Inter Press Service » Health Turning the World Downside Up Wed, 20 Aug 2014 22:29:56 +0000 en-US hourly 1 India: Home to One in Three Child Brides Wed, 20 Aug 2014 06:52:50 +0000 Neeta Lal In India, 27 percent of women aged 20-49 were married before they were 15 years old. Credit: Jaideep Hardikar/IPS

In India, 27 percent of women aged 20-49 were married before they were 15 years old. Credit: Jaideep Hardikar/IPS

By Neeta Lal
NEW DELHI, Aug 20 2014 (IPS)

Basanti Rani*, a 33-year-old farmers’ wife from the northern Indian state of Haryana, recently withdrew her 15-year-old daughter Paru from school in order to marry her off to a 40-year-old man.

“In an increasingly insecure social milieu, where rape and sexual abuse have become so common, marrying off my daughter was a wise move,” she told IPS.

“Who would’ve married her had she been abused or raped? Now, at least, her husband can look after her.”

Such a mindset, widespread across this country of 1.2 billion people, is just one of the reasons why India hosts one out of every three child brides in the world.

A recent United Nations report entitled ‘Ending Child Marriage – Progress and Prospects’ found that, despite the existence of a stringent anti-child marriage law, India ranks sixth among countries with the highest prevalence of child marriages across the globe.

The U.N. Children’s Fund (UNICEF) defines child marriage as unions occurring before a person is 18 years of age, and calls the practice a “violation of human rights.”

In India, 27 percent of women aged 20-49 claim to have tied the knot before turning 15, the survey states.

“The problem persists largely because of the patriarchal vision that perceives marriage and childbearing as the ultimate goals of a girl’s life,” explains Sonvi A. Khanna, advisory research associate for Dasra, a philanthropic organisation that works with UNICEF.

The increasing rates of violence against girls in both rural and urban India, adds Khanna, are instilling fear in the minds of families, leading them to marry their girls off as soon as they reach puberty.

According to the National Crime Records Bureau (NCRB)’s July 2014 records, there were 309,546 crimes against women reported to the police last year against 244,270 in 2012.

Crimes included rape, kidnapping, sexual harassment, trafficking, molestation, and cruelty by husbands and relatives. They also included incidents in which women were driven to suicide as a result of demands for dowries from their husbands or in-laws.

The NCRB said the number of rapes in the country rose by 35.2 percent to 33,707 in 2013 – with Delhi reporting 1,441 rapes in 2013 alone, making it the city with the highest number of rapes and confirming its reputation as India’s “rape capital”.

Mumbai, known for being more women-friendly, recorded 391 rapes last year, while IT hub Bangalore registered 80 rapes.

Obstacles to ending child marriages

The law, experts say, can do little to change mindsets or provide alternatives to child marriage.

A report by Dasra entitled ‘Marry Me Later: Preventing Child Marriage and Early Pregnancy in India’ states that the practice “continues to be immersed in a vicious cycle of poverty, low educational attainment, high incidences of disease, poor sex ratios, the subordination of women, and most significantly the inter-generational cycles of all of these.”

According to the report, despite the fact that child marriage as a practice “directly hinders the achievement of six of eight Millennium Development Goals, as an issue, it remains grossly under-funded.”

If the present trends continue, of the girls born between 2005 and 2010, 28 million could become child brides over the next 15 years, it states.

The increasing rates of violence against girls in both rural and urban India are instilling fear in the minds of families, leading them to marry their girls off as soon as they reach puberty. Credit: Credit: Sujoy Dhar/IPS

The increasing rates of violence against girls in both rural and urban India are instilling fear in the minds of families, leading them to marry their girls off as soon as they reach puberty. Credit: Credit: Sujoy Dhar/IPS

The 2006 Prohibition of Child Marriage Act (PCMA) seeks to prevent and prohibit the marriage of girls under 18, and boys under 21 years of age.

It states that if an adult male aged 18 and above is wed to a minor he shall be “punishable with rigorous imprisonment for two years or with [a] fine, which may extend to […] one lakh” (about 2,000 dollars).

Furthermore, if “a person performs, conducts, directs or abets any child marriage”, that person too shall face a similar punishment and fine.

Experts term PCMA a fairly progressive law compared to its predecessors, one with the rights of the child at its core.

It even allows for annulment of a child marriage if either party applies for it within two years of becoming adults. Even after annulment of the marriage, the law provides for residence and maintenance of the girl by her husband or in-laws until she re-marries.

“Any children born of the marriage are deemed legal and their custody is provided for, keeping the child’s best interests in mind, states this law,” a Delhi-based High Court advocate told IPS.

Yet, the legislation has not been adequately enforced due to its heavy reliance on community reporting, which rarely happens.

“Since reporting a child marriage could mean imprisonment and stigma for the family, immense financial loss and unknown repercussions for the girl, few come forward to report the event,” Khanna said.

“Adding to the problem is corruption among the implementers, or the police, who are insensitive to the need [to] stop child marriages.”

Small wonder, then, that convictions under PCMA have been few and far between.

According to the NCRB, only 222 cases were registered under the Act during the year 2013, compared to 169 in 2012 and 113 in 2011. Out of these, only 40 persons were convicted in 2012, while in 2011, action was taken against 76 people.

Young brides make unhealthy mothers

Apart from social ramifications, child marriages also lead to a host of medical complications for young mothers and their newborn babies.

According to gynecologist-obstetrician Suneeta Mehwal of Max Health Hospital in New Delhi, low birth weight, inadequate nutrition and anaemia commonly plague underage mothers.

“Postpartum hemorrhage (bleeding after delivery) is an added risk. Girls under 15 are also five times more likely to succumb to maternal mortality than those aged above 20.”

According to data released by the Registrar General of India in 2013, the maternal mortality rate (MMR) dropped from 212 deaths per 100,000 live births in 2007-09 to 178 in 2010-12.

Still, India is far behind the target of 103 deaths per live births to be achieved by 2015 under the United Nations-mandated Millennium Development Goals (MDGs).

Infant mortality declined marginally to 42 deaths per 1,000 live births in 2012 from 44 deaths in 2011. Among metropolitan cities, Delhi, the national capital, was the worst performer, with 30 deaths per 1,000 live births in 2012.

One in every 24 infants at the national level, one in every 22 infants in rural areas, and one in every 36 infants in urban areas still die within one year of life, according to the Registrar’s data.

This dire health situation is made worse by the prevalence of child marriage, experts say.

Activists point out that the main bottlenecks they encounter in their fieldwork are economic impoverishment, social customs, lack of awareness about consequences of child marriage and the belief that marriage offers social and financial security to the girl.

This is unsurprising since, according to the Global Hunger Index (GHI) 2013, India is one of the hungriest countries in the world, ranking 63rd in a list of 78 countries, behind Pakistan at 57, Nepal at 49 and Sri Lanka at 43.

Many parents also believe that co-habitation with a husband will protect a young girl from rape and sexual activity.

“Nothing could be further from [the] truth,” explains Meena Sahi, a volunteer with Bachpan Bachao Andolan (Save the Childhood Movement), a non-profit organisation working in the field of child welfare.

“On the contrary, the young girl is coerced into early sexual activity by a mostly overage husband, leading to poor reproductive health. Adolescent pregnancies do the worst damage – emotional and physical – to the mother as well as the newborn,” Sahi told IPS.

Social activists admit that to accelerate change, girls should be provided with robust alternatives to marriage. Education and vocational training should be used as bridges to employment for girls, especially in rural areas.

The 2011 census reported a nationwide literacy rate of 74.04 percent in 2011. Male literacy rate stands at 82.14 percent and female literacy hovers at 65.46 percent.

Engaging closely with those who make decisions for families and communities, explaining to them the ill effects of child marriage on their daughters, as well as providing information, as well as birth and marriage registrations, are some ways to address child marriages and track child brides.

Change is happening but at a glacial pace. In an attempt to eliminate child marriages in the Vidarbha district of the southern state of Maharashtra, 88 panchayats (local administrative bodies) passed a resolution this year to ban the practice.

Following the move, 18 families cancelled the weddings of their minor daughters.

Although annulment of child marriage is also a complex issue, India’s first child marriage was annulled in 2013 by Laxmi Sargara who was married at the age of one without the knowledge of her parents. Laxmi remarried – this time of her own choice – in 2014.

*Name changed upon request.

Edited by Kanya D’Almeida

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Can Land Rights and Education Save an Ancient Indian Tribe? Tue, 19 Aug 2014 12:28:03 +0000 Manipadma Jena Bonda women in the remote Tulagurum Village in the eastern Indian state of Odisha seldom allow themselves to be photographed. Credit: Manipadma Jena/IPS

Bonda women in the remote Tulagurum Village in the eastern Indian state of Odisha seldom allow themselves to be photographed. Credit: Manipadma Jena/IPS

By Manipadma Jena
MALKANGIRI, India, Aug 19 2014 (IPS)

Scattered across 31 remote hilltop villages on a mountain range that towers 1,500 to 4,000 feet above sea level, in the Malkangiri district of India’s eastern Odisha state, the Upper Bonda people are considered one of this country’s most ancient tribes, having barely altered their lifestyle in over a thousand years.

Resistant to contact with the outside world and fiercely skeptical of modern development, this community of under 7,000 people is struggling to maintain its way of life and provide for a younger generation that is growing increasingly frustrated with poverty – 90 percent of Bonda people live on less than a dollar a day – and inter-communal violence.

“The abundant funds pouring in for the Bonda people's development need to be transparently utilised so that the various inputs work in synergy and show results." -- Dambaru Sisa, the first ever Upper Bonda to be elected into the state legislature in 2014
Recent government schemes to improve the Bonda people’s access to land titles is bringing change to the community, and opening doors to high-school education, which was hitherto difficult or impossible for many to access.

But with these changes come questions about the future of the tribe, whose overall population growth rate between 2001 and 2010 was just 7.65 percent according to two surveys conducted by the Odisha government’s Scheduled Castes and Scheduled Tribes Research and Training Institute (SCSTRTI).

First land rights, then education

In a windowless mud hut in the Bonda Ghati, a steep-sloping mountainous region in southwest Odisha, Saniya Kirsani talks loudly and drunkenly about his plans for the acre of land that he recently acquired the title to.

The 50-year-old Bonda man has illusions of setting up a mango orchard in his native Tulagurum village, which will enable him to produce the fruity liquor that keeps him in a state of intoxication.

His wife, Hadi Kirsani, harbours far more realistic plans. For her, the land deeds mean first and foremost that their 14-year-old son, Buda Kirsani, can finally go back to school.

He dropped out after completing fifth grade in early 2013, bereft of hopes for further education because the nearest public high school in Mudulipada was unaffordable to his family.

Upper and Lower Bondas

Since the mid 20th century, many Bonda families left their original lands and settled in the foothills of Malkangiri, where they have easier access to ‘mainstream’ services such as education and employment.

Known as the Lower or Plains Bondas, they are now found in as many as 14 of Odisha’s 30 districts due to rapid out-migration.

Upper and Lower Bondas have a combined total population of 12,231, registering a growth rate of 30.42 percent between 2001 and 2011 according to census data, compared to a low 7.65-percent growth rate among the Upper Bondas who remain on their ancestral lands.

The sex ratio among Upper Bonda people is even more skewed than in other tribal groups, with the female population outweighing males by 16 percent.

A 2009 baseline survey in Tulagurum village among the age group 0-six years found 18 girls and only three boys.

SCSTRTI’s 2010 survey of 30 Upper Bonda villages found 3,092 men and 3,584 women.

The Upper Bonda are one of 75 tribes designated as a Particularly Vulnerable Tribal Group (PTG) in India, including 13 in Odisha state alone.
Moreover, he would have had to walk 12 km, crossing hill ranges and navigating steep terrain, to get to his classroom every day.

Admission to the local tribal resident school, also located in Mudulipada, required a land ownership document that would certify the family’s tribal status, which they did not possess.

The Kirsani family had been left out of a wave of reforms in 2010 under the Forest Rights Act, which granted 1,248 Upper Bonda families land titles but left 532 households landless.

Last October, with the help of Landesa, a global non-profit organisation working on land rights for the poor, Buda’s family finally extracted the deed to their land from the Odisha government.

Carefully placing Buda’s only two sets of worn clothes into a bag, Hadi struggles to hold back the tears welling up in her eyes as she tells IPS that her son is now one of 31 children from the 44-household village who, for the first time ever, has the ability to study beyond primarily school.

She is not alone in her desire to educate her child. Literacy among Upper Bonda men is a miserable 12 percent, while female literacy is only six percent, according to a 2010 SCSTRTI baseline survey, compared to India’s national male literacy rate of 74 percent and female literacy of 65 percent.

For centuries, the ability to read and write was not a skill the Bonda people sought. Their ancient Remo language has no accompanying script and is passed down orally.

As hunters and foragers, the community has subsisted for many generations entirely off the surrounding forests, bartering goods like millet, bamboo shoots, mushrooms, yams, fruits, berries and wild spinach in local markets.

Up until very recently, most Upper Bondas wove and bartered their own cloth made from a plant called ‘kereng’, in addition to producing their own brooms from wild grass. Thus they had little need to enter mainstream society.

But a wave of deforestation has degraded their land and the streams on which they depend for irrigation. Erratic rainfall over the last decade has affected crop yields, and the forest department’s refusal to allow them to practice their traditional ‘slash and burn’ cultivation has made it difficult for the community to feed itself as it has done for hundreds of years.

Mainstreaming: helping or hurting the community?

Since 1976, with the establishment of the Bonda Development Agency, efforts have been made to bring the Upper Bonda people into the mainstream, providing education, better sanitation and drinking water facilities, and land rights.

