AIDS Care Watch

Tuesday, June 19, 2007

Aids fatalities on the rise

By, Robert Laing, The Times, June 18, 2007

HIV/Aids is South Africa’s tenth biggest natural killer.

The number of deaths from Aids-related diseases increased by 3.3percent, which researchers at Statistics South Africa said might partly be attributable to improvements in death registration and population growth.

The report by Stats SA entitled “Mortality and causes of death in South Africa, 2005: Findings from death notification” said that tuberculosis was responsible for most natural deaths (12.5 percent) followed by influenza and pneumonia (7.7 percent) and intestinal infectious diseases (4.8 percent).

The report said: “This release covers mortality and causes of death broadly, and hence does not focus specifically on HIV/Aids. It does, however, provide indirect evidence that HIV may be contributing to the increase in the level of mortality for prime-aged adults, given the increase in the number of deaths due to associated diseases.

“The data captured through this exercise can contribute to detailed studies in which the incidence of deaths due to Aids-related conditions is estimated”.

The data indicated that the death rates of the leading natural killers were generally on the increase, with HIV/Aids deaths increasing by 8.1 percent from 2004 to 2005. Diabetes mellitus was another disease the statistics showed needs to be given priority.

The report is divided into sections with titles like “Death by Sex”, “Death by Age”, and “Death by province”.

The age data shows South Africa’s infant mortality rate is on the rise, listing 1906 babies under the age of 14 months having died of malnutrition in 2005.

The highest number of deaths were children under four (10.4 percent), followed by adults between 30 and 34 (10 percent).

Intestinal infectious diseases were the leading cause of death for those aged one to four years.

Nearly a quarter (23.6 percent) of children aged one to four years died as a result of this disease. The second leading causes were influenza and pneumonia, followed by malnutrition and tuberculosis. HIV ranked sixth.

The report is not entirely depressing in that it showed unnatural deaths decreasing: The data showed that 91 percent of South Africans died from natural causes.

The Western Cape had the highest percentage of deaths associated with non-natural causes, mostly due to assaults.


Friday, June 15, 2007

Women suffer most in AIDS fight; Africa's losing battle takes its heaviest toll on females

By, Mary Katherine Keown, The Sudbury Star, June 13, 2007

She was 27 years old, a single mother of two young children, and had only days to live. Theresia, a former prostitute, was dying of AIDS.

She was frail, weak and had been sick for a long time. She went to the hospital and was tested for HIV. She tested positive, but was sent away without treatment, or pain medication, because she was not a suitable candidate for anti-retroviral treatment.

"It was disgusting," says Madeline Johnson, a Canadian CUSO co-operant working at Uhai Centre, about her visit to Theresia. "She had skeletal hands, and was a pile of ribs and tiny boobs. We prosecute people for allowing animals to live like that, with those kinds of problems. How is it OK to allow humans to live like that?" Uhai Centre is a frontline, Arusha, Tanzania-based agency that works with HIV-positive people, particularly women, orphans and vulnerable children.

Theresia was confined to a filthy foam mattress. She was unable to wear a skirt or pants because of genital infections, and could not speak because of severe thrush. She was given medications for her opportunistic infections, but died 10 days after the Uhai team visited her.

"When the five-year-old picked up the two-year-old and walked out of the room, I saw their future," Johnson says, close to tears.

"It was awful. I have no idea what's happened to those children or whether they're even eating."

HIV is indiscriminate, but in sub-Saharan Africa, and Tanzania in particular, it is an infection that targets women.

It was not always this way.

As in most other regions of the world, HIV initially infected more men than women, but because of the nature of African society, it has become an overwhelmingly feminized illness.

"From the beginning of the AIDS crisis in sub-Saharan Africa, the epicentre of the epidemic, the number of infected women has been growing more rapidly than that of infected men," writes Michael J. Kelly, a Zambia-based priest, in The Female Face of HIV and AIDS.

The article is used as part of an annual lecture delivered through Trocaire, the official overseas development agency of the Catholic church in Ireland.

"The widening gap between the numbers of infected women and men, especially in recent years, provides a dramatic illustration of the increasingly female face of the epidemic," Kelly says. "By the end of 2006, an estimated 59 per cent of infected adults in the region (sub-Saharan Africa) were women. For every 10 infected adult men, there were more than 14 infected adult women.

"This gender differential has arisen partly because HIV transmission in sub-Saharan Africa occurs mainly as a result of heterosexual activity, and partly because of the extensive gender inequality experienced in the region.

"In other regions of the world, where transmission occurs mainly through homosexual activity, injection drug use or commercial sex work, men are still more likely than women to be infected with HIV." There are several reasons HIV/AIDS has been feminized in sub-Saharan Africa, including the severe economic disparities that exist between the affluent and the poor. Nearly 60 per cent of Tanzanians live on less than US$2 per day, or US$730 annually, according to the 2006 UNAIDS Report on the global AIDS epidemic. This extreme poverty has been a major factor driving the HIV/AIDS epidemic in Tanzania.

The UNAIDS report indicates that, at the end of 2005, Tanzania had an HIV prevalence rate of approximately 6.5 per cent. Of those living with HIV/AIDS, approximately 55 per cent were women aged 15 and above, up from 52 per cent in 2003.

