AIDS Care Watch

Monday, May 28, 2007

Women's rights key to Africa AIDS crisis

By, Andrew Quinn, Alernet, May 25, 2007

Improving women's rights could boost the battle against AIDS in southern African countries, where women are often forced into risky sex by male partners or economic desperation, a new report said on Friday.

Physicians for Human Rights said its study of 2,000 women in Botswana and Swaziland showed inequality and gender discrimination were major factors behind a pandemic which has seen the two countries struggle with the worst AIDS crises in the world.

"If we are to reduce the continuing, extraordinary HIV prevalence in Botswana and Swaziland, particularly among women, the countries' leaders need to enforce women's legal rights," study co-author Karen Leiter said in a statement.

"The impact of women's lack of power cannot be underestimated."

Almost 25 million Africans are infected with the HIV virus, giving the continent the worst AIDS burden in the world. Women make up 75 percent of HIV-positive Africans aged between 15-25.

The PHR study concentrated on the two African countries with the highest HIV prevalence rates -- Swaziland, where an estimated 33 percent of adults are infected, and Botswana, where about 24 percent carry the virus.

Researchers conducted random surveys on gender attitudes and sexual behaviour and concluded that greater social and economic inequality between the sexes directly correlated to the HIV risk faced by African women.

"Despite the differences in the two countries, the women in the samples have very similar demographics ... they were poorer, had a greater number of dependents, were less educated and were less food sufficient," Leiter said.

"They are compelled often by their circumstances to engage in sexual behaviour that raises their HIV risk."

Economic dependence on men meant that women often lose control of their sexual choices, including whether or not to use a condom, while social inequality meant that men and women are held to different standards of behaviour when it comes to multiple sexual partners, the report said.

In Botswana, for example, researchers found that survey participants who reported higher levels of discriminatory beliefs about the role of women were almost three times as likely to have had unprotected sex with a non-primary partner on the previous year.

U.S.-based PHR, which was a co-recipient of the 1997 Nobel Peace Prize, said African governments and traditional social leaders were failing to ensure existing legal and constitutional protections for women's rights.

In particular, both Botswana and Swaziland need to work to end discrimination against women in marriage, inheritance, property and employment rights and boost efforts to end domestic and sexual violence against women.


Homespun technology provides HIV-free breastmilk

By, Michael Malakata, Science and Development Network, May 25, 2007

Researchers have devised a simple and cost-effective method of preventing breastmilk transmission of HIV from mother-to-child by 'flash-heating' infected milk to inactivate the free-floating HIV virus.

A study, published online in the Journal of Acquired Immune Deficiency Syndromes (21 May), provides hope that breastfeeding in developing nations could become safer.

National banks that collect, store and disperse human milk already pasteurise it, but commonly use a method that relies on thermometers and timers that can be hard to obtain in resource-poor communities.

The new method involves simply heating a glass jar of expressed milk in a pan of water over a flame or single burner, so can easily be applied by mothers at home.

The research began in 2004 and was driven by HIV-positive mothers from Zimbabwe wanting to know how they could make their milk safe for their babies, according to Kiersten Israel-Ballard, from the US-based Berkeley School of Public Health, who coordinated the study.

Of the 700,000 children who become infected with HIV each year, the study says an estimated 40 per cent contract the virus from prolonged breastfeeding that continues for more than six months.

The World Health Organization (WHO) recommends heat-treating HIV-infected breast milk, but so far there has been sparse research into a simple method that could be used by HIV-positive mothers in developing countries.

"We wanted to be sure that there was scientific evidence that flash-heated milk was truly free of HIV and immunologically beneficial," Israel Ballard told SciDev.Net.

Infants in developing countries at risk of potentially fatal illnesses such as diarrhoea can't afford to lose antibodies or the optimal nutrition found in breast milk.

In the study, 84 HIV-positive women contributed breast milk to the research. Tests on flash-heated breast milk showed that the process kills bacteria and the HIV virus, while retaining most of the milk's nutritional and antimicrobial properties.

Canisius Banda, a spokesperson from the Zambia Ministry of Health, told SciDev.Net that the challenge would be to educate mothers on how to heat the milk.

Current WHO recommendations state that HIV positive mothers should avoid breastfeeding when safe feeding alternatives are available. But in regions where mothers cannot afford the cost of infant formula or where water is contaminated, the WHO recommends mothers should exclusively breastfeed their babies up to six months of age.

Reference: Journal of Acquired Immune Deficiency Syndromes doi: 10.1097/QAI.0b013e318074eeca (2007)

Thursday, May 24, 2007

Nigeria: Global Aids Week - Coalition Seeks Tripling of Foreign Aid

By, Abimbola Akosile, This Day (Lagos), May 22, 2007

A coalition of civil society organisations have called on developed countries and rich donor nations to increase the level of its aid and support toward the fight against the scourge of HIV/AIDS, and help developing countries realise the 2015 Millennium Development Goals; as the world celebrates the global AIDS week.

As part of the activities marking the week, which runs from May 20 to May 26, the coalition in addition to observing a candle-light memorial day, called on the Federal Government and the incoming administration to guarantee Universal Access to HIV/ AIDS prevention, treatment, care and support by 2010.

Working on a theme 'Free the Drugs, Stop the Death', the coalition, which comprised 17 Civil Society Organisations (CSOs), associations, and movements working across the length and breath of the country in the area of HIV and AIDS, and led by ActionAid Nigeria, outlined its demands in a charter and urged relevant governments, including Nigeria, to keep their promises on adequate health services to combat the pandemic.

According to the group, in a statement by Mr. Solomon Adebayo, Reproductive Health Sexual Health Project, ActionAid, Abuja, "the Global AIDS Week of Action provides an opportunity for activists around the world to stand together, generate political pressure and demand action their leaders on best practices and strategies to combat HIV/AIDS".