“Land ownership enables them to stand on their own feet for the purpose of livelihood, and empowers them, as their economy is predominantly limited to the land and forests,” states India’s National Commission for Scheduled Tribes (NCST), a key policy advisory body.

Efforts to mainstream the Bonda people suffered a setback in the late 1990s, when left-wing extremists deepened the community’s exclusion and poverty by turning the Bonda mountain range into an important operating base along India’s so-called ‘Red Corridor’, which stretches across nine states in the country’s central and eastern regions and is allegedly rife with Maoist rebels.

Still, Odisha’s tribal development minister Lal Bihari Himirika is confident that new schemes to uplift the community will bear fruit.

“Upon completion, the ‘5000-hostel scheme’ will provide half a million tribal boys and girls education and mainstreaming,” he told IPS on the sidelines of the launch of Plan International’s ‘Because I Am A Girl’ campaign in Odisha’s capital, Bhubaneswar, last year.

The state’s 9.6 million tribal people constitute almost a fourth of its total population. Of these tribal groups, the Upper Bonda people are a key concern for the government and have been named a Particularly Vulnerable Tribal Group (PTG) as a result of their low literacy rates, declining population and practice of pre-agricultural farming.

Social activists like 34-year-old Dambaru Sisa, the first ever Upper Bonda to be elected into the state legislature in 2014, believe mainstreaming the Bonda community is crucial for the entire group’s survival.

Orphaned as a child and educated at a Christian missionary school in Malkangiri, Sisa now holds a double Masters’ degree in mathematics and law, and is concerned about his people’s future.

“Our cultural identity, especially our unique Remo dialect, must be preserved,” he told IPS. “At the same time, with increased awareness, [the] customs and superstitions harming our people will slowly be eradicated.”

He cited the Upper Bonda people’s customary marriages – with women generally marrying boys who are roughly ten years younger – as one of the practices harming his community.

In customary marriages, Bonda women marry boys who are seven to 10 years their junior. Typically, a 22-year-old woman will be wed to a 15-year-old boy. Credit: Manipadma Jena/IPS

In customary marriages, Bonda women marry boys who are seven to 10 years their junior. Typically, a 22-year-old woman will be wed to a 15-year-old boy. Credit: Manipadma Jena/IPS

Women traditionally manage the household, while men and boys are responsible for hunting and gathering food. To do so, they are trained in archery but possession of weapons often leads to brawls within the community itself as a result of Bonda men’s quick tempers, their penchant for alcohol and fierce protection of their wives.

A decade ago, an average of four men were killed by their own sons or nephews, usually in fights over their wives, according to Manoranjan Mahakul, a government official with the Odisha Tribal Empowerment & Livelihood Programme (OTELP), who has worked here for over 20 years.

Even now, several Bonda men are in prison for murder, Mahakul told IPS, though lenient laws allow for their early release after three years.

“High infant mortality, alcoholism and unsanitary living conditions, in close proximity to pigs and poultry, combined with a lack of nutritional food, superstitions about diseases and lack of medical facilities are taking their toll,” Sukra Kirsani, Landesa’s community resource person in Tulagurum village, told IPS.

The tribe’s drinking water is sourced from streams originating in the hills. All families practice open defecation, usually close to the streams, which results in diarrhoea epidemics during the monsoon seasons.

Despite a glaring need for change, experts say it will not come easy.

“Getting Bonda children to high school is half the battle won,” Sisa stated. “However, there are question marks on the quality of education in residential schools. While the list of enrolled students is long, in actuality many are not in the hostels. Some run away to work in roadside eateries or are back home,” he added.

The problem, Sisa says, is that instead of being taught in their mother tongue, students are forced to study in the Odia language or a more mainstream local tribal dialect, which none of them understand.

The government has responded to this by showing a willingness to lower the required qualifications for teachers in order to attract Bondas teachers to the classrooms.

Still, more will have to be done to ensure the even development of this dwindling tribe.

“The abundant funds pouring in for Bondas’ development need to be transparently utilised so that the various inputs work in synergy and show results,” Sisa concluded.

Edited by Kanya D’Almeida

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Recurrent Cholera Outbreak in Far North Cameroon Highlights Development Gaps Tue, 19 Aug 2014 09:30:30 +0000 Monde Kingsley Nfor Lara Adama digs for water in a dried up river bed in Dumai, in Cameroon’s far north. There has been a nine-month drought in the region and recurrent cholera outbreaks. Credit: Monde Kingsley Nfor/IPS

Lara Adama digs for water in a dried up river bed in Dumai, in Cameroon’s far north. There has been a nine-month drought in the region and recurrent cholera outbreaks. Credit: Monde Kingsley Nfor/IPS

By Monde Kingsley Nfor
DUMAI/YAOUDE, Cameroon, Aug 19 2014 (IPS)

Under a scorching sun, with temperatures soaring to over 40 degrees Celsius, Lara Adama’s family is forced to dig for water from a dried-out river bed in Dumai, in northern Cameroon. 

This is one of the rivers that used to flow into the shrinking Lake Chad but there is not much water here.

There has been a nine-month-long drought in the region and Adama tells IPS that her family “digs out the sand on this river bed to tap water.”

“We depend on this water for everything in the house,” Adama, a villager in Mokolo in Cameroon’s Far North Region, says.

A cholera outbreak has been declared in Adama’s village. But she and other community members have no choice but to get their water from this river.

The lone borehole in this village of about 1,500 people is out of use due to technical problems.

“Every family comes here to retrieve drinking water. Our animals too depend on this water source to survive. When we come after the animals have already polluted a hole, we simply dig another to avoid any health problems,” she says.

This region is threatened by extreme water shortages and climate variability. Barren soils constitute some 25 to 30 percent of the surface area of this region. Lake Chad is rapidly shrinking while Lake Fianga dried up completely in December 1984.

Gregor Binkert, World Bank country director for Cameroon, tells IPS that a water-related crisis is prevalent in the north and there is an increased need for protection from floods and drought, which are affecting people more regularly.

“Northern Cameroon is characterised by high poverty levels, and it is also highly vulnerable to natural disasters and climate shocks, including frequent droughts and floods,” Binkert explains.

The protracted droughts in Far North Region have triggered a sharp increase in cholera cases. The outbreak is mainly concentrated in the Mayo-Tsanaga region as all its six health districts have cases of the infectious disease. The current outbreak has already resulted in more than 200 deaths out of the 1,500 cholera cases reported here since June.

According Cameroon’s Minister of Public Health Andre Mama Fouda, “poor sanitation and limited access to good drinking water are the main causes of recurrent outbreak in the Far North. A majority of those infected with the disease are children under the age of five and women.”

Since 2010 three cholera outbreaks have been declared in Far North Region:
  • In 2010, a cholera outbreak spread to eight of Cameroon’s 10 regions, resulting in 657 deaths – 87 percent of which where were from the Far North Region.
  • In 2011, 17,121 suspected cholera cases, including 636 deaths, were recorded in Cameroon. Again a majority of those who died were from the Far North.
  • The latest cholera case in Far North was registered on Apr. 26, when a Nigerian family crossed into Cameroon to receive treatment. Neighbouring Nigeria has reported 24,683 cholera cases since January and the first week of July.

Poor hygiene practices

“Cholera in this region is not only a water scarcity problem, it also aggravated by the poor hygienic practices that are deeply rooted in people’s culture. Water is scarce and considered as a very precious commodity, but handling it is quite unhygienic,” Félicité Tchibindat, the country representative for the United Nations Children’s Fund (UNICEF) Cameroon, tells IPS.

Cultural practices are still primitive in most villages and urban areas.

Northerners have a culture where people publicly share water jars, from which everyone drinks from.

“These practices and many others make them vulnerable to water vector diseases. [It is the] reason why cholera can easily spread to other communities. Cholera outbreaks are a result of inadequate water supplies, sanitation, food safety and hygiene practices,” Tchibindat says.

Open defecation is also common in the region. According Global Atlas of Helminth Infections, 50 to 75 percent of the rural population in Far North Cameroon defecate in the open, compared to 25 to 50 percent of people in urban areas.

Access to good drinking water and sanitation is also very limited. Two out of three people do not have access to proper sanitation and hygiene. While about 40 percent of the population has access to good drinking water, this figure is much lower in rural areas. In rural Cameroon only about 18 percent of people have access to improved drinking water sources, which are on average about over 30 minutes away.

Development challenges

Water sanitation and health (WASH) is vital for development, yet Far North Region has some of the most limited infrastructure in the entire nation, coupled with security challenges as the region is increasily throated by Nigeria’s extremist group Boko Haram.

Poverty is high in the region, UNICEF’s Tchibindat says. And the security issue in neighbouring countries has not helped Cameroon provide proper access to medical services here.

According to UNICEF, major challenges abound in Cameroon. There is a low capacity of coordination for WASH at all levels, and poor institutional leadership of sanitation issues. The decentralisation of the WASH sector means there is no proper support with inequitable distribution of human resources in regions.

“The government and many development partners have provided boreholes to communities and the region counts more than 1,000 boreholes today,” Parfait Ndeme from the Ministry of Mines, Water Resources and Energy says.

But about 30 percent of boreholes are non-functional and need repair, according to UNICEF.

Ndeme explains that, “the cost of providing potable water in the sahelian region might be three times more costly than down south. Distance is one major factor that influences cost and the arid climate in the region makes it difficult to have underground water all year round.”

A borehole in the northern region costs at least eight million Francs (about 16,300 dollars) compared to two million Francs (about 4,000 dollars) in other regions.

Health care challenges are prominent.

“The Far North has limited access development which also has a direct influence of the quality of health care,” Tchibindat says.

The unavailability of basic infrastructure and equipment in health centres makes it difficult to practice in isolated rural areas. Consequently, most rural health centre have a high rate of desertion by staff due to the low level of rural development, she adds.

Most of Cameroon’s health workers, about 59.75 percent, are concentrated in the richest regions; Centre, Littoral and West Region, serving about 42.14 percent of Cameroon’s 21 million people.

According to the World Health Organisation:

  • 30.9 percent of health centres in Cameroon do not have a medical analysis laboratory.
  • 83 percent of health centres do not have room for minor surgery.
  • 45.7 percent of health centres have no access to electricity
  • 70 percent of health centres have no tap water.

“Due to lack of equipment in hospitals, the treatment might only start after a couple of hours increasing the probability of it spreading,” Peter Tambe, a health expert based in Maroua, the capital of Far North Region, tells IPS.

“Report of new cholera cases are numerous in isolated villages and the present efforts by the government and development partners are not sufficient to treat and also monitor prevalence,” Tambe says.

Since the discovery of cholera in the region, the government and UNICEF and other partners have doubled their services to these localities to enforce health facilities and provide the population with basic hygiene aid, water treatment tablets and free treatment for patients, regardless of their nationality, along the border with Chad and Nigeria.

“Despite insecurity challenges facing this region, the government and its partners have embarked on information exchanges with Niger, Chad, and Nigeria to avoid further cross-border cases,” Public Health Minister Fouda tells IPS.

Edited by: Nalisha Adams

The writer can be contacted at

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Helping Uganda’s HIV positive Women Avoid Unplanned Pregnancies Mon, 18 Aug 2014 12:05:08 +0000 Amy Fallon Contraception is a smart choice but HIV positive women have to jump through the hooks to get it. Credit: Amy Fallon/IPS

Contraception is a smart choice but HIV positive women have to jump through the hooks to get it. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Aug 18 2014 (IPS)

Barbara Kemigisa used to call herself an “HIV/AIDS campaigner”. These days she would rather be known as an “HIV/AIDS family planning campaigner”.

“We need to reduce unplanned pregnancies and the HIV infection rate in our country,” Kemigisa told IPS during Uganda’s first national family planning conference on July 28. “It’s about dual protection.”

Raped by two uncles from an early age, Kemigisa later became promiscuous. When she was 22, she discovered she was HIV positive – and two months pregnant. Her daughter, Kourtney, now five, was born negative. But the mother couldn’t afford to buy her formula milk and, when she was just six-months-old, the baby tested positive, through breastfeeding.

Fast Facts About HIV AND Women in Uganda 2013

36.3m population
58 life expectancy
7.2% HIV prevalence
780,000 women living with HIV
6 total fertility rate
30% modern contraceptive use
57% births with skilled attendant

Source: UNICEF

Kemigisa, an informed activist who gets her ARVs the Infectious Diseases Institute at Mulago Hospital and works with KiBO Foundation in Kampala,never had any problem obtaining contraceptives.

The same can’t be said for many young HIV positive women Kemigisa regularly meets.

“Health workers tell them ‘you’re positive, you’re not supposed to be having children’,” she says.

In the last decade, Uganda’s modern contraceptive use among women has slowly increased from 18 percent to 26 percent.

Though low, this level of contraceptive use likely averted 20 percent of paediatric HIV infections and 13 percent of AIDS-related children’s deaths, says a study. Expanding family planning services can substantially reduce child infections, it concluded.

This is crucial. Uganda’s HIV infection rate of seven percent is steadily rising after a steep drop in the 1990s, when more than a quarter of the population was infected.

Uganda now accounts for the third largest number of annual new HIV infections in the world, after South Africa and Nigeria, according to the United Nations Joint Programme on HIV/AIDS (UNAIDS).

Turning women away

Contraception is the second pillar of preventing mother to child HIV transmission (PMTCT) but one that is often neglected although, at an average of six children per woman, Uganda has one of the world’s highest fertility rates.

Women trying to cope with HIV also struggle to get the “right and correct information” on family planning, says Dorothy Namutamba, of the International Community of Women living with HIV/AIDS Eastern Africa (ICWEA).

“Information doesn’t reach women living with HIV in their reproductive age,” she says.