Traditional gender roles have contributed to the spread of HIV among women. AIDS impacts women differently than men, and poverty and violence make women more susceptible to HIV infection.

"Poverty makes women dependent on men," Johnson says. "Because of that, they must endure violence, including sexual violence. The thing is, in marriage, most men don't feel the need to use condoms. They feel entitled to sex.

"For example, Elizabeth, a client at the Uhai Centre, married out of economic necessity.

Her new husband beat her and her three children, who were severely malnourished. Uhai Centre finally intervened and sent the three oldest children to live in an orphanage. When Elizabeth and her youngest child were tested for HIV, they both tested positive."

Julius Sabuni, a lawyer, and the human rights and advocacy officer at the Eastern Africa National Networks of AIDS Service Organization (EANNASO), agrees with Johnson's assertions.

"Generally, women and children - particularly girl children - are most affected by HIV," Sabuni says. "Historically, women have borne the brunt of community social life. The gender inequalities that exist, and have existed for a long time, have made women carry the burden of day-to-day household chores and socio-economic life, in general.

"They are the ones who care for the sick when people fall sick due to HIV infection. Because the medical system cannot cater to HIV/AIDS patients adequately, most patients are cared for in their homes. It is women who care for the sick."

The virus also infects more women than men.

"Socio-economic factors (that contribute to risk of HIV infection) include the power to negotiate sex, which, of course men have and women lack, in our context," Sabuni explains. "It is the men who make the advances and it is the men who decide whether or not to put on a condom. Because of the economic power that men have and women lack, it is always men who decide."

In Tanzania, marriage has emerged over the last decade as a major risk factor for HIV infection.

"HIV is common among sex trade workers, but the prevalence rate has fallen," Sabuni explains. "The prevalence rate among married couples has risen. Ten years ago, sex workers used to die and were affected very much, but nowadays commercial sex workers are not as high-risk as married people."

Sabuni also attributes the high prevalence of HIV infection among women in sub-Saharan Africa, in part, to traditional practices, such as widow inheritance and spear sex.

While little scientific evidence exists to support this thesis, Sabuni points out that numerous studies have indicated these practices, particularly widow inheritance, put women at higher risk for infection.

"There are many cultural practices in Africa that are believed to contribute to HIV infection," Sabuni says. "There is the practice of widow inheritance in some communities in Tanzania, whereby you find a brother of the deceased husband inheriting the widow of his late brother, allegedly to take care of the family. The inheritor takes on all the responsibilities, including having children with the widow."

For many women, particularly low-income, rural-dwelling and/or poorly educated women, being inherited is not a choice; it is the only way they can continue to support their families.

"Women, particularly, have suffered the most when it comes to discrimination and HIV/AIDS," Sabuni asserts. "They have been denied inheritance. This is a violation of human rights - a number one violation of human rights. They have also been denied property after their husband has died."

Spear sex, although less common now than in the past, is still practiced by some tribes in Tanzania and is also believed to put women at elevated risk of HIV infection.

"There is a practice, which the Masai call 'spear sex,' in which women are shared among male members of the community," Sabuni says. "Men will go to a homestead and if the husband is not there, the visitor will stick a spear in the ground at the front of the house. He will go in and have sex with the woman, if they are of the same age group.

"The practice has existed for some time and now we are seeing its negative results."

Sabuni says that, while awareness-raising campaigns have made some progress in eradicating spear sex and widow inheritance, they continue among the Masai (a semi-nomadic tribe present in several eastern African countries) and in some other tribes, and contribute to the growing number of HIV infections in southern and eastern Africa.

Theresia was a former prostitute.

She died of AIDS, alone on a filthy mattress surrounded by the evidence of her impoverished life. The virus, however, did not target her - entirely - because of her lifestyle or her socio-economic class. Theresia's major risk factor was, simply, her gender.


Uganda: Married Women at Higher Risk of HIV

By, Joyce Namutebi, New Vision (Kampala), June 13, 2007

While HIV prevalence among young people in Uganda has gone down dramatically, married women remained at high risk of contracting the disease, Mrs. Janet Museveni said yesterday.

Addressing hundreds of delegates at the 8th Commonwealth Women affairs Ministers Meeting, the first lady said advocacy efforts, including multi-media campaigns, had contributed to the sharp decline in prevalence rates among the age group 15 to 25 years.

These campaigns also helped to bring down teenage pregnancy from 43% in 1995 to 34% in 2000 and to reduce casual sex by 60% in the last 20 years.

However, adult women, especially married women, remained at the greatest risk of contracting HIV, Mrs. Museveni noted.

"The most immediate cause of women's HIV vulnerability is their limited power to negotiate safer sex, combined with the lack of female-controlled HIV prevention methods other than the female condom," she observed.

"The female condom has proved to be too costly for many women, is not always available and cannot always be used without the partner's knowledge."

Mrs. Museveni, who has been at the forefront of fighting the pandemic and caring for orphans, called upon the Commonwealth countries to help find an Aids vaccine.

She also asked the heavily affected countries to support vaccine trials, like Uganda has been doing.

"If an Aids vaccine is to become a reality, there is need to significantly expand the level of political support globally. Where there is significant political will, there is usually significant financial support," she stated.

The First Lady appealed to the Commonwealth to assist Uganda in addressing the impact of conflict on women and children, especially in the North.

