AIDS Care Watch

Thursday, December 21, 2006

SOUTH AFRICA: Reproductive rights of HIV positive people under discussion

By, IRIN PlusNews, December 20, 2006

JOHANNESBURG - HIV-positive Phindile Madonsela always used a condom with her partner, but one day it broke. When it had happened before, she had gone to the local clinic and obtained emergency contraception, also known as the morning-after pill, but this time she did not go because she feared the disapproving attitude of the nurses. Later she discovered she was pregnant.

Madonsela, a volunteer HIV/AIDS educator for AIDS lobby group, the Treatment Action Campaign (TAC), had mixed feelings. "I promote condoms, so I felt very bad about being pregnant," she told PlusNews. "But I said to people, 'I'm positive, and I still have the right to have a baby.'"

She received no advice from counsellors or health workers but consulted her church elders and her mother. "My mother was very angry with me that I was pregnant - she didn't realise I could have a negative baby."

From her work with the TAC, Madonsela knew that if she took Nevirapine, an antiretroviral (ARV) drug available from the public health sector, during labour and also gave it to her baby soon after birth, she could significantly reduce the chances of infecting her child with HIV, and formula feeding instead of breastfeeding would further reduce the risk. Her little girl, now 2 years old, is healthy.

According to the Guttmacher Institute, a sexual and reproductive health nongovernmental organisation (NGO), research in both the developed and developing world suggests that HIV status does not significantly dampen people's desire to have children. As more and more HIV-infected South Africans access life-prolonging antiretroviral (ARV) treatment, the question of whether or not to have a child, and how to do so as safely as possible, is bound to become more common.

There is no official framework to guide health workers on advising HIV-positive people about their reproductive rights and options. Dr Anna Amos, head of women's health in the health department, said guidelines were being developed and a policy document was likely to be released some time in 2007.

"I think there's a realisation that there's a need, but at the moment it's very haphazard," said Dr Vivienne Black of the Reproductive Health and HIV Research Unit (RHRU) at the University of the Witwatersrand.

The disapproval of friends and family, and even some health workers, may deter those less well-informed than Madonsela from learning more about their options. "Most people think if you're positive you don't have the right to be in a relationship, or to have a baby," she said.

HIV-positive pregnant women in many countries face pressure by health workers to have abortions or to be sterilised, according to the International Community of Women Living with HIV (ICW).

Despite these obstacles, a small but growing number of HIV-positive men and women are deciding to have children. In the developed world there are a number of options: a process called 'sperm washing', which separates sperm from HIV-causing agents before being used for insemination, is safest for couples where a positive man wants to avoid the risk of infecting his negative female partner or reinfecting his positive partner; artificial insemination is the safest way of conceiving for couples with a positive woman and a negative man.

In the developing world, where most HIV-positive pregnant women still aren't even accessing treatment to prevent mother-to-child transmission (PMTCT), sperm washing or artificial insemination are generally either unavailable or unaffordable. In South Africa, they are only available through the private health sector.

"We know there are ways to get pregnant without having sex, but that's not accessible to most positive women," said AIDS activist Phindi Malaza, of the AIDS Consortium, a national umbrella organisation for AIDS NGOs.

Amos of the health department said one of the areas being investigated for the new guidelines was the demand and cost of providing fertility services to HIV-infected people.

Black believes that reproductive health services for HIV-infected people have not been prioritised until now because of a persistent belief that they should not be having children. "Because our PMTCT programmes are not that strong, a lot of children are still being born HIV infected," she said. "I think you'd have to get on top of that before that attitude would change."

According to Department of Health figures, 23 percent of babies born to HIV-positive mothers in South Africa between April 2004 and April 2005 were infected. A combination of two or more ARV drugs has been shown to be more effective than Nevirapine in reducing mother-to-child HIV transmission, but the health department has yet to start using them except in the Western Cape Province. Lack of counselling and support for HIV-positive mothers in their feeding choices has also been blamed for the high number of mother-to-child infections.

Black said HIV-infected couples who want to conceive, but cannot afford sperm washing or artificial insemination, should be advised to take ARVs and limit unprotected sex to the one or two days in the woman's cycle when she is most fertile. They should also plan for the care of their child if one or both of them died prematurely from an AIDS-related illness.

"The problem with the healthcare system is that you don't have time to spend with your patients to go into these things," Black commented. Family planning clinics often process hundreds of patients in a day and the staff receive little or no special training on advising HIV-positive clients.

These hurdles are unlikely to deter HIV-positive men and women who are determined to experience parenthood. "If I decide I want a child, I know what I will face, but I think we all have choices and rights," Malaza said. "I wouldn't want to be told I couldn't have a baby."



Tuesday, December 19, 2006

Uganda: The ABC Strategy is Irrelevant to Children

By, Dr. Okuonzi Sam, New Vision (Kampala), December 17, 2006

THIS year's AIDS Day has come and gone. The passion behind "Unite for Children, Unite against AIDS", the theme for the celebrations, has not materialised into any concrete strategy or policy. With the chest-thumping by politicians and health officials about the miracle of the Abstinence, Be faithful, Condom use (ABC) strategy, the assumption is that this strategy also caters for AIDS in children.

But this is a mistaken assumption. While there has been some success in bringing down HIV/AIDS in Uganda among the adults, it is too simplistic to attribute this success to the ABC strategy alone.

Four key factors for the reduction of HIV/AIDS have been openness, the coherent and systematic approach for public mobilisation and education, multi-sectoral collaboration, and unparalled resource mobilisation. These factors are not captured by the ABC formula.

But the strategy, even with its expanded version, ABC-plus, remains largely irrelevant for the management of HIV/AIDS in children. Ten percent of people living with AIDS are children less than 12 years. The main route of transmission of the virus is from mother to child - in the womb, during birth or through breastfeeding. This route is now responsible for 22% of all new infections in Uganda. While the ABC strategy is concerned with preventing or restricting sex, major challenges of HIV/AIDS in children occur after the act of sex of their parents and are non-sexual.

At least 2.5 million children in Uganda are orphans infected or affected by AIDS. In addition to suffering from HIV/AIDS as a disease, these children are confronted with huge challenges of survival, growth and development. Their basic needs for health, nutrition, education, affection and protection are at stake. They experience rejection, fear, discrimination, loneliness and depression. Children infected or affected by HIV/AIDS are often more abused, and commonly disowned and dispossessed of family property.

Most children have no opportunity to test their sero-status and to be counselled. Only a few facilities are available for child counselling on HIV/AIDS. This service is fragmented, and not particularly highly valued by policy makers as a key service. It is not supervised and is often done by amateurs. The few child counsellors available frequently experience emotional stress or "burn out" and are not readily replaced by others. Other challenges facing counselling include lack of co-operation and fear of disclosure to health workers of children's HIV status by parents and caregivers, and lack of resources to establish and operate child-friendly counselling centres.

Therefore, the ABC strategy, even with some additions, will not do for HIV/AIDS in children. A comprehensive strategy to tackle HIV/AIDS in children should be six- pronged. First, the prevention of mother-to-child transmission (PMTCT) should be intensified and expanded so as to reach every pregnant mother. The coverage by PMTCT of 78% of pregnant mothers attending ante-natal clinics (ANCs) is a good starting point. But more needs to be done to reach those who are not attending ANCs. Also, only 56% of HIV positive pregnant mothers currently receive Nevirapine. This should be improved, in the short term, to 80%.

Second, it will be important to ensure routine screening for HIV of all children who visit or are taken to health facilities for health care. To support this, laboratory capacity, technology and systems need to be set up to provide timely and reliable diagnosis. Empowering lower level health care workers by training, technical and financial support to diagnose and manage HIV/AIDS infection will be critical. Clinical criteria for HIV/AIDS diagnosis need to be established and updated from time to time, guided by researched evidence. Even so, HIV infection in children can still be missed. In the absence of a definitive diagnosis, children with symptoms suggestive of HIV infection should be started on ARV until it is firmly excluded.

Third, counselling of children needs to be comprehensive. Children 0-12 years who are suspected to be infected or demand to be tested should be tested for HIV. They should be accompanied by a parent or guardian. But older children who demand to be tested may be allowed go unaccompanied, if they so wish. However, they should be counselled to seek approval from parents or guardians. Routine counselling and testing in health facilities need to be improved and made child-friendly. This requires some investment. Counselling should provide emotional and psychosocial support, advice on the adherence to ARV treatment, and on behaviour change.

Counselling should cover all important aspects such as coping with the consequences of the disease; stigma and discrimination; relationships with family, friends and community; the need of consent of older children (12 years and above) for testing; confidentiality of HIV results and privacy in counselling and medical examination. Counselling of a child on HIV/AIDS of necessity includes counselling of parents or guardians, teachers and other people who are close to the child. Counselling should be routine at health facilities. It should address the totality of a child's needs. Of particular importance is counselling on sexuality for adolescent children who are HIV positive, and who are thinking of getting partners and starting families. The training curriculum for child counsellors should be expanded to include all these issues. Teachers, the community and school children should be educated on how to treat and relate to HIV/AIDS affected children.

Fourth, at the earliest possible opportunity, children with HIV/AIDS should be started on ARVs. Early treatment results into better response and quick improvement. It also enables prevention and treatment of opportunistic and other coexisting infections. It enables timely parental education to take place, and facilitates easy and timely access to social and emotional support.

Fifth, a comprehensive programme of psychosocial, emotional and material support is necessary. HIV affected children should have access to routine counselling, protection and affection.They need clothes, food and schooling and scholastic requirements. The Orphans and Vulnerable Children programme is an attempt to meet these demands but is woefully inadequate and requires expansion. Finally, a programme to fight discrimination, stigma and abuse of children affected by HIV/AIDS needs to be established, intensified and expanded.

The writers, Dr Sam Okuonzi and Dr Edison Muhwezi, are the director and programme officer, respectively, at the Regional Centre for Quality of Health Care, Makerere University School of Public Health


Thursday, December 14, 2006

Malaria treatment leads to CD4 rise in HIV-positive people

By, Tom Egwang, Aidsmap, December 11, 2006

A malaria attack can substantially reduce the CD4 cell count of an HIV-positive person, while successful treatment of malaria can result in large CD4 cell increases, a study in Zambia has shown. The authors of the study say that malarial status needs to be determined in all patients deemed eligible for treatment where CD4 counts are being used, in order to avoid premature initiation of treatment.