"The theme for this year's Global AIDS Week of Action is 'Free the Drug. Stop the Death'. Civil Society Groups and PLWHA in the forefront of the campaign are therefore demanding that governments should keep their promises to ensure that Nigeria meets the target of Universal Access on prevention, treatment, care and support by 2010".

The coalition demanded the immediate tripling of annual HIV and AIDS spending to developing countries by the club of rich nations (G8), especially as they plan to meet in Germany to discuss the universal access goal in June 2 2007; claiming that the week of activism is critical given the grave picture of HIV and AIDS epidemic in Nigeria.

"Currently 1 in 20 Nigerians is HIV+. The 2005 Sentinel Surveillance showed that 200,000 AIDS deaths were recorded. This increased by 50% in 2006 and it is estimated that by 2010, three million Nigerians would have died of AIDS. And in a country where about one million Nigerians currently require Anti-retroviral (ARV) drugs, statistics show that only 85,300, including children, are on the drugs".

The coalition insisted that adequate steps are yet to be taken to address the identified challenges and ensure that Nigeria does miss the 2010 targets. "This year, Nigeria committed 7 billion naira to HIV and AIDS initiative; this is the highest in the nation's history. However, donor agencies across the country have also committed over one billion dollars to efforts to combat HIV and AIDS".

In its Charter of demands, the coalition focused on stigma and discrimination and called for the establishment and enforcement of progressive legislation that protects the human rights of people living with HIV&AIDS at all levels e.g. national, workplace, schools, prisons, and during VCT/PMTCT interventions or following disclosure.

On access to treatment, there was a call for rapid scale up of access to comprehensive, sustainable, quality treatment, care and support for PLWHA by 2010 HIV programmes are integrated with programmes for TB and other opportunistic infections, to provide the widest access to care possible..

Among the organisations and associations that signed the charter were FAHIMTA Women and Youth Dev. Initiative, Bauchi; Kids and Teens Concern, Ondo; Youth Against Sickle Cell Disease (YOTASCID), Kafachan; Association of Women Living with HIV and AIDS in Nigeria (ASWHAN), Abuja; Medecins Sans Frontieres (MSF), Lagos; ChristianAid, Abuja; Community Based Organisation in 11 states; A37- Youth Advocacy group; Society for Family Health (SFH), Abuja; ActionAid Nigeria (AAN), Abuja; and Media AIDS Project (MAP), Abuja.


Thursday, May 17, 2007

Russia warns of AIDS epidemic, 1.3 mln with HIV

By, Guy Faulconbridge, Reuters AlertNet, May 15, 2007

Russia's AIDS epidemic is worsening with as many as 1.3 million people infected with HIV as the virus spreads further into the heterosexual population, Russia's top AIDS specialist said on Tuesday.

Russia has registered 402,000 people with HIV, of whom 17,000 have died, but the real figure is much higher, said Vadim Pokrovsky, head of Russia's federal AIDS centre.

"Not only is the number of Russians infected with HIV rising but there is an increase in the rate at which the epidemic is spreading, so a rise in the number of newly infected," Pokrovsky told reporters.

"We have an estimate of up to 1.2 million to 1.3 million infected with HIV," he said, adding that the number of those registered as infected was rising by 8 to 10 percent a year.

The United Nations estimates 65 million people worldwide have been infected with HIV and that 25 million people have been killed by AIDS since it was first recognised in 1981.

AIDS, which stands for Acquired Immune Deficiency Syndrome, is caused by the human immunodeficiency virus (HIV).

Most of those infected with HIV are unaware they are carrying the virus, according to the UN.


Pokrovsky said HIV was high among Russia's intravenous drug users but that many of those newly infected were not needle users. And he warned that the virus was spreading fast into the heterosexual population.

Women made up 44 percent of 39,589 registered new infections last year, he said adding that in some cities one in ten Russian males were infected with HIV.

"Evidence of the strengthening heterosexual HIV infection is the increase in the number of women among those newly registered with HIV," Pokrovsky said.

"On average for the country, one out of every fifty males is infected with HIV but in some cities it is one in ten," he said.

Russia's northern city of St Petersburg was worst affected followed by Sverdlovsk region, greater Moscow, Samara region and Moscow, though Pokrovsky said figures for Moscow were probably much higher than the data indicated.

The United Nations said in a report published on Tuesday that HIV was higher in richer regions.

"HIV prevalence is in an inverse relationship to economic development: HIV is more widespread in 'rich' regions," the UN said in a report about Russia's regions.

Pokrovsky said overall funding for fighting AIDS in Russia was rising but that just 200 million roubles ($7.75 million) would be spent on prevention in 2007 out of a total budget of 5.3 billion roubles ($205.4 million).

"The financing is sharply rising," he said. "There is now a lot of money, but the spending is not done entirely properly."

"A very small amount of that directed to preventing the further spread of the epidemic; most of it is being used for treatment. That is good but you need prevention too," he said.


Pakistan: HIV/AIDS will not go away if you ignore it

By, IRIN PlusNews, May 16, 2007

RAWALPINDI - "This is a disease about dirty people doing dirty things," remarked Mohammad Sohail, 18, a mechanic, displaying his limited knowledge of HIV as he repaired a car outside the bustling Pir Wadhai bus station, one of the largest in the city of Rawalpindi, near Islamabad, capital of Pakistan.

His supervisor, Sayid Ramazan, 26, and the father of two, knew even less. "I never heard of it," he said, scratching his head.

Such responses are not unusual in Punjab Province, where nearly 60 percent of the country's 158 million inhabitants live, but they highlight a serious challenge in the national response to HIV/AIDS.

Pakistan's HIV prevalence rate stands at 0.1 percent but the situation is changing rapidly, with new data revealing that an epidemic is concentrated in two risk groups: injecting drug users (IDUs), and men who have sex with men (MSM).