She called for the training of counsellors to help rehabilitate the victims of rape and mutilation, re-integrate young women in their communities and help settle unwanted babies of rape victims.

Earlier at the conference, Uganda was hailed as a 'success story' and an 'interesting case study' for bringing prevalence in pregnant women down from 18% in the early 1990s to 6% in 2005.

"This has made Uganda a subject of intense scrutiny to discover what lessons learnt can be transferred to other contexts," said Dr. Robert Carr of the University of the West Indies in Jamaica.

He stressed that the context in which Uganda was responding to the HIV scourge was complex, considering that 32% of married women were in polygamous marriages.

Quoting from the Aids Policy Research Centre at the University of California, San Francisco, he confirmed that adult women in Uganda were more vulnerable to HIV because of their low status, lower education levels, higher unemployment and weaker negotiating skills in relationships.

"The Government has implemented a far-reaching affirmative action programme to promote women's political participation. However, many customary and statutory laws discriminate against women in areas of marriage, divorce and inheritance. These customs include property grabbing," he stated.

The vulnerable position of Ugandan women was highlighted by a community-based study in Rakai. "Thirty percent of women had experienced physical threats or abuse from their current partners. 90%of women viewed beating of the wife or female partner as justifiable in some circumstances,"said Dr. Carr.

The Rakai researchers found a link between alcohol consumption and domestic violence. "Women whose partners frequently or always consumed alcohol before sex faced risks of domestic violence almost five times higher than those whose partners never drank before sex."

Dr. Carr pointed at the particular vulnerability of girls orphaned by Aids. "Poverty and being orphaned expose the girl child to a greater risk of HIV infection through early marriage, sexual abuse and prostitution."

Uganda managed to turn the HIV/Aids tide by identifying goals and developing policies that related to addressing gender inequality.

He cited promoting behaviour change among sexually active people, the reduction of mother-to-child transmission by a third by 2005, and protecting the rights of at least 50% of the families most affected by HIV/Aids as some of the goals.


Wednesday, June 13, 2007

Ghana: Fighting HIV/Aids Before 2010

By, Ghanaian Chronicle (Accra), June 11, 2007

WITH LESS than three years for all HIV/AIDS prone countries across the globe to fulfill the pledge to achieve universal access to HIV prevention, treatment and care by 2010, Action Aid International Ghana has expressed fears that Ghana, unlike some other African countries, was in danger of missing the target which was fashioned to give hope to the over 40 million people living with HIV/AIDS worldwide.

According to the Northern Regional Senior Programme Officer of Action Aid Ghana, Mr. Anaba Nabila Kumsonyare, Ghana as a nation had failed to recognise that one of the easiest ways of preventing the virus from spreading was providing drugs to HIV positive pregnant women to curtail mother to child transmission, which is currently one of the leading causes of HIV/AIDS.

Speaking at the Global Week of Action on HIV/AIDS celebration here in Tamale, the Action Aid official passionately called on the ruling government to urgently attach seriousness to the implementation of the pledge to achieve universal access to HIV prevention, treatment and care by 2010. The Programme which was sponsored by Action Aid International Ghana was jointly organised by Northern Sector Action on Awareness Centre (NORSAAC), Social Centre for People's Empowerment (SCOPE), Tamale Metro Assembly (TMA), Ghana HIV/AIDS Network (GHANET), Positive Steps Ghana and PLWHA all in Northern Region.

He revealed that global examples of access to drugs, treatment and care had shown that countries like Swaziland, China and Cambodia have been able improve tremendously by 40%, 27% and 91% respectively.

He therefore expressed the hope that government would ensure that Ghana overtakes all these countries in terms of treatment.

Mr. Anaba maintained that, "unless our leaders back their rhetoric with real action and resources to promote and fulfill women's sexual and reproductive rights, we run the risk of losing the fight against HIV/ AIDS. Women and girls are the fastest growing group of people living with HIV/AIDS and the young women constitute 76% of all new cases in sub-Saharan Africa".

He asserted that there could be no effective treatment, care and support for people living with HIV/AIDS, without well resourced, comprehensive and strengthened primary healthcare services that reached the poor in society.

He therefore reminded African governments of a promise they made in 2001 to invest 15% of their annual expenditure on public health systems, which almost all of them had failed to do, apart from Botswana.

Meanwhile, only one out of every ten HIV/AIDS victims has access to drugs and treatment.

Mr. A. Ibrahim Afa-zie of the Ghana HIV/AIDS Network (GHANET), said the Global Week of Action on HIV/AIDS had been instituted to draw attention of the World to the devastating nature of the AIDS pandemic and to canvass world support in terms of financial and human resources to fight the disease.

He greatly expressed worry about the HIV/AIDS pandemic, which he noted was affecting both social and economic fortunes of Africa.

Mr. Afa-zie was of the view that if care was not taken, Ghana and for that matter Africa would be ruled by HIV/AIDS Presidents, Ministers of States, Members of Parliament, District Chief Executives and Assembly persons.


Bangladesh: HIV prevalence rises to 4 pc

By, The New Nation, June 12, 2007

The rate of HIV prevalence increased from 1.4 per cent to 4 per cent in past three years in the country.