Malaria and HIV/AIDS occur together in many countries in Sub-Saharan Africa where 25.4 million people are living with HIV/AIDS (PLWA). Over the years, there have been concerns about the interaction between the two infections but it is only of recent that concrete data have been collected about HIV/malaria interaction.

HIV-infected individuals are at an increased risk of malaria attacks and experience higher treatment failure rates. Malaria, on the other hand, increases HIV viral loads in HIV-infected patients and might accelerate disease progression to full blown AIDS.

PLWA therefore constitute another important vulnerable target population, in addition to pregnant women and children under 5 years old, on which malaria control efforts in Africa should be focused. In addition to malaria, PLWA are susceptible to a legion of opportunistic infections some of which are predominant at certain threshold CD4 counts.

The CD4 cell count has become an important clinical decision-making tool in the care of PLWA. It is used for monitoring PLWA so that treatment with antiretroviral drugs (ARV) can be started or changed. However, in order for CD4 counts to guide clinical decision-making, CD4 count changes must reliability reflect the progression of HIV/AIDS.

Changes in absolute lymphocyte and CD4 counts have been reported during malaria attacks in HIV-uninfected subjects. However, the impact of clinical malaria attacks on CD4 counts in PLWA in malaria-prone areas has not been investigated. A team of Belgian and Zambian investigators from the Institute of Tropical Medicine in Antwerp (Belgium) and the Tropical Disease Research Center in Ndola (Zambia) has addressed this issue in HIV-1-infected Zambian patients with uncomplicated malaria.

The study took place in four peri-urban health centers in Ndola, Zambia. All individuals aged 15-50 years with fever or history of fever in the previous 48 hours were screened for malaria infection and pregnancy. The exclusion criteria included parasite density of 1000 parasites/l, pregnancy, severe malaria, history of antimalarial drug use, and other causes of fever. HIV testing was done anonymously and patients wanting to know their HIV status received voluntary counseling and testing services. Malaria parasitemia, CD4 cell counts, and HIV-1 viral loads were assessed at enrolment (day 0) and after 28 and 45 days of antimalarial treatment.

Three hundred and twenty seven patients had microscopically-confirmed uncomplicated malaria and 32.1 % (105/327) of these were HIV-1 positive at enrollment. HIV-1 positive patients were older, had lower mean hemoglobin levels and higher body temperatures, and were more likely to be females. HIV-1 negative patients had higher median CD4 counts (459 cells/mm3; 95 % confidence interval: 425-517) than HIV-1 positive patients (274 cells/mm3; 234-347).

Among the HIV-1-uninfected and HIV-1-infected subjects with uncomplicated malaria, CD4 counts < 200/mm3 were observed in 9.6 and 28.7 % subjects, respectively. Thus, CD4 counts that would have signaled the need for the initiation of treatment with ARV were observed in a proportion of HIV-1-uninfected Zambians with uncomplicated malaria. Furthermore, CD4 counts in these HIV-1 negative patients were lower than expected.

Following successful antimalarial treatment, the median CD4 count on day 28 post-treatment increased to 811 cells /mm3 (73 % increment) in HIV-1 negative patients and to 447 cells/mm3 (51 % increment) in HIV-1 positive patients. The CD4 increment was inversely correlated with the CD4 count at enrollment for both HIV-1 negative and HIV-1 positive patients. The proportion of patients with CD4 counts < 200 decreased from 9.6 to 0 % and 28.7 to 13.2 % in HIV-1 negative and HIV-1 positive patients, respectively.

CD4 counts and HIV-1 RNA viral loads at day 45 after treatment were similar to those at enrollment. In HIV-1 negative patients with detectable parasitemia the median CD4 count on day 45 was significantly lower than that in successfully treated patients (598 versus 831, P < 0.001). In HIV-1 positive patients, this difference was not significant.

Thus, by monitoring CD4 counts in Zambian subjects who had uncomplicated malaria at enrollment and at 28 and 45 days after successful treatment, van Geertruyden et al have clearly demonstrated that uncomplicated malaria has a significant impact on CD4 counts in both HIV-1-infected and uninfected patients. These findings suggest that the usefulness of CD4 counts as a decision-making tool for providing health care to PLWA in malaria-endemic countries might be confounded by malaria.

In most resource-poor countries like Zambia and Uganda, the CD4 count is currently the marker of choice for monitoring HIV-1/AIDS progression in PLWA. The immediate policy implications of the study is that the malaria status of PLWA need to be unequivocally established before using CD4 counts to guide treatment options.


Van Geertruyden J-P et al. CD4 T-cell count and HIV-1 infection in adults with uncomplicated malaria. J Aquir Immune Defic Syndr 43 (3): 363-367, 2006.


SA lifespan down to 51

By,, December 11, 2006

Johannesburg - Life expectancy in South Africa is down to 51, after being 64 years in 1990.

South Africa has the world's second heaviest caseload of HIV/Aids, behind India, and the highest proportion of population infected with the disease.

The impact of HIV/Aids on life expectancy is highlighted in a new survey by the Medical Research Council and Actuarial Society of South Africa.

The survey, based on epidemiological and demographic data, found that life expectancy this year was "estimated to be 49 years for males and 53 years for females" or an average of 51.

Without anti-retroviral medicines (ARV's) that figure could drop to 48 years by 2015.

Senior MRC researcher Debbie Bradshaw said life expectancy in South Africa was on average 64 years in 1990 and had now dropped by 13 years to 51.

A mathematical Aids model was used to determine how much the disease contributed to the decline in population figures.

Antiretroviral plan

South Africa is second to India as the country with the highest total number of HIV-infected people in the world.

Around 5.5 million people in a population of 47 million are living with HIV or full-blown Aids.

According to government figures for September, 213 000 infected people now benefit from a government-funded antiretroviral plan, and 11 000 more join each month.

Based on a scenario developed by researchers that by 2015, 50% of those needing treatment will be receiving it, the impact of Aids deaths could slow down in the coming years.

"With the programme, the difference is expected to reduce below 16 years, giving a life expectancy of 50 years," according to the new survey.


Unsung Heroes: Uganda: Kangulumira Centre - Beautiful Beginning for Hiv+ Moms

By, Fred Ouma, New Vision (Kampala), December 12, 2006

JOSEPHINE Namusisi is HIV positive. She had never imagined she would deliver a healthy child, free of HIV, till she visited Kangulumira Health Centre IV in Kayunga district.

"It has changed my life, I can live healthy. I don't fall sick," says Namusisi, a mother of one and beneficiary of Prevention of Mother-to-Child Transmission (PMTCT) programme.

"My child is HIV-free, something I never thought could happen."

Several other mothers have benefited from the programmes of Protecting Families Against HIV/AIDS (PREFA), a partner organisation of the health centre.

PREFA has helped 2,653 pregnant women to have HIV tests done at the centre. Of these, 164 were HIV positive and the centre is providing antiretroviral (ARV) drugs to 46 HIV positive deliveries (mothers) and 69 infants born to HIV-infected mothers.

"We are providing technical support and training in counselling, infant feeding, paediatric HIV care and rapid testing techniques to ensure a sustainable process," said Dr. David Seruka, the PREFA executive director.

PREFA has also trained 75 community counselling Aides on PMTCT issues and 30 traditional birth attendants in modern health practices.

Seruka said besides providing accommodation for 10 staff of the health centre, they have also provided a computer to ensure proper storage of data, a motorcycle and bicycles to ease movement of health workers deep into the villages.

"Supervision and monitoring PMTCT clients has not been easy due lack of transport. Now we will be able to penetrate every home," said Dr. Diriisa Musisi, the district director of health services.

HIV prevalence in Kayunga is 7.2%, higher than the national prevalence of 6.7%. Figures from HIV counselling and testing centres indicate women at a higher percentage than men.

Musisi commended PREFA and other organisations for the support. He said 55% of HIV-infected mothers in the district were enrolled on the PMTCT programme.

"If the number of people who need antiretrovirals increases every year, it becomes a bottomless pit," said Musisi. "We have to turn the corner, the actual number of people with the disease needs to go down."

As a result PREFA has already conducted a mapping exercise for 26 community-based organisations to assess capacity in dealing with HIV/AIDS service provision in the district.

Seruka says training needs assessment was also conducted in 13 health facilities involving 105 health workers in the district.

"With goodwill and adequate resources, there is no limit to how much we can do to take care of our people," he said.

Dr. James Makumbi, the director of health services for the Uganda People's Defence Force, called on parents and health workers to educate young people about the dangers of HIV and how to prevent it.

Owing to the benefits from the health centre, Kayunga residents refer to it as the "Mulago" of Kayunga.

PREFA operates in Kayunga, Kampala, Wakiso and Tororo.


Zim receives US$65m grant from Global Fund

By, The Herald, December 14, 2006

ZIMBABWE yesterday received its US$65 million grant from the Global Fund to help in the fight against Aids, malaria and tuberculosis.

The money was from the first and fifth rounds grant.

Health and Child Welfare Minister and chairman of Zimbabwe’s Co-ordinating Mechanism, Dr David Parirenyatwa, National Aids Council chairman Reverend Murombedzi Kuchera and representatives of the United Nations country team and the Zimbabwe Association of Church-Related Hospitals signed for the receipt of the money at a brief ceremony in Harare.

Speaking at the occasion, Dr Parirenyatwa said the grant would significantly boost Government’s efforts to combat Aids. He said the money would be utilised mainly in the procurement of anti-retroviral drugs.

"The funds will go a long way in ensuring that we effectively fight Aids and will enable us to get more anti-retroviral drugs," said Dr Parirenyatwa.

He said about 300 000 people in Zimbabwe needed ARVs and an estimated 50 000 were on treatment.

Forty-two thousand are on the Government ARV scheme while the rest are on private schemes.

"Our vision is to make ARVs available to everyone who needs them by 2010 and we wish that we achieve this even before 2010," said Dr Parirenyatwa.

The minister also revealed that the Global Fund has rejected Zimbabwe’s application for a grant under the sixth round.

Dr Parirenyatwa said the Global Fund had informed Zimbabwe that it had not exhausted funds allocated to it under the first and fifth rounds.

