THAILAND: A new model for the sex business

By, Integrated Regional Information Networks, January 22, 2007

Chiang Mai - Amid the karaoke bars and beer pubs of a 'designated entertainment area' in Thailand's northern city of Chiang Mai, the 'Can Do' Bar stands out for its brightly-coloured décor, large open windows that that allow passers-by to peer inside, and a sign describing it as an "experitainment" venue.

The distinctive look hints at a more profound difference from other businesses in the district: the Can Do is a bar run by sex workers, and its mission is to prove that it is possible to run a profitable 'girlie' bar in Thailand without exploiting young women - a point that Can Do's backers say could help in the battle to protect sex workers from HIV infection.

"It's clear to us that among these girls there is a link between HIV/AIDS, and better and worse working conditions," said Liz Hilton, an advisor to Empower, a Thai nongovernmental organisation providing services and support, including English classes, to sex workers.

"To have safe sex, you need ... knowledge, skill, equipment - like condoms - and the confidence and power to use these three things," Hilton said. "Everybody knows about HIV, and how to protect themselves. But the question is, do they have control over their sex? Your working conditions give you control over sex."

Thailand, which draws an estimated 13 million foreign tourists a year, has thousands of pubs, karaoke bars, massage parlours and other entertainment venues catering to a demand for commercial sex workers. While precise figures are impossible to come by, the number of young women involved in the sex industry has been estimated to range between 500,000 and a million, including women from neighbouring countries like Burma, Cambodia and Laos.

In the 1990s, Thailand garnered praise for turning the tide of what was then one of Asia's most severe AIDS epidemics by launching a massive public awareness campaign to promote the use of condoms in all commercial sex encounters. The '100 percent condom' initiative, with the backing of the highest levels of government, was credited with reducing the number of new infections from 143,000 a year in 1991 to around 23,000 a year in 2003.

But both at the height of the government's prevention campaign, as well as now, HIV prevelence among women in the entertainment industry has always differed sharply, depending on the venue in which they worked.

Hilton attributed this to the dramatic difference in working conditions at various venues, and women's correspondingly different ability, and will, to insist on condom use.

"Clearly, anything that one is doing that will decrease vulnerability, or increase empowerment of women to make their choices, is extremely important in talking about sexual power relationships and transmission of HIV/AIDS," said Patrick Brenney, country coordinator for UNAIDS in Thailand.

In some places in Thailand, especially low-end brothels catering to migrant workers, young women are virtual captives, held in locked rooms or buildings and forced to have sex with whoever walks through the door. Insisting on condom use in these circumstances is virtually impossible, even if the girls were aware of the risk of HIV, which many aren't.

Thailand also has a large sex industry catering to foreign tourists seeking a 'good time' with seemingly willing partners, which flourishes in and around bars and other entertainment venues. Here men can meet women and take them back to their hotel for a night, or even on 'pleasure trips' during their holiday.

While the women working in these venues have more freedom to accept or refuse clients, or demand condom use, most of the establishments are highly exploitive, putting the women under financial pressure and ultimately increasing their vulnerability to HIV by making them less insistent on condom use during every encounter.

The recently opened Can Do Bar operates on different principles altogether: it was founded by a group of sex workers, who pooled their savings to rent the space and renovate it, and employs only three women - two bar tenders and a cleaner. The others are all 'freelancers', who receive no salary but are also not obliged to pay fees for using the Can Do as a place to meet clients.

Hilton said the business model for the bar was to make a profit by selling drinks, rather than by exploiting the girls who used it. "In other bars, men pay the bar and the bar makes money from you. We don't take any of your money - it's all yours. You are not paying anything for your workspace, or your safety."

The women using the bar are also required to contribute to Thailand's social security system, making them eligible for paid sick leave and other benefits.

So far, business at the Can Do has been slow - the bar is located far from areas commonly frequented by Western tourists, where there are plenty of rival bars catering to male holidaymakers. But the investors are planning promotion campaigns and hoping that business will gradually pick up.

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Source: http://www.plusnews.org/aidsreport.asp?reportid=6655

PAKISTAN: Commercial sex workers face HIV threat

By, IRIN PlusNews, February 21, 2007

Lahore - Beena, 50, runs an 'establishment' in Pakistan's eastern city of Lahore, where her two daughters and a niece sell their bodies. "Most of us here know all about this AIDS thing. Some NGO people keep coming and talk to the girls about it – but just knowing about it is not always of much use," she mused, chewing on a wodge of tobacco.

It's a good point: the fact is that although many sex workers in Lahore's red-light area may have some awareness of the HIV risks they face, they can, in real terms, do little about it.

In a 2006 update on the AIDS epidemic in Pakistan, the World Bank noted most sex workers lacked the power to negotiate condom use with the clients on whom they depend.

"Our job is to keep our clients happy. Sometimes they get very angry if we produce a condom, because it is a reminder to them that we have had sex with other men," said a young woman, sitting on one of the shabby, over-stuffed sofas in Beena's sitting room.

She introduced herself as "Dolly", using a pseudonym like almost all the women here, and says she has been in the "business" for nearly 10 years, since she was 15.

There are an estimated 25,000 sex workers in Lahore, Pakistan's second most populous city, the majority based along the winding alleys of 'Heera Mandi' or the 'Diamond Market', which has existed for centuries.

The district reached the height of its glory under the flamboyant Mughul Emperors, who ruled the Indian sub-continent from 1526 to 1857. Famous courtesans were visited by men from aristocratic households, and people came from across the Indian sub-continent to admire the dancing and singing of the legendary 'dancing girls' of the area, who were known also for their charm, wit and ability to recite Persian poetry.

Denial

Since those heady days, the area has declined into a sordid tawdriness. A clamp down against prostitution under the Islamization policies of Pakistan's military dictator, the late General Ziaul Haq in the 1980s, led to many of the women leaving the area to take up residence – and continue their business – in other parts of the city.

Those left behind are often the most impoverished and the most vulnerable. Apart from the traditional families who have lived in Heera Mandi for centuries, taking pride in their classical dancing skills and maintaining they are entertainers, possibly descended from the royalty that once thronged Heera Mandi, many young women from villages around Lahore, or even from Afghan refugee camps, have ended up here.

Looked down upon by the established families, they often tell terrible stories of brutality and exploitation.

"I come from a respectable family in Sheikhupura (a small town on Lahore's outskirts). I was married off to a man in my late teens. He treated me well for a while, but then he accumulated massive gambling debts, turned to drink and brought me here and sold me," said Shahzadi.

