessing treatment and counselling at public health institutions and nongovernmental AIDS service organisations.

"Most AIDS service organisations in this country do not want to be associated with gays. Once they know you are gay, they will not help you - they will try to frustrate you so that you don't come back," he said.

Such discrimination is even more pronounced in public health institutions. "Last year, I was nearly refused treatment at a local clinic because 'I was behaving like a gay'. I was suffering from tuberculosis (TB), coughing persistently. I was finally treated, but they had humiliated me," said Tongai.

Madzikure alleged that the government intentionally excluded gays and lesbians from national HIV/AIDS awareness, prevention and treatment programmes. "If you walk into any government health institution now you will find that there is no information or literature on gays and lesbians."

The Minister of Health and Child Welfare, David Parirenyatwa, refuted these allegations, saying all Zimbabweans were accorded the same status by health institutions. "When a person goes to a health centre, that person is not asked his or her sexual orientation," he told IRIN PlusNews.

Efforts by GALZ to obtain government assistance in establishing the exact number of gays and lesbians infected by HIV have been frustrated, as have their requests to meet with Parirenyatwa.

GALZ's attempts to advertise its services in the media have also met with resistance. The sole national broadcaster, ZTV, and national radio stations have refused adverts by GALZ. Zimbabwe Broadcasting Holdings (ZBH) spokesperson Sivukile Simango refused to comment but an official from ZBH, who requested anonymity, confirmed that it was the organisation's policy not to accept adverts aimed at gays and lesbians.

Many gay people, particularly in rural areas, were unaware of the HIV counseling and education services offered by GALZ, and lacked information on how to protect themselves from the virus. "A lot of gay men in Zimbabwe have died silently through ignorance and multiple stigmatisation of homosexuality and seropositivity. As a result, there is a growing sense of urgency to extend services to this community," Madzikure said.

Chitiga Mbanje of the Centre, a nongovernmental organisation that provides counselling, training and home-based care to people living with HIV/AIDS, confirmed that HIV prevalence appeared to be very high in the gay community.

"Lack of information means they expose themselves not only to AIDS, but to many other diseases. This is a direct result of homophobia in our country," Mbanje commented.

Despite the pervasive homophobia in Zimbabwe, GALZ has seen its membership rise steadily, with about 400 new members joining each year.

"It is apparent that homosexuality exists throughout society, including rural areas," said Madzikure. "Even if Mugabe does not accept it, it [homosexuality] is there, and it will not go away. We have to accept that it exists, so that we can work together in addressing HIV/AIDS among the gay community."

Chairman of the Zimbabwe National Network for People Living with HIV (ZNPP+), Benjamin Mazhindu, called for legislation on homosexuality to be changed. "What we need to do is fight for a change of laws so that gays are given recognition. Without that, fighting AIDS among homosexuals will be futile."



Sunday, October 29, 2006

HIV AND AIDS: 18 million African children may be orphaned by 2010

By, Children Rights Information Networks, October 24, 2006

More than 18 million children in Africa will be orphaned by AIDS by the end of the decade if more is not done to combat the pandemic among the continent's overwhelmingly young population, the United Nations said.

Millions of children already orphaned or infected by the disease were being overlooked as governments and donors drew up strategies to fight HIV and AIDS. This oversight was hobbling the development of some of the world's poorest countries, it said.

"The number of orphans will continue to rise for at least the next decade and progress in education, health and development will remain a distant dream," said Esther Guluma, head of UN children's fund UNICEF in West and Central Africa. Even if the number of new HIV/AIDS infections among adults were to peak today, the number of orphaned children would continue to rise because it took around a decade from the time of infection for a person to die, Guluma said.

This lag effect meant the impact of AIDS would increase "exponentially" in coming years, undermining other development efforts as it left orphans socially marginalised and more likely to face health problems and disruption to their schooling.

More than half of the 350 million people living in West and Central Africa are 18-years old or younger, according to UN figures, many of them sexually active from an early age. Yet adolescent promiscuity is a taboo subject in the region's often conservative societies, leaving many young people ill-informed about how AIDS is transmitted.

Access to drugs for those infected, particularly important to prevent pregnant women from passing the disease to their children, was also a major problem in the region, where 680,000 children aged up to 14 were living with AIDS in 2005. UNICEF estimates only around one per cent of pregnant women and children infected with HIV receive antiretroviral drugs in West and Central Africa, far from a 2010 target of 80 per cent. But broader progress is being made.

Lobbying was helping to bring down the price of drugs and encourage governments to allocate more of their resources to help children and pregnant women, said Eric Mercier, UNICEF's West and Central Africa advisor on HIV/AIDS.

Ivory Coast had set up its first voluntary testing and counselling centre, which paid school fees for the children of infected parents, while 2,000 orphans in Central African Republic had received healthcare and counselling.

"To begin with, people just thought about adults and the effect on the economy," said Abdou Latif Gueye, chairman of Senegalese charity Jamra, which provides food and schooling for street children including those affected by HIV/AIDS. "Children were forgotten. There was no engagement. But things are changing," he said as a gaggle of young boys and girls in the charity's green smocks chattered away behind him.


Uganda: Men in the North Slow to Respond to Aids Message

By, UN Integrated Regional Information Networks, October 27, 2006

Awareness of the AIDS pandemic is generally high in northern Uganda, but the message has not hit home with some men, who are still too afraid of the stigma against the disease to seek treatment.

According to Robert Ochola, coordinator of HIV/AIDS activities at Kitgum's St Joseph's Hospital, the social fabric of the Acholi people - the ethnic group worst affected by the 20-year war in Uganda's northern region - has broken down almost entirely, relegating men to waiting for handouts from relief agencies.

The war has forced an estimated two million people into camps for the internally displaced, drastically altering their lives and roles in their communities.

A walk around Akwang camp for the internally displaced in Kitgum district, home to around 16,000 people, reveals several makeshift taverns crammed mostly with men, even in the early hours of the day, drinking potent local brews and playing cards.

Boredom and excessive alcohol consumption, compounded by the feeling that the war and their subsequent encampment have emasculated them, often led to risky sexual behaviour. Ochola and other health workers said sleeping with many women was one of the few ways the men had left to exert their masculinity.

Charles Odong, who works with Meeting Point, a local nongovernmental organisation, said women made up about two-thirds of their patients and were generally more willing to volunteer to be tested for HIV.

A counsellor attached to the AIDS clinic at St Joseph's, Beatrice Opira, confirmed that far more women volunteered for HIV testing than men. "Men still seem to be greatly affected by stigma, and do not want to be seen openly going for testing," she said.

The upshot of this reluctance to discover their HIV status was that men rarely sought treatment, and died from AIDS-related complications much earlier than women.

At a recent meeting of people living with the virus in Kitgum town, most of the 12 women present were widowed and all were on life-prolonging antiretroviral (ARV) medication, but not a single man attended.

"I discovered I was HIV-positive last year when I got very ill," said Lucy Lalam (not her real name), in her early twenties. "My husband knows my status but has refused to go for testing - he keeps putting it off and I'm worried he will get sick and die soon if he doesn't get treated."

Sylvia Ocan says her husband abandoned her and their two children, and married another woman when he found out she was HIV-positive, accusing her of having been unfaithful. He died about a year later, never having been tested.

At a meeting for people living with HIV in Akwang camp, Patrick Onen was the only man. He said very few were willing to come out publicly with their status, as they felt admitting it would make them "less of men".