Prevalence is rising among the country's estimated 150,000 IDUs: in the southern city of Karachi the rate rose from 5 percent in 2002 to 27 percent in 2007, while in the city of Sargodha, about 100km from the capital, it reached a staggering 51 percent in 2007.

In this staunchly conservative society, misconceptions about HIV, coupled with the taboo nature of the groups most at risk, has meant that most cases go unreported; 3,700 cases of HIV have officially been recorded since 1986, when the first one was noted in the southern port city of Karachi, but the World Health Organisation (WHO) and UNAIDS put the real number at around 200,000.

According to the World Bank, underreporting is the result of social stigma attached to the infection, limited surveillance and voluntary counselling and testing services, as well as a lack of knowledge among health practitioners and the general population.

Startling findings in Punjab

At the end of April the Punjab AIDS Control Programme released its survey of eight districts in the province, including Lahore, Sialkot, Rawalpindi, Gujrat, Gujranwala, Faisalabad, Bahawalpur and Multan, which revealed that 87 percent of all respondents had heard of HIV/AIDS.

However, less than one percent were aware that HIV could be transmitted from wounds, or from mother to child, while 62 percent had not even heard of sexually transmitted infections (STIs), much less transmission modes or prevention measures.

Although 26 percent were aware that the virus could be transmitted through risky sexual behaviour, and 23 percent knew that used needles could pose a risk, only six percent knew that blood transfusions could also be a mode of transmission, and a mere four percent understood that using a condom could be an effective precaution against becoming infected with HIV.

"What is reflected in the Punjab survey is indicative of the whole nation," warned Fawad Haider, the advocacy focal point for UNAIDS in Islamabad. "We still haven't been able to reach the real people of Pakistan," he explained, referring to the majority of Pakistanis, who live in rural areas.

Most awareness interventions have been targeted at policy-makers and people living in urban areas. "When we target the policy-makers and political leadership, the purpose is to get them to use their positions of influence to spread awareness amongst their constituents, allowing them to go back to the district level ... and spread the awareness at that level," the UNAIDS official said.

Although the strategy of placing the government at the forefront of media awareness campaigns has made some progress, it has not always worked. Moreover, the speed at which awareness levels have increased has been far from satisfactory, and the government has yet to give HIV/AIDS priority on the national agenda.

Hina Rabbani Khar, the State Minister for Economic Affairs and Finance, recently downplayed the significance of the disease, making HIV/AIDS a difficult issue to advocate for.

However, there is some optimism: the government hopes to significantly boost behavioural change among groups deemed most at risk, including female commercial sex workers, MSM, and those born biologically male but who wish to be female, called 'hijras' or eunuchs.

According to the country's new universal access targets for the next three years, the government aims to reach 25 percent of each of these groups in 2007, with a coverage target of 60 percent in 2010. "I believe we could even surpass those figures," said Dr Nasir Sarfraz, deputy programme manager of the National Aids Control Programme.

A question of resources

Akbar Babar, a private consultant who carried out the Punjab study, said the findings conveyed a stark message that more resources were needed to improve awareness levels nationwide.

"We all know awareness campaigns are expensive; electronic media is expensive, but extremely poor levels of awareness about HIV and its transmission routes should convince policy-makers that we need to allocate a lot more [resources], so that the media reports can be more intense," he said, calling for a significant boost in allocation, particularly for television.

"The only answer is to spread as much awareness as possible," said Haider, from UNAIDS. "The more people know about the modes of transmission, the better the understanding they would have, and the less taboo, stigma and discrimination will be attached to the virus."



Friday, May 11, 2007

Nepal protesters demand HIV help

By, Mark Dummett, BBC News(Kathmandu), May 10, 2007

People living with HIV and Aids are holding rallies across Nepal in protest at what they say is an inadequate government response to the pandemic.

They complain that health authorities are failing to provide care to the increasing numbers of infected people.

About 75,000 Nepalis are thought to be HIV positive.

Their numbers are growing but clinics and hospitals in more than half the country have no special provisions to care for them.


Protesters say there are not enough trained or competent medical staff, even though the government's HIV-Aids response programme is well funded by foreign donors.

For example, they complain that after a senior doctor was transferred from the main hospital caring for people with HIV and Aids in Kathmandu last month, the standard of treatment collapsed and many people who should still be alive today have died.

The Health Ministry has said it has launched an inquiry into these claims and is examining the protesters' other complaints.

One is that there should be more help for poor patients.

Many are women from impoverished rural communities whose husbands contracted the disease while working as migrant labourers in India.

When they returned home before dying they passed it on to their wives and in some cases their children too.

The protesters say little is done to help these widows and orphans.


Thursday, May 10, 2007

Street kids fight another odd: AIDS

By, The Indian Express, may 9, 2007

Health dept survey finds a number of street children carriers of HIV contracted through regular sexual exploitation and addiction to injectible drugs
They clean your car while you wait at the traffic signal, serve you tea at roadside stalls or just loiter around begging. And a number of them are carriers of the dreaded HIV or may be actually suffering from AIDS.

Deprived of childhood, education and a good future, a large number of street children in West Bengal, especially in Kolkata, have fallen prey to the dreaded disease through regular sexual exploitation and addiction to injectible drugs.

The fact came to the fore after the state Health department conducted a study recently and identified this group as the highly vulnerable "bridge population group".

The conclusion was based on findings of random HIV tests on several children, which found quite a few of them positive for HIV, their behavioural pattern, their living condition, etc.

R S Shukla, special secretary of state Health department and director of the West Bengal State HIV AIDS Prevention and Control Society, said: "Street children are vulnerable to HIV infection for various reasons ranging from injectible drug use to sexual exploitation. The study gave us a clear picture of what was happening to these children as well as the fact that they are emerging as a high-risk group in spreading of the disease. The infections mostly go unnoticed. We are doing the needful to tackle the problem."

