AIDS Care Watch

Friday, August 31, 2007

Papua New Guinea AIDS Crisis May Mirror Africa's, UN Says

By, Emma O'Brien,, August 31, 2007

Papua New Guinea's AIDS epidemic may mirror the crisis in Africa as infections surge with more than 75 percent of sufferers unable to access drugs to manage the disease, the United Nations said.

``It could very much become an Africa-type situation if the required services are not in place,'' Tim Rwabuhemba, Papua New Guinea coordinator for the United Nations AIDS agency, said in an interview from the capital, Port Moresby. ``There is an urgent need for more HIV services across the board here.''

The nation of 6 million people now accounts for 90 percent of the Pacific region's HIV cases and is one of only four Asia- Pacific countries experiencing an epidemic, according to the UN. Sub-Saharan Africa is home to 60 percent of all people living with the HIV virus, a total of more than 25 million people.

HIV, the virus that causes AIDS, appeared in Papua New Guinea in the early 1990s and has spread to the remote highlands, a region where villagers didn't come into contact with Europeans until the 1930s.

More than half a million Papua New Guineans will be infected with the virus by 2025, resulting in a 13 percent drop in the available workforce and a 1.3 percent decline in the $15 billion economy, AusAID, Australia's development agency, said.

In 20 years, 117,000 children will have lost their mothers to AIDS and 70 percent of the country's hospital beds will be needed for patients, it estimates.

Poverty Line

Although rich in natural resources such as copper, timber and gas, about 37 percent of Papua New Guinea's population lives below the poverty line and 80 percent of people in urban areas are unemployed.

The inaccessibility of regions in Papua New Guinea and a shortage of diagnosis and anti-retroviral medication helped the virus infect almost 2 percent of the population, with new infections increasing mostly in the countryside, Rwabuhemba said.

``Stigma and discrimination is an issue as education programs, particularly in the highlands, haven't made the impact we would desire,'' Rwabuhemba said. ``People have not come to terms with this situation and there is an irrational fear.''

Allegations emerged this week that AIDS sufferers in the Southern Highlands province were buried alive by their families because they became too sick to be cared for.

``That was a very big slap for us when we saw it on the front page of the newspaper, a great shock,'' Rwabuhemba said. ``We cannot substantiate it.''

Health worker Margaret Marabe said she saw five people buried in the Tari district of the province, where she conducts AIDS awareness campaigns, local newspaper the Post Courier said Aug. 27. They cried out for help as they were covered with soil, Marabe is reported to have said.

Tribal Tensions

Police are investigating the claim and the National AIDS Council has been instructed to conduct an awareness campaign in the region, Health Minister Michael Ogio said in a faxed statement.

Tensions between tribes and a lack of infrastructure in the Southern Highlands has hampered services to the region, according to the government.

``Without knowledge of what HIV is and the impact of it, people in the area certainly would show strong fear,'' Ogio said. ``The stigma and discrimination which may result in families neglecting people living with HIV/AIDS in the area still has to be addressed more aggressively.''

Cases Increase

HIV cases in Papua New Guinea have been growing at a rate of 30 percent a year since 1997, according to the UN. Heterosexual sex is the most common means of infection, Rwabuhemba said.

Infection often develops around mining and logging sites and along transport routes such as the Highlands Highway, which runs through the middle of the country, said Paul Barker, director of the Institute of National Affairs in Port Moresby.

``People have multiple wives, particularly in the highlands. I knew of one man in a very remote location with 60, so that contributes,'' he said. ``There's a strong social stigma and while people's attitudes have started to change, it's been slow, especially in rural areas.''

When AIDS was first discovered highlanders blamed the boils, night sweats and weight loss on sorcery and retribution was common, Barker said. While awareness has grown in the past decade, sufferers are still routinely dumped at hospitals and medical centers and not visited by their family.

``Sometimes all their relatives may have died as well so the hospitals often shoulder the burden of burials and care,'' he said.

Papua New Guinea shares the island of New Guinea with Indonesia and was an Australian colony until 1975.

To contact the reporter on this story: Emma O'Brien in Wellington on


Tuesday, August 28, 2007

MALAWI: Fish farming eases living with HIV/AIDS

By, IRIN PlusNews, August 27, 2007

Widowed Esnat Singano, 54, did not know her husband was HIV positive until almost two years after his death in 2000, when she also tested positive for the virus.

After one of her four children also died as a result of the disease, she was left to care for two of her grandchildren and struggled to find the money to send them to primary school. "They needed clothes and food and many other things to be in class; these are the things I could not afford," she told IRIN/PlusNews.

Life has become a little easier for Singano since World Vision, an international relief organisation operating in Malawi, introduced a food security programme in her village in the southeastern district of Zomba two years ago.

"I have been able to grow maize twice a year," she said. "But, more importantly, the introduction of a fish-farming project has changed my life."

The programme funded by the World Bank, which aims to increase the income and nutritional status of households affected by HIV/AIDS, helped Singano to build two fish ponds last year.

"I jumped on the idea when it was told to us by World Vision," she said. "Clubs were formed and many people joined. It is now a year since I started farming fish and so far I have harvested three times; from it I have made 1,200 Malawian kwacha (US$850)."

Besides the income Singano earns from selling her fish, they are also an important source of food for her and her grandchildren.

Timamu Muhajiri, 77, is another beneficiary of the project. After 30 years working a mine in Zimbabwe, in 1991 he returned home with his wife, 10 children and five grandchildren. He said the pension he received from his former employer was a fraction of what he earned from his two fish ponds, which yielded a "harvest" worth about US$550 every three months.

"I think I have been wasting a lot of time and money looking for employment outside the country," Muhajiri said. "What I needed was only the technology to improve my farming."

Over 1,000 households headed by orphans and widows have benefited from the World Vision project, which receives technical support from the WorldFish Centre, a non-profit, international research organisation.

Families with small plots of land were helped to dig small, rain-fed ponds, where they raise tilapia, a common local fish species. There are five species of tilapiine cichlids recorded from Lake Malawi, and other species of the fish occur worldwide.

Although the project implementers pulled out in July 2006, families in the Zomba area, where over 60 percent of the population live in poverty, are now earning an income from their fishponds.

The WorldFish Centre developed the project with mainly the children and elderly in mind, because the ponds require little heavy labour and the fish can be fed with farm and kitchen waste.

"The basic principle of integrated agriculture-aquaculture is to grow fish in water bodies that are closely integrated into a household farm, and intentionally make use of the resource flows of all the diverse activities on a farm, such as livestock, vegetables and crops," said Daniel Jamu, the WorldFish Centre's regional director.

He said fish could provide essential nutrients to the 14 percent of Malawi's population estimated to be living with HIV. The ponds yield about 1,500kg of fish per hectare per year, which often leaves some excess that can be sold to pay for medical care and household needs.

Malawi's expanding population has led to a growing demand for fish, but over-fishing of Lake Malawi and the Shire River has caused a decline in fish stocks and reduced annual per capita fish consumption from 14kg in the 1970s to 4.2kg in 2005.

According to Jamu, the success of the fish-farming project in Zomba has enabled his centre and its partners to expand the initiative to include 26,000 farming households in Malawi and neighbouring Mozambique and Zambia.


Monday, August 27, 2007

It Takes a Village to Save a Child: An innovative constructed village offers hope for Thai HIV and AIDS orphans

By, Tania Campbell, Ohmy News, August 7, 2007

What do celebrated classical musician Bruce Gaston, the princess of Thailand, BMW and a German documentary film crew all have in common? They all support Baan Gerda, an innovative orphanage in Thailand for children who are HIV positive. However, don't dare let Karl Morsbach, the founder of this novel enterprise, hear the word "orphanage." His vision instead dictates that it is a constructed community or organization more like a village, where the children live in a loving family environment. Named after Morsbach's deceased mother, the village lies two hours north of Bangkok in the verdant, snake-riddled Lopburi province. Among leafy trees, child-sized plastic dinosaurs and ponds with floating purple lotus flowers are 13 stilt houses where these foster families -- two adults and up to nine children -- live. Painted bright colors and full of ebullient, laughing children, it is a far cry from the notorious state-run orphanages for children with HIV and AIDS.