"Out of 178 registered members of our group, 'Kati Woko' ['come out' in the local Acholi language], only 36 are men," he said. "There is little interest among them even to learn about AIDS - when we try to hold information sessions they tell us they know everything about it, but then you see them drinking and having many women."

The clinic at Akwang actively promotes HIV testing among men, but testing kits are only available at the antenatal care clinic. A mobile counselling and testing unit from St Joseph's, meant to visit the camp every two weeks, had not come in two months, Onen said.

Although condoms distributed by volunteers are freely available, people have to sign for them, which many men are unwilling to do.

Francis Achirei, a community health worker at the clinic, said if men were expected to protect themselves from contracting the virus, test for HIV and seek treatment, the entire process needed to be much more male-friendly.

"The men have to travel to St Joseph's if they want to be tested," he said. "If they had easily available and confidential testing here [in Akwang], they may be more encouraged to come for testing."


Sunday, October 22, 2006

Botswana: Mogae Denies 33 Percent Aids Prevalence Rate

The overall HIV/AIDS prevalence rate in Botswana is about 17.1 percent, instead of the 33 percent reported by the UNAIDS organization, said Botswana President Festus Mogae in a Monday interview.

"The figures used by the UN were based on sample surveys on expectant women, who were not adequately representative," Mogae said. "And the correct national prevalence rate is about 17.1 per cent."

"There are age cohorts where the prevalence is much higher, almost double the national rate ... and as you see at the bottom, in the 15 to 24 age cohort, the prevalence rate is about 10 percent," he said.

"That's how we have 17 per cent." Mogae acknowledged that Botswana was "seriously affected by HIV/ AIDS" and the country "has had to take special measures to fight the pandemic."

Botswana is reported to have one of the highest HIV/AIDS prevalence rates in the world, yet there are positive trends - the free anti-retroviral (ARV) treatment has prolonged many lives, the HIV transmission from mother to child has significantly decreased, and the rate of new infections in the young is decreasing.

Mogae said the prevention of mother-to-child transmission was very important because it gave the country the hope of an AIDS-free generation.

He said that with the free routine testing of everybody, more and more women were receiving tests for HIV/AIDS, with about 85 to 90 per cent of the pregnant mothers agreeing to be tested, and the same percentage of those who tested positive agreeing to be put under ARV therapy.

"As a result of the increased compliance, the number of HIV-positive babies born to HIV-positive mothers has fallen from 40 per cent to a registered 6 per cent. That has been a dramatic improvement," said Mogae.

However, Mogae acknowledged that "on the whole, the problem remains very, very big." According to Mogae, roughly over 75,000 people in Botswana have registered as HIV positive, and over 68,000 of them are on ARV therapy.

"This means that substantial resources have been diverted away from development projects and developing programs into curative services to fight HIV.

And the administrative and management capacity has also been diverted away from development programs to managing the ARV program," said Mogae. He also said that the decrease in new infections did not necessarily translate into a decrease in the prevalence rate.

"With the coming and wide supply of ARVs many people who would have died from HIV/AIDS are alive. Therefore, the prevalence rate is not going down," said Mogae, adding that the people who were under ARV treatment and would live 10 to 15 years with the virus had also contributed to the high prevalence rate. (Xinhua)

source: Mmegi/The Reporter (Gaborone), October 20, 2006

Saturday, October 21, 2006

West Africa: Child Deaths From HIV/Aids to Keep Growing

Almost 99 percent of mothers with the HIV virus are not getting the drugs to stop them infecting their unborn children, sparking a cycle of neglect that is affecting more than 4.2 million children in West and Central Africa alone.

Just 1.3 percent of pregnant women in West and Central Africa who are infected with the HIV/AIDS virus have access to the anti-retroviral (ARV) drugs that stop them infecting their babies, the UN children's agency UNICEF said on Wednesday.

As a result, 22,000 HIV-infected babies are born in West and Central Africa every year, less than one percent of who get ARV therapy. About 680,000 children under 14 years old were living with HIV/AIDS by the end of 2005, with 22,000 new infections during that year alone, the new figures say.

When their parents subsequently die, the children are more likely to skip school, not get enough food to fill their stomachs or nourish them, and to suffer from extreme anxiety, UNICEF says.

"The efforts in favour of orphaned children are very, very inadequate in the region", Cheick Tidiane Tall, who heads one of the biggest NGO networks in West Africa, Africaso, said.

According to UN agencies and donors, more than 4.2 million children have been orphaned by HIV/AIDS in West and Central Africa alone, a region widely perceived to have some of the lowest prevalence on the continent.

More than half the orphans in West and Central Africa live in Nigeria, where UNICEF estimates that 1.8 million children have lost one or both parents to AIDS - more than in any country in Africa.

Progress a "distant dream"

A UN and NGO campaign kick-off one year ago to shine more light on AIDS orphans has made a small dent in the problem.

"In the space of a year a lot has happened. Some of the main donors have given up to 10 percent of their grants to children, and the cost of pediatric drugs has falled," Eric Mercier, HIV/AIDS advisor to the UN children's agency UNICEF in the Senegal capital Dakar told IRIN.

"Civil society is working hard within the communities to help them to cope with their situation, although we need to help them to be more effective," Mercier said.

But NGO leaders are scathing about the response.

According to Tidiane Tall at Africaso, cash shortfalls and not getting the right information are the main obstacles stopping NGOs getting more involved with orphans.

"We, civil society, do not have the technical capacities to take care of this population, our contribution within the international institution boards is far from enough and we do not get access to funding sources", he said.

Sostene Bucyana, regional advisor for US bilateral cooperation on AIDS in West Africa, stressed that financial resources were available but NGOs were in need of assistance and support to raise funds.

"We need to teach the existing institutions like the Global Fund [against AIDS, tuberculosis and malaria], and civil society how to approach the children issue in order to systematically integrate some consistent action plans in their strategies", Bucyana said.

USAID contributes 33 percent to the Global Fund budget, and is one of the main sources of funding in the fight against the HIV/AIDS pandemic. "The resources exist, they are limited but they exist. We now need to make the children issue a priority" Bucyana said.

UN officials say the number of children being orphaned and infected by HIV/AIDS is only going to grow.

UNICEF with UNAIDS, and some NGOs and donors, has responded by launching a new awareness raising appeal, the 'Dakar Call to Action'.

"Considering the 10-year time lag between infection and death, the number of orphans will continue to rise for at least the next decade and progress in education, health and development will remain a distant dream," UNICEF regional director Esther Guluma told reporters at the campaign's launch on Wednesday.

Between 1990 and 2010, the number of children orphaned by AIDS in sub-Saharan Africa as a whole will have risen from less than a million to more than 15 million, UNAIDS estimates.

Source: UN Integrated Regional Information Networks, October 19, 2006

Uganda: Prayers Alone Can't Cure Aids - Janet

THE First Lady has warned religious leaders against misleading people living with HIV/AIDS that prayers alone can cure the disease, writes Kyomuhendo Muhanga.

Janet Museveni said, "Leaders should stop misleading people in this fight against HIV/AIDS. You must give people correct information about the disease. Telling victims to pray and abandon medicine is very dangerous. Advise them to pray and take medicine."

The Ruhaama MP was speaking as chief guest at the opening of Itojo Hospital Art Clinic at Itojo in Ruhaama County in Ntungamo district.

The Joint Clinical Research Centre (JCRC) runs the clinic.

The medical superintendent, Dr. George Kworora, had said some registered patients had stopped taking antiretroviral (ARVs) drugs because their pastors had advised them to abandon medicine and instead concentrate on prayers.

Janet said she would be happy if the prevalence dropped to 0.01 percent.