She now lives in a small room, at the top of a rickety old house, and entertains her clients in a room tucked away at the back.

Along the narrow alleys of Heera Mandi, in lonely, stark, rented rooms, many women tell similar stories. Some talk of violent husbands from whom they escaped, others narrate being lured away from their villages by promises of jobs or a role in a film, and then sold here. Most yearn for stability and security in their lives – and also respect in a society that looks down on them as "fallen" women.

The streets, silent in the day time, bustle at night, as music from the balconies where the women, with heavily powdered faces and gaudy clothes, dance and sing, to draw in customers. The area houses not only the 'dancing girls', but transvestites, drug addicts, down and out musicians and others considered, for one reason or another, to be social outcasts.

Strung along the shops selling musical instruments and the food stalls are the 'money' shops that sell crisp notes of small denominations that are flung before the women as they dance by clients to express admiration. Garlands made of currency notes are available, for men to drape around a favourite performer.

While the women of Heera Mandi, like the svelte Neena, with her henna-reddened hair, are street-wise, and well aware of the risks they live with constantly, AIDS is something many are still reluctant to discuss, despite the fact that the global epidemic is now making rapid inroads in Pakistan.

In April 2006, the World Health Organization (WHO) reported there could be 70,000 to 80,000 unreported HIV cases in Pakistan – a number making up 0.1 percent of the adult population. There are 2,998 reported cases.

According to the WHO/UNAIDS, Pakistan is classified as a low prevalence but high risk country for the spread of HIV, due to the presence of a growing number of injected drug users, unscreened blood donations and unsafe sexual practices by both male and female sex workers.

Recent findings by Pakistan's Ministry of Health have found that while prevalence remained below one percent among prostitutes, over 20 percent in Karachi and Lahore had sold sex to injecting drug users, and condom use was low in those encounters. The same study found high rates of STDs among sex workers and other high risk groups.

Respectability

In most cases they are in no position to demand safe sex from clients. But there are also other factors; many of the women, especially those from 'traditional' Heera Mandi families, maintain that dancing is their main profession and the sex a kind of 'side line' that they occasionally engage in.

While this claim is not borne out by independent analysis, it is used by the women as a means to show their 'respectability' in a society where sex outside marriage is both against the law and taboo.

"I have some regular clients, with whom I spend the night. But these are men from noble families, they are 'clean' and they cannot make me sick," maintained Kiran, taking a rest from dancing practice on her large double bed, where a small group of ragged pink and grey stuffed animals sat.

She also insists, shyly bringing her hand up to her mouth, that she does not know what a condom is, but has heard it is kept by "promiscuous women" who have "sex with everyone". She maintains that her mother, who acts as a chaperone, vetting clients for her daughter, would "not allow anyone 'dirty' with me".

The combination of the women's own low status, exploitation, and the social attitudes towards sex that prevail in society, make sex workers especially vulnerable.

"There is a very real risk of a rapid spread of HIV/AIDS among this population, and other high risk groups, including migrant truck drivers who engage in sex with [sex workers] in many parts of the country," said Dr Qaisar Rana, who for several years ran a small clinic in the Heera Mandi area.

Others, who have emerged as spokespersons for the women of Heera Mandi, including leading artist Iqbal Hussain, whose own mother was a sex worker, emphasise their "lack of empowerment, exploitation and helplessness".

Despite attempts to raise awareness about HIV, it seems the message has not yet hit home in Heera Mandi. This means that apart from all the other risks they face, the women working here could soon confront another, still more alarming danger.

Certainly, the shadow of AIDS seems to be lurking everywhere amidst the narrow alleyways and carved balconies of Lahore’s unique entertainment district – and no one can predict how long it will be before it strikes, claiming more victims among the women who walk the streets here each night, until the call to prayers from the Badshahi Mosque announces the arrival of dawn.

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Source: http://www.plusnews.org/AIDSreport.asp?ReportID=6686&SelectRegion=Asia&SelectCountry=Pakistan

Kenya: Circumcision As an Admission Criterion

By, Lawrence Kinoti, The East African Standard (Nairobi), February 21, 2007

In the early 90s, an expatriate teacher at Nkubu High School in Meru decided to show two films to the high school boys.

Being a teacher of Social Education and Ethics, he knew just the right way of sensitising the boys to the dangers of early sex. One of the films this American teacher screened was on the process of birth.

Students watched in amazement. The movie on abortion graphically showed images of techniques like vacuum suction curettage, in which contents of the womb are forcefully sucked out.

In one of the film shifts, students were keenly following the movie, when, suddenly, there was uproar.

The shouts and screams were so intense that, for those students in class, lessons had to be suspended as everyone ran out to find out what the matter was. Outside the laboratory hall in which the movies were being screened, angry students were almost going bizarre.

Students of Burieruri Secondary School in Maua, Meru-North, playing at the institution. According to the school's principal, Burieruri is one of few high schools in the region where boys do not face discrimination on the basis of circumcision. Picture by Lawrence Kinoti

What could the matter be? Inquiries yielded a finding that made sense to the students and teachers from the local communities: While they were watching a scene that involved nudity, the boys had made a shocking discovery. Among them was a classmate who was not circumcised!

Violation of rights

When 20 Form One boys were recently turned away at Kiriani Boys' High School for being uncircumcised, condemnations flew from far and wide.

Some people described the move as "insane and an embarrassment not only to the Meru community, but also to the Kenyan society as a whole".

A local medical doctor, who is also a politician and a human rights activist, Dr Charles Mwirabua Thiakunu, denounced the school management's action, terming it a gross abuse of human rights. "The right to education is a human right, which should not be denied or violated by anyone," he said.

Reacting to the principal's letter barring the boys from school, Thiakunu said two weeks was not a sufficient healing period. He stressed: "Circumcision is not merely the surgery but the ritual, and a rite of passage, which should not be viewed by the students as punishment."

The important ritual of circumcision, he said, is meant to leave a positively indelible mark in one's life history, and must not be stigmatised.

Cultural debate

During Thiakunu's high school days at the local Miathene Boys' High School (where he did his O-levels between 1975 and 1978), no boy went to secondary school uncircumcised.

Why then does he condemn Kithinji's action? He believes that, even where some uncircumcised boys today join high school, there are civil ways of handling the matter, without necessarily barring them from studies.

Kithinji's letter to the parents of the suspended boys read in part: "You sneaked your son in school without reporting to us that the boy was (not circumcised). When such boys are in school, they not only bring a lot of discomfort to the other boys but also cause a lot of psychological torture to your son Please do the needful within two weeks (ie have him circumcised), and let your son report back to school with you immediately he is well".