"We are already working out to ensure that we get the funds from round seven. We, however, feel that we should have got the funds for round six as there is need for continuity of our fight against Aids after we exhaust the funds allocated to us in rounds one and five," Dr Parirenyatwa said.

The Global Fund has also turned down Zimbabwe’s bids for funds under rounds two, three and four and the Government said this was for purely political reasons.

The money received yesterday comes as yet another boost after the Government, a fortnight ago, signed a US$40 million joint deal with Britain, Sweden, Ireland, Norway and United Nations agencies in Zimbabwe for the initiation of new HIV/Aids projects.

The partnership, code-named the Expanded Support Programme, is expected to provide ARVs to an additional 20 000 people living with HIV/Aids in 16 districts.

The programme, under which Britain, Norway, Ireland and Sweden would provide the money while UN agencies would avail technical support, will run for the next three years with other donors expected to chip in with more funds.

Zimbabwe has reduced its HIV prevalence rate over the past six years from a high of 33 percent to 18,1 percent.


Wednesday, December 13, 2006

Botswana: Behaviour Change Tops World Aids Day Agenda

By, Chedza Simon, The Voice (Francistown), December 12, 2006

Speaking at the World AIDS Day Commemoration held at Tsabong last Friday, Minister of Health Sheila Tlou urged the nation to change sexual behaviour in order to achieve an HIV/AIDS free generation.

Minister Tlou called on her audience to utilise AIDS day to introspect on successes and challenges eminent in fighting AIDS.

She said: "HIV AIDS has been with us for a little more than two decades. We have lost loved ones and breadwinners and our children have been left without parents. Indeed we cry in sorrow but not in despair," she said to a large and attentive crowd.

Although some strides have been made such as the encouraging decline in HIV infection levels, there were still some great challenges to be faced such as very high HIV prevalence rates.

"I wish to reiterate this fact and urge all of you not to be complacent, but to be vigilant and relentless in keeping the promise until we eventually have an AIDS free generation some day."

The Minister revealed that relative to Botswana having a resource poor setting, the country has demonstrated to the world that ARV therapy can work even in resource poor settings.

"This is in view of the skepticism initially expressed by some to the effect that due to low literacy levels in these settings, adherence to treatment would be unattainable. Botswana has proven differently, we have achieved 85% adherence rate since the inception of treatment," she revealed to an overwhelming applause.

Tlou explained that this success has opened doors that would otherwise been difficult to open.

"We offer lessons to be learnt and best practices to be adapted to both the developing world and the developed. Through our fight for survival, we have presented the world, particularly the developing world with a window of hope that it can happen, even in Africa."

Tuesday, December 12, 2006

ZAMBIA: Help for child-headed homes

By, IRIN PlusNews, December 11, 2006

LUSAKA - Zambia is grappling with the growing problem of thousands of child-headed homes, created by one of the highest HIV infection rates in the world.

Kapiri Mposhi, a commercial hub in central Zambia, about 200km north of the capital, Lusaka, has one of the highest levels of HIV prevalence in the country and a significant number of child-headed homes. UNAIDS estimates the national HIV rate at 17 percent.

The town is situated halfway between the industrial Copperbelt province and Lusaka on the Great North road, the only highway linking Zambia to Tanzania in the northeast, and is a mandatory stop for truckers. It is also a significant stop on the railway line connecting Zambia and Tanzania.

"Because it is a transport hub, frequented by truckers, the town has become a commercial sex centre with a high HIV/AIDS prevalence rate," said James Zulu, a spokesman for the Zambia Red Cross Society, which runs programmes supporting child-headed households.

The UNAIDS '2006 Report on the Global AIDS Epidemic' estimated that Zambia had about 710,000 AIDS orphans, of which over six percent were homeless and less than one percent were accommodated in orphanages. The rest either fend for themselves in their parents' homes or are looked after by elderly grandparents.

According to Charles Mwinuna, district director of health in Kapiri Mposhi, there are over 850 officially registered orphans and vulnerable children (OVC) in a population of less than 300,000 but the unofficial number could be higher. "We have not been able to establish as yet how many of these vulnerable children are currently in child-headed homes, but we know that they should be in big numbers because of the locality and socioeconomic nature of this town, which has put people at greater risk of contracting HIV/AIDS."

Many orphaned children end up as sex workers along the highway, but there are exceptions. Memory Kawaya, 16, has looked after her two younger siblings for the past seven years. The family of three lives in a grass-thatched hut on the outskirts of town. She attends schools and sells mushrooms to help support the family, and she and her siblings have twice tested negative for HIV. Kawaya is determined to maintain her negative status by abstaining from sex.

"Many people have been approaching me for sex and [they] promise to give me money, but I refuse to give in because of what I have heard and seen about HIV/AIDS. I want to become a teacher after completing school, so that I can look after my brother and sister - that's why I don't even think about any sexual relationship," she said.

Kawaya was nine when she lost her mother, and her two siblings were aged seven and five. "We do not have any relative to look after us ... we have been living like this and we often eat only once per day - we can't afford three meals. I am only happy that we are all in school, although I am usually frustrated by my headmaster, who is always harsh with me for not looking as smart as other pupils," she said. They grow cassava, beans and maize in an adjoining plot to help feed themselves.

The Red Cross Society has started initiatives working with vulnerable children. "We have identified 734 orphans and vulnerable children in the town, whom we support with groceries, clothing and school fees," said Zulu. The Red Cross caregivers also visit child-headed households in Kapiri Mposhi to ensure they are coping.

Zulu said the society was also encouraging older children to run small businesses, mostly vending, to support their families. "We do not want to encourage child labour, but we provide them with small amounts of money to buy groceries or other foodstuffs to sell."


[Produced in partnership with the International Federation of Red Cross and Red Crescent Societies:]

SWAZILAND: Nurses fleeing the HIV/AIDS frontline

By, IRIN PlusNews, December 11, 2006

MANZINI - "Swaziland is dying. Will the last nurse on duty please turn off the lights?" reads a handwritten note at a clinic in Manzini, the country's AIDS-hit commercial centre, 35km southeast of the capital, Mbabane.

The wry note disguises the pain of Swaziland's diminishing number of nurses and hints at the reason why their colleagues have fled the country to offer their services elsewhere.

"The working conditions, the lack of basic necessities to treat people and all the dying: it is demoralising," said a nurse, 28, who asked that her name not be used. "It's not just the money - it is hard to watch people die and you are helpless to do anything about it because there are no drugs or other things [to treat them]."

Working in a poorly lit, aging ward, with scant equipment and a chronic shortage of drugs after the government failed to award tenders this year, are as much a motivation to leave the country as any promise of greater financial reward in Europe, the United States or neighbouring South Africa.

In the emergency room of Manzini's Raleigh Fitkin Memorial Hospital, a child screams in pain as a nurse removes sutures from a stitched finger wound. "I haven't got the proper cutter -they have such scissors in the paediatric ward," said the nurse as she gouged the tender skin around the wound with large scissors not intended for this procedure.

In a recent report, 'Public sector nurses in Swaziland: can the downturn be reversed?' released by Human Resources for Health, an online medical journal published in collaboration with the World Health Organization, authors Katharina Kober and Wim Van Damme noted, "The public health sector in Swaziland faces a serious shortage of health workers: 44 percent of posts for physicians, 19 percent of posts for nurses and 17 percent of nursing assistant posts are unfilled. We identified emigration and attrition due to HIV/AIDS as major factors depleting the health workforce."

UNAIDS estimates the national HIV infection rate of people aged 15 to 49 at 33.4 percent, the highest in the world. Two-thirds of Swaziland's roughly one million people, ruled by sub-Saharan Africa's last executive monarch, live on US$2 or less per day.

The report concluded, "Our projections show that both emigration and attrition due to HIV/AIDS pose a serious double threat for Swaziland's health system, which, if not effectively tackled, would mean the loss of 44 percent of the nursing workforce in the public sector up to 2010."

Nurses at St Theresa's, a clinic on the outskirts of Manzini run by the Roman Catholic Church with financial support from government, last week held a crisis meeting after two months of erratic salary payments or none at all.

"It is too hard doing what we do, under these conditions that you see," a nurse at the clinic told IRIN/PlusNews. The waiting room contains a few wooden benches, with little ventilation to combat the stifling summer heat.

As a result of the government's policy of zero growth, no new posts were created in over 20 years, even with the onset of the HIV/AIDS pandemic, which began to bite in the mid 1990s. The World Health Organisation has put the total number of health workers posts at 3,726.

"Some 758 of the 944 established nursing posts in the public and mission sectors are filled. The nurse-to-population ratio in the public and mission sectors is therefore around 70 per 100,000. The official number of nursing posts was widely regarded as inadequate for the actual workload in the health sector," the Kober and Van Damme report commented.

The researchers estimated that 288 of the 758 nurses, about 38 percent, employed in the public and mission sectors were probably HIV positive, of whom 29, or 10 percent of the HIV-positive nurses, might have died during 2005. They projected that 3 percent to 4 percent of the entire nursing workforce would succumb to AIDS-linked illnesses each year.

HIV/AIDS is a lesser contributor to the country's nursing shortage than emigration. Researchers found that 100 of the national nursing workforce of about 800 leave the country annually. Swaziland's two nursing colleges produce about 80 to 90 graduates per year, while a school for nursing assistants delivers around 20 graduates.

Although the two training sites receive hundreds of applicants annually, too few student bursaries from the health and social welfare ministry, a lack of teaching staff and student accommodation, and insufficient opportunities for practical training have kept enrolment low.

A basic nursing course last three years, but most students do either one additional year to obtain a qualification in midwifery or a five-year course to obtain a Bachelor in Nursing Sciences degree.

"I left nursing school and went right to work, like all my classmates. I worked at the Mbabane Government Hospital [the country's largest health facility], and right away I saw someone die because they couldn't get the medicines they needed. This is why Swaziland loses more nurses to 'greener pastures', in my opinion. And AIDS is making our work so much harder," the nurse said.

The Kober and van Damme report said 80 percent of bed occupancy in the medical and paediatric wards of government hospitals nationwide was HIV/AIDS-related.