The government has, meanwhile, drawn up a plan for targeted interventions among the street children through NGOs. The programme will involve identification of the children afflicted with the disease, causes of the disease, providing relief and rehabilitation to the children and medical support.

The detailed study not only pin-pointed groups of street children or their locations, but also the probable population under the risk. According to the study, Kolkata has the highest number of street children, 10,714, in the state, concentrated mostly in 208 pockets. The city is followed by South 24 Parganas district, which has 907 street children in 26 pockets, and North 24 Parganas, where 15 pockets and 310 children have been located. The study surveyed all the districts and examined the nature of vulnerability and the population of each vulnerable group in each pocket. Information was also obtained about the reach of NGOs and their nature of work.

Apart from street children, the report has mentioned two other sections of society - truckers and migrant labourers who are potential carriers of HIV. According to previous reports, the three most vulnerable sections were sex workers, injectible drug users and men preferring sex with men.

"Street children are victims of various kinds of perversions, like sodomy, rape, and other paedophilic activities. Many are also drug addicts. Girls are more vulnerable," said Subhasish Guha, associate professor, School of Tropical Medicine. "They are so marginalised that their infections do not come to light, nor do they get medical attention in time. We are providing free anti-retroviral therapy, yet hardly any street children come to us," he added.


China Must 'Move Quickly' To Control Spread Of HIV Because 'Situation Could Worsen Rapidly,' NEJM Perspective Says

By, Medical News Today, May 8, 2007

Health experts are optimistic that China can control the spread of HIV, but the country must "move quickly" because "the situation could worsen rapidly," Bates Gill of the Center for Strategic and International Studies and Susan Okie, a contributing editor of NEJM, write in a NEJM perspective piece. Among new HIV cases in China, 48.6% are caused through injection drug use, 49.8% through sexual contact and 1.6% through mother-to-child transmission, according to Connie Osborne, a Beijing-based senior adviser to the World Health Organization on HIV/AIDS care and treatment.

The country is undergoing rapid social and economic change -- including migration from rural to urban areas and increases in commercial sex work and drug use -- Gill and Okie write. They add, "Given China's enormous population, even a small increase in [HIV] prevalence could be devastating." Although China "has indeed made some tough choices" -- including supporting needle-exchange programs and establishing methadone-maintenance therapy sites for IDUs -- "other critical problems must still be addressed," Gill and Okie write.

Health experts "remain cautiously hopeful about China's chances of controlling its [HIV/AIDS] epidemic," the authors write, adding, "Success, however, will depend on how well the government handles challenges." China needs to overcome stigma associated with the disease; establish "aggressive outreach efforts" for people in high-risk groups; and mobilize "funding, expertise and commitment throughout the vast and diverse country to identify, counsel and care for people" who are HIV-positive, the authors conclude (Gill/Okie, NEJM, 5/3).

"Reprinted with permission from You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at The Kaiser Daily Health Policy Report is published for, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.


Wednesday, May 09, 2007

Men's infidelity is the single greatest HIV risk for women

By, Asian News International, May 8, 2007

Washington - A recent study has found that a hubby's extramarital sex life is the single greatest HIV risk for women around the world.

The study, conducted by Columbia University's Mailman School of Public Health, demonstrated that marital disloyalty by men is so intensely deep-seated across many cultures, that existing HIV prevention programs are putting an increasing number of women at risk of developing the HIV virus.

The findings, signifying that worldwide prevention programs that undertake a "just say no" approach and persuade men to be monogamous are not likely to be of use, highlight the need for programs that make extramarital sex safer, rather than idealistically trying to exterminate it.

These findings are published in the June 2007 issue of the American Journal of Public Health.

The article's lead author, Jennifer S. Hirsch, PhD, associate professor of Sociomedical Sciences at Columbia University Mailman School of Public Health, is the foremost researcher on a large comparative study showing that the certainty of men's infidelity in marriage is true across cultures.

This was confirmed in the research conducted in rural Mexico as well as in similar studies she is supervising in rural New Guinea and southeastern Nigeria. Two additional studies in progress, in Uganda and Vietnam, are expected to show similar results.

The Mexico study was based on six months of anthropological research, including participant inspection, 20 marital case studies, 37 key informant interviews, and document analysis to investigate the factors that outline HIV risk among married women in Degollado, one of the Mexico's rural communities.

In rural Mexico, status is a vital facet of sexual identity, and attention to reputation provides insight into why people act in ways that are communally safer, but physically risky.

"What we found in our research was that culturally constructed notions of reputation in this community led to sexual behavior designed to minimize men's social, rather than viral, risks," said Dr. Hirsch. "We also saw that men's desire for companionate intimacy actually increases women's risk for HIV infection."

A major aspect in the study was that married men in the community left their homes to travel to the United States or large Mexican cities for jobs. While away for long periods, they engaged in extra-marital and unsafe sex, which can lead to HIV infection. When men return home, they infect their wives with the deadly virus during sexual intercourse.

"The result is that women are infected by their husbands, the very people with whom they are supposed to be having sex and, according to social conventions of Mexico, the only people with whom they are ever supposed to have sex," said Dr. Hirsch. "This challenges existing approaches to HIV prevention. It renders abstinence impossible and unilateral monogamy ineffective. Marital condom use is also not a serious option, because of women's deep, culturally supported commitment to the fiction of fidelity."

In New Guinea, researchers also saw labor relocation as a major contributor to infidelity. In addition, many men did not view sexual fidelity as an essential factor for achieving a happy marriage, but they viewed drinking and "looking for women" as central for male friendships.