"Yes, there is a tremendous scale down but I am not yet happy because 6.0% is still high. I would be happy if the prevalence rate dropped to 0.01%," she said.

The JCRC director, Prof. Peter Mugyenyi, said Janet approached them and requested that a clinic be opened to cater for the people living with HIV/AIDS in Ntungamo.

He announced free ARV drugs for all HIV/AIDS patients in Ntungamo.

Mugyenyi said JCRC would contribute sh3m to the hospital monthly to monitor patients on ARV drugs.

"We shall do what it takes to ensure drugs are available," Mugyenyi said.

"The clinic is small now but if things go well we may expand it to be the centre of excellence," said JCRC board chairman Prof. Opio Epelu.

Source: New Vision (Kampala),October 19, 2006

Wednesday, October 18, 2006

South Africa: EC Health Department Takes Over Largest HIV Rural Programme

One of the country's largest rural HIV/AIDS programmes was officially handed over to the Eastern Cape health department on Thursday in a ceremony held in Lusikisiki.

For the past 18 months, Medicins sans Frontieres (MSF) in partnership with the Nelson Mandela Foundation (NMF) have been gradually handing over the care of 2200 people on AIDS drugs and HIV services to nurses and doctors in the province.

The handover is part of the original partnership agreement between the organisations and the health department, that the EC would take full responsibility of the programme when it was sustainable, said the MSF.

After only three years the programme has achieved universal coverage of anti-retroviral treatment within the last two years in one of the poorest, rural areas in the country. According to MSF the community model proves that ARV programmes can be nurse-driven at clinic level with support by community mobilisation and treatment literacy

"We were happy to receive the support of MSF and NMF in 2003. We asked them to help us in one of the most difficult rural areas", said Mrs Nomalanga Makwedini, Chief Director of Primary Health Care of the Eastern Cape health department. "This is a model that we are very keen to roll out to other rural areas and to share it with other provinces," she added.

The programme is run from St Elizabeth Hospital and 12 clinics, serving approximately 150 000 people.

"Four years later this experience proves that decentralized HIV/AIDS care is the optimal model for rural areas. At the same time, the model has brought many benefits to primary health care services as whole, with improvements in clinic and laboratory services, infrastructure, drug supply, training, and staff motivation," Makwedini said.

Health-e visited the programme last year where people on treatment showed high levels of adherence and literacy regarding their treatment despite low levels of school education.

MSF doctors have implemented a decentralized model in the face of a chronic shortage of health staff as an effective strategy for treatment in rural areas. The model entails a mobile team to support nurses at clinics; the recruitment of adherence counsellors; and strong community engagement to support the health system.

"Implementing comprehensive HIV services in Lusikisiki has needed many 'out-of-the-box' solutions to overcome the challenges we faced," said Dr Hermann Reuter, MSF project co-ordinator. "The only way to make this programme sustainable and replicable is to ensure that those solutions are urgently translated into policy changes at National and Provincial levels."

Mothomang Diaho spokesperson for NMF, is confident that the programme is well established under the leadership of the province .

"From its inception the programme was designed to be integrated into the health care system. "In times of huge challenges, government needs the support of NGO partners with their experience, extra resources and flexibility to move quickly", said Diaho.

Source: Nawaal Deane, Health-e (Cape Town, October 13, 2006

Tuesday, October 17, 2006

SOUTHERN AFRICA: Red Cross and Red Crescent HIV/AIDS Global Alliance launches new initiative

JOHANNESBURG - The International Federation of Red Cross and Red Crescent Societies has launched a major new community-based AIDS initiative in Southern Africa, the world's worst affected region where more than 11 million people are living with HIV.

"The international community has not made the strategic shift that is needed in order to tackle this problem on the scale that is needed," the Federation's new Special Representative for HIV and AIDS, Mukesh Kapila, told IRIN.

"Southern Africa needs urgent action to turn words into deeds," he said, adding that "not only is this essential ... it is perfectly feasible".

The new US$300 million initiative aims to strengthen prevention, treatment, care and support programmes built up over the last decade, using the organisation's volunteers in southern Africa.

"The Red Cross family is the world's largest volunteer-based network. If we are to succeed in our HIV/AIDS efforts we will have to mobilise the power of the community," Kapila said.

In a statement, Françoise Le Goff, head of the regional delegation based in Harare, Zimbabwe, said: "With adult prevalence rates now exceeding 20 percent in most countries in the region, and reaching more than 38 percent in some areas, there is an urgent need to take the Red Cross work to a new level, both in terms of preventing further infection and greater support for those already infected."

Over the next five years, the new Red Cross and Red Crescent HIV/AIDS Global Alliance will focus on Angola, Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe.

National Red Cross societies in these countries are already reaching over 50,000 home-based care clients, and approximately 100,000 orphans and vulnerable children. The numbers are expected to double in the next five years, after which the programme will emphasise institutional capacity building, access to antiretroviral treatment and prevention.


Source: IRIN PlusNews, October 11, 2006

Monday, October 16, 2006

The missing picture of Aids

"ANO ang mangyayari sa mga batang hindi nabibigyan ng gamot at tulong," asked a high school girl in the open forum during the first day of the 8th Philippine National Aids Convention held at the Royal Mandaya Hotel the other week.

A hush fell on the huge crowd gathered in the Lantawan Hall for a few seconds, many in the audience shifted on their seat, the reporters gathered in one group stared at the resource speakers, probably wondering who would be brave enough to speak up.

If the situation were to be described, it was as if the whole hall was whispering, "Uh-oh!" under its collective breath, and it was a fitting close to the morning session during the opening of the congress, as it drove the point of the whole congress: the children with Aids...

"One child below 15 years of age dies of an Aids-related illness every minute of every day. One person between 15-24 contracts HIV every 15 seconds. And, as I speak before you today, at least three children would have died of Aids," United Nations resident coordinator Nileema Noble said as she addressed the congress earlier on.

Yes, HIV-Aids does not only affect the bad guys and the perverts, as we would have wanted to believe and the Unicef and UNAids are even more concerned because in the fight against HIV-Aids, the children are regarded as the missing picture.

In the "10 fast facts on Filipino children affected by HIV-Aids", it's said that most Filipino children whose parents are living with Aids don't know about their parents' affliction.

"Filipino parents living with HIV are reluctant to tell their children about their status because they want to protect their children from HIV-related stigma and discrimination. Even infected children aren't being told about HIV," the fast facts said.

The fast facts further pointed out that there is a "deafening silence on Filipino children affected by HIV-Aids.

"The National HIV-Aids Registry lists only know cases of HIV. If most of the 9,000 estimated people living with HIG (PLH) in the Philippines have children, that could mean thousands of children are affected," it said.

Dr. Nicholas Alipui, country representative of Unicef said that when he arrived in the Philippines in 2004, the National Registry of HIV-Aids has already documented 29 children infected since 1984. The Remedios Aids Foundation Inc.'s website reports that from January 1984 to April 2006, there has already been a total of 36 children below ten years old, and 46 more between 10 and 19 are listed in the HIV-positives nationwide.

Whether its still steady at 29 or has already risen to 82, however, is not the major point of concern, rather, it's whether the health sector and government are reaching enough children living with HIV-Aids, Dr. Alipui pointed out.

"The response so far is small and timid," he said.

"There is a long, long, long way to go. What we are happy with is that we have made the first few basic steps," he added, "But concretely, children have to be brought forward for testing."

The problem is, even adults are not coming forward to be tested because of the stigma attached to the disease, and the denial of the general population that they are as vulnerable to the disease as any other person, and cultural taboos in openly discussing sex and HIV-Aids prevention, especially with the young and the youth.