Injecting drug users are 20,000 to 40,000, heroine smokers 30,000, female sex workers at street, brothel and hotel are 54,000 to 90,000, male sex workers and males who have sex with males are 40,000 to 150,000 and hijras 10,000 to 15,000 in the country at present.

In injecting drug users, HIV prevalence increased 4 to 7 .1 per cent in last four years.

Due to low condom use and sharing needles, high-risk behaviour people are increasing in the country every day.

This was disclosed at a national workshop on 'Advocacy Experiences and HIV/AIDS Mainstreaming' organised by Padakhep Manabik Unnayan Kendra (PMUK) in support with the National AIDS/STD Programme and Save the Children at Officers' Club in the city yesterday.

Maj Gen (Retd) Dr ASM Matiur Rahman, Adviser to the Ministry of Health and Family Welfare, Water Resources and Religious Affairs, addressed the workshop as chief guest.

Md Abdul Karim, Secretary of the Ministry of Home Affairs, M Ataur Rahman, Secretary of the Ministry of Religious Affairs, M Didarul Anwar, Secretary of the Ministry of Information, Sheikh Md Wahid-uz-Zaman, Secretary of the Ministry of Science and IT, Md Abdus Sabur, Secretary In-charge of the Ministry of Chittagong Hill Tract Affairs, Md Golam Mostafa Talukder, Secretary, In-charge of the Ministry of Youth and Sports, Abdul Awal Majumder, Additional Secretary of the Ministry of Education, Rokeya Sultana, Secretary, In-charge of the Ministry of Women and Children Affairs, Dr Nizam Uddin Ahmed, Director of HIV/AIDS Programme, Iqbal Ahammed, Executive Director of the PMUK, Kelland Stevenson, Country Director of Save the Children USA, Dr Md Hanif Uddin, Programme Manager of the National AIDS/STD Programme, among others, spoke, while Jamil Osman, Additional Secretary of the Ministry of Health and Family Welfare chaired the session.

Health Adviser said the government is going to introduce HIV/AIDS test for the external migrants. Some 14,000 people are infected HIV/AIDS in the world everyday. But in Bangladesh, this rate is too low.

"If everybody of the country follow the rules to prevent the HIV/AIDS and also follow the religious taboos, HIV/AIDS can not be spread in the country," he also said.

The government will take more steps to prevent the HIV/AIDS in the country with including NGOs, representatives of the civil society and media personnel very soon, he added.

© Copyright 2003 by The New Nation


Tuesday, June 12, 2007

South Africa: Reduced HIV and Aids Pregnancies - Health Dept

By, Seshnee Govender, BuaNews (Tshwane), June 8, 2007

Health Minister Manto Tshabalala-Msimang has highlighted South Africa's progress in decreasing the prevalence of HIV amongst pregnant women.

"I am happy to announce that the 2006 antenatal survey results show a statistically significant decrease in the prevalence of HIV amongst pregnant women who use public health facilities.

"This is mainly as a result of our continued focus on prevention as the mainstay of our response to combat HIV and lead to an HIV free society," said Minister Tshabalala-Msimang during her budget vote Thursday.

The department and its partners have also developed the National Strategic Plan for HIV and AIDS for 2007-2011 which builds on the gains of the Strategic Plan for 2000-2005.

It aims to achieve a 50 percent reduction of new infections by 2011 and provide an appropriate package of treatment, care and support services.

The package of care provided for in the plan includes counselling and testing services as an entry point; healthy lifestyle interventions, including nutritional support; treatment of opportunistic infections; anti-retroviral therapy and monitoring and evaluation to assess progress and share research.

The minister said that her department will do everything in their power to contribute to the successful implementation of the National Strategic Plan.

The department has also re-launched the government's HIV and AIDS communication programme, Khomanani which has been allocated R190 million for a two year period.

"We have re-launched the Government HIV and AIDS communication programme, Khomanani which has been allocated R190 million for a two year period.

"This communication programme encourages responsible sexual behaviour and mobilise access to treatment, care and support services for those who are infected and affected," she said.

During the last financial year, more than 439 million male and more than three million female condoms were distributed.

"We supported home and community based programmes in 60 percent of sub-districts and more than 493 000 patients with debilitating conditions received nutritional support.

Since the start of the antiretroviral treatment component of the Comprehensive Plan, more than 282 836 patients have been initiated on ARVs in the 335 accredited facilities by the end of March 2007.

Tuberculosis (TB) control remains a major challenge, the minister said but some advances have been made in this regard.

"Case finding is relatively good, 89 percent of patients diagnosed with Pulmonary TB are started on treatment and large numbers are placed on direct observed treatment," she said.

The department's efforts to control malaria has improved as 4 404 malaria cases were reported between June 2006 and April 2007 as compared to 11 246 cases reported for the June 2005 to April 2006.

During the same reporting period, the number of deaths decreased from 88 to 31.

The main reasons for this decline include indoor residual spraying using Dichloro-Diphenyl-Trichloroethane which has now been accepted by World Health Organisation as the significant tool in malaria control after many years of South Africa's engagement on this issue.

The department has also made significant gains in the hospital revitalization programme.

"We already have state-of-the art tertiary hospitals in the form of Inkosi Albert Luthuli and Pretoria Academic Hospitals and ten other hospitals have been completed in the past three financial years.

"We currently have 46 revitalisation projects with 30 already on site and 16 in the planning stages.