Even some local headteachers have been outraged. The Principal of Burieruri High School, MM Mutuma, describes Kithinji's action as a "crazy one".

Mutuma says he finds nothing wrong with boys being enrolled in Form One while uncircumcised. He points out that, at his school, a few boys have been completing their secondary education uncircumcised, yet, as he claims, they have never been victimised.

Uncircumcised captain

He cites a case where two boys entered Burieruri at Form One in 2002 and were there for four years, uncircumcised. One of them scored an A- in the Kenya Certificate of Secondary Education (KCSE) examination, while his counterpart attained a B. This, according to Mutuma, is evidence that circumcision is not an issue in schools. Says he: "Every year, we admit more than 10 boys uncircumcised, and they interact freely with their colleagues."

Last year, one uncircumcised boy at the school was a dormitory captain who ably served in his role. But Mutuma says such co-existence is only possible in an atmosphere of discipline.


In good faith

The Principal of Meru School, the oldest school in the region, David Gideon Kariuki, has some kind words for Kiriani's headteacher. He says Kithinji may have taken the action in good faith and should not be condemned unheard.

"But my colleague should have consulted widely, before making the unlawful decision."

Kariuki has observed that, where the majority of students in a school come from the neighbouring communities, local cultural practices inevitably infiltrate the students' social life, because, as he observes, a school is an integral part of the socialisation process.

"But this should not be let to supersede an institution's code of rules and regulations," he cautions.

What does Kariuki have to say about his school's curiously sexist and chauvinistic motto, "In understanding be men"? Listen to him: "Here, a real man is judged by his academic performance, and boys have no time to think about circumcision"

If anything, Kariuki adds, "Ours is like a national school, and some of our students are drawn from certain Kenyan communities that do not circumcise".

Discrimination rife

But Dancan Kirimi Mbatau, a former student of Kanyakine Boys' Secondary School, which is located about 12km away, harbours memories of a harrowing experience. When he joined Form One at the school in 1986, Mbatau faced such ferocious discrimination that, when schools closed, he had one demand for his parents: "Have me circumcised or I will drop out!"

Now an accomplished accountant based in Nairobi, he says he could not have withstood the daily taunts and insults hauled his way, especially when time came to take showers or sleep.

To feel safe, he says, "I had to share a bed with the dormitory captain, and only went to sleep when he also did." He adds: "I was literally a slave of the other boys. At times, I even got a beating from the boys for retorting when I felt pushed to the wall."

Mbatau had to be circumcised immediately the schools closed. To this day, the accountant says he could never take his son, uncircumcised, to Form One.

Teach human rights

An official at the Meru-North District Education Office, Mrs Charity Kimbira, says that, culture notwithstanding, the decision over whether to circumcise should be left to the child and parents, not to a school.

She says unhindered access to education is a basic human right. To curb the rampant practice of discrimination, human rights studies should be included in the curriculum.

A local bank manager, Moses Murianki Nabea, describes the barring of boys from school on account of their circumcision status as "Bad news and primitiveness of the highest order We are no longer in the 17th century, when a Meru could not share a room or other property with someone from a tribe that does not circumcise."

Social misfits

Some of the affected parents have resolved not to return their sons to Kiriani. Peter Meeme and Samuel Muriuki say they had arranged to have their sons circumcised after the school closes for the first term.

They could not, as requested by the school, have had their children circumcised last December, because they were not sure their sons would qualify for high school.

Although the Ministry of Education has intervened and ordered the unconditional re-admission of the boys, parents are wary of returning their children to a school where they have been labelled as social misfits.

A parent, Naomi Ngunjiri, appeals to the government to pardon Kithinji, saying the headteacher may have sensed danger at the school, whose majority of students come from the local community.

Ngunjiri's sentiments are echoed by the local Njuri Ncheke Council of Elders Chairman, Mzee Paul M'Ethingia, who says the teacher took the right decision.

Had the suspended students been harmed, M'Ethingia argues, the principal could solely have been held responsible.

The leader believes there was more to Kiriani's circumcision saga than meets the eye, especially considering that the students went on strike expressing support for their headteacher. Already, the principal has been reinstated.


Source: http://allafrica.com/stories/200702201384.html

Chinese Authorities Release HIV/AIDS Advocate Gao To Accept Award in U.S.

By, Kaisernetwork.org, February 20, 2007

Chinese authorities on Friday agreed to release HIV/AIDS advocate and retired physician Gao Yaojie from house arrest so that she can visit the U.S. to accept an award from the group Vital Voices Global Partnership, the New York Times reports (Yardley, New York Times, 2/17). According to Gao's friend and Beijing-based AIDS advocate Hu Jia, Chinese authorities from the eastern province Henan told Gao not to attend the Vital Voices awards ceremony. When Gao refused, she was put under house arrest to prevent her from traveling to Beijing to apply for a U.S. visa, Hu said. Gao's friends and family were blocked from visiting her or were questioned before being given permission to visit, and her daughter was placed under police surveillance, Hu said. Gao in the 1990s alerted people in Henan of HIV cases that occurred through tainted blood transfusions. Gao also distributed material warning people of HIV and the risks of donating blood. In addition, Gao has distributed medicine to HIV-positive people, provided care for AIDS orphans and hosted people living with HIV/AIDS in her home. She also has written a book about the HIV/AIDS epidemic in China. Chinese authorities in 2001 and 2003 prevented Gao from traveling abroad to accept awards for her work. Communist Party Deputy Secretary for Henan Chen Quanguo earlier this month visited Gao in her home and praised her "long-standing contributions" to the province's "education, health and AIDS prevention work." HIV/AIDS advocate Li Dan said Chen might have visited Gao to offset negative publicity abroad (Kaiser Daily HIV/AIDS Report, 2/16).


Recent Actions

According to the Financial Times, Gao in a telephone interview said that she was told by Chen on Friday that she would not be prevented from traveling to the U.S. to accept the award. Gao also said that Chen offered no apology and did not acknowledge the police guards outside her home. She added that three guards were still present on Sunday (Dickie, Financial Times, 2/19). Sen. Hillary Rodham Clinton (D-N.Y.) -- a Vital Voices honorary co-chair who announced China's decision after hearing from the Chinese ambassador in Washington, D.C. -- in a statement said that she is "delighted" by the decision and that she was assured Gao would be "allowed to travel freely to the" U.S. (New York Times, 2/17).