In the fast facts, it notes that young people know very little about the disease and yet are exhibiting risk behaviors.

The 2002 Young Adolescent Fertility and Sexuality Study showed that 23 percent of young Filipinos aged 15-24 practice pre-marital sex, up from 18 percent in 1994; and that nearly half of sexually active young males have had multiple partners.

Further, the study showed that only half of those aged 15-19 know that condom use can reduce transmission of HIV and many believe that they could not contract HIV.

"Most still believe that Aids only affect adults and that they have Aids because they have done something wrong and thus they are being punished by God," Dr. Alipui said.

There is silence, there is denial, and there are very limited tests being taken, and, thus the trend that HIV-Aids in the Philippines is indeed low and slow as reflected in the National HIV-Aids Registry may in fact be deceiving us into complacency.

Prevalence rate in the Philippines is still at .01, said Teresita Marie P. Bagasao of the UNAids Regional Support Team for Asia and Pacific in her presentation. This means that less than one percent of the adult population are infected.

The first recorded HIV-Aids cases in the Philippines was in 1984; there were two, both Aids-positive. The following year, there were ten cases reported, of which four were Aids cases and the six were asymptomatic, or HIV. The numbers has since grown, 29 in 1986, 38 in 1987... and have been hitting the hundreds since 1993.

For 2005, there has been a total of 210 HIV-Aids cases recorded. While from January to April 2006, 89 have already been added to the registry, of which nine are Aids-positive.

"The average of 10 new HIV cases being reported each month doubled from 2003 and over the last few months, reports show the number of cases more than doubled. For this reason, the Philippine National Aids Council voices its concern that the epidemic in the country may be taking a new direction moving from a low and slow to a hidden and growing epidemic, with majority of cases reported having contracted HIV through unprotected sexual contact," Ms Bagasao said.

Of those affected, current records show overseas workers account for 35 percent compared to 28 percent in year 2000. OFWs are thus listed as among the high-risk groups. But this increase in reported cases may be because OFWs have to show a clean bill of health for them to be deployed, and voluntary HIV-Aids testing is thus higher in this sector than any other sector of the population.

Prevalence is also highest in the 30-39 age group, accounting for 932 (629 males, 303 females) of the total 2,499 recorded between 1984 and April 2006. Next is the 20-29 age group with 737 (362 males, 375 females), then the 40-49 age group accounting for 497 (393 males, 104 females).

These age levels are the productive ages -- and also the making-a-family-ages; meaning, while there are only 82 recorded cases of HIV-Aids among the population aged below 19, there can be many more; the unrecorded ones, the children hidden because of the "deafening silence" on Filipino children affected by the disease.

This already alarming possibility is made worse by the fact that while there is a significant increase in recorded cases in the 2000s, spending for the disease has not followed the same trend.

"In the Philippines, the cumulative Aids spending by 2004 declined to levels below 2000, even as the number of reported cases continues to rise, implying the level of response is not keeping up with the epidemic, despite the milestones in the country's response," Ms Bagasao said.

The country's response to the disease is getting more comprehensive, but this is not matched with corresponding increase in spending, both for medication and care for the affected and prevention for those who are not.

All throughout these contradicting pictures is the missing one -- the children living with HIV-Aids: where they are, how they are coping, who are taking care of them, and how many are they?

Contributing to this missing picture are similar questions: Where are their parents, how they are coping, who are taking care of them, and how many are they?

Clearly, the gap between the known and the huge unknown is made wider because of the low uptake on free HIV-Aids drugs and services, as well as, voluntary testing, a state Dr. Alipui would want to break so that the silence about this toned down threat will also be broken.

"When you know your HIV status, it affects your attitude," he said in his speech during the convention.

Those who test positive can seek medical assistance and counseling, and those who test negative will make conscious actions to remain negative.

Dr. Alipui added that people should not even wait until more children are infected or for more children infected to be recorded. There should instead be a conscious move to ensure that children remain Aids-free, and this can best be done by ensuring that adults are, and that the adults who are infected are aware of their status.

But because there is a general denial even among those who are engaged in risky sexual behaviors, the sense of invincibility prevails among the Filipinos; and for as long as this general denial will show that HIV-Aids remain low and slow in this part of the globe, then assistance to what is considered as a global threat may soon decline.

This early, available anti-retrovirus (ARV) drugs may be pulled out from the country's ready supplies because these expensive drugs that were brought in to help the country deal with the disease have expiration dates; and out there worldwide, millions of poor people are in dire need of these.

"Unless we have an increase in the uptake, clearly we need to bring the drugs to where they are most needed," Dr. Alipui said.

ARVs are available for free in regional health offices, Health Undersecreary Ethelyn Nieto said. And because there are very few recorded children with HIV-Aids, pediatric formulations are available only in three hospitals in the National Capital Region where the recorded children are.

Where are the others, how are they coping and whose taking care of them, no one can tell; for all we know, many of them may have already died.

"At the end of the day all of us have to lean in and give our fair share in the response if we aim to stop the increase in number of infections, illness and deaths," Ms Bagasao said.

Source: Stella A. Estremera, The Sunstar, October 15, 2006

Wednesday, October 11, 2006

HIV/AIDS may orphan 25 mill children by 2010

LAGOS, (Xinhua) -- No fewer than 25 million children worldwide may be orphaned by the HIV/AIDS scourge by 2010, the official News Agency of Nigeria reported on Wednesday.

Dr. Austin Omoigberale, an official of the World Health Organization (WHO), was quoted as saying that "HIV/AIDS infection in children rose significantly in the last decade worldwide."

"AIDS accounts for 7.7 percent of mortality worldwide and 4.19 percent in infant mortality given a 36 percent rise in death of children under five years," said Omoigberale when presenting a paper entitled: "HIV/AIDS infection in Children" at a scientific session organized by the Nigerian Medical Association's on Tuesday.

He said that women and children had been left behind in the campaign against the scourge of HIV/AIDS and it was only in 2005 that drugs were made available for children.

"Many children are infected daily with the virus by their mothers in developing countries, through mother-to-child transmission during pregnancy, labor and delivery and breast feeding," he said.

He said HIV/AIDS in children is preventable even though in children's clinical features, HIV infection overlaps with those of other childhood diseases.

Statistics from the WHO show that HIV/AIDS has already made 13 million children orphans in the world. Enditem

Source: Mu Xuequan, China View, 2006

WHO: Vietnam encounters HIV expansion

HANOI, Oct. 6 (Xinhua) -- Vietnam is facing two major challenges: expansion of HIV infection from vulnerable groups to the general population, and stronger need for provision of treatment to people living with HIV/AIDS, the World Health Organization (WHO) representative in the country said here Friday.

Vietnam, where most of people living with HIV/AIDS are from most at-risk populations such as injecting drug users and sex workers, is facing the risk of the disease's expansion to the general population, WHO representative Hans Troedsson said at a press briefing, noting that the country and the WHO "need to know more about men having sex with men in Vietnam."

Another immediate, critical threats faced by Vietnam is the increasingly high number of people living with HIV/AIDS needing antiretroviral treatment (ART), while the country is now able to provide treatment to a limited number of the people due to complexity in establishing and running facilities offering lifetime treatment to the patients, he said.

"Now, an estimate of 35,000-36,000 AIDS patients (in Vietnam) need treatment, but only more than 10 percent of them have treatment," he said. The number of those in need of the treatment is estimated at 57,600 in 2008 and 73,000 in 2010 based on ART expansion plans with already committed resources, including those from the Global Fund to fight AIDS, Tuberculosis and Malaria and the U.S. President's Emergency Plan for AIDS Relief.