In the Nigerian study, the social organization of infidelity was shaped by economic inequality, aspirations for modern lifestyles, gender disparities, and contradictory moralities. There, it is men's apprehensions and ambivalence about masculinity, sexual morality, and social status in the context of seeking modern lifestyles, rather than immoral sexual behavior and traditional culture that worsen the risks of HIV/AIDS.

"This study has direct implications for the types of prevention programs we should be supporting. We might find men's persistent and widespread participation extramarital sex to be troubling - but it's a deeply rooted aspect of social organization, and one that is unlikely to be easily changed. Public health programs alone can't stop extramarital sex, so we need to think about how to reduce the risk. Saying that 'be faithful' will protect married women is not true - unilateral monogamy is not an effective prevention strategy," Dr. Hirsch said. (ANI)

Tuesday, May 08, 2007

Alliance formed in Assam to fight HIV/AIDS

By, The Times of India, May 8, 2007

GUWAHATI: At least 29 different civil society groups, including people living with HIV, have formed an alliance in Assam to jointly fight HIV/AIDS that has assumed epidemic proportions in the region.

"The need for a common platform of civil society groups, NGOs, media, trade unions, and people living with HIV, is to address various issues from removing stigma to accessing care and treatment, besides allowing people with HIV/AIDS to live a life with dignity," Jahnabi Goswami, president of the Assam Network of Positive People (ANPP), told reporters here.

Goswami, 30, is one of the few women in India fighting to raise awareness about the disease and one of an even smaller number to have publicly declared in 1999 that she is HIV-positive.

The 'Assam People's Alliance to Combat HIV and AIDS' was formed a fortnight ago with several anti-AIDS campaigners, the church, women rights bodies and the government part of the conglomeration.

India accounts for about 5.7 million HIV-positive people, surpassing South Africa.

India's northeast has been declared as one of the country's high-risk zones with close to 100,000 people infected with HIV. There are some 1,780 HIV-positive people in Assam although unofficial estimates put the number at close to 30,000.

"The number of AIDS cases in Assam has swollen from 372 to 578 between October 2006 and February this year. This is an alarming rise," S I Ahmed, head of the AIDS Prevention Society, one of the alliance partners, said.

The Alliance would help formulate strategies and policies for people living HIV/AIDS, besides launching an awareness drive as stigmatisation of the disease and the society's denial are major hindrances in controlling the epidemic.

"Stigma and discrimination are indeed problem areas in tackling HIV/AIDS. There is acceptance of the problem at the highest level, although lots need to be done to make it (the disease) acceptable in the society which is still in a denial mode," Goswami said.

As part of the awareness drive, the Alliance is organising the Global AIDS Week of Action from May 20 to 26 in Assam beginning with the 24th International Candlelight Memorial march in the state in memory of those who died of AIDS.

"Several programmes were being organised from workshops to advocacy programmes, including a session with lawmakers from the state," Ahmed said.

Only 19 percent of Asians who need AIDS drugs receive them, a World Health Organisation (WHO) report released last month said.

The WHO report is backed by the United Nations' anti-AIDS agency (UNAIDS) and UNICEF. India has only around 100,000 people on treatment.

"This is far short of the total need," the report said.


Monday, May 07, 2007

Randall Tobias: Of Pledges and Prostitutes

By, Melissa Gira, from remarks introducing Taking the Pledge at the UC Berkeley Labor Center, May 3rd, 2007

As a sex worker rights activist, based primarily in the US, one of my biggest frustrations is that the rhetoric of anti-prostitution activists mobilizing against trafficking attempts to draw a connection between the sex industry in the US and what they call "sex trafficking" or "commercial sexual exploitation" globally.

What's very challenging as a US-based advocate is to get a solid, evidence-based view of how the sex industry operates in the places that anti-prostitution activists focus on: the global south, the former Soviet republics, and especially, Southeast Asia.

In March of 2006, I had the honor of representing the Desiree Alliance's US network at the Sexual Health and Rights Project's annual meeting, in Phnom Penh, Cambodia. The meeting brought together members of the international sex workers' rights movements to strategize a global agenda for sex worker's human rights. You will see, in Taking the Pledge, members of many these groups and workers and allies who were present.

We were privileged to meet members of Cambodia's sex worker rights organizations, the Women's Network for Unity and Womyn's Agenda for Change, two groups that organize sex workers & advocate for their health & safety, civil and labor rights. These are two of many sex worker organizations who have had their HIV prevention and human rights work significantly curbed or halted by the anti-prostitution policies set by the US government as part of their own strategies - non-strategies, really - to combat HIV and human trafficking - as if a better solution to preventing AIDS and forced labor is to jail someone, not to educate them about their health and rights.

Now here is a place where the sex industry in the US, the sex industry in the developing world, and the anti-prostitution movement do connect, and it's a story that you already know, if you've been following the news this
week: at least, a small part of this story is hitting the press.

Deborah Jean Palfrey is the former proprietor of an adult fantasy and escort service, who, in October of last year, woke up to find her bank accounts frozen. She quickly learned that she was under Federal investigation alleging that her money had been made illegally through running a prostitution business. Now on the eve of her trial, as part of making a case in her defense, she is releasing forty sevens pounds of cell phone records from her business to the media, and this week, making them available one page at a time on her website. Now the media is consumed with extrapolating names from these telephone numbers. So far, only one man named as a customer has confirmed that he did, in fact, use Ms. Palfrey's escort service, and this is a name that no one in this room should forget: Randall Tobias.

Randall Tobias was the Bush appointed administrator of the United States Agency of International Development, or USAID. He has been called the Bush administration's "AIDS Czar," and, until his unexpected resignation last Friday, was responsible for holding NGO's and CBO's to what we in the sex worker rights movement call "the pledge," a signed loyalty oath stating that their organization opposes prostitution. As of 2003, under Tobias, organizations around the globe - with histories stretching to the beginning of the HIV/AIDS epidemic, who, through peer education, direct services, community education and organizing have a proven record of increasing the health and welfare of sex workers - were now condemned for doing anything that the US believes to be "promoting" prostitution.