NPR's "All Things Considered" on Monday reported on Gao's attempt to travel to the U.S. The segment includes comments from Gao, Hu and Wenchi Yu Perkins of Vital Voices (Kuhn, "All Things Considered," NPR, 2/19). Audio of the segment is available online.


Source: http://allafrica.com/stories/200702200686.html

SOUTH AFRICA: AIDS response becomes a test of faith

By, IRIN PlusNews, February 13, 2007

JOHANNESBURG - Local and international experts agree with important new findings this week that faith-based organisations (FBOs) have a major contribution to make to curbing HIV/AIDS in sub-Saharan Africa.

A World Health Organisation (WHO) study, 'Appreciating Assets: Mapping, Understanding, Translating and Engaging Religious Health Assets in Zambia and Lesotho', found that Christian hospitals and health centres were providing about 40 percent of anti-AIDS care and treatment services in Lesotho, while almost a third of the treatment facilities in Zambia were run by FBOs.

Dr Francois Venter, director of the Southern African HIV Clinicians Society (SAHIVS), said the findings reinforced the long-held belief of those in the field of AIDS care that combining the strengths of religion and science could bring greater rewards in the fight against the pandemic.

"Churches and FBOs are uniquely positioned to help realise the goal of universal access to HIV prevention, treatment, care and support in Africa as a result of their stature in communities," Venter told IRIN PlusNews.

However, the report noted that despite providing a substantial proportion of the care available in developing countries, FBOs were rarely recognised as essential contributors to universal efforts to access treatment and care.

Patrick Purtill, director of New Partner Outreach in the office of the US Global AIDS Coordinator, which implements the President's Emergency Plan for AIDS Relief (PEFPAR), warned that failure to understand the role FBOs played in combating AIDS could undermine efforts to scale up services.

Purtill said, "Religion has and always will form part of the foundation of many rural and urban communities. It has been there from before HIV and will continue to be there long after HIV. We [health policymakers] have to acknowledge that FBOs possess an extensive geographic reach and a well-developed infrastructure in the developing world."

US President George W. Bush has routinely called for partnerships with religious charities and PEPFAR has regularly funded FBOs worldwide. In 2005, United States Agency for International Development (USAID) granted US $591 million to FBOs, totalling 14 percent of all grants, according to a March report by the White House Office of Faith-based and Community Initiatives.

"With networks that reach even the most remote villages, many FBOs and community-based organisations are suitably placed to promote stigma reduction and prevention messages, as well as provide HIV counselling and testing, home care, clinical services and antiretroviral treatment," Purtill pointed out.

According to WHO, between 30 percent and 70 percent of the health infrastructure in Africa was owned by FBOs, but there was often little cooperation between FBOs and mainstream public health programmes.

"This data demands that we continue to explore and expand the field ... [it] is the first serious study of FBO engagement in HIV/AIDS, but it cannot be the last," said Ted Karpf, partnerships officer in the HIV/AIDS department of WHO, in a statement. "We have only scratched the surface of what is happening, and it is already clear that there is so much more to learn."

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Access the complete findings: http://www.arhap.uct.ac.za/research_who.php

More details of PEPFAR's work with faith-based organisations: http://www.pepfar.gov/pepfar/press/80248.htm

Farmworkers' risky behaviour creates HIV hotbed

By, Mail&Guardian online, February 13, 2007

January is mango season in Hoedspruit, in the Limpopo province, and casual fruit pickers, mostly women, flood the area's farms in search of work.

Conditions on the farms already make them a potential breeding ground for HIV infection. Workers usually live in overcrowded compounds away from their families and isolated from HIV and Aids interventions. Myths about HIV abound, condom use is low and risky sexual behaviour is high, according to a 2004 survey by the International Organisation for Migration (IOM).

With the arrival of the seasonal workers, the possibility of HIV transmission increases. Desperate to secure employment for the duration of the harvest, it is not uncommon for young women to have sex with male supervisors, known as indunas, in exchange for a job; becoming the "girlfriend" of a supervisor for the season can guarantee accommodation on the farm and better working conditions.

"I can promise a job to a woman in exchange for sleeping with her," one male supervisor says. "A lot of supervisors have maybe 10 girlfriends through the season."

The IOM survey found that 52% of female workers interviewed on farms in Limpopo and Mpumalanga provinces had exchanged sex for food, clothing, gifts or money. Compared with their male counterparts, female workers had lower levels of knowledge about HIV and Aids, and were about half as likely to use condoms in casual sexual relationships.

One of the main reasons they gave for not using condoms was that their husbands or boyfriends did not like them.

Intervention

Following the survey findings, the IOM began partnering with Hlokomela, a programme established by local farm owners to provide their workers with HIV/Aids prevention and care. But such interventions did not go far enough in addressing the unequal relations between male and female farmworkers that were fuelling the incidence of gender-based violence and HIV infection on the farms.

"There was a sense that there needed to be an intervention that would speak to men and bring them on board," says Bafana Khumalo, co-director of Sonke Gender Justice, a Cape Town-based NGO that works to reduce the spread and impact of HIV and Aids by focusing primarily on gender issues.

In August 2006, staff from Sonke Gender Justice facilitated week-long workshops that drew participants from 28 local farms and three distinct groups: male supervisors, young male and female workers, and Hlokomela's caregivers. The workshops used activities aimed at challenging traditional attitudes about the roles of men and women, and educating participants about how those attitudes put them at risk of HIV infection.

"That workshop changed everything for me," says Sam Baloyi, a supervisor on Richmond Farm outside Hoedspruit. "Before, when I beat my wife I was very angry, but after five minutes I felt so ashamed, so I wanted to change."

Since attending the workshop, Baloyi said he now helps his wife with household chores and no longer drinks or has girlfriends. He is still working up the courage to take an HIV test.

Prevalence

HIV prevalence among farmworkers in the Hoedspruit area is not known, but the National African Farmers' Union has estimated that an alarming 30% to 45% of farmworkers are living with HIV nationally.

"We treat a lot of STIs [sexually transmitted infections], but there's still a big reluctance to test [for HIV]," says Christine du Preez, Hlokomela's programme manager and a professional nurse who divides her time between clinics on several farms in the area. "The other day we had a big HIV-awareness event, but out of the 170 or so people who came, only five tested."

Baloyi now belongs to a farm committee called a "lifestyle action team", set up on each of the farms that drew workshop participants with the aim of disseminating some of the workshop's messages, distributing male and female condoms, and coming up with tailored interventions.

"We're trying to engage people with sports and recreation so they drink less," says Baloyi. "And there's no shebeen [informal drinking establishment] here any more -- we've closed it."