"With high political commitment, Vietnam is making good progress in prevention and control of HIV/AIDS," he stated, noting that the country has already adopted a national HIV/AIDS strategy, passed an HIV/AIDS law, established specialized HIV/AIDS agencies, adapted to international guidelines and practices on both prevention and treatment, and intensified fights against stigma and discrimination.

At the press briefing, Heather O'Donell, project officer at the WHO in Vietnam, said the country has actively learned anti-HIV/AIDS experiences and harm reduction initiatives from many parts of the world with same disease conditions. Vietnam has followed methadone therapy, free syringe exchange programs and condom-use promotion activities from such countries as China, Australia, Thailand and Cambodia, she noted.

A high-level delegation led by Kevin De Cock, director of the Department of HIV/AIDS at the Geneva-based WHO, will in next week meet with Vietnamese government officials, donors and partner agencies to learn initiatives from Vietnam's health sector response to HIV/AIDS and address important challenges ahead for the prevention, control and treatment of the disease.

In 2005, an estimated 260,000 people were living with HIV in Vietnam, a 12-fold increase since 1995. Over 13,000 local people died of AIDS in the year, according the WHO in the country.

Vietnam plans to reduce the HIV/AIDS infection rate among its 83-million population to below 0.3 percent by 2010, and keep it unchanged after 2020. Enditem

Source: Mo Honge, China News, October 6, 2006

In Malawi, Breast-Feeding Does Not Pose Health Risks for HIV-Positive Women

In Malawi, HIV-positive women who breast-feed their infants are no more likely to become ill or die than their counterparts who do not breast-feed, according to an analysis of longitudinal data from HIV-infected mothers and their newborns.1 This finding was not affected by women's frequency or pattern of breast-feeding. In addition, the women's breast-fed infants were about 60% less likely to die in the first two years of life than their non–breast- fed counterparts, whether or not they were infected with HIV.

The data came from a pair of clinical trials conducted in Malawi in 2000–2003 that tested antiretroviral therapy for preventing mother-to-infant transmission of HIV. Blood samples were collected from HIV-positive mothers at the time of delivery to measure their HIV load and their hemoglobin level, and from their newborns to test for HIV infection. Social, demographic, medical and reproductive information was recorded at delivery. At each of 10 visits over the next two years, mothers were examined and were asked if they were breast-feeding; those who were breast-feeding their infants were asked how frequently they did so and whether they were giving their infants only breast milk (classified as exclusive breast- feeding) or breast milk plus other liquids or solids (classified as mixed breast-feeding). Multivariate analyses assessed associations of breast-feeding with maternal health and survival, and with infant survival, controlling for maternal age, initial maternal viral load and hemoglobin level, and body mass index (weight for height) at the follow-up visits.

A total of 2,000 women and their singleton infants were enrolled in the trials. On average, the women were about 25 years old and had had three live births. Eleven percent had not attended school, 63% had attended primary school and 26% had a higher level of education.

Slightly more than 2% of mothers died in the two years after delivery. The cumulative probability of death was 18 per 1,000 at one year and 32 per 1,000 at two years. Maternal deaths were most commonly due to tuberculosis, pneumonia, malaria and diarrhea; the cause was unknown in about one-fifth of cases.

About 16% of infants died in the two years after delivery. The cumulative probability of death was 132 per 1,000 at one year and 195 per 1,000 at two years. Infant and child deaths were most commonly due to respiratory infections, gastroenteritis and septicemia; the cause was unknown in about one-seventh of cases. The estimated proportion of infants and children surviving and not infected with HIV was 80% at one year and 73% at two years.

On average, women breast-fed their infants for 15 months overall, exclusively breast-fed for 2.4 months and practiced mixed breast-feeding for 11.7 months. In a comparison of measures of maternal health between women who did and did not breast-feed in the first year (to assess the possibility that health itself influenced this practice), the two groups of women did not differ with respect to initial HIV viral load or hemoglobin level, or body mass index at visits.

Women who breast-fed did not have a significantly different risk of death than their counterparts who did not breast-feed. In addition, the risk did not vary between women who breast-fed five or more times in a 24-hour period and those who did so less frequently, or between women who exclusively breast-fed and those who did not breast-feed. Women who practiced mixed breast-feeding had a lower risk of death than did those who did not breast-feed (hazard ratio, 0.3). In terms of other factors, the likelihood of maternal death was positively associated with initial viral load (3.8–3.9), and negatively associated with initial hemoglobin level (0.8) and body mass index (0.9).

Breast-feeding in general, its frequency and its pattern were not associated with increased risks of illness among the women, as assessed with three measures—hospitalization and use of medicines, the presence of HIV symptoms and the need for assistance with daily activities. In fact, the likelihood of hospitalization and use of medicines was lower among women who exclusively breast-fed than among those who did not breast-feed (odds ratio, 0.8), and the likelihood of needing help with daily activities was lower among women who breast-fed in general (0.7) and those who practiced mixed breast-feeding (0.7) than among women who did not breast-feed. All three measures of illness were positively associated with initial viral load (1.2–1.6), and negatively associated with initial hemoglobin level (0.9–1.0) and with body mass index (0.9). Also, women younger than 25 years of age were less likely to experience illness than their older counterparts (0.6–0.7).

Infants and children who were breast-fed had a lower risk of death than their non–breast-fed counterparts (hazard ratio, 0.4). Both mixed and exclusive breast-feeding were protective when compared with no breast-feeding (0.5 and 0.4, respectively). In addition, infants' and children's risk of death was positively associated with their mother's initial viral load (2.6), but was negatively associated with maternal body mass index (0.9).

The association between breast-feeding and lower mortality remained when infants and children were stratified by their HIV status at 6–8 weeks of age. Specifically, compared with the risk of death among infants who were not breast-fed, the risk was lower among HIV- negative and HIV-positive infants alike who were breast-fed, regardless of pattern (hazard ratios, 0.3 and 0.4, respectively), those who received both breast milk and supplemental foods (0.4 and 0.4) and those who were exclusively breast-fed (0.1 and 0.4).

The researchers conclude that breast-feeding by HIV-positive mothers does not appear to hasten the progression of their illness or their death; moreover, this practice can be life-saving for their children, although it also poses a risk of infection. These findings, they assert, support recommendations adopted by several countries for breast-feeding when breast milk substitutes are not available, despite maternal HIV infection. They note that AIDS, as measured by viral load, remains the main risk factor for death among mothers and children alike. "Therefore, providing antiretroviral treatment to mothers (and their children) should be a major priority in order to save lives," they contend.—S. London

1. Taha TE et al., The impact of breastfeeding on the health of HIV-positive mothers and their children in sub-Saharan Africa, Bulletin of the World Health Organization, 2006, 84(7):546–554.

Source: International Family Planning Perspectives
Volume 32, Number 3, September 2006

Wanted in AIDS fight: 4 million more workers

By, Stephen Smith, The Boston Globe, August 21, 2006

This is what it's like in the children's wing of the big Kenyan hospital where Ruth Nduati is a pediatrician: Most days there are more than 100 gravely ill patients cramming a ward intended for 35. And most shifts there are only three or four nurses to tend to all of the feverish children.

``It's a challenge to make sure the medications are given on time, it's a challenge to make sure the procedures are carried out," said Nduati, her bearing both grandmotherly and disarmingly direct. ``Too often, it's the mothers who have to carry out the procedures for their own children. It should not be this way."