"Doctors from a mission hospital estimated that five years ago they would spend an average of five minutes per patient on a ward round, while presently this was more likely to be 20 to 30 minutes. This was seen as a consequence of the increasing number of terminally ill patients needing time-intensive care. There is an increased demand for health services, and health workers speak of feeling overwhelmed and burned out," the authors said.

Nurses were granted a salary increase in 2005, but little could be done about the poor working conditions; 21 nurses resigned from the Mbabane Government Hospital in the same month that the salary increment came into effect.

On a previous visit to Swaziland, Kober and Van Damme found that public and mission health facilities had 1,481 posts, but only 1,184 staff were reported as actually working at the facilities, leaving 297, or 20 percent, of the posts vacant.

To increase the number of nurses, the Ministry of Health has requested the Ministry of Public Service to lift a ban on the recruitment of foreign nurses, whose salaries would be paid by the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Another solution to the shortage of nurses might come from government's rollout of antiretroviral drugs for people living with HIV. Though hampered by teething problems this year, the rollout could reduce the number of chronic HIV/AIDS patients, as well as throwing a lifeline to HIV-positive nurses.

"No one wants to talk about it, but Swaziland's AIDS problem is frightening nurses. We are on the frontline of this battle, and it is easy for some to run away from the danger," the nurse commented. "It takes real patriotism and a dedication to your calling as a nurse to work as a nurse in Swaziland today."

Friday, December 08, 2006

SUDAN: Darfur at risk of mounting HIV/AIDS epidemic

By, IRIN PlusNews, December 7, 2006

KHARTOUM - The United Nations is raising awareness about HIV/AIDS in Sudan, but has warned that infection rates may be on the rise in the unstable Darfur region.

"There are suggestions that the number of people who have the disease [in Darfur] is increasing," UNAIDS Country Coordinator Musa Bungudu told reporters in the Sudanese capital Khartoum recently.

Sudan's western region of Darfur, home to about 3 million people, was plunged into crisis in February 2003, when the mainly black African tribes of the region rebelled against President Omar al-Bashir's government, which in turn allegedly backed the mainly Arab Janjawid militia, which has been accused of committing a slew of atrocities against unarmed Darfur civilians.

Three years of fighting has caused the death of more than 200,000 people and forced another 2.5 million people from their homes. Rape and sexual assault are widespread in Darfur, and it is thought commercial sex networks have been established around the 7,000-strong African Union peacekeeping force in the region, a development that could fuel the spread of HIV/AIDS.

"When a population is displaced, the socio-economic base is totally affected; there is likely to be a change in behaviour," Bungudu said. "The bottom line is that the disease is in Darfur."

UNAIDS, in partnership with the Sudan National AIDS Programme, has launched initiatives aimed at raising awareness of HIV/AIDS across Sudan. However, HIV education is problematic in the Muslim north, where public discussion of sexual matters is a thorny issue.

Prevention efforts to stop the disease spreading in southern Sudan are complicated by the Roman Catholic Church's negative stance on condom use among the large Catholic population.

The UN estimates that Sudan has the highest rate of HIV infection in North Africa and the Middle East. However, statistics on the rate of HIV/AIDS infection in Sudan has been very difficult to compile. A 21-year long civil war between north and south Sudan, which ended with a peace agreement in 2005, rendered much of the south inaccessible to surveys on HIV/AIDS. In 2003, UNAIDS estimated that the infection rate in the nation of 41 million people hovered around 1.6 percent.

The UN is planning a comprehensive survey in Sudan in 2007, to try and ascertain nationwide infection rates. UNAIDS has warned, however, that statistics from Darfur may be difficult to obtain. Widespread violence in the region has granted only partial access to many areas of Darfur's three states.

"If you are going to do a successful survey you want to have each community represented in that survey," Bungudu said. "Those areas where the fighting is ongoing are likely not to be involved."



Prevention for positives

By, IRIN PlusNews, December 7, 2006

JOHANNESBURG - After Zodwa [not her real name] learned she was HIV positive, six torturous months passed before she felt able to tell her boyfriend. "I had to check his mindset," she said. "We were using condoms, but I worried about the condom breaking, and I felt so guilty." As it turned out, her boyfriend was supportive, but the couple broke up a few months later.

"I was very uncomfortable having sex, so it affected the relationship," Zodwa said. "Now I'm in a relationship with someone who's positive and it's easier, but it took time to think of sex normally."

As more and more HIV-positive South Africans access free antiretroviral (ARV) treatment and look forward to healthier lives, love and sex inevitably regain importance. The challenge to healthcare providers is to recognise the human right of such people to have sex, while helping them to mitigate the risks.

Even for couples where both individuals are HIV-positive, unprotected sex carries major health risks. People infected with HIV are more susceptible to sexually transmitted infections (STIs) and there is the possibility of reinfecting a partner with a new or drug-resistant strain of the virus. Besides non-penetrative sex, the only protection against such risks currently available is male and female condoms.

"Women from our support groups who continued to have [unprotected] sex with their partners - they're not with us today," said Prudence Mabele, director of the Positive Women's Network, an organisation of women living with HIV. "We need to talk about positive prevention because, for a long time, I didn't think prevention was catered to me."

Large-scale prevention initiatives tend to focus on the general population, who are assumed to be either HIV negative or unaware of their positive status. The Social Aspects of HIV/AIDS Research Alliance (SAHARA) is conducting a study in eight African countries to test interventions aimed at reducing the risk behaviours of people who know their HIV-positive status.

Results from the first phase of the study found that of the 1,054 HIV-positive men and women surveyed, 85 percent were sexually active. Of those, 42 percent reported that in the last three months they had had sex with a person they had not told about their status. Most significantly, the study found that participants who had not disclosed were much more likely to have engaged in risky behaviour, such as having multiple partners, having unprotected sex and not knowing the status of their partners.

According to Dr Leickness Simbayi, a senior researcher at South Africa's Human Sciences Research Council and coordinator of the study in four countries, stigma and discrimination that prevented people from disclosing their status was the biggest barrier to their ability to practise safe sex.

Fear of disclosure was often motivated by real events. Forty percent of participants had experienced discrimination and one in five had lost their homes or jobs because of their HIV status. Gay men reported even higher levels of discrimination. The feelings of shame and depression that characterise internalised stigma were also prevalent and contributed to unsafe sexual practices.

The next phase of the SAHARA study will test two interventions aimed at helping people living with HIV/AIDS (PLWHA) to cope with stigma, disclose to their partners and avoid risky sex. One will use a support-group model encouraging participants to share skills and experiences; the other will use one-on-one sessions with counsellors.

HIV-positive people often report getting more information on sexual and reproductive health from their support groups and HIV-positive friends than from counsellors and health workers.

"Most healthcare workers have very negative attitudes," said Zodwa. "The minute you say you have an STI they're very judgmental, even though it could just be an opportunistic infection."

Apart from the need to address these attitudes and to provide more training, Simbayi believes that overwhelmed counsellors simply lack the time to go into such issues with their clients. "Perhaps if there were enough counsellors, part of the need for additional interventions would not be necessary."

Apart from a few minutes of post-test counselling, which should include safer sex information, PLWHAs will often not speak to a counsellor again until they begin ARV treatment. At that point, the discussion will mainly revolve around drug adherence and side-effects.

"We're constantly encouraging people to test and know their status, but when they do, and they learn they're positive, it's like 'good luck'," said AIDS activist Mark De Clark. "Many people don't know what living positively really means."

Catherine MacPhail, a senior researcher with the Reproductive Health and HIV Research Unit at the University of Witwatersrand, in Johannesburg, believes HIV management should move towards a more holistic approach that integrates treatment and care with education on prevention and fertility issues. "We've got to help people maintain safer sex practices for the rest of their lives," she pointed out.

MacPhail is developing a trial intervention, similar to the counsellor-based one SAHARA is about to test, using a technique called 'motivational interviewing' to help PLWHAs assess their risk behaviours and make choices about how to change them one at a time.

Mabele said positive prevention approaches should also be sensitive to the fact that PLWHAs, especially those newly diagnosed with the virus, have complicated feelings about sex that may include anger, fear and denial. "After learning my status, sex equalled death and I abstained for three years," she recalled. She knows of others who reacted by refusing to take responsibility for infecting their partners.

De Clark, who was in a stable relationship when he learned his HIV-positive status, described going through a difficult period with his partner. "He was scared of being infected and I was scared of infecting him. For a long time the only way we could cope with it was to have no sex." Five years later, De Clark and his partner are still together, "but even today there's still that fear, so you become extra careful and your sexual relationship becomes a bit stilted."

Mabele believes discussions about safer sex should become less clinical: "Just because you've been diagnosed, it doesn't mean you stop feeling," she said. "Besides this virus, sex is supposed to be pleasurable."

With these goals in mind, her organisation runs occasional 'love parties' - workshops where positive women can discuss ways of putting some fun and romance into safer sex. "It's partly to get people over their embarrassment about these things," said Mabele. "Our culture doesn't talk a lot about sex, so we need to break that."



Thursday, December 07, 2006

India 360: India serious about AIDS?

By, CNN-IBN, December 1, 2006

It is World’s AIDS Day on December 1 and around 40 million people today are living with AIDS, the world's deadliest contagious disease.

India now holds the second largest absolute number of HIV positive cases in the world, following South Africa, which has 5.5 million HIV infected people.

A staggering 5.21 million adults in India are living with HIV, says the National AIDS Control Organisation (NACO). Of these over 60 per cent are males.

Surprisingly, more than 57 per cent of the infected people are of rural background. And the greatest worry is that about 90 per cent of the infected people do not know that they are carrying the deadly virus.

Andhra Pradesh is one of the worst affected states on India's HIV/AIDS map, having more than 12,000 cases. And the biggest challenge for AIDS agencies right now is to curb the HIV infection, 90 per cent of which is sexually transmitted.

According to the world health organization (WHO) estimates, the Indian Government spends Rs 8,000 on each HIV positive patient in the country under the Anti Retro Viral (ARV) drugs programme available to these patients in most government hospitals.

However, out of the 59,000 patients being treated under the ARV programme, most are at a critical stage and require advanced level of treatment to be able to survive.

With those shocking statistics, we would assume that the government and our lawmakers must be working overtime to take us out of this crisis.