Behaviour change has been more incremental for some workshop participants. Supervisor Victor Madike (41) used to think nothing of groping his female workers' breasts and buttocks. He had numerous girlfriends with whom he never used condoms, and his response to his wife's suspicions about them was to beat her.

Madike still prefers his wife and six children to stay in their village, but he has reduced his extramarital affairs to one girlfriend who stays with him on the farm, and he now uses condoms. "I don't enjoy like before, but I comply," he says grimly.

As a member of his farm's action team, Madike says he is trying to spread the message to other supervisors not to use their position of authority to harass sexually or exploit female workers.

First step

The manager of Bavaria Farm, Johann du Preez, is careful to describe the workshops as just the first step in bringing greater openness about sexual abuse and HIV to the farms.

"I think it has made a difference, even if it's only on an awareness level," he says. "It's getting people talking out there in the orchards, and it's creating a bit of peer-group pressure, whereas before it wasn't even talked about."

Du Preez has noted a dramatic rise in the number of deaths among his employees in recent years, particularly the more senior workers who can afford to offer something in return for sex. Such workers are difficult to replace and, according to Du Preez, most farmers would rather invest in prevention and treatment than in recruiting and training replacements.

A local farmers' forum is discussing the possibility of funding a clinic to provide antiretroviral (ARV) treatment to farmworkers. The nearest government ARV site is Tintswalo Hospital in Acornhoek, about 50km away, where there is a three-month waiting period for treatment, according to Du Preez.

With continued funding from IOM, the European Union and the Department of Health, another set of workshops is planned in the coming months. The eventual goal, says Khumalo, is to train Hlokomela's staff to take over the entire initiative.


Source: http://www.mg.co.za/articlePage.aspx?articleid=298608&area=/insight/insight__africa/

World Bank To Provide Thailand With $750,000 For HIV/AIDS Treatment Programs

By, The Nation, February 6, 2007

The World Bank plans to provide Thailand with a $750,000, three-year grant aimed at providing HIV-positive people with increased access to antiretroviral drugs, Viroj Tangcharoensathien, program director for international health policy at the country's Ministry of Public Health, said recently, Thailand's Nation reports. More than 130,000 HIV-positive people in Thailand need access to antiretrovirals, and the number is increasing annually, according to the Nation. Under the grant partnership, the bank will help address funding issues associated with the country's universal health care system, Viroj said. "We can't rely on the ministry's budget allocation alone," Viroj said, adding that the partnership will seek other resources for health services. In addition, the project will provide training for nurses and doctors in an effort to overcome the shortage of health care personnel in the country, health ministry senior adviser Suwit Wibulpol-prasert said. The collaboration is a "step forward to sustainable development in this field and improving the country's health care," Suwit said. A separate partnership between the Thailand Center of Excellence for Life Sciences and the World Health Organization will aim to standardize clinical research into tropical diseases, the Nation reports. The partnership will focus on the prevention, diagnosis and treatment of diseases such as malaria, tuberculosis and dengue fever (Nation, 2/6).


Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=62575&nfid=rssfeeds

20 anti-Aids gel trial participants test positive

By, iafrica.com, February 7, 2007

About 20 of the 604 women who participated in the microbicide clinical trials have tested HIV positive, the SA Medical Research Council said on Wednesday.

"We are not certain yet whether these women became HIV positive as a result of the use of the microbicide, and this is being investigated," said MRC President Anthony Mbewu.

The purpose of the trials was to test the effectiveness of a vaginal microbicide — cellulose sulphate gel — in preventing the sexual transmission of HIV.

"We have asked all participants to stop using the anti-Aids gel after preliminary results of the study showed a potential to increase the risk of HIV infection instead of lowering it."

Those infected with HIV during the trial had been enrolled into a programme of care, said Mbewu.

He said the participants — all from KwaZulu-Natal — were monitored and saw medical doctors on monthly basis.

"We are still gathering all evidence to show how often they used the gel and investigate other medical factors involved."

Mbewu said the participants were not encouraged to have unprotected sex during the trial.

"At each monthly meeting they were given behavioural education and issued with male and female condoms.

"Unfortunately not all of them used protection every time they engaged in sex, like the case would be with any other women."

The researchers knew the reality that it was very difficult for women, married or single, to force their partners to use protection every time, he said.

"Some of them (participants) told researchers at the monthly meetings that they did not always use condoms during sexual intercourse.

"They said they used the gel always, but we do not know that for sure until our investigation is complete," said Mbewu.

He said consent was obtained from the participants, who were informed of the possible risks and benefits of the trial.

Insurance was taken out by the sponsors of the trial in order to compensate participants should the trial go wrong.

On Tuesday Health Minister Manto Tshabalala-Msimang requested an investigation by the research ethics council following concerns about the HIV status of the participants.

She said in a statement released: "I would request the investigation to establish whether the research followed the protocols approved by the Medicine Control Council and the ethics committees of the relevant research institutions".

She would want it to establish whether participants were given sufficient information to make informed decisions about their participation.

"While we support innovation through health research, the government of South Africa is determined to ensure that the health of our people is not compromised in the process."

The council agreed that the microbicide clinical trial sites be inspected by the Health Research Ethics committee, following the meeting with Tshabalala-Msimang.

Recently, researchers halted two studies of an anti-Aids vaginal gel in Africa and India after early results suggested it might raise the risk of HIV infection instead of lowering it.

It was "a disappointing and unexpected setback" to efforts to get a simple tool to protect women from the risk of Aids through sex, the United Nations World Health Organisation said last month.

It was reported that more than half of all new infections with the Aids virus in Africa involved women and girls.

Scientists and groups such as the Gates Foundation have long sought a method of protection women could use, even without their partners' knowledge, as many men refuse to use condoms.

Sapa


Source: http://iafrica.com/news/sa/621534.htm

Aids strategies paying off

By, Metropolis, iafrica.com, February 7, 2006

The productivity of South Africa's mining sector has not been affected by the Aids pandemic to the extent forecast in some of the "doom and gloom" scenarios of a decade ago, the Chamber of Mines (CoM) said on Wednesday.

Briefing Parliament's select committee on economic and foreign affairs, CoM chief executive Mzolisi Diliza told members that while the disease had a huge impact on the industry, intervention strategies now meant up to 94 percent of workers being treated were returning to work.

"The 94 percent figure is very important because it shows that with intervention you are able to prolong the working life of mineworkers," he said.

Diliza said between 40 and 45 percent of workers in the industry who needed treatment for HIV were receiving it. The sector employs about 450 000 people, many from countries bordering South Africa.