Altogether, there are 71 children. The adults who take on the parenting role are either HIV positive or AIDS widows. Selecting such caregivers was a conscious decision -- providing much needed employment for extremely stigmatized adults who are more likely to have a better understanding of the needs of HIV children. Together, the children and adults create their own family unit, which is glued together not by blood but by love. "We raise the children in a loving environment, in the hope that they will take the love they receive through life," states the Baan Gerda handbook, a bible for anyone wishing to create the same model.

While creating such a village is no mean feat, Morsbach and his Thai wife Tassanee were able to raise the capital to establish their vision, and then attracted generous donations from corporations, well-heeled acquaintances and a godparent-style sponsorship program that ensures the successful continuation of Baan Gerda. Initially, their vision was to build somewhere to care for the children in their final stages and let them die in peace and comfort -- an alternative to the abhorrent and notorious 'Death Hospices' that are the fate of too many Thai orphans suffering from the virus. "When we built it seven years ago, we thought they would die," Morsbach muses. Now, thanks to the cheap availability of antiretroviral (ARV) drugs, a healthy lifestyle and a loving family-oriented environment, they haven't lost a child in three years.

Morsbach's story is somewhat unusual in terms of how he became "Pa" to 71 children. He went from high-flying corporate executive at a German company stationed in Bangkok to children's rights activist after realizing that "I wasn't put on this earth to make other people rich." Along with his wife, he set up five schools on the Thai-Burmese border to give rural children access to an education. Then, after seeing a particularly poignant photo and article in a Bangkok newspaper of a child about to die from HIV, they switched their focus to combating Thailand's HIV epidemic. After two years saving euros in Germany to fund their vision, the couple returned to Thailand and created what has now evolved into a thriving and unique organization that has become a model for the likes of UNESCO.

On closer inspection, Morsbach's background as a corporate executive and his current position as the founder of Baan Gerda may not be as different as chalk and cheese after all. He set up a points system to reward the efforts of the parents, based on the kind of system he used with his employees: they get points based on love, cleanliness, how much TV the children watch, etc. Those who score a certain number of points are rewarded with a year-end cash bonus. "Happy children need happy parents," he says. The parents must also be vigilant in monitoring the children's health and ensuring their medication is administered at 7 a.m. and 7 p.m. daily, no excuses and no exceptions.

In addition to the medicine, a volunteer doctor visits the children regularly for checkups as part of their health routine. She has established a close bond with the children and does it for love, not money. An Australian dentist has donated equipment so that they can set up a dental clinic in their on-site medical center. Morsbach became interested in the mysteries of the ancient Japanese healing art of Reiki and now all of the children receive free Reiki from practitioners in Germany -- healing from thousands of kilometers away. Sounds a bit odd for a straight-laced German but Morsbach asserts that he's "far from believing it doesn't work." In fact, he cites several examples of children whose health improved markedly overnight after a Reiki session. He even practices it himself on the children.

With his big vision and entrepreneurial streak, Morsbach has steamrolled ahead and started something of a cottage industry in the village. He used his contacts in Vienna's fashion world to have the women of Baan Gerda trained by professional tailors to make environmentally and socially conscious fair trade clothes and accessories to be exported to Austria. This gives them an opportunity to learn new skills while making money. The men are taught carpentry and with their skills make things for the village. With most of the children away at school during the day, many of them welcome this training as a way of breaking up their routine, and the vocational training will be an invaluable asset if they ever decide to leave Baan Gerda.

The children are surprisingly well adjusted considering the trauma most of them have endured such as watching their parents die and being ousted from their communities. The children first came to them from a temple hospice, but now many come through word of mouth. They found one girl digging through trash at a market. She, like many of the children, had literally been left for dead. On occasion, the adults turn up with only a suitcase in hand after being ostracized from their communities.

Morsbach believes the children at Baan Gerda shouldn't be defined by the fact that they have HIV. A jolly, optimistic man, his glass is half-full: "It's important to see the positive side -- the children are happy." Now that they are all, for the most part, in glowing good health, Morsbach has focused on their intellectual, social and emotional development. For the past few months, the children have been receiving weekend music lessons from the famous American musician, Bruce Gaston, who resides in Thailand. He fell in love with the kids, as everybody does, after visiting the house and now makes the two-hour trip from Bangkok every Saturday to teach them for several hours before rushing back to Bangkok to perform in his band's regular Saturday night concert. He has made them his project, a kind of Thai Partridge Family, and recently they performed an invitation-only concert in Bangkok. The fact that the children have HIV was a minor detail on the invitation. Now there is talk of making an opera with the children, reflecting their own, and humanity's struggle for survival.

Ever the pragmatic German, Morsbach, when not begging for money from corporations, spends a lot of time thinking about the future and how the children will integrate into the "real world." With donations from various companies, they have built a library, computer room and a music room. "Some people criticize us for using the money to buy things like a piano when we could help save another child with medicine." Still, he emphasizes, the children must not only be physically healthy but also mentally well-adjusted, as one day, they will complete high school and move onto university or vocational training and inevitably have to leave the village.

Every year, the children are treated to a special outing. On one occasion, they went to a large amusement park in Bangkok. However, upon learning about the children's HIV status, officials banned them from entering the park. One volunteer with the group posted this refusal on a Web site and soon enough a hoard of university students arrived and took all the children, one-by-one, into the park undetected. This event was recaptured in a recent documentary about the village entitled "Heaven's Meadow: The Small Wonders of Baan Gerda" by a German documentary filmmaker. In addition to these outings, they celebrate Christmas, go to the beach once a year and have sports' days. Often, inspired visitors drop by, such as artists, dance therapists and English teachers.

Morsbach encourages visitors to come, especially university students. He believes that it will reduce the stigma surrounding HIV in Thailand, because, as he puts it "many people are scared to breathe the same air as a child with HIV." The downside to this is that the place becomes something of a zoo, especially on weekends, with visitors roaming around taking pictures of the children. Still, it's a small price to pay considering that if it wasn't for the village in the first place, the children and many of the adults would most likely be dead. Although things are slowly changing, he acknowledges that "our biggest enemy is stigma." He cites the example of one girl who, before she came to the village, was forced to take her lessons from outside the classroom, peering in through the door to see the board. And that was only after the school was forced to reinstate her having earlier expelled her.

Slowly, around 3:15 p.m., the place comes to life as 60-odd children wander home from their nearby schools built by the king of Thailand. Most of them stop by the playground to coddle the smallest child -- a one-year-old boy who will not be able to walk due to leg deformation. The love is evident as they shower kisses upon him and push him around on his little plastic tricycle. Another young child has a compromised lung and the parents are not sure how much longer he'll live. Still, he trots about with a spring in his step and a huge, gaping grin. He knows that he may not be around forever, so he makes the most of each day and is a lesson for how to appreciate every waking moment, just as Baan Gerda is a lesson and model in how to effectively and lovingly treat orphans with HIV and AIDS.


HIV+ and orphaned: Children no one wants

By, S. Shanthi, The Times of India, August 27, 2007

New Delhi: It's a ray of hope in an area of gloom. Recently, a 15-day-old baby, Chhoti, was found abandoned. Though rumoured to be HIV positive, many couples on hearing about her through the media, volunteered to adopt her.

However, not many are as lucky as her. Most people don't come forward to adopt HIV positive children. Recently, an HIV positive woman in Chhattisgarh, driven by poverty, offered her newborn daughter for sale. But no one wanted the baby as she too was infected. Later, the local administration, which got to know about the issue, stopped her from selling the baby and made arrangements for her treatment.

Says Sonia Kohli, who runs Sahyog, an NGO, and in whose custody Chhoti was, "Since the news was out in the media, people initially came forward to adopt Chhoti. When the hype died, people backed off. Even some doctors advised me against keeping the child. I have now given the child to a family, but I am sure that if Chhoti was HIV positive, nobody would have legally adopted her."

Arun Dave, president, AIDS prevention club, Rajkot, corroborates, "Ever since we started working for the cause of AIDS, 18 years back, not even one family has volunteered to adopt an HIV positive child."