In hospitals and clinics across Africa, the story is the same: too many patients and too few healthcare workers to treat them. While more than 60 percent of the world's AIDS patients live in sub-Saharan Africa, the region has only 3 percent of the world's health workers, according to the World Health Organization, which estimates that developing nations need an additional 4 million health workers.

At the 16th International AIDS Conference, the shortage of healthcare workers was recognized as a dire threat to the global campaign against the disease. The massive effort to deliver AIDS medications could be squandered without enough doctors and nurses to dispense the drugs appropriately.

Former President Bill Clinton and Microsoft founder Bill Gates, both of whom addressed the conference, said that something must be done. So did bellowing protesters wearing white lab coats, who interrupted speeches.

And the World Health Organization weighed in, too, issuing an elaborate blueprint that calls for spending as much as $14 billion over the next five years to fix the problem.

In part, the shortage stems from too many healthcare workers moving from the countryside to the city, and from too many medical professionals in the city dying of AIDS. In Botswana, for example, 17 percent of medical personnel were killed by AIDS between 1999 and 2005.

In Kenya, despite the incredible shortages Nduati faces, the nation is known to have thousands of unemployed nurses. But the government, like others in Africa, is subject to caps on public-sector spending -- a result of efforts by the International Monetary Fund and World Bank to enforce fiscal discipline -- so it can't afford to pay them to staff crowded clinics.

That's one reason so many doctors, nurses, and other professionals have left their homelands, tempted by the salaries of wealthier nations.

``We can't really blame people for wanting to have a better life," said Dr. Jim Kim, a Harvard professor who just spent three years as director of the WHO's AIDS division. ``So we will have to establish the conditions that will make them want to come back."

That doesn't only mean raising their pay. ``The medical institutions are often bankrupt and devoid of intellectual stimulation," Kim said, ``and young physicians will say, `I trained to be a doctor, not a mortuary attendant.' "

Kim, along with a Harvard colleague, Dr. Paul Farmer, established Partners in Health, a model that aims to bring high-quality healthcare to the poorest parts of the world, using the people who live there to deliver the treatment. It has also become a beacon for young doctors who otherwise would have left their homeland.

Dr. Cruff Renard was a star in his medical school class, and when he graduated from medical school in Haiti a few years ago, he knew exactly where he wanted to practice: with Partners in Health, treating the subsistence farmers of his homeland's Central Plateau region.

``Now," said Renard, an infectious disease specialist, ``we receive a lot of demand from young physicians. They don't learn about HIV or TB in school. They know they will learn about that with us."

The Harvard Medical School doctors who founded Partners in Health also recruited, trained, and employed villagers as community health workers. Often, Kim recalled, the villagers were illiterate and learned by looking at pictures. Now, hundreds of community health workers fan out across central Haiti, making sure neighbors take their drugs for tuberculosis and AIDS.

But it isn't only the patients who benefit. So do the health workers themselves, moving from lives as peasants to lives as paid medical workers, respected in their villages.

The same thing must happen in Africa, said Northeastern University law professor Brook K. Baker, who this fall will teach a global AIDS policy class.

In South Africa's Limpopo Province, for example, an AIDS service agency called Center for Positive Care has 1,000 volunteers, said Baker, who has visited Africa annually for a decade. All but 54 of them are women. Those volunteers, Baker said, should become paid staff members, which will empower them and, by extension, do something to curb HIV infections.

``We know there are women who are volunteers at health programs during the day and engaging in transactional sex at night simply to put food on the table," said Baker, who joined other protesters at the AIDS Conference in urging for increased spending on healthcare workers.

The protesters demanded that the United States invest $650 million next year toward easing the medical worker shortage in Africa.

``Think of how much we're spending every day on wars in Iraq and Afghanistan," Kim said. ``Why don't we take a war holiday for just one day to pay for healthcare workers?"

Source: Stephen Smith can be reached at

Zimbabwe: HIV Prevalence Decline - Will It Last?

Johannesburg - News of Zimbabwe's declining HIV prevalence rates have been met with skepticism and confusion, particularly in view of the country's economic and political climate. Can this good news be attributed to behavioral change or skewed statistics?

Earlier this month, findings from the Zimbabwe Demographic Health Survey (ZDHS) for 2005-06 revealed that the prevalence rate had declined from 20.1 percent to 18.1 percent among adults. But women are still the hardest hit, with prevalence figures reaching 21.1 percent, while 14.5 percent of all men were HIV-positive.

Zimbabwe, which has one of the world's highest rates of HIV infection, is going through a severe economic crisis. There are shortages of food and fuel, and inflation has topped 1,200 percent.

Given the severe economic and food security difficulties, a falling prevalence rate might indicate that the number of people dying from AIDS was outnumbering those newly infected with it.

In a presentation at a recent conference on the US President's Emergency Plan for AIDS Relief (PEPFAR), Dr Owen Mugurungi, head of the government's HIV/AIDS unit, told delegates that after the dramatic decline was announced, further investigations revealed that the mortality rate could not cause a reduction by itself, and there had also been lower numbers of new people becoming infected.


Karen Stanecki, a UNAIDS senior advisor in the epidemiology monitoring group, told PlusNews there was evidence of high rates of mortality, as well as "some behavior change, including reduced number of [sexual] partners and increased condom use".

Dr Simon Gregson, epidemiology senior lecturer at the Imperial College London, agreed, and noted that in the early 1980s, Zimbabwe became one of the first countries in the region to implement programmes to manage sexually transmitted infections, and condom distribution began in the early 1990s, steadily increasing over the years.

One clear example of behavior change is increased condom use. During the 1990s, the public sector was the principal provider of male condoms but social marketing now accounts for more than a half of all condoms distributed. The fact that most condoms were now purchased rather than freely distributed, made it more credible that people were using condoms more frequently, he said.

"Data from local scientific research studies in Manicaland [province] indicate recent delays in onset of sexual activity, reductions in rates of sexual partner change and, for women with high rates of partner change, further increases in consistent condom use," a UNAIDS review on the HIV decline in Zimbabwe noted.

Pinpointing when the reduction started taking place, however, was difficult. "We cannot be precise as to when it started ... but it looks like behavior change was occurring in the late 1990s. It is possible that other intervention programmes from the early 1990s may have contributed and could still be contributing [to the decline]," Gregson, who authored the report, told PlusNews.


Nongovernmental organizations (NGOs) have been cautious about the recent drop, preferring to adopt a 'wait and see' approach, but have argued that gains against the disease have been damaged by current conditions.

Last year's Operation Murambatsvina ('Clean Out Garbage'), officially aimed at rooting out the parallel market and criminal activities, also encompassed unapproved housing owned or rented by the poor, making life even more difficult. A year after the campaign, AIDS NGOs are still trying to locate displaced HIV-positive people, and fear that many have had to discontinue their treatment.

NGOs have warned that the vulnerability of women would be heightened, as violence against girls and women was on the increase, and girls would be forced to sell their bodies to survive.

"If it [decline in prevalence] can be attributed to behavior change, we need to find out what behavior change took place and why, so we can capitalize on this and see what works and what doesn't. But we have to move fast, before more damage is done," said Lindiwe Chaza, director of Zimbabwe's AIDS Network.

Inevitably, comparisons have been drawn between wealthier countries, such as South Africa and Botswana, which have failed to record any significant declines, while cash-strapped Zimbabwe has managed to bring down its level of HIV infections.

Questions have also been raised about whether the large numbers of Zimbabweans leaving the country, have affected the prevalence rates.