Do Indians understand the seriousness of the AIDS threat? This was the question addressed by an elite panel on CNN-IBN's India 360 show. On the panel were Pooja Bedi, actor/TV personality, Anu Malhothra, creative director, Haath Se Haath Mila and Nafisa Ali, social activist.

Bhupendra Chaubey:The statistics which says 90 per cent of those who are carrying the HIV virus don’t even know that they are carrying this virus. Is it really a situation?


-In India, about 202,000 children are estimated to be infected by HIV/AIDS

-The highest HIV prevalence rates are found in Maharashtra in the west; Andhra Pradesh and Karnataka in the south; and Manipur and Nagaland in the north-east
90% of the infected people do not know that they are carrying the infection.

-India now holds the second largest absolute number of HIV infections in the world

-India's adult HIV prevalence will peak at 1.9% in 2019.54

-The number of AIDS deaths in India (which was estimated at 2.7 million for the period 1980-2000) will rise to 12.3 million during 2000-15, and to 49.5 million during 2015-50.55

-Around 0.9% of India's population is living with HIV

- 40 million people are living with HIV around the world.

-More than 25 million people are estimated to have died since 1981 as a result of Aids-related diseases.

-In 2005, around 2.8 million people died of Aids-related illnesses, 570,000 of them children. Meanwhile, approximately 4.1 million people were newly infected.

-A staggering 5.21 million adults in India are living with HIV, says the National AIDS Control Organisation. Of these over 60 per cent are males.

-Astonishingly, more than 57 percent of the infected people are of rural background.

-But the greatest worry is: About 90 percent of the infected people do not know that they are carrying the deadly virus.

-Since 1986 when AIDS was first reported in India, 1,24,995 cases of the disease have been recorded till date.

-According to estimates over 85 per cent of these cases are due to unsafe sexual intercourse.


Uganda: Know Your HIV Status

By, New Vision (Kampala), November 30, 2006

AS Uganda joins the rest of the international community in marking World AIDS Day, focus should be on the report published earlier this year which indicates that HIV infection rates have risen from 6.2% to 7%.

What is probably most alarming is the fact that infection is rising mostly among the married people, of all the demographic groups.

There are numerous reasons why this is so. Uganda's campaign in the last 15 or so years has concentrated on the youth, who were then correctly identified as a most vulnerable group. It largely succeeded, which is why rates fell quite drastically.

But now a new reality has emerged, with the married (formal and informal unions, such as living together) as a most susceptible group - an alarmingly high 85% of transmission risk behaviour is with spouses/regular sexual partners.

In addition the sero-behavioural survey also indicates that HIV prevalence increases with wealth.

It says that 77% of HIV positive Ugandans are sexually active, of whom 84% do not use condoms.

But the survey's results also point to helpful advice. It found that HIV positive people who know their status are three times more likely to use condoms; and those aware of their partner's status are 2.5 times more likely to use condoms.

Because awareness of one's HIV status tends to encourage safe sex, the focus should now be placed on Ugandans establishing their status. There is already a routine testing for HIV in public hospitals, though results may not necessarily be given to patients. The United States is debating mandatory testing. This may be the way to go.

We need to bring down the statistic that says that 79% of HIV positive Ugandans do not know their sero-status. The message needs to be put out that the earlier one goes onto ARV treatment, and the earlier one resorts to safe sex like condoms, the more likely they are to prolong their lives. That is why everyone should know their HIV status.


South Africa targets 50 percent drop in new HIV cases

By, Fran Blandy, Agence France Presse, December 1, 2006

NELSPRUIT - South Africa has unveiled plans to halve the number of people being infected with the AIDS virus within five years by persuading youngsters to delay the start of their sex lives.

A new action plan launched by Deputy President Phumzile Mlambo-Ngcuka also contained target pledges to provide care for 80 percent of sufferers and their families in a country with the second highest incidence of HIV in the world.

"Key priority one: reduce by 50 percent the rate of new infections by 2011," read the plan which was unveiled in one of the regions worst hit by the epidemic.

The plan emphasised that the key to success in the fight against AIDS rested on the ability to reduce the number of new infections among young people.

Greater sex education was needed while it was also vital to ensure that "a large proportion of youth 14-17 years of age delay the initiation of sex".

"The future course of the epidemic hinges in many respects on the behaviour young people adopt and maintain," it added.

With South Africa registering one of the highest rates of teenage pregnancy in the world, Mlambo-Ngcuka said that there had to be a change in attitude towards sex among the country's youth.

"The estimate suggests that there are still many new infections among young people in our country and that delaying sexual activity by the young is critical," she said.

Her comments came after US President George W. Bush said that abstinence was "the only sure way to avoid the sexual transmission of HIV/AIDS."

The South African government has been heavily criticised both at home and abroad over its approach to the epidemic which affects 5.5 million of the 47 million population.

Health Minister Manto Tshabalala-Msimang, dubbed Dr Beetroot, has attracted particular derision for advocating a diet of garlic and vegetables to help combat the epidemic.

Mlambo-Ngcuka however has come to play an increasingly high-profile role in the fight against the disease. Tshabalala-Msimang, who has had health problems, was absent from the launch in this northwestern city.

The new 2007-2011 action plan however said that further research would be financed on the role of nutrition as well as traditional medicine in building up immunity to the disease.

The government has been riven by internal divisions over the approach to the epidemic with Tshabalala-Msimang's deputy attacking a culture of "denial".

The vice-president said it was important that the government did not become distracted by internal battles.

"If we focus our energy on conflicting with one another and on differences between us we will lose sight of our shared goals and weaken collective resolve and efforts to implement this plan," she said.

Anti-AIDS campaigners have said that Tshabalala-Msimang's focus on vegetables has been at the expense of anti-retroviral drugs (ARVs) which they say are the key to winning the fight against the disease.

Mlambo-Ngcuka said that a total of 213,000 people were beneficiaries of a government-funded ARV programme and 11,000 were joining every month. In addition, more than 360 million condoms were being distributed annually.

Macharia Kamau, chief representative in South Africa of the UN children's fund Unicef, hailed the government's recent performance.

"This country has made great strides in the provision of treatment over the past couple of years. It has the fastest growing uptake and largest number of people on ARV treatment," he told AFP.

"I make a special plea that this country makes a special effort to contain the impact of AIDS on children."

The words of praise are in stark contrast to criticism from the UN's chief envoy on AIDS in Africa who accused the government in August of espousing "theories more worthy of a lunatic fringe than of a concerned and compassionate state."


World AIDS Day 2006: ILO Report

By,, December 1, 2006

The workforce and HIV/AIDS: Employment is a crucial lifeline

In 2005, more than 3 million labour force participants worldwide were partially or fully unable to work because of illness due to AIDS. A new ILO report on HIV/AIDS and work 1/ shows that both prevention and treatment could bring significant benefits to the global labour force and the economy, more particularly accessible and effective antiretroviral drug therapy (ARVs). ILO Online reports from Kenya.

NAIROBI, Kenya (ILO Online) – For workers living with HIV/AIDS, employment is a crucial lifeline.

A recent study from Kenya 2/ covering 769 households showed that providing antiretroviral drug (ARV) therapy resulted in a large and immediate increase in the number of people with HIV/AIDS who were able to continue working: within 6 months after beginning treatment, 20 per cent more were likely to be at work and 35 per cent more were able to work longer hours.

How does treatment translate into productivity and income? In the United Republic of Tanzania, for example, the ILO has calculated that a worker living with HIV/AIDS who is able to regain three-quarters of his or her current level of productive activity due to ARV treatment would gain about 18 months of productive life – or the equivalent of about $US 1,000 in monthly productivity gained.

ILO projections of access to treatment suggest that survival of labour force participants will increase substantially with access to antiretroviral drugs (ARVs), and even more so if their adherence to treatment is high.

“Assuming that treatment is initiated in 2006 for all workers with advanced AIDS and each year new workers are added to the treatment pool, 2.5 million workers would be alive globally at the end of 2010 who would otherwise have died, if 80 per cent of workers continue the treatment each year”, explains Odile Frank, the main author of the report.

The report shows that a worker with AIDS given treatment in 2004 could have worked for 34 of the next 54 months on average. Every 12 months the average worker in the 60 countries most affected by HIV contributes 7 times the average per capita income of those countries.

“Essentially, to a worker living with HIV/AIDS, remaining employed is the foundation for treatment and a major therapeutic component as well as the only safeguard against impoverishment”, says Ibrahim Coulibaly, another author of the report.

Call for action

According to the ILO report, these projections for 2006 argue loudly for comprehensive workplace action against HIV/AIDS, especially in the developing regions of Africa and Asia. But despite the current and anticipated rates of increase in access to ARVs, the HIV epidemic continues to have a very damaging impact on the labour force.

In 2005, more than 3 million labour force participants worldwide were partially or fully unable to work because of illness due to AIDS, and three-quarters of them lived in sub-Saharan Africa. Moreover, the global number of labour force participants unable to work is expected to stabilize between now and 2020, and not yet decline, whereas it is expected to continue to increase in Africa, where slower growth of access to ARVs is projected.

“Access to ARVs is woefully delayed in resource-poor settings, although there has been some progress in broadening access just in the last year, 2005. Projections of labour force participants who will become ill and die underscore the urgent need to raise access to treatment to the very highest levels to avert the labour force losses otherwise projected”, says Odile Frank.

Taking account of the global impact of the epidemic on all persons of working age, whereas 3.4 million working-age youth and adults died annually by 2005, the toll is expected to rise to 4.1 million by 2010, 4.4 million by 2015, and to reach 4.5 million by 2020, even with anticipated increases in access to ARVs. In developing regions, fewer deaths are expected to occur in Latin America and the Caribbean, but more deaths are projected in Asia and Sub-Saharan Africa.

To tackle this challenge, the report recommends vigorous action on all fronts, particularly in favour of workers in resource-poor settings, youth, women, and mobile populations.

“These new analyses show clearly that both prevention and treatment can bring significant benefits to the global labour force and the world of work, even if prevention is too late for millions of persons already living with HIV. Each labour force life preserved represents a potential productive gain for the economy, the household and the family, especially children, as well as recognition of the fundamental rights of each and every working man and woman”, the report concludes.