Drop-in centers in Bangladesh serving some of the country's the most vulnerable and impoverished women and children were shutdown because they accepted sex workers into their programs. English language education programs in Thailand were defunded because they taught sex workers. Condoms for sex workers in East Africa became so hard to come by that sex workers would wash and reuse them out of desperation. In Brazil, in resistance, $40 million of USAID funds were returned to the US on the grounds that excluding sex workers from their work was a public health and human rights failure too great to risk any money over.

If the "pledge" were, as the Bush administration and its supporters in the anti-prostitution movement contend, an effective strategy to end violence and human rights violations against vulnerable workers, then why are its only measurable effects the closing of social service programs that better the health and welfare of sex workers, and the increased kidnapping and incarceration of sex workers "for their own good"?

When you watch this video, I want you to reflect on the fact that the government agency, the very man himself responsible for enforcing this "pledge" is himself a client of sex workers. Tobias does not deny that he's used Ms. Palfrey's services - in fact, he's bragged to ABC news how easy it was to invite "gals over to the condo for massages." We, in this room. well, those of us who can or do who pay taxes. pay his salary, with which he hires sex workers for his own pleasure and robs other sex workers of their human rights to education, health, and safety. But Randall Tobias isn't to be condemned for his desire for erotic companionship - rather, for his utter hypocrisy and his agency's direct role in violating the human rights of the very people it claims to serve.

We in the US - sex worker rights advocates and our networks of supporters - all have a role to play in ensuring the wellbeing of sex workers around the world, and holding policies like those of USAID and its most celebrated now-former administrator accountable - are one of the most sound steps we can take, as our actions against these polices are, unlike the policies themselves, based in evidence of these programs failures, the hypocrisy of their administrators, and the requests of sex workers themselves around the world to take a stand in their name, for our collective good.

Now, Taking the Pledge.

Friday, May 04, 2007

More MSM Practicing Sero-Sorting To Prevent HIV; MSM In Committed Relationships Less Likely To Practice Risky Behaviors, Studies Say

By, Medical News Today, May 2, 2007

An increasing number of men who have sex with men in San Francisco are practicing sero-sorting -- in which people who know their HIV status search for partners of the same status -- as a way to protect against HIV, according to a study published Friday in the American Journal of Public Health, the San Francisco Chronicle reports. According to the Chronicle, sero-sorting evolved among MSM "without the kind of institutional support given to programs" that promote condom use and a reduction in sexual partners. The study authors, Dennis Osmond and colleagues at the University of California-San Francisco, found that 27% of MSM in San Francisco reported practicing sero-sorting in 2002, up from 19% in 1997. Forty percent of study participants ages 18 to 29 reported sero-sorting in 2002, the study found. The researchers also found that higher-risk sexual behaviors have increased among MSM, with the highest risk concentrated among men ages 30 to 50. Researchers found that the percentage of men reporting unprotected anal intercourse with a partner of different or unknown HIV status increased from 9% in 1997 to nearly 15% in 2002. The study also found that 27% percent of MSM in San Francisco were HIV-positive in 2002, compared with 20% in 1997. According to the Chronicle, the increase in HIV prevalence among MSM is "not surprising" because the study was conducted during a period when new antiretroviral drugs became available, which helped to "dramatically" reduce HIV/AIDS-related deaths.

In a second study, Sandra Schwarcz and colleagues at the San Francisco Department of Public Health also found that about 25% of MSM in the city are HIV-positive, the Chronicle reports. Schwarcz also found that MSM in committed relationships are less likely to practice risky sexual behaviors with each other than partners in more casual relationships. Mitch Katz, director of the health department and a study co-author, said the study shows a deviation in behavior from the early days of the HIV/AIDS epidemic, when the risk of transmission was highest among MSM in committed relationships. "The higher risks occurred with the more intimate relationships," he said, adding, "People took their highest risk with their closest partner." Both studies were conducted by telephone surveys among thousands of randomly selected men (Russell, San Francisco Chronicle, 4/27).


Thursday, May 03, 2007

HIV-positive people ignored in prevention campaigns

By, IRIN PlusNews, May 2, 2007

KISUMU - HIV/AIDS prevention programmes in Africa are failing to include people living with the virus, despite the fact they are vulnerable to reinfection and could, unless properly informed, transmit the virus to others.

"We know that sex goes on between HIV-discordant people [one person is HIV-positive and the other not], and between HIV-positive people, but few studies have been done on behaviour risk reduction among HIV-positive people," said Leickness Simbayi, southern Africa regional director for the research group, the Social Aspects of HIV/AIDS and Health Research Alliance (SAHARA).

Most African governments have launched large-scale HIV prevention campaigns that target the youth and other vulnerable groups, but the programmes have not explicitly taken into account the estimated 25 million people already living with the virus.

Speaking at a SAHARA conference this week in Kenya's western city of Kisumu, Simbayi said stigma, denial, exclusion and discrimination against those living with HIV and AIDS led people to hide their status and potentially keep engaging in risky sexual behaviour.

Simbayi said the current focus on antiretroviral (ARV) treatment had blunted prevention programmes. "The emphasis on treatment has left prevention as a secondary concern," he commented. "There is also some evidence that ARVs increase risky behaviour among HIV-positive people due to treatment optimism."

The key to encouraging prevention among HIV-positive people lay in getting more people into voluntary counselling and testing centres, Simbayi said. Despite information blitzes across the continent over the past decade-and-a-half, most Africans still did not know their HIV status.

According to a 2005 national survey by South Africa's Human Sciences Research Council, just 20 percent of the 5.4 million South Africans thought to be HIV-positive knew they were infected.