Women may face violence at home for being HIV positive and for using contraception, only to be further mistreated when they turn to health workers, says Namutamba.

“Some are told ‘oh, this is best for you’ and brushed off at the health facility,” says Namutamba.

In the worst-case scenarios, some HIV positive women have undergone coerced sterilisation.

Namutamba says this may happen when the woman has a caesarean section or goes for family planning services: “They’re told that this is the best for you as a HIV positive woman.”

In Kenya, ICWEA and other groups have documented about fifty cases of coerced sterilisation and will release later this year a report about similar cases in Uganda.

Because of discriminatory attitudes, “a large percentage of women are hesitant to share their status with health workers when they come to receive family planning services,” Dr Deepmala Mahla, country director for Marie Stopes Uganda, told IPS.

Two services, one trip

Inadequate coverage, frequent stock outs of commodities, limited offer of contraceptive methods and lack of trained staff affect family planning services for all women in Uganda, says Dr Primo Madra, programme officer with the United Nations Population Fund (UNFPA) in Kampala.

But for women living with HIV, he says, the main problem is the time and effort required.

An HIV positive woman who goes to the clinic for a refill of ARV pills must line up at the HIV clinic and then at the family planning clinic, both likely with long queues. She may have to do two trips.

“Most often the woman will prioritise the ARVs,” says Madra.

In a number of districts, the government and UNFPA are setting up “one-stop-shops” that offer both HIV and reproductive health services, and training health workers in the new system.

“This will enable a woman who walks into an ARV clinic to access all services more conveniently,” Primo told IPS.

But, he adds, the nationwide rollout of one-stop-shops is constrained by lack of staff: “Many health facilities have vacant health worker positions and are overwhelmed by the patient load.”

Edited by: Mercedes Sayagues

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TB Epidemic Threat Hangs Over Ukraine Conflict Sun, 17 Aug 2014 10:40:33 +0000 Pavol Stracansky By Pavol Stracansky
KIEV, Aug 17 2014 (IPS)

Doctors are warning of a worsening tuberculosis epidemic in Eastern Ukraine as the continuing conflict there begins to take a heavy toll on public health.

With thousands of people fleeing the region every day, medical supplies severely disrupted and those left behind under growing physical stress and increasingly unable to access medical services, conditions are ripe for a rise in new TB cases.

Dr Masoud Dara, Tuberculosis Programme Manager at the World Health Organisation (WHO) Europe, told IPS: “The situation with TB was not good before the conflict, but we can say that the conflict has certainly made it worse.”Since the outbreak of hostilities and the Ukrainian military’s push to reclaim control of areas in Eastern Ukraine from pro-Russian separatists, health care providers in the region have come under increasing pressure

Since the outbreak of hostilities and the Ukrainian military’s push to reclaim control of areas in Eastern Ukraine from pro-Russian separatists, health care providers in the region have come under increasing pressure.

Not only have hospitals been forced to deal with treating of casualties of the fighting, they have also had to cope with patients being moved in and out of hospitals and abandoning or interrupting treatment as the security status of individual towns and cities changes.

It has also become increasingly difficult to obtain supplies of vital medicines, and terrified staff – up to 70 percent of medical staff are estimated to have fled Donetsk and Luhansk, according to U.N. officials – have left hospitals and clinics.

The problems have been particularly acute with regard to TB. Ukraine has one of the worst TB problems in Europe, second only to Russia in terms of infection numbers.

According to official data, there are 48,000 people registered with the disease and it claimed the lives of just over 6,000 people in 2013. However, one in four people with TB are not officially registered, according to WHO.

The country also has a particular problem with multidrug-resistant tuberculosis (MDR-TB) which is much harder to successfully treat than normal TB.

WHO reports that Ukraine is one of “27 high multidrug-resistant tuberculosis (MDR-TB) burden countries in the world,” adding that “despite the adoption of the Stop TB Strategy by the National TB Programme (NTP), its components have not been sufficiently implemented.”

Organisations working in the region say they fear the disease will claim lives as the fighting is making it impossible to identify cases, monitor or guarantee timely treatment for those who need it.

Dr Dara told IPS: “There are indications that incidence of TB may increase. TB sufferers need to have medicines provided to them in a timely fashion and if that cannot be done and TB sufferers’ treatment is interrupted and they cannot access treatment elsewhere, there is a risk that the disease could then be spread and that people may die.

“We do not have detailed information at the moment on how exactly the conflict has affected the TB situation in Eastern Ukraine, but we do know that it has, at least, affected TB control efforts. It is hard to thoroughly implement checks on all people with TB in the conflict zone.”

Doctors in Donetsk, a city of one million and regional stronghold for pro-Russian separatists, have told humanitarian organisations working in the region of their fears over the fate of patients needing treatment.

Ole Solvang of Human Rights Watch, who carried out detailed research in Eastern Ukraine on the effects of the current conflict on the region’s health care, told IPS: “One hospital administrator in the main hospital in Donetsk told us that his hospital had a capacity for 1,200 patients but that because of the war they had only 450 at the moment.”

Solvang said that “the explanations put forward for this are that because people were afraid of travelling they were not coming to the hospital, that they were saving money and did not want to pay to get to hospital or that so many people have left the region because of the conflict.”

But his fear was that people with medical problems not connected to the conflict, such as serious diseases, are now not getting the treatment that they need.

Other doctors have warned that problems with medicine supplies because of the conflict could turn out to be an even bigger problem than the interruption of TB treatment.

One who spoke to IPS said that if a TB patient was given only a few drugs instead of the full range of medicines needed as part of treatment, it could lead to developing the much more dangerous drug-resistant TB.

The true scale of the problem with TB in the region is impossible to ascertain clearly because of the rapidly changing conditions in the conflict zone, while many under-pressure medical staff working directly in the conflict zone have been reluctant to speak in detail to anyone other than colleagues.

Regional officials also declined to comment when approached by IPS.

One doctor from Donetsk who spoke to IPS said that TB patients in regional hospitals, as well as hundreds being treated on an out-patient basis, were receiving the treatment they needed.

According to Dr Yuriy Semionovich, “there are 550 tuberculosis patients in Donetsk and Slavyansk hospitals at the moment. They are getting all the medicines and treatment they need. There are 200 patients treated on an out-patient basis and they too are receiving what medicines they need. We have the situation under control.”

However, some others are far more pessimistic in their assessment of the TB threat to the region.

Natalia Chursina, deputy head of the Donetsk Regional Tuberculosis Hospital, told local media earlier this month that “we will definitely have an outbreak in prevalence of all forms of TB after all this ends”.

Despite claims from some Ukrainian officials that the separatists will soon be dealt with and that fighting could be over in a matter of weeks, many experts say a quick end to the conflict is unlikely. And even if that were to happen, it is unclear how quickly medical service provision would return to normal, nor how many TB patients may have abandoned or interrupted treatment.

What is clear though is that without a change in current conditions, the situation with TB in the region is unlikely to improve any time soon.

“If conditions improve with regard to the supply of treatment, medicines and provision of health care services then we can foresee some improvement with the TB situation,” Dr Dara told IPS. “But without a change in those, then there is little hope that TB treatment can improve.”

(Edited by Phil Harris)

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Burning the Future of Gaza’s Children Sat, 16 Aug 2014 16:34:22 +0000 Khaled Alashqar Soundus, a young girl being treated in hospital for injuries from Israeli shelling of Gaza (August 2014). Credit: Khaled Alashqar/IPS

Soundus, a young girl being treated in hospital for injuries from Israeli shelling of Gaza (August 2014). Credit: Khaled Alashqar/IPS

By Khaled Alashqar
GAZA CITY, Aug 16 2014 (IPS)

“My child became blind and lost the ability to speak, his dad died and his three brothers are seriously wounded. He still has not been told about the loss of his dad,” says the mother of 7-year-old Mohamad Badran. 

Mohamad is in hospital for treatment after being seriously injured in Israel shelling of Gaza. “My only way to communicate with him is by hugging him,” his mother adds.

Israeli air attacks and shelling in Gaza have left more than 1,870 dead and thousands injured. They have caused damage to infrastructure and hundreds of homes, forcing a large number of families to seek shelter in schools run by the U.N. agency for Palestine refugees (UNRWA).Some of the children have suffered serious injuries which cannot be treated in Gaza due to the limited medical infrastructure and capacities caused by the Israeli blockade.

In a news note, the U.N. Children’s Fund (UNICEF) said that Israeli airstrikes and shelling have taken a “devastating toll … on Gaza’s youngest and most vulnerable.” It said that at least 429 children had been killed and 2,744 severely injured.

Some of the children injured have suffered serious injuries which cannot be treated in Gaza due to the limited medical capacities caused by the Israeli blockade.

According to UNICEF, about 400,000 children – half of Gaza’s 1.8 million people are children under the age of 18 – are showing symptoms of psychological problems, including stress and depression, clinging to parents and nightmares.

Monika Awad, spokesperson for UNICEF in Jerusalem, told IPS that 30 percent of dead as a result of the Israeli military attacks are children, and “UNICEF and its local partners have been implementing psychosocial support programmes in Gaza schools where refugee families are sheltering.”

”We have a moral responsibility to protect the right of children to live in safety and dignity in accordance with U.N. charter for children’s rights,” she added.

However, the acute psychological effects of the Israeli attacks Gaza that have emerged among children, such as loss of speech, are among the biggest challenges that face psychotherapists.

Dr Sami Eweda, a consultant and psychiatrist with the Gaza Community Mental Health Programme (a local civil society organisation working on trauma and healing issues), told IPS: “When the Israeli war against Gaza ends, psychotherapists will grapple with many expected dilemmas such as the cases of the murder of entire families and the murder of the parents who represent the central protection and tenderness for the children. Such terrible cases put children in a state of loss and shock.”

According to Eweda, “we first need to stop the main cause of these traumas and psychological problems, which is the Israeli war against Gaza, and then begin an emergency intervention to support children’s health and treat traumas and severe psychological effects, including the loss of speech, which is considered as one of the self-defence mechanisms for overcoming traumas.”

Throughout the Gaza Strip, where entire neighbourhoods such as Shujaiyeh and Khuza’a have been destroyed by the Israeli invasion and heavy bombardment, access to basic services is practically impossible.

Displaced children in a UN-run school in the Shujaiyeh neighbourhood of Gaza (August 2014). Credit: Khaled Alashqar/IPS

Displaced children in a UN-run school in the Shujaiyeh neighbourhood of Gaza (August 2014). Credit: Khaled Alashqar/IPS

People in these areas have been suffering difficulties in accessing drinking water and have been living in an almost complete blackout since the Israeli shelling of the power station which was the sole source of electricity in besieged Gaza.

Social Watch– a network of civil society organisations from around the world monitoring their governments’ commitments to end poverty and achieve gender justice – Thursday called on the international community to declare the Gaza Strip an “international humanitarian disaster zone”, as requested by Palestinian NGOs.

“The unrestricted violation of international law and humanitarian principles adds to the instability in the region and further fuels the arms race and the marginalisation of the issues of poverty eradication and social justice that should be the main common priority,” said Social Watch.

“The recurrence of these episodes in Gaza is the result of not having acted before on similar war crimes and of not having pursued with good faith negotiations towards a lasting peace,” it added.

In a press release, Save the Children, the world’s leading independent organisation for promoting children’s rights, said: “Children never start wars, yet they are the ones that are killed, maimed, traumatised and left homeless, terrified and permanently scarred.”

“Save the Children will not stop until innocent children are no longer under fire and the root causes of this conflict are addressed. If the international community does not take action now, the violence against children in Gaza will haunt our generation forever.”

In an interview with IPS, Save the Children’s spokesperson in Gaza, Asama Damo, said: ”We call for a permanent ceasefire and for lifting the siege on Gaza to ensure the delivery of humanitarian aid and basic services to children.”

“We also need the international community to intervene to end the catastrophic humanitarian situation and fight the skin diseases that are widely spreading among the refugees at UNRWA schools due to overcrowding and congestion.”

According to UNRWA, 87 of their schools are being used as shelters by the refugees, half of whom are children under the age of 18. Ziad Thabet, Undersecretary of the Ministry of Education in Gaza, told IPS:

“Israel deliberately targeted educational institutions and the education sector in general; large proportion of those killed and wounded are children and school students. Many schools and kindergartens were attacked.”

In the current disastrous situation in Gaza, it seems not only that the burnt bodies of Gaza’s children are the heritage of war, but also that their educational and health future is being burned.

(Edited by Phil Harris)

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Côte d’Ivoire Steps Up Public Education to Keep Ebola Count at Zero Amid West Africa’s Worst Outbreak Sat, 16 Aug 2014 09:31:23 +0000 Marc-Andre Boisvert Translator Serge Tian in village of Gueyede in south-west Côte d’Ivoire. He translates sub-prefect Kouassi Koffi’s message about the spread of Ebola in West Africa and how people can recognise the virus and avoid infection. Credit: Marc-Andre Boisvert/IPS

Translator Serge Tian in village of Gueyede in south-west Côte d’Ivoire. He translates sub-prefect Kouassi Koffi’s message about the spread of Ebola in West Africa and how people can recognise the virus and avoid infection. Credit: Marc-Andre Boisvert/IPS

By Marc-Andre Boisvert
GUEYEDE, Côte d’Ivoire, Aug 16 2014 (IPS)

The whole village of Gueyede in south-west Côte d’Ivoire gathers under the tattered roof of a shelter as the rain drizzles outside, and listens carefully as sub-prefect Kouassi Koffi talks.

“We are not allowed any complacency. You might not know Ebola. And it is better that you don’t,” says Koffi, the highest governmental authority of the area, through translator Serge Tian.

Koffi explains how one can contract the virus and how to recognise the basic symptoms of Ebola hemorrhagic fever.