But the UNAIDS review stated: "International migration is believed to have been extensive and the possibility that it contributed in a small way to the decline in HIV prevalence cannot be ruled out given the limited data available. Nonetheless, the evidence available does not support the view that the overall level of migration ... needed to cause a decline in national HIV prevalence in the absence of behavior change has occurred in Zimbabwe."

Acknowledging the skepticism, Stanecki explained: "People tend to forget that it takes a long time for programmes to have an impact [on statistics]. In the mid- to late [19]90s there were probably more resources available, and community and grassroots programmes being run."

Stressing that the reduced figures were not a reflection of current conditions in Zimbabwe, Stanecki admitted that the present situation "could reverse the trend".

The effects of the clean up operations would only become evident over the next two or three years, Gregson added.

Source: UN Intergrated Regional Information Networks, September 25, 2006

Zimbabwe: Women Seek Protection Against HIV

By, Karen Shiri, The Herald (Harare), September 28, 2006

WOMEN activist groups are advocating a change in societal attitude towards speaking freely about sex and sexuality in order to reduce the vulnerability of women to HIV and Aids.

This comes from the realisation that the Sexual Offences Act does not compel spouses to reveal their HIV status to each other.

The Act, the women argue, has two clauses that stipulate that it is a criminal offence to transmit HIV willfully and that marital rape is a crime.

However, the legislation does not have clauses that make disclosure and confidentiality compulsory, hence women remain the largest group affected by HIV and Aids in the country since they cannot initiate for safe sex.

In an interview recently, Zimbabwe Women Lawyers' Association director Mrs Emelia Muchawa said women are more susceptible to HIV infection because of their weakened position in initiating sex.

She said the Sexual Offences Act came into being as a measure against the "I do, I do for ever" convention that seemed to perpetuate gender-based violence.

She said as a result, the Act was limited in its capacity for reducing the vulnerability of women with regard to HIV and Aids.

She, however, opted for the redefining of gender roles and change in attitude towards sex and sexuality.

Mrs Muchawa said her organisation was conducting sensitisation programmes in Murombedzi, Esigodini and Matshetsheni outside Bulawayo.

In a separate interview, Musasa Project director Mrs Ednah Bhala said there was urgent need to amend the Sexual Offences Act.

She said her organisation was zeroing in on improving family relations, since "amicable relations in the family are imperative for encouraging women to negotiate for safe sex.

"This is a social concern if we are to protect our women because most of them are not economically independent for them to be able to purchase anti-retroviral drugs," she said.

Less than 5% of HIV positive children ever get treatment

By Christian Nordqvist, Medical News Today, 26 Oct 2005

According to the United Nations, less than five per cent of HIV positive children ever get any treatment.

The UN, UNICEF and UNAIDS have launched a campaign, Unite for Children, Unite Against AIDS, to eradicate what they call ‘this disgrace'. A tiny fraction of children affected by HIV/AIDS are receiving any help at all, said Kofi Anan, UN Secretary-General.

He said that after 25 years of living with AIDS in our midst, we are leaving too many children to grow up alone, grow up too fast or not grow up at all. Every minute of every day four children become infected with HIV, said Kofi Anan.

In Sub-Saharan Africa the situation is awful - 15 million children have lost either one or both parents to AIDS.

The aim of the campaign is fourfold:
1. Prevent mothers infecting their children
2. Provide medical treatment for children
3. Help prevent people from becoming HIV positive in the first place
4. Assist children who are affected by AIDS.

Source: Medical News Today

St. Paul's Trust of India, saving lives of PWHA

People living with HIV/AIDS need empathy, not sympathy, spoke Dr. KI Jacob at the 1st National Conference of the AIDS Society of India last month. Dr Jacob told participants that helping patients live healthy and meaningful lives was the best thing healthcare providers could do.

Experience from the St Paul's Trust in India suggest ways that this philosophy can be put to work to enhance the lives of people with HIV/AIDS.

Dr Jacob illustrated this approach with the example of his first HIV positive patient, Raju, whom he met in the early 1990s. Raju finally began taking antiretroviral drugs, or ARVs, after 13 years of good nutritional support, prompt treatment of opportunistic infections and sexually transmitted infections, as well as good personal hygiene. Raju also exercised great caution, drinking only boiled water and eating only bland and home-cooked food to avoid opportunistic infections. Discipline in life helped keep Raju alive, which Dr Jacob sees as a valuable lesson in terms of life-extending options.

Dr Jacob, a doctor who founded St. Paul's trust in 1991, works with organisation, in Samalkot, India. The trust takes care of more than 5,000 HIV positive people, including 220 HIV positive children and close to 6,000 children of people living with HIV/AIDS. The challenge is to ensure that they are able to live their life with productively, with dignity, and without stigma or discrimination.

At the trust, children are not required to work. Instead, they study in public schools. The school administration, students and families receive intensive sensitisation to HIV/AIDS issues, so the children can study in an environment free from stigma and discrimination. Out of 220 HIV positive children, 100 are studying in the lower grades at school.

According to Dr Jacob, the common belief that a child living with HIV may not see his or her 3rd or 4th birthday is misleading. St Paul's shows that good nutritional support, a sensitive paediatrician able to treat opportunistic infections, and caution with issues such as drinking water and hygiene, help children infected with HIV to live long, meaningful lives, he says. The oldest child at the trust is now 16 years old and still attending school.

Maintaining health is key, but not difficult, argues Dr Jacob. For example, it is important that children living with HIV sleep under mosquito nets, because bites cause itching, allergy and skin diseases. HIV infected children at St Paul's also receive inexpensive milk powder made locally. Simply locating such financially sustainable options for nutritious food supplements is another way of maintaining overall health.

These experiences bear out. Because of good healthcare, nutrition and other support, no HIV positive child has fallen sick or died at St Paul’s over the last two years. Knowing the disease progression, Dr Jacob says that ARVs will clearly become vital to ensure survival at some stage. The trust is there to make this available.

St Paul's Trust also promotes income generation programmes (IGPs). To do this, people with HIV/AIDS are provided with from Rs 500 to 5,000 [US $12 to US $115] to start various kinds of small-scale businesses.

Not all people living with HIV/AIDS are able to endure heavy agricultural labour work, so alternative IGPs are extremely important to allow them to sustain themselves with dignity. Some of the trust's beneficiaries have sold milk, fish and flowers, while others have begun old bottle collection, started mobile kirana, which are small 'general stores', and opened mini hotels.

The people who have been helped report little stigma or discrimination. But the main challenge, says Dr Jacob, is not only helping start small-scale enterprises, but in sensitising the community enough that the products or services will be bought.

Income generation programmes (IGP) are a form of occupational therapy, because they help to restore and maintain people's sense of worthiness. Culturally, this is also appropriate because bread-winners will benefit from more respect at home and within the community.

A particular component of this livelihood support approach is intended to support the huge population of HIV-infected and -affected widows. To address this, St Paul's started self-help groups (SHGs), each with about ten members. About 250 women with HIV/AIDS, and a further 250 who are directly affected by the disesase, are now running their own mahila (women's) bank. Whenever a woman needs money she can withdraw up to Rs 2,500 (US $58), with friendly repayment terms. In fact, repayment has been so good that the amount the bank provides to each SHG has been increased from Rs 40,000 to Rs.4,00,000 [US $920 to US $9190 respectively].

Ten women in each self-help group meet once a month to share grievances. This builds tremendous camaraderie and a support network among the members. The president and secretary of each group regularly visits the government bank for meetings, which gives them confidence and a chance to promote their own interests.