1/HIV/AIDS and work: global estimates, impact on children and youth, and response, International Labour Office, Geneva, 2006. ISBN 92-2-119070-6 and 978-92-2-119070-7 (print). ISBN 92-2-119071-4 and 978-92-2119071-4 (web PDF).

2/Thirumurthy, H., J. Graff-Zivin & M. Goldstein (2006). The Economic Impact of AIDS Treatment: Labor Supply in Western Kenya. National Bureau for Economic Research (NBER) Working Papers No. 11871.

For more information, please contact the ILO Department of Communication, or see the ILO World AIDS Day site:

World Aids Day 2006

New ILO report says HIV/AIDS epidemic costing more than 1 million new jobs per year

Says workplace should become major entry point for prevention and access to treatment

International Labour Organization


Firms should administer life-saving AIDS drugs -UN

By, Reuters, December 1, 2006

GENEVA - The workplace may be the best setting for millions of people with HIV and AIDS to be administered drugs that could extend their lives, the International Labour Organisation (ILO) said on Friday.

In a report published on World AIDS Day, the United Nations agency said that more than 24 million people in the global workforce in 2005 suffered from HIV or the disease it causes, AIDS. Nearly 67 percent of these lived in Africa.

Giving these workers access to anti-retroviral drug therapy, or ARVs, could have lengthened their working lives by more than two years, and considerably increased per capita incomes in places like sub-Saharan Africa, the report found.

"Access to ARVs in the workplace must rise substantially," it said, estimating that 1.8 million more African workers would be alive in 2010 if 80 percent of the workforce were to start and stay on ARV therapy from this year.

Public health experts say that the life-extending drugs have transformed the once-deadly HIV and AIDS into chronic conditions. But they need to be taken at regular intervals to be effective, and can cause drug resistance when taken improperly.

The ILO estimated that the HIV epidemic stripped an average of 0.5 percentage points off the economic growth of 43 affected countries every year between 1992 and 2004.

In sub-Saharan Africa, 31 countries lost 0.7 percentage points of economic growth per year during the period.

Employment growth also suffered markedly. The ILO said HIV and AIDS caused a 0.5 percent yearly decline in sub-Saharan Africa's annual employment growth rate, "equivalent to an employment loss of 1.1 million (jobs) per year for Africa."


Wednesday, December 06, 2006

Can India be the inventor of an anti-AIDS vaccine?

By, Tamil Nadu News,, December 1, 2006

Chennai, Dec 1: World AIDS Day is being observed around the globe today, and in India, a team of scientists is carrying out trials of an indigenous anti-AIDS vaccine, providing a ray of hope to many suffering from the deadly disease.

The vaccine, which has been developed by an Indian virologist, is being tried on 32 volunteers for its efficacy.

"At the National AIDS Research Institute (NARI), the vaccine being tried is a part of a multicentric trial where other countries are also taking part. The vaccine trial is being done only in Chennai, and is designed by a virologist from another ICMR institute, the National Cholera and Enteric Disease Centre from Kolkata. The virologist is Dr Shekhar Chakravarty," said Dr V D Ramanathan, Deputy Director, Department of Clinical Pathology, Tuberculosis Research Centre, Chennai.

The vaccine has been specifically designed to detect strains of HIV commonly seen in India. It has been tailored to the HIV strain C, the sub-type of the virus most common in India.

"This is a very unique vaccine, and it is specifically designed for strains of HIV commonly seen in India. Therefore, it is India specific and a matter of pride for us that it has been designed by a fellow Indian," said Dr. Ramanathan.

The Chennai trial results are likely to be made available by mid 2008.

Vaccine trials on humans for different strains of the virus are already being conducted in the United States, Europe, Africa and South America.

India is an active participant in the global search for an AIDS vaccine, and a part of the International Aids Vaccine Initiative (IAVI), which sponsors research partnerships to develop and test promising vaccine candidates.

The IAVI, a New York-based global non-profit scientific organization, is working on speeding up the search for an HIV/AIDS vaccine.

The Bill and Melinda Gates Foundation, the Rockefeller, the Sloan and Starr Foundations and the World Bank are the main funding agencies for this initiative.

"The initiative was to first form a partnership of agencies which can successfully carry out a very complex task like production and invention of the vaccine. The second part was to generate the necessary scientific concepts for producing a vaccine. And, once this was over, we had to identify the agencies, which could do this. These were the three essential components that have been identified and put into practice," added Dr Ramanathan.

Dr. Suniti Solomon, the founder-director of the Y.R. Gaitonde Center for AIDS Research and Education (YRG CARE), a premier HIV/AIDS care and support centre here, says more laboratories and pharmaceutical outfits should come forward to encourage this research initiative.

"We need more centres and laboratories. You know the infrastructure to prepare the vaccine and once it is produced and we are successful in India, we need to manufacture it. So, we definitely need pharmaceutical companies to chip in. So, it would be a network of organisations that need to be together if we want a successful vaccine," said Dr. Solomon.

The demand for a vaccine would eventually be on a mass scale that would mean necessary facilities for its manufacture, which has to be shared by the pharmaceutical manufactures in the private sector.

Available studies indicate that an AIDS vaccine even with 50 per cent efficacy, provided to 30 per cent of the population would avert 17 million new infections worldwide between 2015 and 2030. Ultimately, this would translate to reduction of new infections by more than half by 2030.

India continues to fall far short of its own target of giving ARV drugs to 100,000 AIDS patients by 2005 - it still only reaches 47,300 of the estimated 500,000 to 750,000 people who need the drugs.

Experts have warned that, if India does not get on top of its HIV epidemic by next year, it could spiral out of control.

The rising prevalence of HIV in more than 100 districts shows that a decade of government efforts has not slowed down the virus, which is now estimated to have infected 5.7 million Indians.

But, the National AIDS Control Organisation says that only 5.2 million Indians are affected.

--- ANI


Maternal deaths rise due to Aids

By, Sunday Times, December 1, 2006

As South Africa marks World Aids Day, the surge of HIV/Aids and tuberculosis is leading to a rise in the mortality rates of maternal mothers and new-borns.

The number of mothers and new-borns who die because of HIV/Aids and tuberculosis is on the increase, Health Systems Trust (HST) reported.

"The strides made from 1996 to now (2006) in improving maternal care in South Africa has been great, but that figure is marred by the HIV and tuberculosis (TB) infection rate," said HST spokeswoman Ashnie Padarath.

HST is a government and privately commissioned research organisation.

She said whereas in 1996, 38 percent of all TB patients were female, the figure increased to 43.5 percent in 2004.

"HIV has also been implicated in a lot of deaths and aggravation of existing (treatable) medical conditions."

This meant that health care workers’ efforts to save the life of a patient, who could ordinarily be cured, was be hampered due to HIV infection.

Said Padarath: "Many children also still fall ill and die from preventable and treatable conditions. Child mortality has also [been] fuelled largely by HIV, which is reversing the gains made in child survival over the last decade."

She said the number of deaths occurring among women and children was indicative that HIV and TB was a hindrance to successful health care in the country.

The department of Health’s strides to minimise the scourge of HIV in the country was largely commented on.

"Last year, only 3,000 [of a possible 110,000 children infected with HIV] were administered with antiretrovirals. This year, that figure has increased to 14,000."

Padarath said the statistics were proof that government had begun to tackle the problems faced in health care from renewed perspectives.

"We’re talking about [the department’s] skills training for nurses, campaigns and extending ARV rollout to all areas. All that [effort] is from government’s initiatives."

But while government’s efforts were applauded, Padarath said there was still room for improvement.

She added that the HST’s review of women and children’s deaths revealed that the rate of TB infections were growing faster each year.

High HIV and TB infection rates aside, the HST said all government sectors needed to pull together to ensure fewer women and children died from preventable diseases.

"A lack of running water in the rural areas brings upon problems of cholera, where, if there were running water, we wouldn’t have to deal with those kinds of problems."

Padarath said an "innovative and sustainable response" to the unacceptable mortality rates among maternal women and children would be needed to decrease the number of deaths.


Africa: On World Aids Day, UN Leaders Underline Need for Accountability

By, UN News Service (New York), December 1, 2006

Stressing this year's theme of accountability, senior officials from across the United Nations system have marked World AIDS Day with calls for international leaders to maintain recent momentum and make good on their promises to ensure greater access to treatment, prevention and support.

"The latest global AIDS figures give us reason for concern and for some hope," said Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS, (UNAIDS), in one of a series of messages today by the heads of UN organs and agencies.

Almost 40 million people live with HIV and another 4.3 million will be infected this year, while at least 25 million others have died from AIDS-related diseases in the 25 years since the first case was reported. The pandemic is now the leading cause of death among both men and women aged between 15 and 59.

Yet the number of countries providing antiretroviral (ARV) treatment to sufferers and the breadth of access to HIV testing, counselling services and health care have also continued to expand, including in sub-Saharan Africa, the region hardest hit by AIDS.

"However, we must increase the scale and impact of HIV prevention activities, including those directed at the drivers of the epidemic," Dr. Piot said. "New data show that HIV prevention programmes have better results if focused on reaching people most at risk and adapted to changing national epidemics."

General Assembly President Sheikha Haya Rashed Al Khalifa said the theme of accountability applied to everyone, from world leaders who have previously vowed to improve reproductive health care services and information, particularly for women, to individuals who can help establish healthy behaviour when their children are young.

"The challenge for all of us is to make good on our commitments and work in closer partnership towards our common goal. Civil society, NGOs [non-governmental organizations], the media, private sector and faith groups have an important role in promoting public awareness and holding leaders to account for their promises," she said.

Anders Nordström, Acting Director-General of the UN World Health Organization (WHO), said the international community had reached "a critical juncture" and needed to become smarter and more adaptable as it responded to HIV/AIDS.

"We have to be aware of which approaches are successful, and flexible enough to adapt our resources accordingly," Dr. Nordström said. "We do not just need 'more.' We need to commit to clear-sightedness about what is working and what is not - and quickly apply that knowledge."

Antonio Maria Costa, Executive Director of the UN Office on Drugs and Crime (UNODC), warned against the stigmatization and marginalization of people living with HIV/AIDS, especially women, young people, injecting drug users, prisoners and victims of human trafficking - all groups that are particularly vulnerable to the pandemic.