In many cases, even when the child turns out to be negative later, people are scared to adopt. HIV positive children turn negative only until they are one-and-a-half years old. After that, it's believed their status doesn't change. But medical miracles do happen. Anyhow, adoption agencies have a definite role to play here — in convincing the families and educating them about the issue. "If we have a child who is HIV positive-turned-negative, we tell the family about the child. After counselling and making them understand the medical aspects, if they are still willing, they accept the child. However, this happens only once in a blue moon," says Madhavi Hegde Karandikar, adoption practitioner, Bal Asha, Mumbai.

Such children are mostly adopted, either by rich parents and those settled abroad or foreigners. "Adopting an HIV positive child requires a lot of willpower. Moreover, social acceptance of such children is less in our country. Outside India, people are more educated about HIV," says Nilima Mehta, chairperson, Child Welfare Committee, Mumbai.

"There is a social stigma attached to it. Even today, there is not much awareness about HIV. Not many even know the difference between HIV positive and AIDS. They are ignorant about how HIV is passed and so don't want their families and friends to know that the child was born with the virus," says Dave.

Outside India, there are many organisations which have been successful in placing HIV positive children in permanent and foster homes. One such project is Children With AIDS Project of America, which seeks out adoptive parents for HIV infants and children. Its database has over 1,000 waiting families.

Experts say there are no legal restrictions for adoption of HIV positive children. "We can give such children in adoption, provided there are families willing to take them and all documents are in place," says Wendy Andrews, adoption officer, Hope Foundation, New Delhi. Despite various measures taken by the government, people suffering from the disease still face stigma and isolation. A UNAIDS report claimed in 2006 that India had the largest number of people living with HIV/AIDS, an estimated 5.7 million.

"Adopting a child involves knowledge within oneself that all children are equal, be they healthy or with special needs and therefore equally deserve security within a family. One should be better informed about the subject and make a choice knowing and understanding all these aspects," says Aloma Lobo, chairperson, IYC Community Centre, Bangalore.


Friday, August 24, 2007

Human trafficking helps spread HIV/AIDS in Asia-UN

By, Ranga Sirilal, Reuters, August 22, 2007

Colombo - About 300,000 women and children are trafficked across Asia each year, acclerating the spread of HIV/AIDS, the United Nations said on Wednesday.

"Trafficking ... contributes to the spread of HIV by significantly increasing the vulnerability of trafficked persons to infection," said Caitlin Wiesen-Antin, HIV/AIDS regional coordinator, Asia and Pacific, for the United Nations Development Programme (UNDP).

"Both human trafficking and HIV greatly threaten human development and security."

Major human trafficking routes run between Nepal and India and between Thailand and neighbours like Laos, Cambodia and Myanmar. Many of the victims are young teenage girls who end up in prostitution.

"The link between human trafficking and HIV/AIDS has only been identified fairly recently," Wiesen-Antin told the International Congress on AIDS in Asia and the Pacific.

"Neither HIV/AIDS nor human trafficking have been integrated or mainstreamed adequately, either at policy or programmatic level."

UNAIDS estimates 5.4 million people were living with HIV in the Asia Pacific region in 2006, with anywhere between 140,000 and 610,000 people dying from AIDS-related illnesses.

That makes it the world's second largest number of people living with HIV after sub-Saharan Africa, where 25.8 million people are infected with the virus.

Conference host Sri Lanka has one of the lowest rates of HIV in Asia, with an estimated 5,000 infected people out of a population of around 20 million.

Neighbouring India, by comparison, has the world's third highest HIV caseload after South Africa and Nigeria, with around 2.5 million people living with the virus.


Wednesday, August 22, 2007

Children worst affected by HIV and AIDS, says World Vision

By, Reuters Alertnet, August 21, 2007

In Mumbai, India, a woman widowed by AIDS lives with her ten-year-old son on the doorstep of the house she should have inherited, barred entry by her in-laws.

In a village in Nepal, a former migrant worker mourns his wife as he cares for his four children, two of whom are HIV positive.

In Cambodia, an orphaned nine-year-old boy and his little brother travel alone across the country in search of relatives who will offer them a home.

Across Asia and the Pacific there are countless stories like this with one common theme; they involve children.

Orphaned, stigmatized, driven to work and exploitation, sometimes contracting the virus from their mothers at birth, children feel the effects of HIV and AIDS more than any other sector of society.

The theme of next week's 8th International Congress on AIDS in Asia and the Pacific (ICAAP) in Colombo is 'Waves of Change, Waves of Hope.' Alongside UN agencies, NGOs and government representatives discussing a diverse range of HIV-related issues, international NGO World Vision will be highlighting the plight of children.

"Without adults to care for them, children orphaned by HIV and AIDS are vulnerable to many forms of hardship and discrimination, from missing out on school or being underpaid in child labour, through to sexual abuse or trafficking," said World Vision regional advocacy director Laurence Gray.

"Governments, local authorities and community members need to open their eyes to the vulnerabilities of the children in their care and take urgent steps to protect them from the effects of HIV and AIDS."

World Vision will produce and circulate a summary of each day's proceedings at the ICAAP meeting, commencing Monday 20 August, with a special emphasis on the issues and solutions that concern children.

This summary will be available online at and will be emailed daily to partners and media expressing interest.


Married monogamous women silent sufferers of AIDS

By, Daily News, August 21, 2007

Colombo: Married monogamous women are the most silent sufferers of HIV/AIDS. They are estimated to constitute nearly 25-49 per cent of the total number of people infected, yet they are faceless, Prasad Rao, Director, Regional Support Team, Joint United Nations Programme on HIV/AIDS, UNAIDS said.

He said that according to one UNDP studying South Asia, 40 per cent of women leave their in-laws' house after their husband's death due to AIDS, and 80 per cent of these women mostly infected by their husbands are denied of property rights.

Answering some questions posed by journalists during a press briefing held at the BMICH, Colombo yesterday in connection with Eighth International Congress on AIDS in Asia and the Pacific (ICAAP) going on till August 23, Mr. Rao said that political commitment can be measured by the national policy on HIV/AIDS, openly talking about the subject and making available adequate resources.

Ms. Annmaree O'Keeffe, AusAID said that when it comes to the Asian region more attention should be paid on the social stigma and related issues of the epidemic. Doctors are not the best communicators and therefore professional health communicators are needed to educate the people on the issue, she added.

Prof. Samuel of the IAS said that social science and medical science should be combined and come together to combat HIV/AIDS. Ms. Anandi Yuvaraj of PATH also spoke. Dr. Nafis Sadik chaired the press briefing.


Tuesday, August 21, 2007

India: Nearly 70,000 children living with HIV virus

By, Hindustan Times, August 21, 2007

An estimated 70,000 children are HIV positive in the country, while nearly 21,000 others get the infection every year, the Rajya Sabha was informed on Friday.

Union Minister of State for Health and Family Welfare Panabaka Lakshmi said paediatric antiretroviral ARV drugs are available at 127 centres across the country.

She said as per the revised estimates, there are 70,000 HIV infected children in the country and nearly 21,000 new infections occur in children every year.

"Following the launch of paediatric ART initiative in November 2006, more than 18,000 infected children have been identified and currently nearly 6,500 eligible children are receiving ARV paediatric drugs," she said.

Denying that there was any shortage of ARV drugs, she said about 17,000 children are availing them.

The minister said the estimates for the year 2006 recently released by the National AIDS Control Organisation (NACO), supported by UNAIDS and WHO, indicated that there are around 2 million to 3.1 million people living with HIV in the country.

Noting that the epidemic has stabilised at 0.36 per cent prevalence level during the last four years, she said in 2006 and 2005, the HIV figure in the country stood at 2.47 million.

By using the new method of estimation, she said the number of HIV infected persons in 2004 was found to be at 2.44 million.

Andhra Pradesh, which has a prevalence rate of 1.6 per cent, has around 4,79,866 people infected with the virus, while in Manipur, having a prevalence rate of 1.68 per cent, the figure stands at 22,010.

In Nagaland with a prevalence rate is 1.27 per cent, around 15,277 people have been infected with the virus.


Monday, August 20, 2007

Kenya: Young Women Weep in Anguish As HIV Infection Rates Increase

By, Arthur Okwemba, The Nation (Nairobi), August 18, 2007

As anti-Aids campaigners smiled and gave each other a pat on the back for the drop of HIV prevalence rates from 5.9 per cent to 5.1 per cent, young women wept in anguish.