"All African citizens must have access to testing facilities so they can be part of 'positive prevention'," said Richard Muga, of Great Lakes University of Kenya, in Kisumu. "Even after becoming HIV-positive, sexual life does not stop."

Simbayi said two "positive prevention" models were being tested for efficacy in Africa. One, based on social support groups of men and women living with HIV, was designed to combat fear and encourage disclosure; the other, a clinic-based method, used motivational techniques, such as seeing someone disclose their status without negative consequences, to promote behaviour change.


Wednesday, May 02, 2007

One In Three HIV Positive Gay Men Report Unprotected Sex

By, Medical News Today, May 1, 2007

More than one in three HIV positive gay men say they have unprotected sex, reveals a community survey, published ahead of print in the journal Sexually Transmitted Infections.

And almost one in five HIV negative men said that they do the same, the figures show.

The findings are based on a survey of men at gay bars, clubs, and saunas in London, Manchester, and Brighton between 2003 and 2004.

The surveys, which were carried out at 90 venues, involved information on lifestyle, background, and sexual behaviour.

Almost 3600 questionnaires were handed out, 2640 of which were completed. Saliva samples were also requested to find out about HIV prevalence, and 2311 men agreed to provide these.

The rate of HIV infection was highest in Brighton, at almost 14%, and lowest in Manchester, at 8.6%.

But the rates of undiagnosed infection was high in all three cities, ranging from one in three in Brighton to more than four out of 10 (44%) in London.

Across the entire sample, one in three men who was HIV positive did not know they had the infection.

This was despite the fact that over two thirds of these men said they had been to a sexual health (GUM) clinic within the past year.

Almost one in five (18%) of HIV negative men and over a third (37%) of HIV positive men said they had had unprotected sex with more than one partner in the past year.

Over the same time period, one in five HIV negative men and four out of 10 HIV positive men said that they had had a sexually transmitted infection.

The authors conclude that despite the availability of treatment and a national policy to promote HIV testing, a significant proportion of infection remains undiagnosed.

They call for renewed efforts to be made to boost diagnosis and curb risk behaviours that encourage onward transmission of HIV and other sexually transmitted infections.

"A tale of three cities: persisting high HIV prevalence, risk behaviour and undiagnosed infection in community samples of men who have sex with men
Online First Sex Transm Infect 2007; doi: 10.1136/sti.2006.021782



Tuesday, May 01, 2007

Male Order Business

By, Cindy Tilney, The Irrawaddy News, May, 2007

Why young Shan migrants enter Thailand’s sex scene

Amid a long strip of bars close to Chiang Mai’s bustling Night Bazaar is a small, neon-lit hangout where a group of western men sit surrounded by attentive Asian male youths. Some of the foreigners are being massaged by the young men, while others are chatting and laughing intimately with them.

Ton, a 25-year-old Thai man with an engaging smile, has owned this bar for a year. Though he is heterosexual, he runs a bar that is a prime pickup spot for male clients looking for sexual encounters with “bar boys.”

According to Ton, about 95 percent of male sex workers are heterosexual men whose motivation is purely economic—a statistic confirmed by the NGO Mplus. Jay, who works as a host and cleaner at a bar across from Ton’s, is typical. A Shan from Burma, Jay has a boyish, angelic face that belies his 21 years. He used to be a favorite with the customers and, after chatting with him for a few minutes, it’s easy to understand his popularity: his good looks are complemented by the warmth and friendliness he exudes.

But Jay stopped going home with clients over a year ago. He is heterosexual and has had a serious girlfriend for the past 10 months. “I came to Chiang Mai from Shan State two years ago to look for work,” he says. “I used to go with the clients because I needed the money, but I stopped when I got a job as ‘captain’ because it’s not good. I didn’t like it. None of the boys who work here likes doing what he does—they just need the money.”

Jay’s job is to welcome customers, make them feel at home and help negotiate terms between boys and clients—a kind of pimp.

An increasingly large number of Chiang Mai’s male sex workers come to Thailand from Burma’s Shan State. A shared border between Shan State and northern Thailand makes Chiang Mai one of the most accessible areas for Shan migrant laborers seeking work outside Burma.

While many Shan come to Thailand to escape human rights abuses such as mass relocations and forced labor, others, such as Jay, cross the border because of the country’s economic instability. Thailand is the gateway to a better life, a lucrative job and the opportunity to send money to families at home.

But conditions facing Shan and other migrant laborers in Thailand are tough. Though they may register for an official work permit, the document restricts their movement to the area in which they are registered and is valid for only one year. The annual cost of 3,800 baht (US $107) for the permit is too expensive for many—the equivalent of one month’s salary or more. Burmese migrant workers often end up taking jobs that few Thai nationals are willing to do and, as a result, suffer mistreatment at the hands of their employers.

It is, therefore, not surprising that some have turned to a livelihood where the economic benefits are more alluring. Many Shan migrants see Chiang Mai’s booming sex trade as the city’s most attractive solution to their economic and social difficulties. While the average daily wage for migrant labor is between 80 and 180 baht ($2.25-5.07), a single night of sex work can bring in up to 10,000 baht ($280).

Ong is a Shan who works as a male prostitute in Chiang Mai. Ong’s lean, muscular body and flawless pale skin from his part-Chinese heritage make him one of the highest earners in the area. With his exotic good looks, Ong can earn up to 10,000 baht from a single client. “Most Thai customers will only pay 1,000 or 2,000 baht ($28-56), but farangs [Westerners] will often pay more,” says Ong. “I sometimes ask farangs who look like they can afford it for 5,000 or 10,000 baht ($140-280) and they pay it.”