Credit: Centres for Disease Control and Prevention

Credit: Centres for Disease Control and Prevention

He has held hundreds of meetings like this since the first Guinean cases of Ebola appeared last March. He travels from village to village in the Tiobli region he is in charge of, often visiting the same village two, three or four times, to utter the same message.

After the stop at Gueyede, IPS will follow him in another village, to answer the same questions from locals with well-prepared lists.

“It is a lot of work. But I think the population gets the message as we discuss [Ebola],” Koffi tells IPS as he drives his SUV on a particularly bad road.

His peer sub-prefects and prefects hold the same meetings in other Ivorian regions. This West African nation has had no cases of Ebola yet. But the Liberia border is few kilometres away. And the epicentre of the current Ebola outbreak is not more than 100 kilometres in Sierra Leone, Liberia and Guinea.

“We should not wait to have a first case of the illness to take measures. Public mobilisation is important as the state cannot be everywhere,” said the Health Minister Raymonde Goudou Coffie during her last press conference on Thursday, Aug. 14.

Two of out of the four countries hit by the current epidemic, now declared out of control by the World Health Organisation (WHO), share a border with Côte d’Ivoire. Nigeria is the fourth country in West Africa that has had cases of Ebola.

And many worry that Côte d’Ivoire will soon be the next country to be hit by the most severe outbreak of the illness since its discovery in 1976. So far, there have been more than 1,000 deaths and the number of infected people is expected to soon hit 2,000. However, WHO said Friday, Aug. 15 that those numbers were “vastly underestimated”.

Credit: Centres for Disease Control and Prevention

Credit: Centres for Disease Control and Prevention

Moving fast to implement preventive measures

When the first cases appeared in Guinea last March, the Ivorian government took several preventive measures, including the creation of advanced detection centres, and a strict ban on bush meat — which is believed to be a vector of contamination for the Ebola virus.

For the inhabitants of Gueyede, it is a big deal to not eat bush meat. Most of their protein comes from it. They especially fancy grass-cutter, a big rodent. Giving up this popular delicacy has meant that Ivorians had to change their habits. But they did. And government has closed all bush meat markets in the area.

“At first, we thought Ebola was a joke — a rumour invented." -- Albertine Beh Kbenon, Gueyede villager

Nevertheless, locals still have to figure out what to eat and what not to eat. “We can eat fish. But we can’t eat bush meat. So can we eat crocodile?” asks Gueyede chief Bernard Gole Koehiwon.

Puzzled, the under-prefect redirects the question to the area nurse, Drissa Soro. “I’m not sure. But I think it is safe. I will check and come back to be sure,” Soro says.

Diet is not the sole concern, and is not enough to fight the spread of a disease that kills almost 90 percent of infected persons and which spreads mostly through body fluids.

At public meetings villagers learn what to do if someone seems to have the illness. But they mostly share their thoughts, try to figure out how the disease spreads, and to sift out the facts amid the rumours about the virus that spread very fast.

The sub-prefect has a difficult task explaining why it is dangerous to shelter a member of their family from Liberia. In Côte d’Ivoire, the ethnic groups here are split along the Liberia’s borders with families having members living in both countries.

In addition, 50,000 Ivorians are still sheltered in refuge camps in Liberia since the 2010-2011 electoral crisis here.

One lady at the meeting, who came back from Liberia few weeks ago, worries about who will take care of her old parents that she left in the refugee camp. She travelled home ahead of them to prepare the house for their return. The sub-prefect says that they are taken care of, but it is difficult to find the words to reassure her.

Involving communities

Changing diet and avoiding family members are difficult changes. But Ivorian authorities are betting that it is possible through peer education.

Once the under-prefect leaves, community leaders push the message. In each village, a coordination committee incorporating several members from all ages and genders is created to pursue the discussion.

“Those villages are very isolated. Some of them are not accessible by car,” explains sub-prefect Koffi. It would not be possible to contain an eventual pandemic without community support.

Nurse Soro agrees. “I am on alert since last March. Every time I see someone, I talk to him about Ebola. I try to see if there could be possible cases,” he tells IPS.

As there are no doctors in the area, Soro is the most qualified medical source for about 6,000 inhabitants. Even if he drives from village to village in his little motorcycle on muddy tracks, he does not have the time to see everyone.

“Community health aides are necessary. They know how to speak to their community. And they are able to maintain presence for me.”

Albertine Beh Kbenon is part of the coordination committee in Gueyede. “At first, we thought Ebola was a joke — a rumour invented,” she tells IPS.

She is now taking the threat seriously enough to go from door to door and to talk about it. She was herself first very sceptical of what authorities were saying. When the local and international media, especially radio, relayed the information, she realised that it was serious.

“In Liberia they took this as a joke. They believed the government was lying. This killed them. We don’t want this to happen here,” concludes Kbenon.

Edited by: Nalisha Adams

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East Africa Breaks the Silence on Menstruation to Keep Girls in School Fri, 15 Aug 2014 14:30:18 +0000 Amy Fallon Students from Great Horizon Secondary School in Uganda's rural Kyakayege village pose proudly with their re-usable menstrual pads after a reproductive health presentation at their school. Credit: Amy Fallon/IPS

Students from Great Horizon Secondary School in Uganda's rural Kyakayege village pose proudly with their re-usable menstrual pads after a reproductive health presentation at their school. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Aug 15 2014 (IPS)

When Peninah Mamayi got her period last January, she was scared, confused and embarrassed. But like thousands of other girls in the developing world who experience menarche having no idea what menstruation is, Mamayi, who lives with her sister-in-law in a village in Tororo, eastern Uganda, kept quiet.

“When I went to the toilet I had blood on my knickers,” she told IPS. “I was wondering what was coming out and I was so scared I ran inside the house and stayed there crying.

“I just used rags. I feared telling anybody.”For girls, “pads are as good as schoolbooks” -- Dennis Ntale, 18, a student at co-ed Mengo Senior School in Kampala, Uganda

Not having access to or being able to afford disposable sanitary pads or tampons like millions of their Western counterparts, desperate Ugandan girls will resort to using the local ebikokooma leaves, paper, old clothes and other materials as substitutes or even, as a health minister told a menstrual hygiene management conference this week, sitting in the sand until that time of the month is over.

“We always try to give them something to use at school, just at school,” Lydia Nabazzine, a teacher at Mulago Private Primary School in Kampala, where about 300 out of 500 students are female, told IPS.

“When they go home we don’t know how they go about it, because we cannot afford funding up to home level.”

But the 2012 Study on menstrual management in Uganda, conducted by the Netherlands Development Organisation (SNV) and IRC International Wash and Sanitation Centre in seven Ugandan districts, found that over 50 percent of senior female teachers confirmed there was no provision for menstrual pads for schoolgirls.

When some girls have their period, they may miss up to 20 percent of their total school year due to the humiliation of not having protection, according to separate research from the World Bank. This profoundly affects their academic potential.

“Those days when I was menstruating I could be absent for up to five days a month until menstruation had stopped,” recalled Mayami.

It’s a continent-wide problem. The United Nations Children’s Fund says one in 10 African girls skipped school during menstruation. Some drop out entirely because they lack access to effective sanitary products.

A number of recent initiatives have, however, tried to address this.

On May 28 this year, the world marked the first Menstrual Hygiene Day to help “break the silence and build awareness about the fundamental role that good menstrual hygiene management (MHM) plays in enabling women and girls to reach their full potential.”

On Aug. 14 – 15, East Africa’s first national menstrual hygiene management conference, which has the theme “breaking the silence on menstruation, keep girls in school,” has been taking place in Uganda’s capital Kampala.

At least 100 schoolteachers, schoolgirls – and boys – NGOs, including Network for Water and Sanitation (NETWAS) Uganda, civil society members and others are taking part in the two-day event. They’re calling on the government to put in place a menstrual hygiene management school policy. They also want the government to provide free sanitary pads to girls in schools, like neighbouring Kenya has done.

Despite keeping silent about the horrors of menstruation for months, Mamayi shared with the conference attendees the solution she found to that time of the month.

The student, now 13, had been walking home from school when some older pupils told her, “madam [the teacher] said menstruation is a normal thing for every girl.”

“So I asked them about it,” she told IPS.

“Now I’m using AFRIPads.”

Invented by the eponymous Uganda-based social business, AFRIPads are washable cloth sanitary towels designed to provide effective and hygienic menstrual protection for up to a year.

One Ugandan, Dr. Moses Kizza Musaazi, a senior lecturer in the Department of Electrical and Computer Engineering at Kampala’s Makerere University, has also invented the environmentally-friendly MakaPads, from papyrus reeds and waste paper. MakaPads are said to be the only trademarked biodegradable sanitary pads made in Africa.

Mamayi said the re-useable pads work out to be 5,500 Ugandan shillings (2.11 dollars) a year, compared to the 30,000 shillings (11.49 dollars) that disposable pads would have set her back.

“Now when I go somewhere [when I have my period] I sit and am comfortable,” said Mamayi. “I’m not bothered by anything. I don’t worry whether I’ve got anything on my skirt. I don’t miss school.”

She added: “I’m going to tell my friends that menstruation is a normal thing in girls.

“I want my friend also to be free, to tell their parents to buy for them pads. Let them not fear.”

Understanding and Managing Menstruation, was launched by Uganda’s Ministry of Education and Sports at East Africa’s first national menstrual hygiene management conference. The 50-page reader has photos and a section on how to make reusable pads at home, and sections for parents, guardians, peers, friends and schoolboys. Courtesy: Amy Fallon

Understanding and Managing Menstruation, was launched by Uganda’s Ministry of Education and Sports at East Africa’s first national menstrual hygiene management conference. The 50-page reader has photos and a section on how to make reusable pads at home, and sections for parents, guardians, peers, friends and schoolboys. Credit: Amy Fallon/IPS

Breaking the culture of silence around menstruation is the aim of a new book, Understanding and Managing Menstruation, launched by Uganda’s Ministry of Education and Sports at the conference. The 50-page reader has photos and a section on how to make reusable pads at home, and sections for parents, guardians, peers, friends and schoolboys.

Maggie Kasiko, a gender technical advisor at the Ministry of Education and Sports, told IPS that the government hoped the book would reach as many students, teachers and parents across the country as possible.

“Not many girls have the opportunities to have their mothers and aunties around, so they start their menstruation without knowing,” she said, adding many parents and relatives were busy trying to earn a living for their families.

Dennis Ntale, 18, a senior five student at co-ed Mengo Senior School in Kampala, said he didn’t know what menstruation was when he encountered a fellow student with her period in class earlier this year, and tried to comfort her. It was only sometime later when he relayed the incident to his male friends and they told him she was “undergoing her MP [menstrual period].”

“They’re [teachers] not teaching this to the boys in schools,” Ntale told IPS.

“I believe boys should be informed about this because there are many of them out there who have no idea about this.”

He said for girls, “pads are as good as schoolbooks”.

“If you don’t have that pad she won’t be able to do a thing,” Ntale said. “[We should] make sure she has what will keep her in school.”

Kasiko said the Ministry of Education and Sports was continuing to ensure schools had separate facilities for boys and girls, with the girls having washrooms and changing rooms where they could bathe and change, had access to clean water, extra pads and Panadol.

But she said she didn’t see the government providing free pads to girls “in the short-term or the long-term”.

“Starting to distribute sanitary towels to each and every girl, every month, is quite a cost for the ministry when you look at all the other areas that the ministry needs to take care of,” she said.

“That, our guidelines for Universal Primary Education (UPE) is very clear, is a role of parents. It’s sanitary wear. Just like you buy a panty for your child, you should be responsible for buying a sanitary towel for your child.

Kasiko added: “But we’ll support the parents and work together with the parents to give them knowledge to ensure the environment is clean and girls stay in school.”

Edited by: Nalisha Adams

The writer can be contacted on Twitter @amyfallon 

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Abuse of Older Women Overlooked and Underreported Thu, 14 Aug 2014 17:11:17 +0000 Chau Ngo Abusers are often family members, making victims reluctant to report the violence. Credit: Boris Bartels/cc by 2.0

Abusers are often family members, making victims reluctant to report the violence. Credit: Boris Bartels/cc by 2.0

By Chau Ngo

A veteran women’s rights activist, Patricia Brownell was still taken aback by the prevalence of abuse against older women she discovered during dozens of conversations she and her colleagues had with victims.

They found that for every one official report of abuse made by agencies in New York State, there are 23 self-reports, with the abusers ranging from husbands, sons, daughters and other relatives to complete strangers.“In many cases, the victims did not want to talk about it. They felt guilty. They felt it was their fault.” -- Patricia Brownell

“It’s underreported,” Brownell, vice president of the National Committee for the Prevention of Elder Abuse, told IPS. “In many cases, the victims did not want to talk about it. They felt guilty. They felt it was their fault.”

Most research on the abuse of older women has focused on North America and Europe. A study conducted in five European countries in 2011 found that around 28 percent of older women had experienced abuse.

The situation in developing countries, where the socio-economic conditions are worse and the welfare system weaker, mostly remains unknown.

“It could be worse,” said Brownell, citing harmful traditional practices against widows or those accused of witchcraft in some developing countries. “It really introduces another dimension of abuse against older women. It’s community abuse.”

Violence directed against younger women has long overshadowed that against the elderly, who in some cases are more vulnerable. There has been so little research into the issue that activists said they do not know its full scope yet, hampering efforts to prevent and fight the violence.

Abuse of older women can take various forms, from physical, psychological and emotional (verbal aggression or threats), to sexual, financial (swindling, theft), and intentional or unintentional neglect, according to the World Health Organisation (WHO).