"We hope to complete the following hospitals during this financial year: Mamelodi Hospital in Gauteng; Worcester Hospital in the Western Cape; Rietvlei Hospital in KwaZulu-Natal; and Barkley West in Northern Cape," the minister said.

The department has also highlighted the success of the Emergency Medical Services (EMS).

"We have developed a national EMS Plan for 2010 and we are confident that with the right levels of investment in EMS as well as in hospitals in the host cities, we will be ready for any eventuality that may occur during the 2010 FIFA Soccer World Cup," she said.


India Downsizes Number With HIV/AIDS

By, The Associated Press, June 8, 2007

The number of Indians infected with HIV is far smaller than previously believed, according to new data that appears to vindicate critics who said earlier U.N. assessments of the country's epidemic were vastly overestimated.

Experts say the still-unreleased survey is likely to show that India's number of HIV cases, which last year was said to be the highest in the world at 5.7 million, is actually well below that mark.

"The actual number we've come up with in aggregate is likely to be lower, and perhaps substantially lower," said Ashok Alexander, director of the Avahan, the Indian program of the Bill & Melinda Gates Foundation, which helped fund the study.

Alexander declined to estimate what the new number would be, saying the data is still being analyzed and precise numbers would not be released for a few more weeks.

The new estimate comes from combining data collected from prenatal clinics; a survey of high-risk groups, such as sex workers; and from the government's National Family Health Survey - a method Alexander said was more reliable than the previous estimates, which relied largely on extrapolating from the prenatal clinic data.

The health survey - the third conducted since 1992-93 but the first to provide an HIV estimate - is considered the most comprehensive source and carries the most weight in determining the new figures. It covers about 200,000 people between the ages of 15 and 54, more than half of them women, and was conducted through face-to-face interviews all across India between December 2005 and August 2006.

A statement released Friday by the government's HIV control program, UNAIDS and the World Health Organization acknowledged that the new data provided "a more accurate picture of the epidemic because of availability of more information based on population surveys and improved data from high-risk groups."

But in an indication of how sensitive the new data is in India, where billions of dollars have been poured into prevention programs to stop the spread of HIV, the statement made no mention of the lower overall estimate.

Instead, it only pointed out that HIV rates remain high about groups most at risk - sex workers and their clients, especially truckers; men who have sex with men; and intravenous drug users.

Daniel Halperin, an HIV and AIDS expert at the Harvard School of Public Health, said the new data put health officials in a bind.

"On the one hand there's a real HIV epidemic in India and it needs to be addressed, but on the other, there's an understandable concern that people were worried that funding or attention could be diminished if the prevalence numbers come out lower," he said.

While health experts called the new data good news, they cautioned that HIV is still a major problem, particularly in southern Indian states where rates might be as high as 1 percent of the general population.

"This is a bit like declaring victory before even fully fighting the battle," Alexander said.

This is not the first time experts have questioned India's official HIV numbers.

Halperin and colleagues have published several studies in leading medical journals arguing that the number of AIDS victims in India and other parts of the world are actually far lower than the official numbers claim.

In 2006, Indian doctors argued in a published report that the methodology gave a flawed picture because the amount of HIV-positive people reporting to prenatal clinics, sexually transmitted infection clinics and public hospitals was not representative of their true numbers in the population.

The lead investigator behind the report, Dr. Lalit Dandona of the Administrative Staff College of India in the southern city of Hyderabad, estimated the number of infected adults at between 3.2 million and 3.5 million.

In a country with a population of more than 1.1 billion people, that's far fewer than 1 percent.

While Africa has long attracted most of the attention from international HIV experts, some Western AIDS organizations have argued in recent years that the Indian government was underestimating the scale of its HIV problem, Halperin said.

He thought the new data could serve as vindication for Indian officials.

"It turns out that some people in the government years ago were correct in rejecting the notion that the epidemic was spiraling out of control," he said.

Experts found the dramatic revision in line with an improved understanding of AIDS across the globe.

"There are corrections that happen in the data from time to time," said Paul Zeitz, executive director of the Global AIDS Alliance in Washington. "But if India still has millions of infections, there are still risks for increasing those numbers."


Friday, June 08, 2007

Africa: Thousands of Babies Are Still Being Infected With HIV By Mothers

By, Kerry Cullinan, Health-e (Cape Town), June 7, 2007

Shocking figures about HIV infection in babies and high AIDS-related child mortality have made the transmission of HIV from mothers to babies a key focus of third South African AIDS conference.

South Africa has had a prevention of mother-to-child HIV transmission (PMTCT) programme since 2003, yet it is only reaching an estimated one-sixth of pregnant, HIV positive women.

This means that thousands of babies are being infected each year as at least one in three pregnant women nationally was HIV positive by 2005 and around a third of HIV positive mothers transmit HIV to their babies.

"South Africa is one of only nine countries in the world where the child mortality rate is increasing instead of decreasing, mainly as a result of HIV-related deaths," revealed Professor Nigel Rollins, head of the Centre for Maternal and child health at the University of KwaZulu-Natal.

"In KwaZulu-Natal alone, 20 000 to 30 000 children are being infected with HIV each year and half of them will need antiretroviral drugs by the age of 12 months.

"There is no way that the health system will be able to meet the treatment and care demand for these children if this infection rate continues," Rollins told a session convened by the United Nations children's organisation, Unicef.