The UN Population Fund's (UNFPA) Executive Director, Thoraya Ahmed Obaid, saw signs of hope among the young, noting that HIV prevalence rates among youth have fallen in several countries because of increased condom use and other behavioural changes.

UN High Commissioner for Human Rights Louise Arbour said it was vital that Member States are made to live up to their earlier commitments to eventually provide universal access to comprehensive prevention programmes, treatment, care and support by 2010.

Achim Steiner, Executive Director of the UN Environment Programme (UNEP), said it was important to recognize that combating HIV/AIDS is linked to resolving other key global challenges, from promoting economic development and fighting poverty in poorer countries to encouraging gender equality to supporting environmental sustainability.

Numerous events are being staged around the world today to draw attention to the pandemic and to some of the ways that individuals can help to reduce or ameliorate its impact on communities.

In New York, Drawing IT Out, an exhibition of 300 cartoons drawn by artists, in 50 countries opened at UN Headquarters. The event is sponsored by UNAIDS, the Brazilian Ministry of Health and the International Planned Parenthood Federation/Western Hemisphere Region.


South Africa: Government Outlines New Aids Strategy

By, UN Integrated Regional Information Networks, December 1, 2006

The South African government marked World AIDS Day with the release of a broad framework for its HIV/AIDS strategy over the next five years.

The nine-page document listed as key targets a 50 percent reduction in the rate of new HIV infections by 2011, and the provision of treatment, care and support to 80 percent of HIV-i

cted South Africans. Youth were identified as "a special target group" that would receive particular focus in the new plan. A monitoring and evaluation framework, an element acknowledged as largely missing in the previous plan, was also identified as a priority.

The framework's release coincided with publication of guidelines for the restructuring of the South African National AIDS Council (SANAC), much criticised in the past as ineffectual and non-inclusive. Poor coordination by the country's national AIDS body was identified in the framework as a major weakness of the 2000-2005 National Strategic Plan.

A new and improved SANAC will consist of high-level representatives from the business, religious, NGO, academic, media and human rights sectors, as well as a number of government departments. A technical committee charged with monitoring implementation of the national strategic plan is to meet at least four times a year. Another committee, "linked to but separate from SANAC", will be responsible for financial management, including grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Several elements of the framework and the SANAC guidelines seemed to reinforce recent moves by the South African government to work more closely with civil society in its AIDS response. A commitment to involve all government departments and civil society sectors appeared first in a list of principles underpinning the framework. The SANAC document concludes: "If we work together, AIDS can be beaten. South Africa is uniting in its efforts to combat the epidemic and from now on, SANAC will embody that unity and purpose."

Government bowed to pressure from activists and medical experts last week to delay the launch of the full National Strategic Plan for 2007-2011, originally intended for release on Friday.

"It was largely a matter of a need for broader consultation," explained the health department's chief director for HIV/AIDS, Dr Nomonde Xundu. Input from a technical task team over the next three months will culminate in a conference in March 2007, at which representatives from the various sectors will adopt a final version of the plan. A first meeting of the newly formed SANAC is expected to take place shortly after the conference.

AIDS activists and experts who have seen drafts of the strategic plan welcomed the delay. "ARV [antiretroviral] treatment is the most complex health initiative ever undertaken in this country," said president of the Southern African HIV Clinicians Society, Dr Francois Venter. "We need this plan to be fantastic and, at the moment, it's not even close."

Xundu described the draft plan as in need of "fine-tuning", but AIDS Law Project head Mark Heywood said it contained serious shortcomings, including the lack of a thorough assessment of the previous strategic plan, the absence of a budget, and the lack of engagement with the recommendations that emerged from a civil society conference in October.

"There hasn't been much consultation with stakeholders who have the most immediate relevance, in particular the medical community - the health professionals and the health researchers," Heywood said.

The latest draft, dated November 2006, set a goal of increasing provision of treatment by 100,000 a year to adults, to reach a target of 650,000 by 2011 (the target figure for children was 100,000). The targets have been widely criticised as too conservative, considering that an estimated 800,000 people need treatment now and an additional 500,000 HIV-positive people are expected to need treatment every year, according to the Southern African HIV Clinicians Society. "We need to scale up much faster," said Venter, pointing out that the draft targets would meet only about 20 percent of the need.

The broad framework released on Friday contained no target figures for treatment, but Xundu confirmed that the figures in the draft would be reviewed in the coming months. She also made the distinction between the strategic plan and a yet to be developed operational plan.

"This is a statement of what needs to be done and should be used as a guide," she told PlusNews. Local and national government departments will use it as a basis for developing implementation plans.

At a World AIDS Day event in Mpumalanga Province on Friday, Deputy President Phumzile Mlambo-Ngcuka called on all South Africans to work together in fighting the HIV and AIDS pandemic. "If we focus our energies on conflicting with one another and on differences between us, we will lose sight of our shared goals, and weaken collective resolve and effort to implement this plan. We have a lot more that unites us."


HIV 'afflicting 24m workers'

By, Gulf Daily News - The Voice of Bahrain, December 2, 2006

GENEVA: The workplace may be the best setting for millions of people with HIV and Aids to be administered drugs that could extend their lives, the International Labour Organisation (ILO) said yesterday. The ILO report, marking World Aids Day, came as US President George Bush joined world leaders in renewing a vow to combat the disease. The ILO report said more than 24 million people in the global workforce in 2005 suffered from HIV or Aids. More than 67 per cent of them lived in Africa.

Giving these workers access to anti-retroviral drug therapy, or ARVs, could have lengthened their working lives by more than two years, and considerably increased per capita incomes in places like sub-Saharan Africa, the report found.

"Access to ARVs in the workplace must rise substantially," it said, estimating that 1.8m more African workers would be alive in 2010 if 80pc of the workforce were to start and stay on ARV therapy from this year.

Public health experts say that the life-extending drugs have transformed the once-deadly HIV and Aids into chronic conditions. But they need to be taken at regular intervals to be effective, and can cause drug resistance when taken improperly.

ILO estimated the HIV epidemic stripped an average of 0.5pc off the economic growth of 43 affected countries every year between 1992 and 2004.

Employment growth also suffered markedly. ILO said HIV and Aids caused a 0.5pc yearly decline in sub-Saharan Africa's annual employment growth rate.

The theme of this year's World Aids Day is accountability.

Accountability requires every president, prime minister, parliamentarian and politician, to decide and declare that 'Aids stops with me.' And it requires every one of us to help bring Aids out of the shadows and spread the message that silence is death," said UN Secretary General Kofi Annan.

Bush meanwhile, put a big emphasis on promoting abstinence.

Abstinence is derided by many activists as moralising. These campaigners plead instead for sex education and access to condoms.

South Africa said it would launch awareness programmes in the hope of persuading teenagers aged 14-17 to "delay the initiation of sex."

In Britain, Prime Minister Tony Blair hit out at religious bans on condoms, saying "if all the churches and religious organisations were facing up to reality, it would be better."


Nigeria: HIV Is Crippling Global Workforce -- ILO *Cumulative Loss Could Rise to 45 Million by 2010

By, Sola Ogundipe, Vanguard (Lagos), December 5, 2006

THE HIV and AIDS epidemic is having a crippling effect on the workforce of many countries in the world, says a new report released by the International Labour Organization (ILO) for World AIDS Day.

In its report, the ILO calls for sustained action, worldwide, to improve access to AVR treatments to cut mortality rates. Without this, it estimates that the cumulative loss to the global workforce from the virus could rise to 45 million by 2010 and almost double again by 2020.

The ILO estimates that more than 36 million people of working age are now living with the virus, the vast majority in sub-Saharan Africa.

It warns that HIV and AIDS is adding an enormous burden to countries struggling to emerge from poverty and this has had a damaging effect on the availability of labour in the worst-affected countries and has stunted economic growth.

In a research conducted on the impact of the virus on 43 countries with some of the highest rates of infection in the world, the ILO found that over 70 per cent of these countries were in sub-Saharan Africa.

Based on its findings, it estimates that 1.3 million new jobs have been lost every year, between 1992 and 2004, because of the virus. This, in turn, reduced annual economic growth by an average of 0.5 per cent over the period and 0.7 per cent for sub-Saharan countries. The report calls for "more employment opportunities for people living with HIV and AIDS and an end to discrimination to help those affected to secure jobs."

More than two million children around the world are now living with AIDS, while those aged 15-24 account for half of new infections. The report says many children are forced to seek employment because they live in extreme poverty, while their parents had either died from AIDS or are too sick to work. Other children find themselves working in unregulated industries, such as the sex trade, which exposed them to being infected. The ILO also highlighted that increased access to ARV treatments could significantly reduce the impact on the global workforce.

"The prospect of averting between one-fifth and one-quarter of potential new losses to the labour force should serve as a powerful incentive to target the workplace as a major entry point to achieve universal access to ARVs," the report concluded.

Annan urges more frank talk on AIDS

In a speech to mark the World AIDS Day, UN Secretary General, Kofi Annan, urged more frank and open discussion of the epidemic, saying all politicians must consider themselves personally accountable for stopping the spread of the virus as much as every individual should.

According to Annan: "It requires every one of us to help bring AIDS out of the shadows and spread the message that silence is death."

Several African governments have, in the past, been accused of not doing enough to fight the pandemic. In Nigeria, over four million persons are living with HIV.

India is the new AIDS epicenter of the world.

Figures recently released by the UN reveal that in terms of numbers, India is now facing the most severe HIV and AIDS burden than any country in the world, with 5.7 million people infected. The challenge to control the spread of the virus in India is described as "breathtaking".


Tuesday, December 05, 2006

Africa: Who/Africa Director Highlights 2006 in Fight Against Aids

By, Angola Press Agency (Luanda), December 1, 2006

The regional director for Africa of the World Health Organisation (WHO), Luís Gomes Sambo, said on Friday that 2006 was an important year in global response to the fight against HIV/AIDS, specially in Africa.

These statements of Luís Sambo are part of the message on occasion of World AIDS Day, marked on December 01 worldwide, under the theme "Primary Responsibility´´.

The Angolan national at the head of the World Health Organisation for Africa said that this is the most important year, because there had been held key events, namely, the top meeting on HIV/AIDS, held last June in the Headquarters of the United Nations in New York, that marked the fifth assessment of the Declaration of Compromise on AIDS and the assessment of Abuja Declaration of 2001, in June 2006.