According to his colleague, chamber executive Frans Barker, the HIV prevalence rate among the country's 170 000 gold miners — close to half of whom are foreign workers — is between 23 and 24 percent.

Speaking after the briefing, he said antiretroviral therapy programmes instituted by chamber members were proving effective.

"The impact (of Aids) on productivity in the past was big; we were losing skills. The success of therapy... has certainly been worthwhile," Barker told Sapa.

Contacted for further comment on the issue, CoM health adviser Dr Fazel Randera said the situation in the industry with regard to HIV and Aids was very different now compared to the late 90s, when ARV treatment first became available.

"There was a 'doom-and-gloom' time back then when people spoke of productivity being affected. It is very difficult now to say that is a trend that has been followed," he said.

Mining companies had embarked on "wellness programmes" for workers, including setting targets for convincing workers to know their HIV status.

One Mpumalanga coal mine was now in a position where 95 percent of its workers knew their HIV status. Among other mining companies, the figure was 75 percent.

As a result HIV infection was being detected — and managed — earlier.

"In the past, CD4 counts were 50 to 100. The programmes have changed this, and we're now catching it much earlier, with CD4 counts of between 150 and 200."

CD4 counts are used by doctors as an indicator to help them decide when to begin treatment of HIV-infected patients.

Randera said on certain mines "every person who should be on treatment, is on treatment".

Across the sector, sickness and absenteeism associated with the disease was down.

On HIV prevalence rates in the industry, he said the gold mines were worst hit, with between 23 and 24 percent of workers HIV positive. In the platinum sector the figure was between 20 and 24 percent, and the coal and diamond mines were "much lower".


Sapa


Source: http://iafrica.com/news/sa/621527.htm

HIV Rate Continues to Climb in African American Community

By, Chicago Tribune, February 6, 2007

ATLANTA _ More than 25 years into the AIDS epidemic, HIV continues to soar in the black community, accounting for more than half of the newly diagnosed infections in the U.S. in a recent yearly assessment by the Centers for Disease Control and Prevention.

At the same time, health officials say, the African-American community has been slow to acknowledge the problem, prompting the CDC and grass-roots organizations to mark a yearly observance to bring attention to the epidemic.

Wednesday is National Black HIV/AIDS Awareness Day, a national effort designed to mobilize blacks to get tested, educated and treated for the disease. Well-known African-Americans _ including Tony Dungy, head coach of the Super Bowl champion Indianapolis Colts; entertainer Patti LaBelle; Sen. Barack Obama, D-Ill.; and former Secretary of State Colin Powell _ have joined the campaign by taping public-service announcements to run on radio and television.

Of the roughly 1 million people estimated to be living with HIV in the United States, 47 percent are African-American, according to CDC statistics for 2005, the most recent year for which numbers are available. Though blacks represent only about 13 percent of the U.S. population, 56 percent of the newly diagnosed cases in 2005 were African-Americans.

"The ability to manage this terrible disease has improved and more people are living healthier and longer lives, but African-Americans have been diagnosed late and are not availing themselves to treatment," said Dr. Kevin Fenton, director of the CDC's National Center for HIV, STD and TB Prevention. "The stigma within the community has prevented people from getting tested and accessing services needed to help manage infections."

African-American women are disproportionately affected, and black men who have sex with men have a much higher rate of infection than men of other backgrounds who have sex with men, Fenton said.

"HIV is closely associated with socioeconomic disparity in our country. Poverty, poor access to services and lack of knowledge all factor into this," said Fenton. "Stigma, homophobia and lack of open conversation in the black community have further compounded the problem."

To increase early detection of HIV, the virus that causes AIDS, the CDC recently issued a new policy recommending that HIV testing become a routine part of medical care for Americans 13 to 64 years of age. It should be given much like a cholesterol or blood-pressure test, the CDC said, adding that patients should be allowed to refuse the HIV test if they choose.

Illinois state Rep. Mary Flowers recently introduced a bill in the Illinois legislature that would include HIV testing in routine physical examinations that Illinois students take before entering school. HIV tests would be administered during school physical exams, just as tuberculosis tests and vaccinations are given.

Black HIV/AIDS Awareness Day is an important part of a comprehensive awareness program to stop the spread of the disease, according to supporters, and it helps to get the message out.

"Black people are going to have to take responsibility for themselves in this epidemic," said Debra Fraser-Howze, president of the National Black Leadership Commission on AIDS. "We have to make some serious decisions, a decision to first talk about the epidemic and a decision to own it. It is ours, with 56 percent of all new infections."

While there has been progress in confronting the disease in the black community, Fraser-Howze said, much work remains in getting the subject to the forefront in churches, schools and community groups. And while much attention has been given to the epidemic in Africa, not enough has placed on the problem in black communities in the United States, she said.

"We are in a quandary because we as African-Americans have to be concerned about what is going on in Africa. But at the same time we are concerned about Africa, we have to be concerned about South Central Los Angeles. Both have to be addressed," said Fraser-Howze. "Funds are dwindling and everybody is taking money to Africa when African-Americans are dying in this country."


Source: http://www.redorbit.com/news/health/830321/hiv_rate_continues_to_climb_in_african_american_community/index.html?source=r_health

Uganda: HIV-Related Memory Loss is Now Common, Says Study

By, Kakaire A. Kirunda, The Monitor (Kampala), February 4, 2007

According to a study published in the January 30th issue of the journal Neurology, HIV-related neurological problems are common in Uganda and Africa in general.

"HIV dementia is common in HIV-sero positive Ugandan individuals attending an Aids clinic.

It is more frequently associated with patients of advanced age and decreased CD4 count," concluded the study. It was aimed at measuring the frequency and associated risk factors of HIV dementia in an HIV clinic where 24 of 78 (31 per cent) randomly sampled patients had HIV dementia.

Dementia is a medical term, which in lay-language refers to loss of one's memory; continuous loss of one's brainpower.

The study looked at 178 subjects from September 2003 to January 2004. Seventy-eight were HIV-positive patients recruited from the Infectious Disease Clinic in Mulago Hospital, Makerere University, while 100 were HIV-negative individuals recruited from the Aids Information Centre who were used to obtain normative data for the cognitive tests.

According to a January 29 release from the Johns Hopkins University in the United States of America, whose researchers in collaboration with Ugandan counterparts carried out the study, HIV dementia is defined as memory, learning, behavioural and motor disabilities that interfere with normal daily life and in extreme cases lead to total disability and a bedridden state.