Addressing the Fifth Working Group on Aging at the United Nations in New York, Silvia Perel-Levin, chair of the NGO Committee on Ageing in Geneva, showed how fragmented the picture is: the prevalence of abuse ranges from six percent to 44 percent of those surveyed, depending on the geographic location and socio-economic conditions. 

While there has been an increase in reports of abuse and violence against older women in the past few years, it does not necessarily mean the problem is worsening, Perel-Levin told IPS.

“I believe [violence and abuse] have always been there, but they were never investigated, never reported,” she said. “That was always a taboo. We don’t have enough data about violence against older women.”

A long-neglected issue

The issue has been neglected partly because of the misconception that older women are less likely to suffer from domestic violence, activists said. Studies on domestic violence and reproductive health tend to examine the situation of women under 49 years old. The age range has only been broadened recently.

“People may think that older women are not subject to rape, and that their husbands stop beating them because they are 50,” said Perel-Levin. “This is not true.”

For many women, the abuse begins later in life. The abusers are sometimes beloved family members, which complicates the situation, as the victims are reluctant to report the violence.

Living with an extended family does not guarantee protection, because in many cases, the sons and other family members are the abusers. In several Asian countries, the daughters-in-law, who are expected to take care of their husbands’ aged parents, sometimes turn out to be abusers, activists said.

In developing countries, the situation is difficult for the victims even when they report the abuses, said Kazi Reazul Hoque of the Bangladesh National Human Rights Commission.

The older women in that South Asian country most likely to face abuse and violence are from ethnic minorities and religious communities, Hoque, a former judge, told IPS. These are already weaker and poorer communities, which encouraged the offenders to commit violence.

“Even when they bring the case to the court, it’s still difficult for them to pursue ‘the war’,” he said. “How long can these poor people fight?”

Activists have been calling for more research into violence against older women, such as by U.N. Women, the United Nations agency for gender equality and women’s empowerment.

James Collins, representative to the United Nations of the International Council on Social Welfare, told IPS, “We will continue to raise this issue during the events of the Sustainable Development Goals. We’re here push for the rights of older people.”

Edited by: Kitty Stapp

The writer can be contacted at

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One Woman’s Struggle to Find the Right Contraceptive Thu, 14 Aug 2014 15:18:29 +0000 Miriam Gathigah Because men wield power in decisions around pregnancy, family planning services should include them. Couple-centred family planning services are sorely needed in Africa. Credit: Mercedes Sayagues/IPS

Because men wield power in decisions around pregnancy, family planning services should include them. Couple-centred family planning services are sorely needed in Africa. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Aug 14 2014 (IPS)

Beatrice Njeri had just come home from her job as a janitor at a primary school in Nairobi. It was August 2009.

Arriving home earlier than usual, the married mother of two found her husband waiting for her in their shanty at Kisumu Ndogo, in the sprawling Kibera slums.

He had just discovered he was HIV positive. A week later, she too tested positive.

Both were 29 years old at the time. “We were very young and knew very little about HIV,” she says.

Having had two daughters, both HIV negative, they desired a son, but decided not to have another baby.

At the time, to prevent pregnancy, Njeri was on Depo-Provera, a hormone injection that lasts three months, and she needed a new shot.

On discovering that Njeri was HIV positive, the nurses encouraged her to undergo tubal ligation as a permanent birth control method – a step that neither Njeri nor her husband were prepared to take.

Unbeknown to Njeri, during this period, the country was facing a massive contraceptives shortage. It was so bad that rumours spread that women seeking the hormone injection, the most popular, family planning method, were injected with water instead of the hormone.

Njeri told IPS that the nurses said that they were giving priority to other women with pressing need of contraceptives.

“They said I was being selfish for not agreeing to have my tubes tied,” she says. “The nurses were forcing me to give up the only thing that made me feel like a real woman. I did not want that taken away from me.”

Sex became a chore

She was advised to use a condom to prevent a pregnancy. Condoms were new to them, and not easy.

“Using it all the time was very difficult. Sex became a chore. I hated it,” she says.

Fast Facts about Contraception in Kenya

Most Popular Contraceptives

14.8% Injectables
4.7% Pill
3.2% Female sterilization
3.2% Rhythm (safe days)
2.6% Male condom
1.3% Implant
1.1%: IUD
0.4%: Lactation
0.4%: Withdrawal
0.4%: Folk method
28%: Total married women using modern contraception
26%: Unmet need for contraception

Source: DHS 2009

Price was another issue. “We are both casual labourers. In the slums, putting food on the table is the only priority,” she says. Their sole support comes from her church, parcels of clothes and food every now and then.

Njeri shared her predicament with a traditional birth attendant, who advised her to only have sex on safe days.

But neither knew that antibiotics can interfere with the menstruation cycle, and Njeri was taking them to fend off HIV-related opportunistic infections.  This made safe days ineffective as a contraceptive method.

Eight months later, Njeri found out that she had conceived. At her first antenatal visit, her CD4 count was a low 400. After delivering her baby boy in 2011, she was down to 180. She began using antiretrovirals, as did her husband.

But her son is infected with HIV.

Although Njeri was on the prevention of mother to child transmission program at the government’s Mbagathi Hospital near Kibera, she chose to deliver with a traditional birth attendant because they are kinder than hospital staff.

“Most government hospitals are too crowded; they don’t have time to show kindness or respect. You are lucky if a nurse actually attends to you,” she says.

Between 2012 and 2013, a series of labor strikes in the health sector resulted in shortages of injectables. Reluctantly, the couple resorted to condoms.

Being HIV positive, sexually active and young enough to get pregnant is a big problem, she says.

“Many health facilities are not able to take care of our needs,” she told IPS.

Some clinics have set aside a day of family planning services for HIV positive women but Njeri is not always able to attend because of work.

For now, Njeri is back on the injectable contraceptive. She prays that when she returns to the clinic in two months for another injection, it will still be available.

Edited by: Mercedes Sayagues

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The Weakest Link of HIV Prevention in Africa – Contraception Thu, 14 Aug 2014 15:02:46 +0000 Miriam Gathigah The contraceptive needs of HIV positive women are often put on the background. Credit: Mercedes Sayagues/IPS

The contraceptive needs of HIV positive women are often put on the background. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Aug 14 2014 (IPS)

In the rush to save babies from HIV infection and treat their mothers, experts warn that a key element of HIV prevention is being neglected in Africa – contraceptives for HIV positive women.

Yet contraception is the second pillar of successful prevention of HIV transmission from mother to child (PMTCT), along with preventing infection among women and babies, and caring for those infected.

“The contraceptive needs of HIV positive women are often put on the background, the main focus is on keeping mother and child healthy,” Florence Ngobeni-Allen, a spokesperson with the  Elizabeth Glaser Paediatric AIDS Foundation, told IPS. A South African, she was diagnosed with HIV in 1996, lost a baby to AIDS and now has two healthy boys.

Contraception is crucial in East and Southern Africa, where high HIV prevalence combines with high unmet needs for family planning, and where eight in ten HIV positive women are within their reproductive years, according to the United Nations Population Fund (UNFPA). 

Fast Facts about Contraception and HIV
Most modern methods of hormonal contraception are safe for women with HIV.
Some hormonal methods not recommended for women on ARV therapy due to potential for drug interactions.
IUD insertion is not recommended for a woman with AIDS, due to weakened immune system.
Spermicides and diaphragms are not suitable for HIV positive women.

Source: World Health Organisation

Studies suggest that women living with HIV have equal “if not more desire to limit childbearing compared with HIV negative women. Reducing unmet need for family planning among these women is critical for meeting the target of reducing new child HIV infections by 90 percent,” says the United Nations report Women Out Loud.

Surveys of HIV positive women in Kenya and Malawi show that nearly three-quarters did not want more children within the next two years or ever, but only a quarter used modern contraceptives.

Weakness in programmes

A study by Family Health International among HIV positive women in Rwanda, Kenya and South Africa showed that more than half did not plan their most recent pregnancy.

Although the women wanted family planning, access was difficult. One barrier was health staff: they were not trained on contraceptive options for women living with HIV; had misconceptions about contraceptive safety; most only offered male condoms, although women preferred long-acting implants and injections, and many were judgmental about the women’s sex lives

“Sometimes nurses forget that women are still sexual when they find out you are HIV positive,” says Ngobeni-Allen.

Kenya’s unmet need for contraceptives is 25 percent nationwide but 60 percent among HIV positive women, Dr John Ong’ech, assistant director at Kenyatta National Hospital, told IPS.

Low access to family planning for HIV positive women, who are six to eight times more likely to die from pregnancy-related complications compared to HIV negative women, “is a weakness in health programmes,” he told IPS, although it is cheaper and more effective to provide contraceptives than PMTCT.

Husbands and mothers-in-law

Mary Naliaka, who works in paediatric AIDS in Kenya’s health ministry, told IPS that family planning should be part of the HIV treatment package and offer a variety of contraceptive options.

But the health systems in East and Southern Africa often suffer commodity stock outs and many clinics lack adequate infrastructure.

“To insert an intrauterine device you need a sterile environment,” Ong’ech says.

Injection is the most popular method because women can use it without telling the husband, he adds.

Unequal gender relationships and weak negotiating power influence contraceptive use. Naliaka observes that in African culture, “the mother-in-law can engineer the end of a marriage if a baby is not forthcoming.”

Dorothy Namutamba, of the International Community of Women Living with HIV in East Africa (ICWEA), who is based in Kampala, Uganda, told IPS that women are raised to please husbands.

“If a man demands that you should have ten children [you must] and if you’re not able, he’ll look somewhere else,” she says. “Most men do not encourage women to go on family planning, it’s a big problem.”

Stigma and domestic violence compound the problem.  “Women fear to declare their HIV status because they may face gender violence, and this limits their access to family planning,” Anthony Mbonye, Commissioner of Health Services in Uganda, told IPS.

Given men’s power over decisions about pregnancy, couple-oriented reproductive health services are crucial, but “health facilities are too overcrowded to absorb the male partner,” Naliaka told IPS.

The coerced sterilisations of HIV positive women in Kenya, Malawi, Namibia, South Africa and Zambia, with lawsuits pending, further cloud the issue of reproductive rights and needs and HIV.

“This shamed the health sector,” says Naliaka.  However, she adds, “through these publicized cases, the health sector and the public have understood that these women have reproductive health needs similar to those of HIV negative women.”

One-stop shops

Moving forward, experts recommend integrating HIV, family planning and maternal and child health care services, saving time for both users and health staff.

Seven Southern African countries have set up such “one-stop shops” for reproductive health, where a woman can get ARVs, cervical cancer screening, breastfeeding advice and family planning in one visit, under one roof, sometimes in one room with one health worker.

Linking services is cost effective and efficient, says UNFPA. It makes “people sense”.

Edited by: Mercedes Sayagues

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What’s More Important, the War on AIDS or Just War? Wed, 13 Aug 2014 07:20:13 +0000 Kanya DAlmeida and Mercedes Sayagues The budgets of many African countries reflect greater interest in arms deals than in managing the deadly HIV epidemic. Credit: Thomas Martinez/IPS

The budgets of many African countries reflect greater interest in arms deals than in managing the deadly HIV epidemic. Credit: Thomas Martinez/IPS

By Kanya D'Almeida and Mercedes Sayagues

They say there is a war on and its target is the deadly human immunodeficiency virus (HIV).   

This war runs worldwide but its main battleground is sub-Saharan Africa, where seven out of 10 HIV positive persons in the world live – 24.7 million in 2013. The region suffered up to 1.3 million AIDS-related deaths in the same year, according to the United Nations.

A ragtag army is fighting the war on AIDS. Sometimes it is comprised of well-dressed aid officials sitting in conference rooms allocating funds. At other times, it deploys shabby foot soldiers – community healthcare workers and AIDS activists – into desolate rural areas with no running water, let alone antiretroviral therapy.

With many competing health problems, funding for AIDS is a growing concern. Yet a look at the defence of budgets of several countries plagued by HIV portrays a startling picture of governments’ priorities, with huge military expenditures belying the argument that the key obstacle to winning the war against AIDS is money.

Nigeria's Military Budget Dwarfs AIDS Budget
With an HIV prevalence of three percent, Nigeria has the second largest number of people living with HIV in Africa – 3.4 million in 2012, according to UNAIDS.

Government’s response to the epidemic picked up last year but is still woefully inadequate. Many people are not accessing the treatment and care services they need, or at a steep price. Out of pocket expenditure for HIV and AIDS services accounts for 14 percent of household income, according to the United Nations Children’s Fund.
Nigeria has US$600 million for AIDS until 2015, with donors shelling out 75 percent. This is an improvement: government provided only seven percent of total AIDS funding in 2010, compared to 25 percent now.
This year, the government is expected to allocate 373 million dollars to HIV programmes and 470 million in 2015, to meet the target of contributing half of AIDS financing needs.
But it remains to be seen if this will be done. Nigeria has many competing health priorities, and the recent Ebola fever outbreak will require extra funding and urgency.
Meanwhile, the proposed defence budget for 2014 awarded 830 million dollars to the Nigerian army, 440 million to its navy, and 460 million dollars to the air force.
In total, the country has allocated 2.1 billion dollars to defence this year, according to the Nigerian Budget Office.
This includes 32 million dollars for two offshore patrol vessels purchased from China, and 11.2 million dollars for the procurement of six Mi-35M attack helicopters, according to DefenceWeb.

And, as the 2015 deadline for the United Nations Millennium Development Goals looms large – with donor countries tightening their purse strings – health experts worry about financing for HIV prevention and AIDS treatment after 2015.

New funding for AIDS in low- and middle-incoming countries fell three percent from 2012 to 8.1 billion dollars in 2013, says a joint report by the Kaiser Family Foundation and the Joint United Nations Programme on HIV/AIDS (UNAIDS) released in June.