The health system is already failing to treat HIV positive children. By last year, only 21 000 children were getting ARVs out of an estimated 123 000 children who needed the medicine, according to Farai Dube from Enhancing Children's HIV Outcomes.

Over six out of 10 children under the age of five who died in Durban last year showed clinical signs of HIV infection, yet "the vast majority" did not have access to PMTCT or ARV treatment, according to Dr Kimesh Naidoo of King Edward Hospital.

The new National HIV/AIDS Strategic Plan aims to reduce the rate of mother to child transmission to 5% by 2011.

To do so, government needed to prioritise pregnant women with a low CD4 count (measure of immunity in the blood) who were most likely to transmit HIV to their babies, said Rollins.

These women should be treated with at least two antiretroviral drugs to reduce their infectiousness and ensure that they were well enough to look after to look their babies, he added.

At present, the PMTCT programme gives one dose of nevirapine to women when they are in labour and to their babies within 72 hours of birth.

"We will never cut the transmission rate to 5% with one dose of nevirapine. In the US and Europe, mother-to-child transmission has been reduced to around 2% with the use of two to three antiretroviral drugs," said Dr Francois Venter, head of the SA HIV Clinicians' Society.

"If we fix PMTCT, we don't have to expand child HIV treatment."

A wide range of conference delegates pleaded for government to change the way that PMTCT was being implemented to reach more women. Among the proposals put forward were that:

PMTCT should be integrated into antenatal clinics and run by midwives and nurses instead of being a stand-alone programme run mainly by lay counsellors.

All antenatal clinics and hospitals should stock nevirapine.

Clinic staff should be involved in developing locally appropriate messages to encourage women to have HIV tests.


Thursday, June 07, 2007

Women won’t wait

By, Susana Fried, Open Democracy, June 6, 2007

It is dangerous to separate the fight against HIV/Aids and the struggle for women’s health and rights, Susana Fried warns the G8.

The German presidency of the G8 has made fighting HIV and Aids in Africa a priority for the Summit at Heiligendamm this week. Leaders of the world's wealthiest countries have committed to supporting HIV/Aids prevention, treatment, and care, with the goal of coming "as close as possible" to universal access to treatment by 2010. But these lofty promises have not yet translated into dedicated funding to address a major and prevalent driver of the pandemic - the deadly intersection of HIV/Aids with violence against women and girls.

To state the obvious - violence against women and girls is a big contributor to death and illness among women, as well as to a host of human rights abuses. Moreover, gender-based violence, and particularly intimate partner violence, is a leading factor in the increasing "feminization" of the global Aids pandemic. Simultaneously, HIV/Aids is both a cause and a consequence of the gender-based violence, stigma and discrimination that women and girls face in their families and communities, in peace and in conflict, within and outside of intimate partnerships, and by state and non-state actors.

Yet agencies continue to treat HIV/Aids and violence against women and girls as separate issues - so that not only are efforts to address violence as a cause and consequence of HIV infection under-funded, but also the strategic imperative for integrating these efforts continues to suffer from a dangerous and dysfunctional split. Rather than comprehensively addressing this deadly intersection, national and global Aids responses continually fail to grapple with its implications.

The discrimination and abuse faced by same sex desiring and gender non-conforming individuals is captured by the term "heteronormativity". This term is used to encompass practices used to enforce "normal" (men as 'masculine' – read assertive and in control, and women as feminine – read passive and docile) heterosexuality. Cathy Cohen has defined heteronormativity as the practices and institutions "that legitimize and privilege heterosexuality and heterosexual relationships as fundamental and "natural" within society" (2005: 24). Her work emphasizes the importance of sexuality as implicated in broader structures of power, intersecting with and inseparable from race, gender, and class oppression. See also

The roots of the problem

Women and girls are at persistent risk of attack. According to the recent World Health Organization (WHO) multi-country study on violence against women, in 13 of their 15 study sites, one-third to three-quarters of women had been physically or sexually assaulted by an intimate partner. Violence, or the threat of it, not only causes physical and psychological harm to women and girls, it also limits their access to and participation in society because the fear of violence circumscribes their freedom of movement and of expression as well as their rights to privacy, security and health. Women and girls encounter violence in their homes, communities, schools, workplaces, streets, markets, police stations and hospitals. And women who are HIV-positive face an additional danger: the stigma and threat of violence against people living with HIV and Aids.

Women are two to four times more likely to contract HIV during unprotected sex than are men, because their physiology places them at a higher risk of injuries, because they are less able to control the circumstances and conditions of sexual intercourse, and because they are more likely than men to be at the receiving end of violent or coercive sexual intercourse. Elements of the Aids testing, treatment and prevention machinery may also bring risk, such as the danger of violence connected to disclosure of HIV positive serostatus, coercive testing in the guise of voluntary counseling and testing (VCT), or the insidious treatment of women as vectors of disease, as in the case of prevention of mother-to-child transmission programmes (PMTCT) that fail to treat pregnant HIV positive women as clients with rights, or only as, and nothing more than, child-bearers.