Ong is heterosexual but feels he has little choice but to sell himself to men if he wants to earn the money he needs to help his family in Burma. “I don’t want to do this work, but what can I do?” he asks. “When I came to Chiang Mai I didn’t speak any Thai. I didn’t know my way around. I didn’t know anything, and I had to send money home to my family. In the three years I have been doing this work, I have been able to send 150,000 baht ($4,226) to my parents so that they could build a new house.”

The exact number of Shan sex workers in Chiang Mai is difficult to estimate, but a 2003 study conducted in collaboration with the Thai Ministry of Public Health for the XV International AIDS Conference in Bangkok found that 49 percent of the 198 male sex workers surveyed in 14 establishments were of non-Thai ethnicity and, of these, 64 percent were Shan.

Because prostitution is officially illegal in Thailand, sex workers tend to keep a low profile, making accurate statistics almost impossible to obtain. It is possible, however, to get a rough idea of the industry’s growth by looking at a city’s number of gay establishments. According to a study by the University of Amsterdam’s Department of Anthropology, there were only eight venues in Chiang Mai catering mainly to homosexual clientele in 1994. Today, there are around 35.

Because they fall below the radar, this growing population of migrant male sex workers receives little assistance from NGOs. While several organizations in northern Thailand address the issue of migrant labor and others work with ethnic minorities, very few NGOs deal directly with male sex workers.

“Swing in Bangkok and Mplus in Chiang Mai are the only organizations that work with sex workers because they are male sex workers and not primarily for some other reason,” says Marcus Dresner, a German human rights worker who recently conducted a study into social stigma and support for male sex workers in Chiang Mai. Mplus provides northern Thailand’s only free clinic for MSM, or “men who have sex with men.”

“We try to provide male sex workers with information, healthcare and support,” says Mplus project manager Pad Thepsai. “We want to help them to help themselves.” The organization also does outreach work with male sex workers and youths, providing information and distributing free condoms with the aim of curbing the spread of sexually transmitted diseases. While the incidence of HIV/AIDS and other STDs is much lower in Thailand than in other parts of Asia, a 2005 study conducted in conjunction with the Thai Ministry of Public Health and the US Center for Disease Control and Prevention estimated that 11.4 percent of male sex workers in Chiang Mai are HIV positive.

“The contribution of Mplus is invaluable, but there is still great need for additional outreach work, especially with the Shan men, as the language barrier makes it more difficult for them to get involved in the Mplus activities,” says Dresner.

Shan and Burmese sex workers, especially those new to the country and industry, are also the least likely to know about sexual health education; their culture regards talking openly about sexual issues as taboo, and Burma’s limited education and healthcare services offer very little access to information. “The Shan are really at the bottom of the industry hierarchy,” says Dresner. “They are the ones who are most in need of support but very little is available to them.”

The stigma experienced by sex workers compounds the problem, and male prostitutes are perhaps the most stigmatized of all sex workers in Thailand. Yet it is abundantly clear that Chiang Mai’s male sex trade is thriving and expanding at a rapid rate. Sadly, without the development of additional support services, the social, emotional and health problems of young, male Shans are likely to increase.

*All names of the sex workers in this article have been changed to protect their identity


Male attitudes need to change to stop HIV spread

By, World Vision New Zealand, April 30, 2007

Male attitudes need to change to stop spread of HIV, says World Vision CEO

Male attitudes towards women need to change if we're to reduce the spread of HIV and AIDS in the Pacific. That's the strong message World Vision CEO Lisa Cescon will bring to Wellington when she meets with MPs, the Governor General and the Prime Minister this week.

"We have a window of hope in the Pacific, an opportunity now to stop HIV becoming generalised in the population. We know we need better nutrition and healthcare for people with HIV. We know we need anti-retrovirals, and the people and the infrastructure to distribute these. All of these take resources and time," says Miss Cescon.

"But what we really need now to prevent this epidemic becoming generalised throughout the whole Pacific Region is strong leadership and clear prevention messages. What we can do right now is help change attitudes, especially the attitudes of men towards women in Pacific nations, and we need leadership from the top to help achieve this."

Miss Cescon will suggest to the Prime Minister that New Zealand could well take a lead in educating men in the Pacific about these issues.

"Teachers, social workers and medical workers from New Zealand could well be seconded to train their counterparts in the Pacific on these matters," she says.

Miss Cescon says the HIV and AIDS pandemic is increasingly becoming feminised, and this is reflected in the numbers of infections – 7,000 women and girls become infected with HIV every day globally.

"One of the drivers of the spread of HIV is gender-based violence, particularly sexual violence against women.

"There is no doubt this is encouraging the spread of the disease. In Papua New Guinea, where AIDS is now generalised, there are 60,000 reported cases of HIV, and there's been a 30 per cent increase in HIV infections every year since 1997.

"Perhaps more concerning, though, is that young women are three times more likely to be infected than young men. We also know from studies that 60 per cent of married men in Port Moresby are having sex outside of marriage and using commercial sex workers."

World Vision conducted a survey among sex workers in Port Moresby and found 27 per cent were HIV positive.

Miss Cescon said similar circumstances in sub-Saharan Africa in the 1980s led to the AIDS epidemic devastating whole countries.

"In Africa, the spread of HIV was exacerbated by poverty. Men being forced to live and work away from home; women driven by poverty to work as commercial sex workers on the trucking route. These are not issues of morality, they are issues of poverty and deeply ingrained attitudes."

Women in developing communities are often powerless to protect themselves, says Miss Cescon.

"They're faced with physical and sexual violence; they're unable to negotiate safe sex, and they face community and societal discrimination and stigma. We need men globally to take responsibility for the plight of women and children, and to take leadership in changing male attitudes, behaviours and practices towards women."

Miss Cescon will be talking to MPs, government officials, the Prime Minister and the Governor General about this issue as well as addressing Wellington Central Rotary club and church leaders.