Five of the 14 major donor governments – the U.S., Canada, Italy, Japan and the Netherlands – decreased AIDS spending last year.

And yet, while governments claim to be too cash-strapped to fight the AIDS war, funding for other wars seems much more forthcoming.

Spending on arms and on AIDS

Africa will need to do more with less to manage AIDS, concludes a 2013 UNAIDS report entitled Smart Investments.

In Kenya, a funding shortfall is expected soon, since the World Bank’s 115 million-dollar ‘Total War on HIV/AIDS’ project expired last month.

Meanwhile, the country’s defence budget is expected to grow from 4.3 billion dollars in 2012-2014 to 5.5 billion dollars by 2018, as the country stocks up on helicopters, drones and border surveillance equipment, according to the news portal DefenceWeb.

True, Kenya is under attack from Al-Shabaab terrorists. Still, five out of 10 pregnant Kenyan women living with HIV do not get ARVs to protect their babies.

Mozambique’s fighter jets

In Mozambique, a dearth of funding puts the country’s recent military expenditures into a harsh light.

Daniel Kertesz, the World Health Organization representative in Mozambique, told IPS the country’s six-year health program has a 200 million dollar finance gap per year.

Mozambique being very poor, it is difficult to see how the country – with 1.6 million infected people, the world’s eighth burden – will meet its domestic commitments.

“Today, Mozambique spends between 30 and 35 dollars per person per year on health. WHO recommends a minimum of 55-60 per person per year,” Kertesz said.

The same week, the government announced it had fixed eight military fighter jets, which it had discarded 15 years ago, in Romania, and is receiving three Embraer Tucano military aircraft from Brazil for free, with the understanding that purchase of three  fighter jets will follow.

According to a 2014 report by the Economic Intelligence Unit, Mozambique’s spending on state security is expected to rise sharply, partly owing to the acquisition, by the ministry of defence, of 24 fishing trawlers and six patrol and interceptor ships at the cost of 300 million dollars – equal to half the 2014 national health budget of 635.8 million dollars.

 The same week the refurbished fighter jets landed at Maputo airport, the press reported that the main hospital in Mozambique’s north-western and coal-rich Tete province went for five days without water.

Indeed, the country’s public health system is in such dire straits that the United States President’s Emergency Plan for AIDS Relief (PEPFAR) meets 90 percent of the health ministry’s annual AIDS budget.

Military Spending in Africa
Angola spent 8.4 percent of its 69 billion dollar budget on defence and just 5.3 percent on health in 2013.
In 2013, Morocco’s military expenses of 3.4 billion dwarfed its health budget of just over 1.4 billion dollars.
South Sudan spent one percent of its GDP on health and 9.1 percent on military and defence in 2012.

“The state budget for social programmes is not increasing at the same level as military, defence and security spending,” Jorge Matine, a researcher at Mozambique’s Centre for Public Integrity (CIP), told IPS.

“We have been pushing for accountability around the acquisition of commercial and military ships for millions of dollars,” he said.

A coalition of NGOs has requested the government to explain “its decision to spend that money without authorisation from Parliament when the country is experiencing severe shortages of personnel and supplies in the health sector,” Matine explained.

The coalition argues that, if defence spending remained as it was in 2011, the country would save 70 million dollars, which could buy 1,400 ambulances (11 per district, when many districts have only one or two) or import 21 percent more medicines.

A similar pattern unfolds across the continent where, according to the Stockholm International Peace Research Institute (SIPRI), military spending reached an estimated 44.4 billion dollars in 2013, an 8.3 percent increase from the previous year. In Angola and Algeria, high oil revenues fuel the buying spree.

The South Africa-based Ceasefire Campaign reported recently that arms deals with private companies are also on the rise in Africa, with governments expected to sign deals with global defence companies totalling roughly 20 billion dollars over the next decade.

Credit: Marshall Patstanza and Nqabomzi Bikitsha/IPS

Credit: Marshall Patstanza and Nqabomzi Bikitsha/IPS

Failing Abuja 

At the same time, the 2001 Abuja Declaration, whose signatories committed to allocating at least 15 percent of gross domestic product to health, has “barely become a reality”, Vuyiseka Dubula, general-secretary of the South Africa-based Treatment Action Campaign, told IPS.

 “Regardless of our calls, very few countries have even come close to 12 percent, including some of the richer African countries such as South Africa and Nigeria,” Dubula said.

Between 2000-2005, she added, “almost 400,000 people died from AIDS in South Africa; during that same period we spent so much money on arms we don’t need, and one wonders whether that was a responsible [use] of public resources.”

Mozambique is a sad example of Abuja failure. Back in 2001, Mozambique’s health budget represented 14 percent of the total state budget, tailing the Abuja target. It declined to a low of seven percent in 2011 and clawed to eight percent since.

“Financing mirrors the priorities of the government,” Tedros Adhanom Ghebreyesus, Ethiopia’s minister of foreign affairs and former minister of health, told IPS. “We have seen that in countries that had the political will to turn around their health sectors, they upscale finance and really invest in the health sector.”

If this is true, the budgets of many African countries reflect greater interest in arms deals than in managing the deadly HIV epidemic.

Edited by: Mercedes Sayagues

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Putting the Littlest Disaster Victims on the Caribbean’s Climate Agenda Tue, 12 Aug 2014 18:04:41 +0000 Desmond Brown Students of Buccament Government Primary School in St. Vincent receive gifts from sixth graders at the Green Bay Primary School in Antigua following the terrible flooding that occurred in Dominica, St. Lucia and St. Vincent and the Grenadines on Christmas Eve 2013. Credit: Desmond Brown/IPS

Students of Buccament Government Primary School in St. Vincent receive gifts from sixth graders at the Green Bay Primary School in Antigua following the terrible flooding that occurred in Dominica, St. Lucia and St. Vincent and the Grenadines on Christmas Eve 2013. Credit: Desmond Brown/IPS

By Desmond Brown
CASTRIES, St. Lucia, Aug 12 2014 (IPS)

Children are often the forgotten ones when policy-makers map out strategies to deal with climate change, even as they are least capable of fending for themselves in times of trouble.

According to David Popo, head of the Social Policy Unit at the Organisation of Eastern Caribbean States (OECS). “Very often when we speak about poverty reduction we are not seeing children, children are invisible in terms of development.“If we fail to build resilience to adapt to those potential impacts now, we will risk consigning our future generations of Anguillians, and the entire OECS region, to an irreversible disaster." -- Anguilla’s Environment Minister Jerome Roberts

“And it’s not just St. Lucia but especially throughout the wider Caribbean,” Popo told IPS.

He cited the findings of a recent UNICEF-facilitated workshop that showed climate change has a litany of negative consequences for children, in areas such as education, poverty reduction and other forms of social development.

The OECS Rallying the Region to Action on Climate Change (OECS-RRACC project) is supporting St. Lucia through the establishment of a Geographic Information System (GIS) platform that will enable the mapping of water infrastructure for improved management and delivery services to consumers.

Popo said such a platform must make provision for the impact of the findings on children, who often appear to be overlooked when disaster mitigation plans are being considered.

“This instrument, this GIS platform has to be able, in addition to mapping the infrastructural facilities throughout the island, I think it’s very important as well to have some very strong correlations with respect to what happens to people and especially our children,” he said.

“We can very well imagine the impact in terms of schooling, education, health and the other related impacts within the unit of the household especially in areas which are impoverished and impoverished households…If there is no water in the house, the parent cannot send the child to school.”

The RRACC Project is a joint effort by the OECS Secretariat and the United States Agency for International Development (USAID) to assist Eastern Caribbean States in various ways relating to climate change.

The UNICEF Office for Barbados and the Eastern Caribbean in an analysis titled “Children and Climate Change in the Small Islands Development States (SIDS) of the Eastern Caribbean” said trends in the Caribbean during the last 30 years are already showing significant changes to the environment due to climate change.

It said the results of climate change are all expected to negatively impact children and families due to lost/reduced earnings for families from loss in the agricultural, fishing and tourism sectors; threatened environmental displacement – 50 percent of the population live within 1.5 kilometres from the coastlines – increased vector- and water-borne diseases; and family separation due to migration because of challenges in some countries.

David Popo, head of the Social Policy Unit at the OECS. Credit: Desmond Brown/IPS

David Popo, head of the Social Policy Unit at the OECS. Credit: Desmond Brown/IPS

The analysis also cited the loss of classroom time for children due to emergencies during the storm season; that fact that the rights of children were not addressed within most emergency plans/policies; the psychological toll of constant fear of natural disasters; and further family separation and migration.

UNICEF said children, as an especially vulnerable group, will bear a disproportionately large share of the burden.

Anguilla’s Environment Minister Jerome Roberts told IPS the region’s response to the climate change challenge must involve children, adding it will be judged by history.

“If we fail to build resilience to adapt to those potential impacts now, we will risk consigning our future generations of Anguillians, and the entire OECS region, to an irreversible disaster,” he said.

“As minister with responsibility for education and the environment, it will be remiss of me not to emphasise the need to ensure that Anguilla provides quality climate change education.

“Our approach must encourage innovative teaching methods that will integrate climate change education in schools. Furthermore, we have to ensure that we enhance our non-formal education programme through the media, networking and partnerships to build public knowledge on climate change,” he added.

Roberts noted that as a small island, Anguilla is very susceptible to the potential impacts of climate change, droughts, flooding and the inundation of the land by sea level rise.

“We are aware that the threat from climate change is serious, it is urgent, and it is growing,” he said, commending those educational institutions that have already established school gardens for themselves and their communities and encouraging those in the process of doing the same.

“I am aware that some students have learnt about the fragility of their environment by participating in such initiatives. In fact, conservation projects allow children to acquire first-hand knowledge on the delicate nature of their environment,” Roberts said.

“I therefore applaud and encourage other schools to be creative and to develop similar or even more innovative schemes related to climate change and environmental management in their schools.”

Popo stressed that climate change is not going away and the impacts are predicted to be worse going forward.

“All of us are aware of the occurrences of recent climatic events: the drought in 2009, Hurricane Tomas in 2010 and, of course, the more recent Christmas Eve storm in 2013, which apart from bringing to the front a number of our development issues, signaled the need as well for capacity building and planning for the accompanying negative impacts on our islands’ resources,” he said.

A two-year-old child was among more than a dozen people killed when a freak storm ripped through the Eastern Caribbean, destroying crops, houses and livelihoods in its wake in three of the world’s smallest countries – St. Vincent, St. Lucia and Dominica —on Dec 24, 2013. A 12-year-old child was also washed away in the flooding and remains missing.

The storm dumped more than 12 inches of rain on St. Vincent over a five-hour period — more than the island’s average rainfall in a month. This triggered massive landslides and the cresting of more than 30 rivers and streams.

Hundreds of houses were destroyed. In addition, 14 bridges were washed away, and the pediatric ward of the country’s main hospital was left waist-high in water.

Sonia Johnny, St. Lucia’s ambassador to the United States, said her island was battered by torrential rains for 24 hours, interspersed with thunder and lightning.

“As one little boy said, we thought it was the end of the world. Nobody in St. Lucia had ever experienced such heavy rains before,” Johnny said.

Editing by: Kitty Stapp

The writer can be contacted at

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Aleppo Struggles to Provide for Basic Needs as Regime Closes In Mon, 11 Aug 2014 06:37:41 +0000 Shelly Kittleson Syrian boy carries bread back from underground bakery in severely damaged opposition-held area of Aleppo (August 2014). Credit: Shelly Kittleson/IPS

Syrian boy carries bread back from underground bakery in severely damaged opposition-held area of Aleppo (August 2014). Credit: Shelly Kittleson/IPS

By Shelly Kittleson
ALEPPO, Syria, Aug 11 2014 (IPS)

The single, heavily damaged supply road remaining into the rebel-held, eastern area of the city is acutely exposed to enemy fire.

All lorries with wheat for the areas’ underground bakeries, soap for hygiene purposes, and fuel for vehicles and generators travel by this route. While snipers focus on this road and other frontlines throughout the city, regime barrel bombing is meanwhile steadily, painfully reducing the rest of the city to rubble.

Although many areas are now under the control of the more moderate Islamic Front, Al-Qaeda affiliate Jabhat Al-Nusra helps provide for basic needs in some areas where the underfunded Syrian National Council-linked administration is unable to do so.While snipers focus on this road [the only remaining supply road into the rebel-held, eastern area of the city] and other frontlines throughout the city, regime barrel bombing is meanwhile steadily, painfully reducing the rest of the city to rubble

IPS watched as members of the armed group handed out metre-long rectangular blocks of ice, after they slid down a metal shaft to armed men waiting to give them to inhabitants waiting nearby who have been without electricity and running water for months.

‘’They’re good people,’’ said one inhabitant of the city, who nonetheless had been arrested by them for undisclosed reasons a few months back. ‘’They’re friends.’’

In private, however, many Syrians will say that they are not happy with the group, though it is ‘’not anywhere near as bad as ‘Daeesh’ (the Islamic State, formerly known as ISIS).”

Inside the Aleppo city council offices, bright red filing cabinets and a new coat of white paint mark a sharp contrast with the crumbling buildings and concrete slabs hanging precariously above streets where those left continue to go about their daily affairs as best they can.

‘’We have been hit many times, but we need to show that we will keep rebuilding,’’ one employee said.

Council chief Abdelaziz Al-Maghrebi, a former teacher and manager at a textile factory, walks with a limp from what he says was an injury from a tank bomb never properly treated.

The council has civil registry, education, legal affairs and civil defence directorates – and an office for electricity, water, sewage, and rubbish – but often receives no money from the ‘government-in-exile’, said Mohammed Saidi, financial manager of the council.