The impacts of both HIV/Aids and violence against women is exacerbated by inadequate services and failure to protect sexual and reproductive health and rights; laws that are weak or discriminatory toward women living with HIV/Aids; social and community standards that validate the subordination of women and all others whose sexuality and gender identity do not conform to social standards of appropriate femininity and masculinity; and the intersecting forms of discrimination faced by women and girls because of their race, language, sexuality, ethnicity, and other similar factors.

This is why national and international commitment to universal access is crucial to reversing the HIV/Aids pandemic. But only in rare instances have states fully committed to grappling with women's human rights in relation to violence or HIV/Aids. Equally rarely have donors and other multilateral agencies created structures of accountability in service of respecting, protecting and fulfilling the human rights of women and girls. The Women Won't Wait campaign's March 2007 report looked at the policy, programming and funding patterns of the five largest public HIV/Aids donors and found that strong statements of policy concern 'evaporate' at the level of implementation. The level of funding for efforts to address gender-based violence remains small and often marginalized, while the integration of violence against women programming in the much larger pot of funding for HIV/Aids is inadequate and hard to trace.

Gender-based violence continues to be treated as an "add-on" rather than as integral to work on HIV/Aids. Meanwhile, levels of funding for women's rights work are 'dismal', according to the Association for Women's Rights in Development. Violence against women and girls is rarely highlighted as a major driver and consequence of the disease, nor measured statistically to contribute to the evidence base. It is nearly impossible to determine the precise amount of money contributed to work at the intersection because none of these donors publicly track their programming for and funding to violence eradication efforts within their HIV/Aids portfolio. All this despite the fact that - as WHO Director-General Margaret Chan has said - "what gets measured gets done".

Show us the money

Real commitments on the issues of gender-based violence against women and girls and the feminization of the AIDS epidemic from member nations of the G8 are long overdue. G8 member nations must now take bold steps to demonstrate their commitment to respect, protect and fulfill women's rights - especially in the context of HIV/Aids - by promoting policies and negotiating positions that ensure adequate health care, education, legal services, and gender-sensitive and rights-based Aids and anti-violence interventions.

Women's movements throughout the world have long fought for concrete action to promote and protect the human rights of all women - including the rights to be free from violence, coercion, stigma and discrimination, and the right to achieve the highest attainable standard of health, including sexual and reproductive health. But this global standard is rarely translated into policy and practice. In the case of HIV/Aids, this results in a deadly failure in policy and an abrogation of governments' and donors' accountability. The waiting must end


Wednesday, June 06, 2007

HIV And Malaria Combine To Adversely Affect Pregnant Women And Their Infants

By, Medical News Today, June 4, 2007

University of Toronto researchers have uncovered the basis by which pregnant women protect themselves against malaria and have also discovered how the HIV virus works to counteract this defence. The research could lead to improved vaccines for pregnant women in malaria-ravished regions.

Malaria is a parasitic disease spread by mosquitoes that kills more than one million people every year. While the disease affects mostly children, malaria also severely affects pregnant women, especially during their first pregnancy, accounting for an estimated 400,000 cases of severe anaemia and 200,000 infant deaths each year. With the recent realization that HIV further aggravates pregnancy-associated malaria (PAM) there is an urgent need to understand these diseases during pregnancy and turn this knowledge into effective therapies.

Until now the mechanisms by which pregnant women defend themselves against malaria and how HIV impairs this defence have been unknown, but a paper published in PLoS Medicine (Public Library of Science) pinpoints how the virus targets the immune response in pregnant women. "PAM can be a deadly condition that leaves mothers and their children particularly vulnerable," says Professor Kevin Kain, an infectious disease specialist and lead author of the study. "We set out to understand how women acquire protection against malaria during pregnancy and how HIV infection impairs that protection. By understanding how they lost protection in the face of HIV we learned how they acquired protection against malaria in the first place."

PAM occurs when red blood cells infected with malaria parasites gather in the placenta resulting in damage to both mother and developing infant. First-time mothers are particularly susceptible to PAM whereas women in subsequent pregnancies become protected against PAM. Having HIV results in this loss of protection and makes them as susceptible as first-time mothers.

To uncover how HIV affects PAM, Kain and his team collected samples from women in the first pregnancy as well as from women in their subsequent ones living in the Kenyan region where malaria is common. The researchers demonstrated that protection to PAM is mediated by a special type of antibody that allows women to preferentially clear the parasites in their placentas. They found that HIV-infected women lose these antibodies and again become susceptible to the ravages of PAM.

The findings, according to Kain, may help in the development of PAM vaccines. "This is only the first step in creating therapeutics to treat this devastating disease," he stresses. "We hope to help translate this knowledge into more effective vaccines designed to generate these types of protective antibodies."


The study was funded by Canadian Institutes of Health Research (CIHR) Team grant in Malaria, Genome Canada through the Ontario Genome Institute, and the McLaughlin-Rotman Centre/MCMM.


Tuesday, June 05, 2007

One out of 100 adults in India HIV-positive

By, The Times of India, June 4, 2007

NEW DELHI: India might be a low prevalence country for AIDS with only 0.9% of the adult population estimated to be infected with HIV. But in numbers, the situation looks grave with nearly 1 out of 100 adults in the country being HIV-positive.

In Bihar and Uttar Pradesh, the task of raising awareness about HIV is especially difficult due to the high proportion of rural population and relatively low levels of literacy. In Bihar, nearly 90% of the population lives in villages. In Uttar Pradesh, the figure is 79%. A particular problem is the literacy levels of females in both states. In Bihar, only one-third of females were literate at the time of the 2001 Census, as were 42% in Uttar Pradesh.