Information released by National Aids Control Council this week shows that being a girl aged between 15 and 24 years is no fun at all, as one is at a high risk of HIV infection compared to female adults.

For every one young man in the age bracket who is infected with HIV, there are four young women. HIV and Aids prevalence among males was 3.5 per cent and 6.7 per cent among females.

"There is great concern with a ratio that is too high as this one. We want to bring it to every one man infected there are two women infected or an infection ratio of one man to one woman," says council chairperson Miriam Were.

"But we have to address some of the most difficult issues if this is to happen."

Aids experts and anthropologists say a significant proportion of the women cannot negotiate for safer sex through use of protection. A case in point is the female condom.

Although introduced in the country a few years ago, it is yet to reach those who need it most. With the cheapest of the few outlets selling it asking for Sh80 a piece, most women find the price prohibitive.

Its manufacturers argue that the material used is very expensive, hence the pricing.

On the other hand, the male condoms retail at Sh10 or are given out at no cost.

But men either refuse to use them or if they do, it is not always correctly.

It is against this backdrop that the Government has started distributing the female condoms free of charge.

For the past three years, the National Aids and STDs Control Council (Nascop) has distributed over a million female condoms.

Family panning

Beneficiaries have been commercial sex workers and couples, who obtain them in bars, restaurants, family panning clinics, or women and youth groups.

Despite the effort, few young people have benefited.

The institutions used were cited as "hostile" or "not favourable" for youngsters.

Arguments are now being advanced for introduction of sexual and reproductive health service centres that are friendly to young people through which the condoms can be distributed.

International Planned Parenthood Federation-Africa Region which offers reproductive health services to youths in 44 African countries, says opening up of the youth-friendly centres will enable young people access the condoms. Dr Josephine Kibaru, head of Division of Reproductive Health revealed that the Government will set up youth friendly services centres in every district hospital.

But accessibility and cost are the only challenges on the use of the female condom as some women are still likely to shun it.

The majority of the women who have used the gadget say it was difficult to insert, cumbersome, and troublesome to remove.

And their male partners asked them to remove it.

"I tried it with my boyfriend, but I had to remove it before finishing the act due to the noise it was making," says 22-year-old Lydia Nyambura, a city resident.

With all these problems, the focus seems to have remained largely on male condoms.

Male condom

While statistics show use of male condom to have increased from two million per month in 2000, to more than 10 million monthly today, this increase seems not to benefit women, particularly young girls. Yet, the assumption has been increase in condom use would see a significant drop in the number of women infected with HIV. This is not, however, the case.

It is reckoned that the men either use the condoms incorrectly, inconsistently, or not at all during sexual intercourse.

The 2003 Kenya Demographic and Health Survey findings show that of those aged between 15 and 24 years, only 12 per cent of the young women and 14 per cent males used condoms during their first sexual intercourse.

Another study by University of Nairobi social scientists in 2002 indicated that condom use decreased as relationships matured.

Prof Omu Anzala of Kenya Aids Vaccine Initiative says a woman's biological make-up makes them more susceptible to HIV infection than men.

"A man is at risk of HIV infection during the sex act, but the woman is exposed during and long after the act," he says. When the semen carrying the virus gets into the woman's vaginal track, it can stay there for more than two days, giving the virus enough time to infect her.

Poverty has also fuelled the spread of the virus.

A World Bank study whose findings were released this week, says poor women exchange sexual favours for food.

Women from Bungoma and Kiambu interviewed during the study said they resorted to extra-marital sex to meet household needs.

1st Asia Pacific Court of Women on HIV to be held in Colombo

By, People's Daily Online, August 17, 2007

Twenty HIV positive women will tell their stories of being denied of inheritance and property rights in Sri Lankan capital Colombo as part of the 8th International Congress on Aids in Asia and the Pacific (ICAAP), a senior UN official said Thursday.

Caitlin Wiesen, Regional HIV/AIDS Team Leader of the UNDP Regional Center in Colombo, told reporters that the "Asia Pacific Court of Women on HIV, Inheritance and Property Rights" will be the first regional summit on this compelling issue.

Wiesen said, "When women are denied their rights to inheritance and property, they are robbed of the social and economic empowerment needed to help prevent HIV infection and cope with its impact on families and communities."

She said the feminization of epidemic in the region are daunting, with about 30 percent of the new infections in the region being among women.

"With little or no control over their sexual lives and burdened by abuse, exploitation and violence, women in the region are extremely vulnerable to HIV," Wiesen said.

About 30 testifiers and expert witnesses from Sri Lanka, Nepal, Bangladesh, Pakistan, India, Cambodia, Vietnam, Papua New Guinea, Thailand, Malaysia and other countries will present testimonies to the Eminent Jury in the Court.

Wiesen said the Court, aiming at bringing to public focus the challenges faced by women in the context of HIV and AIDS, is scheduled to be held on Saturday.

Organizers said over 2,000 delegates from 40 countries will attend the 8th ICAAP from Aug. 19 to Aug. 24.

Source: Xinhua

Friday, August 17, 2007

CHAD: AIDS funding flows again

By, IRIN PlusNews, August 16, 2007

Almost a year after suspending a grant of over US$20 million for Chad's AIDS and tuberculosis response, the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria announced this week that it had lifted the sanctions, which had severely disrupted efforts to curb the spread of the HIV epidemic, health officials said.

In November 2006, The Global Fund froze funding for the impoverished West African country worth more than US$ 20 million over five years, following concerns over the misuse of funds and the ability of the recipients to manage the money.

According to UNAIDS country coordinator Claire Mulanga, the money had not been effectively absorbed by organisations, resulting in too few activities being implemented to address the country's pandemic.

"Because we didn't have in-country presence, it is very important that the principal recipients have adequate capacity. This was not the case with Chad," Nicholas Demey, Global Fund communication officer, told IRIN/PlusNews. In addition, "there was some minor misuse of funds", which prompted the Global Fund to take action.

Since then, UN agencies, the government and other development partners have been working to put measures in place "to make sure this doesn't happen in future," he added.

Stricter conditions have been laid down: technical partners will become more involved in the process; the Global Fund Secretariat will be monitoring the principal recipient more closely; and there will also be regular audits and tighter control of expenditure.

"The money that was stolen is now being reimbursed, and the people responsible have been suspended from their functions. Now we need to have the human capacity in place, in order to fulfil the projects," Mulanga added.

Dr Barou Djouater, coordinator of the National AIDS Programme, welcomed the move: "We worked hard to make sure we met all the conditions of the Global Fund; a lot of people have suffered; now the hard work begins."

Chad, which has a HIV-prevalence rate of 4.8 percent, relied heavily on the Fund's resources. "This is a very poor country, and very few donors are willing to invest here, so it was a big, big loss for the country when the grant was stopped. There was no other way to get money for AIDS," Mulanga told IRIN/PlusNews.

Although the Global Fund continued to support the provision of life-prolonging antiretroviral treatment during the suspension, other initiatives, such as the prevention of mother-to-child transmission of HIV, mass awareness campaigns and orphan support projects, ground to a virtual halt.

The war in neighbouring Sudan's western Darfur region has brought growing instability to eastern Chad. Attacks on civilians in the Central African Republic (CAR), to the south, have sent waves of refugees into Chad, threatening security in the region.

Mulanga noted that the conflict and instability in the country had also weakened the government's ability to respond effectively to the epidemic. "AIDS is not at the top of the agenda ... the government is more focused on managing the conflict."


Thursday, August 16, 2007

KENYA: Lower infection rates creates new challenges

By, IRIN PlusNews, August 15, 2007

New statistics showing a decline in Kenya's HIV prevalence demonstrate that the government's fight against the pandemic is having an impact, but they also present fresh challenges, health officials said this week.

Prof Alloys Orago, director of the National AIDS Control Council (NACC), noted that the rollout of the antiretroviral (ARV) treatment programme, with over 105,000 participants, had significantly "averted deaths", making it more difficult to measure the impact of the pandemic.

"Kenya will have to shift from prevalence measurement to incidence [new infections] monitoring mechanisms to determine the impact of HIV/AIDS if the dramatic decline in prevalence witnessed over the past three years is sustained," he told IRIN/PlusNews after opening a two-day HIV/AIDS Programme Review conference in Nairobi on 14 August.