HIV dementia is treatable and potentially reversible with the same antiretroviral medication that is used to treat the infection. Treatment can even restore completely normal cognitive function to some of those affected. The Mulago study none-the-less, found that each additional 10 years of age conferred a greater than two-fold risk of HIV dementia and reduced levels of CD4 count, which was associated with a 60 percent increase in the odds of having HIV dementia.

An editorial on the study noted that in countries that have few, if any, neurologists, and where HIV infection often presents with an overwhelming opportunistic infection such as tuberculosis or cryptococcal meningitis, it is no surprise that what can seem to be mild cognitive deficits are under-recognised or considered unimportant.

However, the editorial further notes that the findings could also have significant implications on HIV control in the region, since HIV-related neurocognitive impairment has been associated with both high rates of risky sexual behaviour, and the failure of patients to be adherent to treatment (which in turn increases the risk of drug resistance).

Failure to recognise cognitive impairment will not only impair individual therapy but will harm the efforts to control HIV in a community, as cognitively impaired patients are less inhibited and are more likely to engage in HIV-related risk behaviour. This may be compounded if the transmitted strains are also resistant to HAART."

The authors say although done on a small scale, the study showed that HIV dementia exists in high proportions in sub-Saharan Africa and is an under-recognised condition that needs to be studied and treated.


Source: http://allafrica.com/stories/200702050358.html

Cameroon: Collaborating to Prevent Mother-to-Child HIV Infection

By, Elvis Tah, The Post (Buea), January 30, 2007

It not only steals life. It steals life from spouses, children and grandchildren. That is HIV/AIDS. And that is why the Government of Cameroon has ratcheted higher the priority of preventing the transmission of the dreadful virus from mother to child.

The Government, therefore, will start scaling up anti-retroviral prophylaxis in pregnant women using bi-therapy this year.This will commence after a good number of health personnel must have received training nationwide from both private and public health centers.

A medical doctor from the Buea Provincial Hospital Annex, Dr. Pascal Nji Atanga, made this declaration at an international workshop on Prevention of Mother-to-Child Transmission of HIV/AIDS (PMTCT, HIV/AIDS) held at the University of Buea from January 22 to 24 2007.

The seminar organised by the Health Bridge Foundation of Canada and sponsored by the Canadian Government through the Canadian Ministry of Health, falls within the framework of encouraging collaboration in the prevention of mother-to-child infection of HIV/AIDS in 16 countries in Africa.

Dr. Atanga said the HIV/AIDS epidemic is highly feminized in Cameroon with a ratio of 100 infected men to 170 infected women.He said the prevalence in pregnancy varies from six percent to 17 percent depending on the province.

Dr. Atanga told participants that the main objective of Cameroon (PMTCT) program is to reduce by at least 50 percent the number of HIV infected babies born to mothers who are HIV positive by the year 2010.

He, however, regretted that most spouses of positive women often refuse testing and there are a lot of dropouts in antenatal care and the labour room.He stated that in one centre the antenatal prevalence was 22 percent but that of the delivery room was 8.7 percent.

He explained that the reason for this discrepancy is that some women deliberately hide their antenatal results when they get to the delivery room.

In a presentation, Dr. Ismael Ngnie Teta, Health Specialist and Professor of Faculty of Health Science, University of Ottawa, Canada, reminded participants that for postpartum care for women who are HIV-infected, there should be continuous routine health care including pap smears and monitoring for vaginal infections; monitoring and treatment of opportunistic infections, malaria and tuberculosis and referring to anti-retroviral treatments when indicated.

Another resource person, Dr. Paul Mkandawire, a medic from the Presbyterian Synod Health Department, Malawi, said the PMTCT in Malawi provides preventive therapy to 80 percent of eligible infants until they are confirmed HIV negative.

He said they equally provide nutritional counseling to all HIV infected pregnant and lactating mothers.The seminar which drew participants from Canada, Tanzania, Malawi and a host of lecturers in the Faculty of Health Science, students of Medical Laboratory Technicians, MLT, of the University of Buea, UB, was coordinated by Dr.Ismael Ngnei Teta and Dr. Eric Achidi, Head Of Department Health Sciences, UB.

Source: http://allafrica.com/stories/200701300804.html

PAKISTAN: Commercial sex workers face HIV threat

By, IRIN PlusNews, February 3, 2007

LAHORE - Beena, 50, runs an 'establishment' in Pakistan's eastern city of Lahore, where her two daughters and a niece sell their bodies. "Most of us here know all about this AIDS thing. Some NGO people keep coming and talk to the girls about it - but just knowing about it is not always of much use," she mused, chewing on a wodge of tobacco.

It's a good point: the fact is that although many sex workers in Lahore's red-light area may have some awareness of the HIV risks they face, they can, in real terms, do little about it.

In a 2006 update on the AIDS epidemic in Pakistan, the World Bank noted most sex workers lacked the power to negotiate condom use with the clients on whom they depend.

"Our job is to keep our clients happy. Sometimes they get very angry if we produce a condom, because it is a reminder to them that we have had sex with other men," said a young woman, sitting on one of the shabby, over-stuffed sofas in Beena's sitting room.

She introduced herself as "Dolly", using a pseudonym like almost all the women here, and says she has been in the "business" for nearly 10 years, since she was 15.

There are an estimated 25,000 sex workers in Lahore, Pakistan's second most populous city, the majority based along the winding alleys of 'Heera Mandi' or the 'Diamond Market', which has existed for centuries.

The district reached the height of its glory under the flamboyant Mughul Emperors, who ruled the Indian sub-continent from 1526 to 1857. Famous courtesans were visited by men from aristocratic households, and people came from across the Indian sub-continent to admire the dancing and singing of the legendary 'dancing girls' of the area, who were known also for their charm, wit and ability to recite Persian poetry.

Denial

Since those heady days, the area has declined into a sordid tawdriness. A clamp down against prostitution under the Islamization policies of Pakistan's military dictator, the late General Ziaul Haq in the 1980s, led to many of the women leaving the area to take up residence - and continue their business - in other parts of the city.

Those left behind are often the most impoverished and the most vulnerable. Apart from the traditional families who have lived in Heera Mandi for centuries, taking pride in their classical dancing skills and maintaining they are entertainers, possibly descended from the royalty that once thronged Heera Mandi, many young women from villages around Lahore, or even from Afghan refugee camps, have ended up here.

Looked down upon by the established families, they often tell terrible stories of brutality and exploitation.

"I come from a respectable family in Sheikhupura (a small town on Lahore's outskirts). I was married off to a man in my late teens. He treated me well for a while, but then he accumulated massive gambling debts, turned to drink and brought me here and sold me," said Shahzadi.