Despite such obstacles, awareness of HIV, how it spreads and ways to avoid it have risen in both states, according to bilingual HIV statistical chartbooks on the situation of HIV/AIDS in India, Bihar and Uttar Pradesh brought out by the Population Foundation of India, New Delhi, and Population Reference Bureau (PRB), Washington DC. The books were released at a seminar organised on Saturday. According to the charts, testing for HIV prevalence at sentinel sites in Bihar and UP has shown that HIV infection is spreading in the states, although the overall level of prevalence appears to be low at present.

Women are the most vulnerable to AIDS and yet their knowledge of the deadly disease is abysmally low. India's most scientific survey — the National Family Health Survey III, which for the first time came up with trend data on HIV/AIDS-related behaviour — has made some startling revelations.


Directly observed HIV therapy for children is promising

By,, June 3, 2007

Directly observed antiretroviral therapy is a promising strategy to ensure that HIV-infected children in developing countries take life-saving medications, new research from The Warren Alpert Medical School of Brown University shows.
The study was conducted in collaboration with Maryknoll, the international Catholic charity that runs a program for AIDS orphans in Phnom Penh, Cambodia's capital city. The study is the first to test the benefits of directly observed treatment in children living in developing countries. Findings are published in the June issue of the American Journal of Public Health.

"Results of this study tell us that directly observed treatment for children with HIV is an important strategy to consider in resource-limited settings, said David Pugatch, M.D., director of the pediatric and adolescent HIV program at Hasbro Children's Hospital and an assistant professor of pediatrics at The Alpert Medical School.

"With the cost of AIDS drugs dropping, antiretroviral treatments are increasingly becoming available in Asia, Africa and Latin America," Pugatch said, "yet there is little evidence of what is the best way to deliver these drugs to children living in these countries. We found that directly observed therapy is an effective and economical way to go."

Without antiretroviral treatment, half of all HIV-infected children die by age 2. With therapy, however, many children survive to adulthood. That's why the World Health Organization is calling for worldwide universal access to antiretroviral therapy by 2010.

But what's the best way to deliver these drugs to children in developing countries, places with often limited access to basic tests and trained professionals" Pugatch and his Brown colleagues, who have helped combat AIDS in Cambodia for years, decided to find out.

They evaluated the outcomes of HIV-infected children receiving directly observed therapy, a method that calls for health care workers to either watch patients take every drug dose or deliver those doses themselves. This method, widely used to combat tuberculosis, is aimed at ensuring that people take their medications. That adherence will keep patients healthy and reduce the likelihood of drug resistance.

Researchers evaluated HIV-infected children living in orphanages or with extended family in Phnom Penh. Researchers assessed 117 late-stage HIV-infected children ages 1 to 13.

Because treatment started so late, 22 children died of AIDS within the first six months. The remaining 95 children were treated for at least six months or as many as 18 months. Trained childcare workers administered the generic drugs, in liquid or pill form, twice daily.

The results: The number of immunity-boosting T helper cells in the blood of children more than tripled. Children gained significant amounts of weight. Drug toxicities were uncommon and easily managed. And the price was right: Staff costs for the program were about $5 per child per month, or 15 percent more than the price of the medications. Calculated another way, it cost $400 per child per year to buy the drugs and another $60 to pay the professionals who administered them.

"For just a little extra money, we could be sure that children had 100 percent adherence to their medications," Pugatch said. "We know that a high degree of adherence reduces the chances of drug resistance , which can lead to treatment failure and the need to put kids on more expensive, second-line therapies."

The next steps researchers must take, Pugatch said, are to conduct a randomized, controlled trial to compare directly observed therapy with standard care as well as to conduct a rigorous cost-benefit analysis. "We need to know what works in treating children in resource-poor settings so we know where to put limited HIV treatment dollars," he said.


Monday, June 04, 2007

Cultural traditions regarding women fueling spread of HIV in Botswana and Swaziland

By, Medical News Today, June 1, 2007

Cultural traditions that do not value women are fueling the spread of HIV in Botswana and Swaziland, according to a Physicians for Human Rights report released on Monday, AFP/Yahoo! News reports. "The legal systems in both countries grant women lesser status than men, restricting property, inheritance and other rights," the report said. It added, "Neither country has met its obligations under international human rights law," and as a result, women "continue to be disproportionately vulnerable to HIV/AIDS."

According to AFP/Yahoo! News, women do not have control over sexual relationships, including condom use, and they are afraid that testing positive for HIV will jeopardize their relationships or lead to stigma. The report also found that women's HIV status in Botswana, which has not criminalized partner violence or marital rape, affects their ability to provide food for themselves and their children after contracting the virus. The report found that many HIV-positive women in Botswana engaged in risky sex in exchange for food.

The report found that 19% of people who participated in a community survey in Botswana said it is more important for women to respect male partners than for men to respect their female partners. In addition, the report found that 97% of respondents held at least one discriminatory belief toward women. According to AFP/Yahoo! News, Swaziland has an HIV prevalence of about 40%, and men in the country are encouraged to have multiple sexual partners (AFP/Yahoo! News, 5/28).