On 13 August, NACC reported that national prevalence had dropped from 5.9 percent in 2006 to 5.1 percent in 2007, with the possibility of reaching less than 5 percent in 2008.

The statistics, compiled by the National AIDS and Sexually Transmitted Infections Control Programme, showed that HIV/AIDS-related deaths, which stood at 116,000 in 2001, had dropped to below 83,000 in 2006.

"The success in scaling down infection rates is creating another challenge: that of the growing population of HIV patients who need care and support," Orago said.

Another worrisome issue was the continued feminisation of Kenya's HIV/AIDS pandemic: in the 15 to 24 age group there are four infected women to each infected man.

"Men still dominate the instruments of power, while women are still left out of major decision-making," Orago said. "Even decisions about sex are still made by men, in spite of the high level of HIV awareness."

However, the decreased prevalence showed that the government's aggressive Total War against AIDS campaign was changing behaviour. "After the government declared HIV/AIDS a national disaster in 2003, HIV/AIDS ceased to be just a health issue," he said. "All sectors were co-opted into the campaign."

Good progress made

Encouragingly, the new report points out that HIV prevalence was significantly lower in people aged 15 to 24: in 2003 it fell from 1.2 percent to 0.8 percent among males, while among females it dropped from 5.8 percent to 4.4 percent.

Orago attributed this decline to a behavioural shift by teens delaying their first sexual experience, as well as the increased distribution of male condoms.

Another effective strategy in the government's anti-AIDS campaign was "the use of infected patients ... to bring about behavioural change", he said, and the "visual evidence" of 'live witnesses', or infected people, to drive home anti-HIV messages had "contributed to the drop in the number of sexual partners".

Orago noted that more funding was needed if the pandemic were to be effectively controlled.


Tuesday, August 14, 2007

BENIN: Internet new frontline in AIDS awareness

By, IRIN PlusNews, August 10, 2007

Dieudonné Sourou never leaves the cybercafé in Cotonou, Benin’s commercial capital, where he comes every week to check his personal emails, without sending what this 25-year-old calls "useful messages" raising HIV awareness.

In this little cybercafe in the northern outskirts of Cotonou, Sourou focuses on typing his note, a process he repeats week after week. A long list of addresses awaits him in the corner of his screen.

"Last week, I sent a message to this list of people about the new report by the World Health Organization on the preventative role of circumcision in the fight against transmission of HIV," he told IRIN/PlusNews.

Like Sourou, several young Beninese have decided, of their own accord, to involve themselves in the fight against the virus.

"It's our way of having an impact, so that the community really becomes aware of the disease," explained Alain Doumin, a student in his final year of high school in Cotonou, who came to the cybercafe with a series of documents on HIV/AIDS.

"We don't have the money for big measures to raise awareness on the public stage. This avenue doesn't require much money and allows us to get involved in the fight," he added, before diving into his work once more.

These youth send the messages to recipients they've never met - friends comprise "at most 10 percent of the recipients", Doumin said - with the goal of reaching as large an audience as possible.

"The impact is far-reaching. We send messages outside of Benin. We gather addresses from listings of the main internet providers without knowing exactly who we're sending to in most cases," Sourou explained.

Real-life experiences at the heart of it

Most of the youth said it was often a personal experience that convinced them to get involved in the fight against HIV and AIDS.

"I started [sending messages] after watching a young man die of AIDS in my neighbourhood," said Gabin Ogbonikan, another youth who said he has sent more than 50 messages in two years. "That really affected me, and I told myself the response to a tragedy cannot be indifference."

Claude Dossa, a young manager of a cybercafe in Porto Novo, the Beninese capital, decided to use his keyboard to influence behaviour when he noticed that many young people of his generation were associating with sex workers, and probably not using condoms.

"I figured naivety and the lack of information constituted the fundamental problem at the sources of this risky behaviour," he said. "Every person, within the framework of his own life and profession, has to try to contribute to fill the gaps on this issue. As a cybercafe manager, this is the best way I can contribute."
Not everyone is in the position to go and find the information. So we have to do the work in their place

Saturnin Afolabi, a second-year linguistics student at the Abomey Calavi University in the north of Cotonou said he sends "at least two messages every week about what is at stake in terms of preventing the disease" and tries "to inform people about new strategies emerging at the national or international level".

"Nobody asked us to write these messages. We just became aware of a situation," he said.

UN figures from 2005 show that about 1.8 percent of Benin's population is HIV-positive, a decrease from 2003.

However, "that shouldn't mean the end of mobilisation", said Afolabi, who, like Ogbonikan, has been tested for HIV. "For example, in the big towns, there is considerable work to do, and that's not yet sufficiently understood by the majority of people."

Well-received messages

The recipients of the messages appreciate the initiative and regularly send encouraging responses, Afolabi said.

"It's very encouraging and it permits us to meaningfully evaluate the impact our work is having. If they respond and encourage the initiative, we've already won half the battle."

These spontaneous initiatives are encouraged by more orthodox advocacy groups.

"I know that some young people are doing excellent work in dispersing information, discretely, without asking for any financial or material support," said Daniel Gbaguidi, a community leader in the fight against AIDS. "Many people who receive the messages in turn forward them to others, which simply reinforces the action. We can't ask for more."

While the internet is still far from being used by the majority of Beninois, its use is on the rise.

Honore Chintan, computer specialist and owner of a cybercafe in a slum neighbourhood of Cotonou, acknowledged there was "work to be done to democratise the internet", but predicted it could become "a useful tool in the fight against AIDS" in Benin.


Women step up to raise HIV/AIDS awareness

By, The Desert Times, August 10, 2007

AIDS is a disease with the ability to affect many people - including women and children.

The 100 Women group at Desert AIDS Project knows that and is trying to spread awareness.

"My initial motivation was that if we could get 100 women to step up and become major donors, it could (help) our female clients," said founder Susan Unger.

The group, now almost two years old, is made up of female donors who support the Desert AIDS Project. In the last two years, they have raised about $150,000. All of that money is earmarked for programs that benefit women and children.

"They don't want to just write a check," Unger said. "They want to volunteer and make a difference."

The group was founded to aid the growing number of women who are infected with HIV or AIDS in the valley.

"Many see it mainly as gay men (who have the disease)," 100 Women member Joy White said. "The female population is growing."

Desert AIDS Project Executive Director David Brinkman said the gay male community has been impacted for years by educational programs, but women and children have not received the individualized care.

The group hopes to increase outreach and education. For example, they are helping the Desert AIDS Project fund a women's health fair.

"When you feel like you are the only one, you're isolated, it's very rewarding to see these leaders stepping up and lending a hand," Brinkman said.

The group hosts quarterly events that feature a guest speaker, sometimes a client of the Desert AIDS Project. New and current members can attend the events to learn more about how AIDS affects women and children.


Friday, August 10, 2007

Even older women at high risk have little interest in being tested for HIV

By,, August 8, 2007

Few older women were interested in being tested for the virus that causes AIDS despite having significant risk factors for lifetime exposure, according to a study published in the July/August edition of the Journal of Women's Health.
The risk is especially great among African-American women, who represent 73 percent of new HIV cases in women over age 50.

"Older people largely have been overlooked in HIV prevention and testing programs, and consistently have lower HIV testing rates as compared with younger adults," said Aletha Akers, M.D., M.P.H., assistant professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine and the study's lead author. "Those who are tested tend to do so late in their disease, when they are more likely to have overt symptoms such as opportunistic infections. Often, they progress more rapidly to AIDS and die within a year of HIV diagnosis, which leaves little opportunity for treatment or secondary prevention for their partners."

For this investigation, Dr. Akers and her colleagues analyzed data collected from 514 women ranging in age from 50 to 95. The women visited a general internal medicine clinic at a large, inner-city hospital in Atlanta over a period of 11 months in 2001 and 2002. To evaluate attitudes concerning lifetime HIV infection risk and interest in HIV testing, trained research assistants administered a 68-item questionnaire in a private room over the course of a single, face-to-face interview with study participants, most of whom said they were not currently sexually active.