St Paul's Trust is committed to the principles of GIPA (Greater Involvement of People living with HIV/AIDS) and MIPA (Meaningful Involvement of People living with HIV/AIDS) principles. One example is the fact that 20 of the 60 full-time staff are people living with HIV/AIDS. Some of the credit for the trust’s comprehensive care and support programme, recognised as one of the best in the world, thus goes to the people with HIV/AIDS who have become involved.

Another example of GIPA are the 25 young people living with HIV/AIDS who volunteer as 'positive speakers'. These speakers have made a big difference in addressing stigma and discrimination within the region. They have also promoted the formation of Coastal Network of Positive People (CNP+), now a completely independent network directly supported by the state AIDS Control Society and Family Health International.

CNP+ has 15 full-time staff who have lived with HIV for more than eight years. With salary support from CNP+, these individuals are now able to continue their advocacy and sensitisation work while also meeting their own healthcare expenses, including ARV.

A key lesson to draw from these experiences is how crucial it is to work with local government administrations and to sensitise them towards HIV/AIDS. Dr Jawahar Reddy, district collector is now highly supportive of initiatives geared towards improving care and support facilities for people with HIV/AIDS. Very recently he gave a part-loan-part-grant of Rs.15,000 [US $345] to 200 Dalit women living with HIV.

Dr Reddy has also helped improve the access of the poorest people, especially those living with HIV, to government help schemes. Another example of a good return that sensitisation to HIV/AIDS of officials can have, Dr Reddy invited over 100 HIV positive women to his bungalow last World AIDS Day, and his family had breakfast together with them. Such gestures go a long way to addressing stigma and discrimination.

Reducing stigma in the healthcare setting is also crucial to effective support for people living with HIV/AIDS. It took Dr Jacob more than five years to sensitise the staff of the 900-bed Kakinada General Hospital, so they could provide good quality, appropriate healthcare to people with HIV with no stigma or discrimination. To do this, Dr Jacob invited groups of hospital staff to interact with people with HIV/AIDS, so they could understand care and support issues first hand.

For nearly ten years, St Paul's Trust has managed to keep people living with HIV/AIDS alive and well without ARV therapy, relying instead on nutritional supplementation, treatment of infections and health literacy. But now, about 1,000 of the trust's patients need ARV to continue, while only a handful are actually able to get them. With the World Health Organization’s '3 by 5' behind schedule, and government assurances on ARV roll-out not being met, Dr Jacob wonders what will become of the other 975 people who need the drugs.

Mahatma Gandhi said, "Science without humanity is one of the seven deadliest sins". This is the guiding principle of the St Paul's Trust. Dr Jacob feels humanity cannot stay quiet while thousands of people will die a slow death during the long wait for proper ARV access.

But people with HIV/AIDS can stay alive while they wait for access to ARV medications, he stresses. And the methods used by St Paul’s are simple and effective, and applicable in many other places. Empathy, not sympathy will help the world understand that people with HIV/AIDS can and should live dignified, productive lives.

[This report was written at the 1st National Conference of the AIDS Society of India, held in New Delhi, 2-4 April 2005.]

HDN Key Correspondent Team

NGOs in India making a difference in the lives of PWHA

“Go to the people…live with them… learn from them… love them ... start with what they know and build with what they have ...”

These inspiring words by Lao Tsu, the famous Chinese philosopher were quoted by Mr. Apurva Dave from the Association of Rural People and Nature (ARPAN) during a session held at the International Conference on community care and support for people living with HIV/AIDS in Mumbai, India (7-9 December 2004). ARPAN is an NGO working on HIV and development in Himmatnagar, Gujarat state, India and a partner of the AIDS-Care-Watch campaign. (

The need for people living with HIV/AIDS (PWHA) to participate in the process of designing HIV/AIDS prevention programmes was stated repeatedly throughout the conference. Paradoxically however, people living with HIV/AIDS are often reluctant to become involved because of the pervasive HIV/AIDS related stigma and discrimination that adversely impacts their health and social well-being.

ARPAN works closely with PWHA in its prevention and care programs to ensure that the voices of PWHA and those affected by the epidemic are recognized and brought to the decision and policy making settings. This inclusive human rights-based approach to AIDS prevention programmes was the first of its kind to be launched in the state of Gujarat, India.

With the increasing barriers faced by PWHA for access to essential services, ARPAN is supporting them and their families by providing counseling, referrals for treatment, and nutritional support, including the provision of nutritional supplements and information. The formation of the PWHA self-help group ‘Jagruti’ has been an important feature of prevention responses. The group was initially established to provide moral support among the members, and now serves as the voice of people with HIV/AIDS and provides opportunities for skills building within the local community.

Dr Murukute Milind, a general practitioner, ayurvedic medicine consultant and yoga instructor in Maharashtra state spoke on the issue of doctors caring for patients living with HIV. Dr. Milind emphasized the need for counselling services and acknowledged that doctors themselves often make ideal counsellors.

Counselling is an important component in the care of persons living with HIV. Because many people seek help from their family doctor, it is essential that doctors are trained with the requisite skills to undertake the task. Counselling is based on the give-and-take interaction between a client and a care provider, with the aim of empowering the client to self-manage stress and make informed personal decisions related to his or her HIV/AIDS care, treatment and support.

Counseling sessions should include evaluating the risk of HIV transmission and information on how to prevent HIV-associated infections. Doctors who effectivley communicate the most up-to-date information on HIV/AIDS management and treatment to their patients will undoubtedly improve and extend lives. In addition, training doctors in HIV/AIDS counseling sensitises them to the issues facing those living with HIV, decreasing the associated stigma (especially in health care settings), which often keeps people from accessing health services.

Dr Vibha Marfatia from ‘Sahas’ –an NGO based in Surat, Gujarat state India, also spoke about developing an effective response for care and support of PWHA, through the vision of ‘Sahas’ - to uphold human rights and support vulnerable populations.

The ‘Sahas’ response provides appropriate care linked with prevention services, which provides multiple benefits for the individual and community. The key component of their comprehensive care and support continuum is the referral system developed between ‘Sahas’ and voluntary counseling and testing centres (VCTC), government hospitals, urban health centres and private medical practitioners. The referral services help PWHA access appropriate levels of care according to their health needs. Services provided by ‘Sahas’ include psychosocial counseling, support groups, general health clinics, treatment of opportunistic infections (OIs), nutritional support, home and hospital visits, support to children, and provision of subsidized antiretroviral (ARV) drugs. Their programme also provides linkages with the tuberculosis (TB) control programme.

The goal of ‘Sahas’ is to provide psychosocial and medical care and support for positive living and empowerment. Roughly 600 PWHA and 130 children living with or affected by HIV are served by the project. Twenty-five PWHA are being provided with ARV drugs through a pilot project aimed at supplying subsidized ARVs to those in need.

The model is based on a shared responsibility between people living with HIV/AIDS, donor agencies, ‘Sahas’ and health workers. The model aims to reduce drop-out rates, increase the provision of appropriate education, and provide counseling and nutritional support. Some challenges found in the pilot include the need to provide continuous motivation to PWHA and difficulty in getting PWHA volunteers on an ongoing basis.

Support for PWHA is directed by ethical guidelines to provide health and care services to those living with and affected by HIV/AIDS- especially persons who are marginalized and/or poor- and ensuring that services are accessible to all without discrimination according to age, gender, life-style, or economic status.

HDN Key Correspondent

(Report from the International Commuity Care and Support Conference for People Living with HIV/AIDS, Mumbai India, December 2004)