‘’The amount of money depends on the month, and no money was received from the SNC in July.’’

However, Saidi stressed, all reports of siphoning off of money by members ‘’are false’’.

Private donors and foundations play a large part in the council’s budget as well, and ‘’funding depends on the project proposals that are accepted’’, he said.

One of the recent proposals was for underground shelters, which the head of the civil defence directorate – established at the council only recently after long acting as an entirely volunteer force – told IPS had been granted four months ago, and 16 of which had since been built.

For medical needs, doctor Ibrahim Alkhalil, head of the Aleppo health directorate for rebel areas, said that as doctors and hospitals continue to be targeted, the location of medical facilities ‘’has to be kept confidential and change frequently’’.

The doctor, who is Syrian but who spent most of his professional career in Saudi Arabia and only came back after the uprising started, noted that everything was in short supply or lacking entirely: antibiotics, water, electricity and trained staff.

He added that the lack of maintenance for vehicles and the terrible road conditions meant that many people were dying simply from being unable to reach the few existing medical centres.

Moreover, the local council can afford to provide funds only to some medical facilities that do not receive any from other donors, council chief Al-Maghrebi told IPS.

Alkhalil pointed out, however, that no amount of supplies would solve the main problem if ‘’the regime isn’t stopped from killing and injuring in the first place.’’

A truck with lights switched off to avoid attracting regime aircraft attention often makes its way through the streets of a central neighbourhood at night, calling out ‘haleeb’, ‘haleeb’ (‘milk’).

A number of children in the area have been hit by snipers while crossing a street now ‘protected’ by a bullet-riddled sheet of canvas meant to reduce visibility.

In another area, Salahheddin – the ‘first liberated area of Aleppo’ and the very name of which retains a sort of mythical status in the eyes of some – children laugh and play soccer in the empty street near the frontline after nightfall. The blood of a boy hit by a sniper recently still stains the ground nearby.

Despite the constant risk of government snipers, IPS was told, near the frontlines was often the ‘’safest place, since it is too close to regime areas for them to drop barrel bombs on.’’

IPS was asked by a freckled, red-haired boy barely out of his late teens now working for a local Muslim, ‘’Why have you come here? What is there left to say?’’

The boy works to get charities abroad to help his organisation provide 50 dollars per month to the neediest widows and orphans of those killed in the fighting and for food packages.

A barrel bomb outside the charity’s offices killed a good friend and co-worker about 15 days ago. Sandbags are now stacked in front of windows and, according to another volunteer, over half of the staff left immediately after the incident, either for other parts of the country or for Turkey – or they simply no longer come to the office out of fear, a niqab-clad woman also working at the organisation said.

The charity has an underground bakery with which it normally provides bread to those in need, but its equipment had broken down a few days prior to IPS’s visit. It was unclear when it would be fixed, whether the spare parts needed could be brought into the city, and whether the regime might soon take the one road left in.

(Edited by Phil Harris)

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Nepal’s Poor Live in the Shadow of Natural Disasters Mon, 11 Aug 2014 03:45:19 +0000 Naresh Newar A poor Muslim family in the Habrahawa village of the Banke district in west Nepal has little means of recovering from natural disasters. Credit: Naresh Newar/IPS

A poor Muslim family in the Habrahawa village of the Banke district in west Nepal has little means of recovering from natural disasters. Credit: Naresh Newar/IPS

By Naresh Newar
BANKE, Nepal, Aug 11 2014 (IPS)

Barely 100 km north of Nepal’s capital, Kathmandu, the settlement of Jure, which forms part of the village of Mankha, has become a tragic example of how the country’s poorest rural communities are the first and worst victims of natural disasters.

Barely a week ago, on Aug. 2, a slope of land nearly two km long located roughly 1,350 metres above the Sunkoshi river collapsed, sweeping away over 100 households and killing some 155 people in this tiny settlement with a population of just 2,000 people.

“The majority of natural disaster victims have always been [from] the poorest communities and the tragic incident in Jure is an unfortunate reminder of that fact." -- Pitamber Aryal, national programme manager of the U.N.’s Comprehensive Disaster Risk Management Programme in Nepal
According to the Nepal Red Cross Society (NRCS), the country’s largest humanitarian agency, the death toll from last week’s disaster ranks among the worst in the history of this catastrophe-prone South Asian nation.

With so many dead, and fears rising that the artificial lake – created by blockages to the river – may burst and flood surrounding villages, experts are urging the government to seriously consider mapping out hazard areas across the country and integrate the management of natural disasters into its national economic and development plans.

Such a move could mean the difference between life and death for Nepal’s low-income communities, who are often forced to live in the most vulnerable areas.

When disasters strike, these groups are left homeless and injured, stripped of the small plots of agricultural land on which they subsist.

Poorest suffer worst impacts

Steep slopes, active seismic zones, savage monsoon rains between July and September and mountainous topography make Nepal a hotbed of disasters, according to the World Bank.

Over 80 percent of the country’s 27.8 million people live in rural areas, with a quarter of the population languishing below the poverty line of 1.25 dollars a day.

The poorest of the poor, who largely rely on agriculture, typically live on steep slopes under the constant shadow of landslides, or in low-lying flood-prone areas, and have virtually no resources with which to bounce back after a weather-related calamity, says the United Nations Development Programme (UNDP).

“In many cases, communities that live in high-risk areas tend to have higher levels of poverty and as a result, do not have the ability to relocate to safer areas,” Moira Reddick, coordinator of the Nepal Risk Reduction Consortium (NRRC), told IPS.

Most homes are abandoned in the flood-prone Holiya village in Nepal but poor families often return to them in the aftermath of natural disasters. Credit: Naresh Newar/IPS

The NRRC, a collaborative body of local and international humanitarian and development aid agencies acting in partnership with the Nepal government, have long advocated for disaster risk reduction (DRR) to be incorporated into the state’s poverty reduction strategies in order to better provide for vulnerable communities and “minimise the impact of disasters” Reddick added.

“The majority of natural disaster victims have always been [from] the poorest communities and the tragic incident in Jure is an unfortunate reminder of that fact,” Pitamber Aryal, national programme manager of the U.N.’s Comprehensive Disaster Risk Management Programme in Nepal, told IPS.

In the last three decades, landslides have resulted in 4,511 fatalities and flattened 18,414 houses, affecting 555,000 people, according to official data.

Forced to take risks

Nepal: Fast Facts

According to the Global Facility for Disaster Reduction and Recovery (GFDRR):

• Nepal faces several types of natural disasters every year, the most prominent being floods including glacial lake outburst flooding (GloFs), drought, landslides, wildfires and earthquakes.

• Nepal ranks 11th in the world in terms of vulnerability to earthquakes and 30th in terms of flood risks.

• There are more than 6,000 rivers and streams in Nepal. On reaching the plains, these fast-flowing rivers often overflow causing widespread flooding across the Terai region as well as flooding areas in India further downstream.

• Another potential hazard is Glacial lake outburst Flooding (GloF). In Nepal, a total of 159 glacial lakes have been found in the Koshi basin and 229 in the Tibetan Arun basin. Of these, 24 have been identified as potentially dangerous and could trigger a GloF event.

• Out of 21 cities around the world that lie in similar seismic hazard zones, Kathmandu city is at the highest risk in terms of impact on people. Studies conducted indicate that the next big earthquake is estimated to cause at least 40,000 deaths, 95,000 injuries and would leave approximately 600,000 – 900,000 people homeless in Kathmandu.
With little help from the government, civil society is struggling to provide necessary services to the affected population.

Dinanath Sharma, DRR coordinator for the international NGO Practical Action, told IPS that his organisation has made several attempts to move communities to safer locations, but their efforts are thwarted by the lack of a comprehensive relocation plan that offers both secure residence and economic viability.

“We will not move anywhere unless the government finds us a place that is fertile and good for our livelihoods,” a Muslim farmer from the remote Habrahawa villagein the Banke district, 600 km southwest of the capital, told IPS.

This simple demand is heard often throughout Nepal’s numerous villages, particularly in those that sit on the banks of the Rapti River, one of the largest in the country that has been the source of major flooding over the past decade.

Although floods have affected over 3.6 million people in the last decade alone, according to the government’s National Disaster Report for 2013, villagers continue to return to their ancestral homes where they at least have access to fertile land and water, which enables them to eke out a living.

“Where can we go really? How can we abandon our homes here and go to a new place where there is no fertile land?” Chitan Khan, a farmer from the Khalemasaha village, also in the Banke district, told IPS.

Several families told IPS they sometimes temporarily relocate to villages far from the river during the monsoon season, but always return when the rain subsides. Khan is already stockpiling food in a safer place, but he is resigned to the fact that the annual floods will wash away half his food stores in the village.

According to the ministry of home affairs, floods and landslide cause 300 deaths and economic damages of about three million dollars annually – adding to an already precarious situation in Nepal, where an estimated 3.5 million people are food insecure, according to the United Nations Food and Agriculture Organisation (FAO).

History repeats itself

For those familiar with Nepal’s vulnerabilities, the government’s unwillingness to establish comprehensive DRR programmes is nothing short of baffling.

The International Centre for Integrated Mountain Development (ICIMOD), for instance, has been studying and analysing the fragile mountain ecosystem across the Himalayas in Asia’s central, south and eastern regions for the last 30 years.

One of its observations included the Sunkoshi Valley’s vulnerability to water-induced hazards due to a weak geological formation and steep topography, made worse by frequent and heavy rainfall.

The lack of an appropriate monitoring and early-warning system, however, resulted in a tragedy on Aug. 2 that could easily have been avoided, experts say.

In response, the government has created a high-level committee to seek solutions for longer-term disaster preparedness, said officials.

“There is definitely serious discussion now on how to reduce vulnerability of [poor] communities and the only way to do that is to relocate them with a comprehensive economic programme,” Rishi Ram Sharma, director general of the Department of Hydrology and Meteorology (DHM), told IPS.

To ensure the safety of villagers, the government must create intensive geological studies to map the dangerous areas, which could also help to also identify the safest places to relocate whole villages, explained Sharma, who now heads the newly created disaster preparedness committee.

Local aid workers told IPS the government’s emergency response, coordinated through the army and police force under the supervision of the home ministry, was efficient but that rescue workers faced challenges in reaching remote villages due to a combination of difficult terrain and heavy rainfall.

Edited by Kanya D’Almeida

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Egypt’s Poor Easy Victims of Quack Medicine Sun, 10 Aug 2014 16:41:18 +0000 Cam McGrath Many pharmacies and herbalists in Egypt prescribe their own 'wasfa' (secret drug or herbal elixir). Credit: Cam McGrath/IPS

Many pharmacies and herbalists in Egypt prescribe their own 'wasfa' (secret drug or herbal elixir). Credit: Cam McGrath/IPS

By Cam McGrath
CAIRO, Aug 10 2014 (IPS)

Magda Ibrahim first learnt that she had endometrial cancer when she went to a clinic to diagnose recurring bladder pain and an abnormal menstrual discharge. Unable to afford the recommended hospital treatment, the uninsured 53-year-old widow turned to what she hoped would be a quicker and cheaper therapy.

A local Muslim sheikh claimed religious incantations, and a suitable donation to his pocket, could cure the cancer. But when her symptoms persisted, Ibrahim consulted a popular herbalist, whose wasfa (secret drug or herbal elixir) was reputed to shrink tumours.

“I felt much better for a few months and thought the tumour was shrinking,” she says. “But then I got much worse.”

When she returned to hospital the following year, tests revealed that the tumour was still there, and the cancer had spread to her lymph nodes. Moreover, the herbal mixture she was taking had caused her kidneys to fail.“Successive [Egyptian] governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery” – Dr Ahmad Bakr, Egyptian health care reform lobbyist

Egypt is a “minefield” of bad medicine, says paediatrician Dr Ahmad Bakr, a health care reform lobbyist. He says successive governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery.

“Our health care system is deeply deformed,” Bakr told IPS. “It’s not just a matter of low funding and corruption, ignorance (pervades every tier of) the health system, from government and doctors to the patients themselves.”

He says Egypt’s lax regulation and poor enforcement has created room for unqualified doctors to perform plastic surgery out of mobile clinics, peddle snake tonic on satellite television, and dabble dangerously in reproductive health.

It is estimated that one in every five private medical clinics in Egypt is unlicensed, and thousands of medical practitioners are suspected of using false credentials or having no formal training.

“There are a lot of so-called doctors who practise medicine in Egypt,” says Bakr. “They mostly work out of small clinics, but you’ll even find them in the most prestigious hospitals.”

The incompetency goes all the way to the top.

In February, Egypt’s military announced it had invented a device to remotely detect hepatitis C – along with acquired immunodeficiency syndrome (AIDS), swine flu and a host of other diseases. The device, which is said to work by detecting electromagnetic waves emitted by infected liver cells, is based on a fake bomb detector marketed by a British con artist.

The military also claimed that it had invented a revolutionary blood dialysis machine that can cure hepatitis C, AIDS and even cancer in a single treatment.

“I was shocked when I saw these incredible claims were being made with barely any clinical evidence,” says Dr Mohamed Abdel Hamid, director of the government-run Viral Hepatitis Research Lab (VHRL). “With any new medical treatment you should perform peer-reviewed, double-blind clinical trials before announcing it.”

Critics say Egypt’s government contributes to a climate of medical irresponsibility. State media routinely exaggerates health threats and feeds public hysteria, while the knee-jerk reactions of government authorities – including high-ranking health officials – are coloured by popular sentiment and political motives.

Reacting to the global swine flu pandemic in 2009, overzealous parliamentarians passed a motion to slaughter all of Egypt’s 300,000 pigs.