More than 60 percent of the participants had never been tested for HIV, although more than half of them could be described as moderate- to high-risk for lifetime exposure to the virus based on sexual history and other factors. Only 115, or 22 percent of participants, said they would be interested in HIV testing. Their most often cited reasons were curiosity and concern about a current or past sexual partner's behaviors. About a third of women had already been tested. Previously tested women were more likely to be younger, sexually active, better educated about HIV and tested at the suggestion of a health care provider.

Most women, however, felt little need for testing. "Those who lacked interest were more likely to be older, African-American and not sexually active," said Dr. Akers, who also is an assistant investigator at the university-affiliated Magee-Womens Research Institute. "These women had a low perceived risk, which was not always accurate based on their histories. A third of all the women who were not interested in HIV testing reported lifetime risk factors for the disease, but we found that they tended to point to ,those people, when talking about the danger of HIV rather than at themselves or their partners."

In short, women with little HIV knowledge and low perceived personal risk were less interested in HIV testing, a finding that is consistent with attitudes in much younger, high-risk adults, the study found. Fewer than 25 percent of the participants could recall ever receiving counsel to get a test for HIV from a provider, despite their risk factors.

"Yet, in part because of a lack of education and prevention efforts targeted at older populations, older women appear to be less capable of accurately assessing their lifetime risk of HIV even when they have significant risk factors and live in communities with high rates of infection," Dr. Akers said. "We need to design prevention strategies and AIDS education for this vulnerable population and help providers to incorporate HIV risk screening into the services offered to older women from high-prevalence communities."


Namibia: Woman Most Affected By HIV-Aids - ICW

By, Kakunawe Shinana, The Namibian (Windhoek), August 9, 2007

Many more women than men in Namibia are living with HIV-Aids, Caroline Thomas of the International Community of Women living with HIV-Aids (ICW) said at the Sister Namibia press briefing on Monday.

Sister Namibia in collaboration with the Women's Leadership Centre organised a briefing on the impact of HIV-Aids on women and girls.

Thomas said this impact has resulted in women and girls being burdened with caring for the sick and the dying with little support, while providing for a rapidly growing number of orphans.

"Young women are particularly at risk of new infections, because of the many cultural practices that involve sexual and other violation of their bodies," she said, adding; "Girls and young women in poverty are also exposed to HIV infection through 'sugar daddy' relationships with older men."

UNAIDS estimates that 62 per cent of people living with HIV are women, compared to 38 per cent men.

Despite prevention campaigns over the years, the infection rate has not decreased.

The Namibian Ministry of Health and Social Services conducted a national survey among pregnant women which shows a national average of 19,9 per cent of those tested in 2006 were HIV positive compared to 19,7 per cent in 2004.

Figures vary greatly among the regions of Namibia, with the highest rate in the Caprivi Region amongst the age group 25 to 49.

Almost 50 per cent of pregnant women tested in 2006 in Katima Mulilo were HIV positive.

Thomas said poverty drives many women and girls into prostitution, or they are trapped in unhealthy and often violent relationships as a means of survival.

Gender inequality is in many ways sanctioned by cultural practices.

Culture teaches boys to become men to rule over women and control their bodies, while girls are taught to be submissive and to be dependent on men, instead of promoting women's right to body integrity and choice.


Wednesday, August 08, 2007

30 percent of pregnant women HIV positive — SA report

By, The Harald, July 22, 2007

Just over 30 percent of pregnant women in South Africa are infected with the HIV/Aidsvirus, according to a government report released yesterday which estimated that 5,5 million South Africans are living with HIV/Aids.

The survey, conducted in October 2005 and released yesterday by the Department of Health, said the figures showed little increase over 2004. It said this was a sign that the level of new infections was levelling out.

"This is encouraging to note, but a great deal of work still needs to be done to ensure that new infections no longer take place at all in South Africa," said Health Minister Manto Tshabalala-Msimang in the foreword to the report.

South Africa has the highest number of people living with the virus in the world, accounting for more than one eighth of the estimated 40,3 million cases.

The government has often been accused of doing too little to prevent and treat the disease, even though it has done much to step up its care and treatment program, which recently became the largest in the world.

President Thabo Mbeki used to question the link between HIV and Aids and the health minister, in particular, has attracted the wrath of health activists for preaching the benefits of garlic and beetroot rather than antiretroviral medicines.

But the survey said there were finally grounds for hope that new infections had peaked.

It said that HIV prevalence among teenagers was an estimated 15,9 percent in 2005, down from 16,1 percent the previous year. — AFP.


Aids rate in young women drops

South Africa has recorded the first significant drop in the HIV and Aids rate since 1990, with women younger than 20 showing a 2,2 percent decrease in prevalence.

But although Health Minister Manto Tshabalala-Msimang said the encouraging results of the 2006 Annual Antenatal Survey were a cause for celebration, the department has acknowledged that the decrease is inconclusive.

Dr Lindiwe Makubalo, chief director for monitoring and evaluation, said other empirical studies would need to be conducted to verify whether the decrease was a real one.

The survey showed the overall HIV and Aids prevalence among pregnant women using public antenatal clinics to be 29,1 percent in 2006, against 30,2 percent in 2005.

However, the infection rate for women in the 30-34, 35-39 and 40-plus age groups showed respective increases of 0,6 percent, 1,3 percent and 1,5 percent.

The decreases in the younger-age categories dovetail with predictions by UNAids that HIV and Aids incidence in South Africa would plateau out and decline in the next few years.

Makubalo said the trend would therefore need to be observed carefully for confirmation in the next three years. The government, therefore, could not afford to be complacent.

Makubalo noted, however, that the decrease in the under-24 categories was significant because a decline in prevalence in young women was suggestive of a decline in new HIV infections.

In addition, the modelling used to collate the survey data adjusted the figures to take death rates into consideration, so the decreases could not be attributed to higher fatalities among young women.

From the study, the department deduced that the number of people estimated to be living with HIV in South Africa is about 5,41 million, down slightly from the previous estimate of 5,54 million.

Overall, HIV prevalence among adults between 15 and 49 was estimated at 18,34 percent.

The minister said a big thank-you to the youth of the country for "taking prevention messages seriously".

The overall picture suggested that HIV prevalence "may be at the point where we should begin to witness a downward trend", she said.

She added that she did not want to give the impression that the department intended "throwing a party" because of the results.

"HIV and Aids is still a public health problem and we need to redouble our efforts in this regard," she said.

Makubalo said the prevalence increases for women older than 30 were likely due to women in stable relationships finding it increasingly difficult to get their partners to use condoms or to follow any of the other prevention messages encouraged by the department.

There was also the possibility that increases were due to infected women merely moving age categories - what she described as the cohort factor.

A total of 33 034 pregnant women attending public antenatal clinics participated in the study at 1 415 facilities - double the number of participants in the 2005 study.

Provincially, prevalence has progressed at different paces. In Gauteng, prevalence has decreased from 32,4 percent in 2005 to 30,8 percent in 2006.

The Free State was the only province to show an increase (0,8 percent), while the other seven provinces recorded decreases in prevalence of between 0,6 and 3,1 percent. KwaZulu-Natal's rate remained the same.

The highest prevalence rate in the country is found in KwaZulu-Natal (39,1 percent) and the lowest in the Western Cape (15,1 percent).

For the first time, the survey included prevalence data for each district, with rates varying greatly between areas within districts in some instances.

The district with the highest prevalence was Amajuba (KwaZulu-Natal) with 46 percent, with the Northern Cape's Namakwe district showing the lowest prevalence, 5,3 percent.


Monday, August 06, 2007

AFRICA: Falling HIV rates tell complex story

By, IRIN PlusNews, August 2, 2007

When it comes to sub-Saharan Africa's devastating AIDS crisis, there is an understandable tendency to latch onto any scrap of good news.

Figures suggesting the epidemic is waning in some countries are being trumpeted by governments and international donor agencies as evidence that their prevention efforts are succeeding.

Kenya's National AIDS Control Council recently ascribed a small drop in the country's HIV infection rate to people absorbing the messages in awareness campaigns and changing their behaviour accordingly.

South Africa's health minister, Manto Tshabalala-Msimang, claimed that the first evidence of declining HIV prevalence in pregnant women - from 30.2 percent in 2005 to 29.1 percent in the latest survey - was mainly due to "our continued focus on prevention as the mainstay of our response to combat HIV".