During this year there was also held the Commitment of Brazzaville Declaration on Universal Access to Prevention, Treatment and Care to HIV/AIDS Victims from March 2006 to 2010, the launching of the acceleration process of the efforts for HIV/AIDS prevention in the African continent, in April 2006 and the fifth anniversary of the Declaration of 14 November, 2001, on access to generic medicines.

He added that the year of 2006 offered a good opportunity of reflection on the lessons of the past and about the strategies that enable to achieve progresses in the framework of universal Access to HIV/AIDS prevention, treatment and care, as well as the accomplishment of the Sixth Goal of Millennium Development.

"As it is reflected on achieved progresses, the signs of hope can be seen. There are signs of reduction of HIV/AIDS prevalence in various countries such as Kenya, Tanzania, Zimbabwe and Rwanda and in several cities such as Ouagadougou in Burkina Faso, Abidjan in Ivory Coast and Lome in Togo", he underlined.

The African continent is the world's most affected region with the HIV/AIDS, mainly due to the lack of a vaccine and the change in human behaviour.

The number of people infected with the HIV/AIDS with access to antiretrovirals (ARV) in Africa is still growing, from 100,000 in 2003 to more than one million people in last June.

The World Health Organisation (WHO) and its partners helped 24 African countries hardly affected with the HIV/AIDS to train health professionals in administering antiretrovirals (ARV) and 28 nations have already developed plans to intensify the supply of antiretrovirals, while 20 others set out plans to monitor and assess the ARV.


Kenya: Poverty Fuelling Spread of Aids

By, Zipporah Musau, The Nation (Nairobi), December 1, 2006

Men, money, and mobility may have been among the main drivers of the HIV/Aids epidemic in its early days, but now poverty, widespread in Africa, has increasingly become one of the major risk factors.

Although we have known for the past 20 years the cause of HIV infection and how it is spread, we are only now beginning to understand what fuels the epidemic.

Food insecurity and malnutrition accelerate the spread of HIV, both by increasing exposure to the virus and by increasing the risk of infection following exposure, according to Dr Stuart Gillespie, a senior research fellow at the International Food Policy Research Institute (IFPRI).

"Hunger and HIV/Aids are entwined in a vicious cycle. Malnutrition and lack of food heighten susceptibility to HIV exposure and infection, while Aids in turn exacerbates hunger," says Dr Gillespie.

When people are short of food, they may be forced to separate from their families to earn a livelihood. Migrant workers are at the heightened risk of HIV exposure and infection, and may spread the virus when they return home. Poor women may trade sex to feed their families. They may also be less able to access information about the disease or less able to act on their knowledge of risk to minimise HIV exposure.

Lack of proper nutrition may lead to increased HIV transmission efficiency by lowering immunity and compromising the strength of stomach and genital lining. Malnutrition among pregnant and breast-feeding women may increase the chances of infecting their babies.

In addition, reduced food intake and food quality hasten the progression to full-blown Aids among people already infected with HIV. Studies show that weight loss of five per cent over a period of four months, for example, leads to opportunistic infections and increased risk of death. Infections are longer-lasting and more severe in someone who is malnourished. They may also be more frequent.

Food an important weapon

According to Dr Gillespie, links between HIV/Aids and hunger are particularly acute in rural communities, where households are often dependent on agriculture for both income and food. Improving rural livelihoods and agricultural production can help reduce both the spread of HIV and the effects of Aids. He says that programmes that reduce the need for poor people to migrate to look for work, for example by restoring degraded land, can also reduce their risk of being exposed to the virus.

As evidence of the interactions between Aids and hunger has accumulated, both agriculture and nutrition specialists have begun to take Aids into account. In turn, Aids experts have become increasingly aware of the critical importance of nutrition, particularly if anti-retroviral drugs (ARVs) are to be effective.

A recent study shows that if patients are malnourished when they start ARV therapy they are six times more likely to die than well-nourished patients.

They are also more likely to suffer side-effects, which may cause them to stop taking the ARVs altogether. And if many people stop, drug resistance will spread fast.

Malnutrition also increases the chances of disease transmission between adults. For example, Vitamin A deficiency is particularly associated with an increased risk of STDs, including genital ulcers and cervical herpes simplex virus shedding, which increase the risk of HIV transmission.

Focusing on the single premise that high rates of HIV prevalence in Africa are mainly due to high levels of unprotected, non-monogamous sex has restricted policy interventions. Hence, prevention of HIV is pursued predominantly through initiatives to "change behaviour", such as the ABC approach (Abstain, Be faithful, and use a Condom). Several studies stress the need to look beyond proximal factors of high-risk behaviour in HIV transmission. There is need to investigate why people engage in high-risk behaviour to successfully address the crisis.

Moreover, the use of the term "pandemic" conceals the fact that multiple epidemics may differ in causation, velocity, duration, and impact.


UGANDA: An HIV/AIDS campaign in crisis?

By, IRIN PlusNews, December 4, 2006

KAMPALA - Uganda's success in lowering its HIV/AIDS level, lauded as a rare African achievement, could be unravelling. The latest UNAIDS statistics show rising prevalence, and questions are being asked about the government's commitment to fighting the epidemic.

The 2006 UNAIDS epidemic update revealed that Uganda's prevalence rose marginally to 6.7 percent in 2005.

Neighbouring countries remained silent about HIV/AIDS in the 1990s when President Yoweri Museveni's administration took an open and aggressive stance against the epidemic, which paid off when infection rates tumbled from a peak of more than 20 percent to a low of 6.4 percent in 2000.

The health ministry has recently appeared to be in a state of crisis: there was a nationwide shortage of condoms after the government imported defective condoms in 2004, and life-prolonging antiretroviral drugs worth an estimated $500,000 expired in government stores in September 2006, a blunder activists said was "inexcusable" when Ugandans were dying from AIDS-related complications.

Positive developments, such as the country exceeding its targets for antiretroviral (ARV) rollout, have been overshadowed by high-profile corruption scandals involving the diversion of millions of dollars in AIDS grants from the Global Fund to fight AIDS, Tuberculosis and Malaria.

The Global Fund temporarily suspended grants worth US$367 million to Uganda in August 2005, citing "serious mismanagement" of funds; the grants were reinstated three months later. Museveni appointed a judicial commission of inquiry in 2006, which recommended that three former health ministers undergo further questioning with a view to prosecution for perjury, causing financial loss and uttering false statements.

Despite the fact that the ministers were dropped from the cabinet, no charges have yet been brought, causing donor countries to urge the government to take "expeditious" action against those accused of mismanagement.

To make matters worse, the Global Fund excluded Uganda from the list of countries receiving funds in its current round of grants for HIV/AIDS and malaria, and the country will only receive funds for combating TB in this grant year.

As Uganda joined the rest of the world in celebrating World AIDS Day on 1 December, questions remain as to the direction of the country's HIV/AIDS response, and activists are calling for the government to be held accountable for the misuse of Global Fund aid.

"This money went into politics instead of helping people; the governing leaders must explain exactly what happened," said Rubaramira Ruranga, an HIV-positive former army major and the founder of an NGO for people living with HIV/AIDS.

Uganda's new health minister, Dr Stephen Malinga, told PlusNews his ministry was developing a new system for channelling funds, and would have the "strictest possible attitude" to the use of donor money in future.

He suggested that the spike in prevalence could be attributed to "complacency". ARVs were now becoming more widely available, allowing HIV-positive people to live longer, which was somewhat blunting the message that AIDS was a life-threatening condition. "Some people mistakenly believe that ARVs are a cure when they are not," he added.

Ruranga agreed. "There is so much complacency," he said. "People don't feel as vulnerable as they used to feel in the past, and when they forget the risks, we know what happens."

There are still wide disparities between rural and urban HIV service provision. "There are so many claims being made about drugs and services being provided but when you actually go and look, particularly in rural areas, it's not actually working," said Ruranga. "People are coming from across the country to Kampala in search of their drugs. They spend money they don't have to get here, and many others are forced to give up."

Malinga acknowledged the gap, and said his ministry would be paying greater attention to people living in rural areas. "That's where the frontline is now," he said.

Some analysts have also blamed the loss of momentum in the struggle against AIDS on the apparent change in strategy from the well-established ABC - Abstinence, Be Faithful and use a Condom - to emphasising abstinence over condom use, an approach favoured by First Lady Janet Museveni.

ABC was widely credited with helping bring down Uganda's prevalence, but a shift to the religious right - brought about, some say, by the desire to access funding from US President's Bush's Emergency Plan For AIDS Relief (PEPFAR) - has seen the 'C' become increasingly condemned as promoting promiscuity and permissiveness.

Beatrice Were, co-founder of the National Community of Women Living with AIDS support group, and now HIV/AIDS coordinator for ActionAid International, believes infection rates are creeping up because "the political will has dwindled ... Museveni has stopped listening to voters with HIV and increased the stigma by giving a platform to evangelical radicals."

Ruranga echoed the view. "When you get the wife of the president and other senior people actually discouraging condoms, people listen," he said. "They think, 'who else knows better than them'?"

Pastor Martin Ssempa, who regularly organises pro-abstinence rallies at Makerere University, in the capital, Kampala, said the emphasis had moved too far in the direction of condoms. "We don't have to say C every time we say A and B," he insisted.

The government has always denied changing its strategy from ABC, but new data from the UNAIDS epidemic update suggests that people haven't stopped having casual sex, but are now less likely to use protection. Around three-quarters of men aged 15-24 had casual sex in the last year and, worryingly, only half the men and women between 15 and 49 years old reported using a condom the last time they had sex with a casual partner.

"The only policy change [needed] now is to be even more aggressive," said minister Malinga. "Do condoms play a part of that? Yes, there needs to be a role for both condoms and abstinence concurrently."

Dr Bernard Etukoit, ARV coordinator at The AIDS Support Organisation, one of Uganda's oldest AIDS NGOs, said a period of reflection from those working in the field was required.

"There has to be a review, and that is taking place now. We need to go back to where we began and see where we impacted well in the past," he said. "We have to go back to the roots."


/This article is part of a series on HIV/AIDS and communities of humanitarian concern.