She now lives in a small room, at the top of a rickety old house, and entertains her clients in a room tucked away at the back.

Along the narrow alleys of Heera Mandi, in lonely, stark, rented rooms, many women tell similar stories. Some talk of violent husbands from whom they escaped, others narrate being lured away from their villages by promises of jobs or a role in a film, and then sold here. Most yearn for stability and security in their lives - and also respect in a society that looks down on them as "fallen" women.

The streets, silent in the day time, bustle at night, as music from the balconies where the women, with heavily powdered faces and gaudy clothes, dance and sing, to draw in customers. The area houses not only the 'dancing girls', but transvestites, drug addicts, down and out musicians and others considered, for one reason or another, to be social outcasts.

Strung along the shops selling musical instruments and the food stalls are the 'money' shops that sell crisp notes of small denominations that are flung before the women as they dance by clients to express admiration. Garlands made of currency notes are available, for men to drape around a favourite performer.

While the women of Heera Mandi, like the svelte Neena, with her henna-reddened hair, are street-wise, and well aware of the risks they live with constantly, AIDS is something many are still reluctant to discuss, despite the fact that the global epidemic is now making rapid inroads in Pakistan.

In April 2006, the World Health Organization (WHO) reported there could be 70,000 to 80,000 unreported HIV cases in Pakistan - a number making up 0.1 percent of the adult population. There are 2,998 reported cases.

According to the WHO/UNAIDS, Pakistan is classified as a low prevalence but high risk country for the spread of HIV, due to the presence of a growing number of injected drug users, unscreened blood donations and unsafe sexual practices by both male and female sex workers.

Recent findings by Pakistan's Ministry of Health have found that while prevalence remained below one percent among prostitutes, over 20 percent in Karachi and Lahore had sold sex to injecting drug users, and condom use was low in those encounters. The same study found high rates of STDs among sex workers and other high risk groups.

Respectability

In most cases they are in no position to demand safe sex from clients. But there are also other factors; many of the women, especially those from 'traditional' Heera Mandi families, maintain that dancing is their main profession and the sex a kind of 'side line' that they occasionally engage in.

While this claim is not borne out by independent analysis, it is used by the women as a means to show their 'respectability' in a society where sex outside marriage is both against the law and taboo.

"I have some regular clients, with whom I spend the night. But these are men from noble families, they are 'clean' and they cannot make me sick," maintained Kiran, taking a rest from dancing practice on her large double bed, where a small group of ragged pink and grey stuffed animals sat.

She also insists, shyly bringing her hand up to her mouth, that she does not know what a condom is, but has heard it is kept by "promiscuous women" who have "sex with everyone". She maintains that her mother, who acts as a chaperone, vetting clients for her daughter, would "not allow anyone 'dirty' with me".

The combination of the women's own low status, exploitation, and the social attitudes towards sex that prevail in society, make sex workers especially vulnerable.

"There is a very real risk of a rapid spread of HIV/AIDS among this population, and other high risk groups, including migrant truck drivers who engage in sex with [sex workers] in many parts of the country," said Dr Qaisar Rana, who for several years ran a small clinic in the Heera Mandi area.

Others, who have emerged as spokespersons for the women of Heera Mandi, including leading artist Iqbal Hussain, whose own mother was a sex worker, emphasise their "lack of empowerment, exploitation and helplessness".

Despite attempts to raise awareness about HIV, it seems the message has not yet hit home in Heera Mandi. This means that apart from all the other risks they face, the women working here could soon confront another, still more alarming danger.

Certainly, the shadow of AIDS seems to be lurking everywhere amidst the narrow alleyways and carved balconies of Lahore's unique entertainment district - and no one can predict how long it will be before it strikes, claiming more victims among the women who walk the streets here each night, until the call to prayers from the Badshahi Mosque announces the arrival of dawn.

kh/ds/oa

Zimbabwe: Ongoing Medical Strike Could Cost Lives

By,UN Integrated Regional Information Networks, January 31, 2007

As Zimbabwe's disgruntled doctors and nurses continue their strike over low salaries and poor working conditions, concern is growing about how the prolonged stayaway is affecting HIV-positive patients.

The strike by health professionals, now more than a month old, has left dozens of desperate patients without medical care in rural and urban areas. Doctors, who earn less than US$240 a month, opened the gate to what has become a growing torrent of wage protests by demanding an 8,000 percent increase to cushion themselves against inflation, and high transport and food costs.

AIDS service organisations are worried that HIV-positive people living in a country with one of the world's highest prevalence rates could be in real danger.

"It is possible that some of our members have already died as a result of the strike. I urge the government to solve this matter urgently, because it's devastating," said Benjamin Mazhindu, national chairman of the Zimbabwe National Network for People Living with HIV (ZNPP+), which has 60,000 members.

Mazhindu warned that if the strike continued, more people living with the virus would develop side effects or become resistant to antiretroviral (ARV) medication, which they were finding difficult to obtain during the industrial action. Any interruption in treatment can lead to the HI-virus becoming resistant to the medication, hastening progress towards AIDS.

Some patients have been forced to wait for more than a week to get ARVs, Mazhindu noted. ZNNP+ member Tabeth Moyo, for instance, had been unable to receive her monthly supply of the life-prolonging treatment from Parirenyatwa Hospital, one of the country's largest health facilities. "I fear that I will become drug resistant because my drugs ran out two weeks ago and I have not been able to replenish them."

The Community Working Group of Health (CWGH), a local nongovernmental organisation dealing with health matters in 25 of the country's districts, has been trying to determine the impact of the strike on HIV-positive Zimbabweans. CWGH executive director Itai Rusike said people were no longer going to hospitals, and were waiting to die. "It's a disaster in the making."

Inevitably, women are bearing the brunt. Mary Sandasi, executive director of the Women and AIDS Support Network (WASN), said pregnant women, most of whom were on ARV treatment, had no access to healthcare workers, which could cause serious complications when giving birth. Many pregnant women have been delivering at home with the help of midwives as a result of the strike.

Few Zimbabweans have turned to private health institutions because the tariffs were unaffordable to ordinary people grappling with an unemployment level above 80 percent and inflation that has reached 1,281 percent, the highest in the world.

Arnold Mungezi, who has been living positively for the past 10 years, is more fortunate, as he can afford to buy his medication from a pharmacy. Nevertheless, he called on the government to address the concerns of doctors and nurses. "They should be given salaries that go hand in hand with their work to avoid this disaster, where people are just dying."

cc/kn/he


Source: http://allafrica.com/stories/200701310291.html