But the real story behind increases and decreases in HIV prevalence is far less clear. "There's an awful lot of vested interests, but it's sufficiently murky that no one really knows what's going on," Prof John Hargrove, director of the Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA) at the University of Stellenbosch, South Africa, told IRIN/PlusNews.

Twenty-five years is not long to get to grips with an epidemic that has evolved very differently in different parts of the world: in Europe, North America and Asia it has largely been confined to high-risk groups like injecting drug users, sex workers and men who have sex with men; in southern Africa it has spread rapidly via heterosexual networks.

Although theories abound, "nobody really knows why southern Africa is worst affected", said Dr Brian Williams, another epidemiologist at SACEMA. "And if we don't know that, it's very difficult to explain why prevalence is going up or down."

Lack of reliable data

Part of the problem was having adequate, reliable surveillance figures. In general, said Hargrove, the data had been "bitty" and mostly derived from urban populations.

The first generation of HIV-prevalence figures were obtained by testing pregnant women at antenatal clinics, but the age groups of the women, and the fact they were clearly having unprotected sex, meant the numbers tended to overestimate HIV infections in the general population.

Where possible, antenatal surveys are now combined with more representative data gathered in household surveys, but UNAIDS noted in its 2005 epidemic update that the high numbers of people who refused to be tested in household surveys, or were absent from home, could lead to underestimations of HIV prevalence.

While prevalence only tells us how many people are living with HIV and AIDS, incidence measures the number of new HIV infections occurring during a specific period. Incidence provides the most up-to-date and revealing snapshot of an epidemic, but the technology for determining recent infections is still quite new and prohibitively expensive for most African countries.

In the absence of such surveys, HIV prevalence in people aged 15 to 20 is often used as a proxy, because it is probable that most infections in this age group are recent.

The variety and unreliability of most surveillance methods causes epidemiologists like Hargrove and Williams to take any news of apparent declines in HIV prevalence with a large pinch of salt.

For years, Uganda has been held up as the poster child of successful prevention policies: from a peak adult HIV-infection rate of about 15 percent in the early 1990s, UNAIDS now estimates Uganda's prevalence at 6.7 percent.

President Yoweri Museveni swiftly responded to the emerging crisis as early as the late 1980s, and grassroots campaigns communicated basic prevention messages, such as abstinence from sex before marriage, being faithful to one's partner and the use of condoms. The ABC approach, as it has now been dubbed, combined with Museveni's leadership, have been widely credited with reducing risky sexual behaviour and lowering the prevalence rate.

But Williams pointed out that the evidence for Uganda's falling infection rate was "not really clear", and was based on a handful of antenatal surveys in the capital, Kampala. "We're desperate for a success story, so Uganda will be a success story regardless of the lack of evidence," he said.

Justin Parkhurst, of the London School of Hygiene and Tropical Medicine, also questioned the "so-called proof" of Uganda's success in reducing HIV infections in the British medical journal, The Lancet. He pointed out that the evidence supporting prevalence declines had been based on "selective pieces of information, which have been falsely presented as representative of the nation as a whole."

Parkhurst suggested that governments in low- and middle-income countries were under pressure to respond to donor fatigue by exaggerating the success of their AIDS programmes. "The standard of proof for policy recommendations seems to have been lowered, to provide the international community with the African success story it wants, or even needs," he concluded.

If Uganda's prevalence had indeed declined, there was still no sure way of determining why. Parkhurst cautioned against attributing the decline to "a few specific interventions introduced by the Ugandan government": not only were there numerous players in the AIDS fight besides the government, but "individuals can change their behaviour for reasons unrelated to intervention programmes".

Williams believed that while real behaviour changes, such as having fewer partners and higher condom use, might have taken place, they had less to do with the government's efforts and more with the widespread experience of watching friends and relatives die from AIDS-related illnesses.

Natural history of an epidemic

The dynamics of an epidemic can also bring about changes in HIV prevalence: in the early phases, HIV infections have tended to rise steeply and then level off as they reached a "saturation" point in the population; at a later stage, HIV prevalence might start declining, not necessarily because of widespread behaviour change, but because the number of people dying from AIDS-related illnesses has outpaced the number of new infections.

When the mortality rate of those infected reaches a balance with the incidence of new infections, prevalence will plateau - the stage South Africa is currently experiencing.

Paradoxically, the impact of a national antiretroviral (ARV) programme that keeps large numbers of HIV-infected people alive for longer might actually increase prevalence, or offset a lower rate of new infections.

This could explain why a country with a large ARV programme, like Botswana, has not seen significant declines in HIV prevalence, while Zimbabwe, with it's relatively small programme, has. But the real story is probably far more complex, and impossible to decipher at present, due to the lack of investment in research, monitoring and tracking national AIDS epidemics.

"Billions have been spent on virology, but we just haven't done enough basic public health research," said Williams. "Very few studies have been done trying to understand what's actually going on."

Ideally, such a study would need to monitor several thousand people over a period of at least five years, testing them regularly for HIV. According to Williams, such studies have not been done, and even in-depth evaluations of the impact of specific prevention programmes have been few and far between.

The case of Zimbabwe

When news broke in 2006 that Zimbabwe's HIV prevalence had fallen from a peak of around 36 percent in 1996 to 21 percent by 2004, it was greeted in many sectors with puzzlement and even disbelief, in light of the country's social and economic collapse in recent years.

Prof Alan Whiteside, director of the Health Economics and HIV/AIDS Research Division (HEARD) of the University of KwaZulu-Natal, in South Africa, said government prevention campaigns in the mid-1990s had probably contributed to Zimbabwe's falling HIV infection rates, but the country's economic collapse could have played an even bigger role. With less disposable income and mobility, people were perhaps less likely to maintain multiple sexual partners.

Michael Chome, country director for Population Services International (PSI), an international NGO that partners the Zimbabwean government in prevention programmes, was ambivalent for nearly a year about the real causes of Zimbabwe's decline in prevalence.

Eventually he was swayed by PSI's own data, showing large increases in condom sales - a figure considered more telling than a greater distribution of free condoms - as well as significant increases in reported condom use and decreases in non-regular sexual partners.

He attributed these changes to a "very open-minded ministry of health and a very literate population", as well as the concentrated efforts of donors, which had created "a needle-like focus".

Zimbabwe's pariah-like status has tended to scare away donors but, according to Chome, news of the country's declining HIV prevalence was helping to attract more funding for AIDS programmes.

Social indicators

On the thorny question of whether prevention programmes have had a direct impact on HIV prevalence, Whiteside was as reluctant to give a definitive answer as the epidemiologists: "We can't say for sure, but equally we can't say they haven't," he said.

"There is a natural history [of an epidemic], and perhaps we've underestimated it ... The trouble is, we're looking at things that are going to take years to develop, and our monitoring and evaluation tends to be short-term."

In the absence of reliable long-term data, Whiteside believed the key to interpreting HIV/AIDS figures was "to understand what is going on in our societies more broadly".

He suggested that looking at social indicators such as the rates of rape and teenage pregnancies, or the numbers of children completing school, could provide indirect evidence of behaviour change, or lack of it.


Thursday, August 02, 2007

Botswana: HIV Prevalence Reduces, But Still High

By, Monkagedi Gaotlhobogwe, Mmegi/The Reporter (Gaborone), July 31, 2007

The HIV/AIDS surveillance report for 2006 says HIV prevalence among pregnant women between the ages of 15 and 49 years in Botswana continues to slide downward, but the prevalence rate continues to be one of the highest in the world.

This year's sentinel surveillance survey also said it recorded the highest sample size ever used and the lowest exclusion rate in surveys done in Botswana.

However, the report, sponsored by the Ministry of Health, National Aids Coordinating Agency (NACA), World Health Organisation, UNAIDS, BOTUSA, ACHAP and the Botswana-Harvard School of Public Health AIDS Initiative, also warns that HIV prevalence among pregnant women in Botswana remains one of the highest in the world at 32.4%.

The report says a close look at statistical trends shows that the decline of HIV prevalence among pregnant women has been constant since 2001 except in 2003 when it took a sharp increase.

According to the report, the overall percentage decline in HIV prevalence from 2001 to 2006 is estimated at 10.5 per cent. "This decline was greatest among young people aged 20-24 (23.8 percent) followed by those aged 15-19 years (23.2 percent).

The report attributes the downward trend in HIV prevalence to the sharp increase in condom use among the youth aged between 15 and 24 years.

It says in general, males report a higher condom use than females and condom use remains generally stagnant across age groups between 2002 and 2005.

The adjusted HIV prevalence in Botswana among women (pregnant or not pregnant) continues to be high at 32.4 per cent for women between 15-49 years, according to the report.

Chobe District has the highest HIV prevalence of 42 per cent, and Selebi-Phikwe has HIV prevalence of 41.1 per cent.

In general, the report noted that HIV prevalence remains highest in the northern part of the country.

The report blames resistance to behavioural change as a contributing factor to high prevalence rates. "There doesn't seem to be much change in the trends of reported multiple partners for males and females," it says.

It says the percentage of sexually active young people increased from 2001 to 2003 and remained high since then.

" Sexual behaviour dynamics observed over the last five years based on data from surveys were not encouraging as far as their contributions to reducing HIV incidence," the report says.

It further added that apart from condom use with non-marital, non-cohabiting sex partners which was high among the 15-24 year olds, all other sexual behavior indicators included in the analysis have remained stagnant.

The report also observes that being single and living in cohabitation have been strongly associated with very high risk of HIV infection compared to living in marital union.

It was also discovered that educated women rarely fall pregnant, while domestic workers and women with primary education consistently recorded high HIV prevalence.

" The two variables are closely related to the impact of poverty on HIV transmission", says the report.


Wednesday, August 01, 2007

High Rates of HIV Infection Documented Among Young Nepalese Girls Sex-Trafficked to India

By, Newswise, July 31, 2007

A study by Harvard School of Public Health (HSPH) researchers of girls and women who were sex-trafficked from Nepal to India and then repatriated has found that 38 percent were HIV positive. The infection rate exceeded 60 percent among girls forced into prostitution prior to age 15 years. One in seven of the study’s participants had been trafficked into sexual servitude prior to this young age.

Approximately 600,000 to 800,000 people are trafficked across the globe every year, and 80 percent of these individuals are estimated to be women and girls, according to the U.S. Department of State. The State Department further reports that the majority of transnational victims are females trafficked into commercial sexual exploitation. An estimated 150,000 women and girls are trafficked annually within and across South Asia, with the majority destined for major Indian cities, according to a report by the Congressional Research Service.

“The high rates of HIV we have documented support concerns that sex trafficking may be a significant factor in both maintaining the HIV epidemic in India and in the expansion of this epidemic to its lower-prevalence neighbors,” said Jay Silverman, Associate Professor of Society, Human Development, and Health at HSPH.

India has the third largest HIV/AIDS population in the world, with approximately 2.5 million infected individuals, according to the country’s National AIDS Control Organization, supported by UNAIDS and the World Health Organization. Neighboring Nepal has far lower but increasing numbers of HIV/AIDS cases. Trafficking of Nepalese women and girls to India has been cited by the World Bank as a risk factor for HIV transmission in the region.

Silverman is the lead author of the study published in the August 1, 2007, issue of the Journal of the American Medical Association (JAMA). He led a research team in reviewing the medical documentation and case records of 287 girls and women who had been sex-trafficked from Nepal to India between the years 1997 and 2005. All had been repatriated back to Nepal and had received rehabilitative services from Maiti Nepal, a non-governmental organization that works to assist trafficking victims. The word “Maiti” means “mother’s home” in Nepali.

The researchers found that among the 287 girls and women, 38 percent tested positive for HIV. Among those with complete documentation of trafficking experiences (225 girls and women), the median age at time of trafficking was 17 years, with 33 girls (14.7 percent) trafficked prior to age 15 years. Compared to those trafficked at 18 years or older, girls trafficked prior to age 15 years had an increased risk for HIV, with 60.6 percent infected among this youngest age group. Risk was also associated with being trafficked specifically to Mumbai, India, and with longer durations in brothels.

“HIV infection has been seen as perhaps the most critical health consequence of sex trafficking, but sex-trafficked girls and women are rarely studied — leaving the prevalence of HIV and other health issues among this highly vulnerable population little understood,” said Silverman. “This study sheds new light on infection rates among a sex-trafficked population and exposes both the tragic existence of the youngest victims and the dire health consequences of this crime.”

Silverman and his team suggest several likely explanations for the observed high risk for HIV infection among the youngest trafficked girls. Previous research on male brothel clients in India suggests that these men prefer very young girls, often presented as virgins, due to fear of HIV and other infection, as well as to the widespread myth that sex with a virgin will cure such illnesses. As a result of client demand and of the relatively high profits earned from prostituting these very young girls, brothel owners take steps to keep them in captivity for longer periods of time. The HSPH team found that girls trafficked under age 15 were more likely than older girls to be held in brothels for a year or longer, and that the risk of HIV infection increased by two percent for every additional month of brothel detention.

“Historically, there has been little recognition of these young girls in brothels because they are typically hidden from both legal authorities and those working to help and study prostituted women,” said co-author and former HSPH doctoral student Jhumka Gupta.

Added co-author and HSPH doctoral student Michele Decker, “Now, we are learning that these youngest girls not only exist, but are actually the most vulnerable to HIV, highlighting the need for improved prevention of trafficking and greater efforts to identify and rescue sex-trafficked girls.”

Silverman and his team suggest that the prevention of sex trafficking and the intervention into the practice should be seen as a critical aspect of preventing both the spread of HIV/AIDS and reducing a widespread and violent human rights violation.

The authors assert that few resources have been devoted to the prevention of sex trafficking, particularly in relation to the large estimated numbers of affected individuals and to the public health consequences. In particular, the authors specify that approaches oriented to male clientele that reduce the demand for sex from young prostituted girls must be emphasized.

“Just as in other areas of HIV prevention, we can no longer afford to ignore the behavior of men and boys,” said Silverman. “Addressing the widely accepted male demand for commercial sex is critical to ending this modern day form of female slavery.”

The study was supported by grants to J. Silverman and B. Willis from the Office of Trafficking in Persons, U.S. Department of State; J. Silverman and A. Raj from the Harvard University Center for AIDS Research; A. Raj from the Center for International Health at the Boston University School of Public Health; and J. Silverman and J. Gupta from the Harvard University South Asia Initiative.

“HIV Prevalence and Predictors of Infection in Sex-Trafficked Nepalese Girls and Women,” Jay G. Silverman, PhD, Michele R. Decker, MPH, Jhumka Gupta, ScD, MPH, Ayonija Maheshwari, MD, MPH, Brian M. Willis, JD, MPH, Anita Raj, PhD, JAMA, August 1, 2007, vol. 298, no. 5.

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Sixty per cent of HIV-infected living in rural India: WHO

By, Hindustan Times, August 1, 2007

Sixty per cent of the estimated 5.2 million HIV-infected adults in India are living in rural areas, according to a WHO report.

Though commercial sex is the major reason behind the prevalence of the pandemic in most parts of the country, injecting drug use (IDUs), especially in north-eastern states, Delhi, Mumbai and Chennai, is fast emerging as a major source of transmission.

"Analysis of surveillance data by place of residence indicates that HIV has been spreading to the rural areas," the report said.

"Of the estimated 5.2 million HIV-infected adults in India, 3.05 million or nearly 60 per cent were residing in rural areas. Of the reported AIDS cases, sexual transmission accounts for 86 per cent in India," the report said.

Apart from several states recording a higher HIV prevalence among rural sentinel surveillance sites than urban sites, the dreaded disease has now started penetrating the low-risk general population, the report pointed out.

"The HIV epidemic of Manipur that was once a concentrated epidemic among IDUs, is now considered a generalised epidemic," the report said.

In 2005, seven of the 10 ante-natal clinic sentinel surveillance sites in Manipur recorded an HIV prevalence of one per cent or above indicating the spread of infection from high-risk to low-risk populations, the report said.

The report said HIV among IDUs increased markedly from seven per cent in 2002 to 23 per cent in 2005.

Increasingly, HIV infection rates are being observed among IDUs in not only the northeastern states, but other urban areas like Delhi, Mumbai and Chennai, it said.