There was no evidence that pigs transmitted swine flu to humans, nor had the virus been detected in Egypt. But officials, swayed by the Islamic prohibition on eating pork, appeared to seize the opportunity of a like-named virus to rid the Muslim-majority nation of its swine.

“The pigs were kept almost exclusively by poor Christian zebaleen (rubbish collectors), who used them to digest the organic waste,” says Milad Shoukri, a zebaleen community leader. “Thousands of families lost their livelihoods to this absurd decree, which had no scientific basis.”

Global pandemics such as severe acute respiratory syndrome (SARS), avian flu and the latest contagion, Middle East Respiratory Syndrome (MERS), have presented golden opportunities for Egypt’s myriad quacks and swindlers to fleece the uninformed masses.

“With each health scare we see the same patterns,” says Cairo pharmacist Amgad Sherif. “People panic and throw science out the window. The low level of education and high illiteracy among Egyptians makes them susceptible to believe even the most ridiculous medical claims.”

When a swarm of desert locusts descended on Cairo, enterprising charlatans took out ad space in local newspapers offering a “locust vaccine” to anxious citizens.

Not surprisingly, the injected serum, which turned out to be tap water dyed with orange food colouring, offered no protection against “locust venom”. But it did leave duped households poorer, and at risk of blood contamination or hepatitis C infection from jabs with unsterilised needles.

“The people doing this only care about getting money from people who don’t know any better,” says Sherif. “They know nothing about medicine and do not follow even the most basic hygiene practices.”

In one popular scam, people claiming to be state health officials troll low- and middle-income neighbourhoods offering costly “preventative medicine” for infectious diseases. The fake medical personnel, dressed in lab coats and wearing official-looking badges, administer bogus vaccinations to unsuspecting families.

“Sometimes they give people injections – who knows what’s in them,” says Sherif.

Health officials say the sham physicians create confusion that affects legitimate health campaigns, such as Egypt’s national door-to-door polio eradication campaign.

Egyptian authorities have also found themselves in a cat-and-mouse game with thousands of “sorcerers”, whose superstition-based folk medicine draws desperate working-class patients suffering physical and psychological ailments. The self-proclaimed doctors and faith healers are particularly difficult to catch, say prosecutors, because they tend to work out of rented apartments and advertise mostly by word of mouth.

An Egyptian judicial official told pan-Arab newspaper Al Arabiya that despite attempts to prosecute sorcerers for swindling and fraud, most cases are dropped when the sorcerers reach a settlement with their victims. “There is almost one sorcerer for every citizen,” he concluded.

(Edited by Phil Harris)

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Stigma Still a Major Roadblock for AIDS Fight in Africa Sat, 09 Aug 2014 00:12:39 +0000 Julia Hotz Rwandan children orphaned by AIDS in Muhanga village. Credit: Aimable Twahirwa/IPS

Rwandan children orphaned by AIDS in Muhanga village. Credit: Aimable Twahirwa/IPS

By Julia Hotz
WASHINGTON, Aug 9 2014 (IPS)

Though West Africa’s massive Ebola outbreak may be dominating the spotlight within the global health community, HIV/AIDS remains an enormous issue for Africa as a whole – a sentiment that Washington officials made clear this week in their discussions of legislative and technological setbacks plaguing progress in fighting the epidemic.

Despite the World Health Organisation’s announcement Friday that Ebola is now an “international public health emergency,” doctors, academics and policymakers met Thursday at the Washington office of Kaiser Family Foundation (KFF), a health-policy non-profit, to discuss the similarly urgent threat posed by HIV/AIDS, the subject of last month’s 2014 International AIDS Conference in Melbourne, Australia.Uganda’s anti-LGBT environment may explain the nation’s distinct increase in the number of new HIV infections, a trend that - with the exception of Angola - has been reversed in surrounding African nations.

Ambassador Deborah Birx, the global AIDS coordinator for the U.S President’s Emergency Plan for AIDS Relief (PEPFAR), echoed the threat’s urgency, explaining that “the AIDS pandemic in southern Africa is the primary cause of death for adolescents, and the primary killer of young women.”

President Barack Obama announced Wednesday at the end of his three-day leaders’ summit with Africa that PEPFAR and the Children’s Investment Fund Foundation (CIFF) will pledge 200 million dollars to work with 10 African countries to help them double the number of children on lifesaving anti-retroviral drugs.

But Ambassador Birx, along with other prominent HIV/AIDS activists in Washington, seemed to suggest that distributing anti-retroviral drugs to children would only address a fraction of the issue.

Fear of HIV/AIDS stigma

While making note of PEPFAR’s unprecedented  progress in moving towards an “AIDS-free generation,” a commitment that President Obama deemed possible in a 2013 national address, Birx suggested that countries with anti-LGBT laws may have disproportionately high rates of new HIV infections.

“People are afraid to be stigmatised,” Birx told IPS, explaining that gay people may refuse to seek diagnosis and treatment for HIV/AIDS if they are legally and culturally persecuted by their homeland.

Identifying nearly 80 countries with such discriminatory environments, Birx’s PEPFAR report highlights Uganda, where the recent passage of anti-LGBT legislation and discriminatory comments of Ugandan President Museveni has attracted substantial condemnation from the international community.

“This is a human rights question,” Birx told IPS, calling specifically on the community of faith- one she describes as “there to wrap its embracing arms in need”- to respond to such LGBT persecution.

Yet beyond humanitarian concerns, PEPFAR’s report notes how Uganda’s anti-LGBT environment may explain the nation’s distinct increase in the number of new HIV infections, a trend that – with the exception of Angola – has been reversed in surrounding African nations.

Birx stressed that the majority of HIV infections are transmitted through heterosexual sex, despite the common misperception that homosexual activity is the cause of HIV/AIDS.

It is perhaps this association, Birx reasoned, that incites fear of seeking diagnosis, and explains why approximately half of all people with HIV are still unaware that they are infected, despite the tremendous increase in HIV testing capacity.

“Incredibly powerful” potential of tech innovation

Panelists at Thursday’s conference spoke about the tremendous expansion of testing capacity, an noted how technological innovation is a leading force not only in HIV/AIDS diagnosis, but also in treatment, prevention and education.

“I think there’s actually a lot going on in innovations in technology,” Chris Beyrer, president of the International AIDS Society, told IPS. “And it’s not only internet technology and mobile technology, but it’s also in other domains, like self-testing and home-testing.”

Beyrer added how “getting testing out of the clinics and getting them directly to people” reduces the strain on medical personnel and funding, two areas in which panellists agree there are great shortages.

“Technology is moving to a place where there are much more local kinds of facilities that can actually do staging,” Beyrer explained to IPS.

“You don’t have these kinds of problems with people waiting forever to get a CD4, and then being told to go somewhere else with their CD4 result.”

“One size does not fit all”

Birx, who also participated in Thursday’s panel, added that technology can potentially be used to disseminate information about HIV/AIDS, and can potentially even correct some of the misconceptions about what causes HIV/AIDS.

She referenced the “incredible work” coming out of Cambodia, which utilises different internet strategies to cater not only to people of different ages, but also to people of different sexual practices, in an attempt to distribute key medical information.

The technique, she says, allows everybody to “click on the site and find the voice that resonates with them and gives them different knowledge [about HIV/AIDS] that they need.”

“I found that so incredibly powerful, and if we can figure out how to do that and get broadband throughout sub-Saharan Africa, it would be terrific.”

Beyrer reiterated the need for technology to offer individualised options for the transmission of knowledge about HIV/AIDS, telling IPS that “one size doesn’t fit all in these innovations.”

“It turns out, for example, from looking at interactive supports for treatment, there are very age-dependent differences even among population,” he said.

“Men under 25,” Beyrer explained, “really like SMS interactive messages, and want to be notified at all times, while older men [tend to say] no thank you, leave me alone…it’s very specific so we’re going to have to get that right.”

Yet despite Beyrer’s enthusiasm for more individually-tailored solutions to those seeking knowledge about HIV/AIDS, he also urges that there be more awareness-building for those not expressly seeking knowledge about HIV/AIDS.

“One sector that hasn’t engaged very much in HIV is social media,” he said, calling specifically on Facebook, Google, and others in Silicon Valley to engage more thoroughly.

“We need that, and we would love them to be way more engaged than they are.”

Edited by: Kitty Stapp

The writer can be contacted at

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Atom Bomb Anniversary Spotlights Persistent Nuclear Threat Thu, 07 Aug 2014 04:00:23 +0000 Suvendrini Kakuchi The atomic bomb dome at the Hiroshima Peace Memorial Park in Japan was designated a UNESCO World Heritage Site in 1996. Credit: Freedom II Andres_Imahinasyon/CC-BY-2.0

The atomic bomb dome at the Hiroshima Peace Memorial Park in Japan was designated a UNESCO World Heritage Site in 1996. Credit: Freedom II Andres_Imahinasyon/CC-BY-2.0

By Suvendrini Kakuchi
TOKYO, Aug 7 2014 (IPS)

It has been 69 years, but the memory is fresh in the minds of 190,000 survivors and their descendants. It has been 69 years but a formal apology has yet to be issued. It has been 69 years – and the likelihood of it happening all over again is still a frightening reality.

As foreign dignitaries descended on Japan to mark the 69th anniversary of the atomic bombing Wednesday, the message from officials in the city of Hiroshima was one of urgent appeal to governments to seriously consider the enormous threat to humanity and the planet of another nuclear attack.

Survivors, known here as hibakusha, who have worked tirelessly since August 1945 to ban nuclear weapons worldwide, urged diplomats – including ambassadors from four of the nine nuclear weapons states (United States, Israel, Pakistan and India) – to heed the words of the 2014 Peace Declaration.

Representing the anguished wishes of aging survivors and peace activists, the declaration calls on policy makers to visit the bomb-scarred cities to witness first-hand the lasting devastation caused when the U.S. dropped its uranium bomb (Little Boy) on Hiroshima and its plutonium bomb (Fat Man) on Nagasaki three days later.

The Center for Arms Control and Non Proliferation reported earlier this year that the nine nuclear weapons states possessed a combined total of 17,105 nuclear weapons as of April 2014.
Some 45,000 people observed a minute of silence Wednesday in a peace park close to the epicenter of the bomb, which killed an estimated 140,000 people in Hiroshima before the second bomb claimed a further 70,000 lives in Nagasaki.

The tragic events came as Japan was negotiating its surrender in World War II (1939-45).

The presence of so many survivors, whose average age is estimated to be 79 years, provided stark evidence of the debilitating physical and psychological wounds inflicted on those fateful days, with many hibakusha and their next of kin struggling to live with the results of intense and prolonged radiation exposure.

In a tribute to their suffering, the Hiroshima Peace Declaration states, “We will steadfastly promote the new movement stressing the humanitarian consequences of nuclear weapons and seeking to outlaw them.

“We will help strengthen international public demand for the start of negotiations on a nuclear weapons convention with the goal of total abolition by 2020,” the declaration added.

But the likelihood of this dream becoming a reality is dim, with the Center for Arms Control and Non-Proliferation in Washington reporting earlier this year that the nine nuclear weapons states possessed a combined total of 17,105 nuclear weapons as of April 2014.

The United States, the only state to deploy these weapons against another country, has steadfastly held out on issuing an official apology, claiming instead that its decision to carry out the bombing was a “necessary evil” to end World War II.

This argument is now deeply entrenched in global geopolitics, with states like Israel – not yet a signatory to the Nuclear Non-Proliferation Treaty (NPT) – vehemently protecting its arsenal as essential for national security in the face of protracted political tensions in the region.

Following Israel’s military offensive in Gaza, which resulted in 1,800 civilian casualties in the Palestinian enclave before a ceasefire brokered by Egypt came into effect Tuesday, some in the Arab community insist that Israel represents the biggest security threat to the region, and not vice versa.

China, a nuclear state with an inventory of 250 warheads and currently embroiled in a territorial dispute with Japan, was conspicuously absent from the proceedings.

With run-ins between East Asian nations in the disputed South China Sea becoming increasingly confrontational, peace activists here feel an urgent need to address tensions between nuclear weapons powers, including North Korea.

Professor Jacob Roberts at the Hiroshima Peace Research Institute told IPS, “The call is to ban nuclear weapons that kill and cause immense suffering of humans. By possessing these weapons, nuclear states represent criminal actions.”

He said the anti-nuclear movement is intensely focused on holding states with nuclear weapons accountable for not abiding by the 1968 NPT.

He cited the example of the Mar. 1 annual Remembrance Day held in the Pacific Ocean nation of the Marshall Islands, which suffered devastating radiation contamination from Operation Castle, a series of high-yield nuclear tests carried out by the U.S. Joint Task Force on the Bikini Atoll beginning in March 1954.

Thousands fell victim to radiation sickness as a result of the test, which is estimated to have been 1,000 times more powerful than the Hiroshima blast.

In total, the U.S. tested 67 bombs on the territory between 1946 and 1962 against the backdrop of the Cold War-era nuclear weapons race with Russia.

In a bid to challenge the narrative of national security, the Marshall Islands filed lawsuits this April at the International Court of Justice in The Hague, and separately in U.S. Federal District Court, against the nine nuclear weapon states for failing to dismantle their arsenals.

The lawsuits invoke Article VI of the Nuclear Non-Proliferation Treaty (NPT), which contains a binding obligation for five nuclear-armed nations (the U.S., UK, France, China and Russia) “to pursue negotiations in good faith on effective measures relating to cessation of the nuclear arms race at an early date and to nuclear disarmament.”

As in Hiroshima, the United States has not apologized to the Marshall Islands but only expressed “sadness” for causing damage. A former senator from the Marshall Islands, Abacca Anjain Maddison, told IPS, “The U.S. continues to view the disaster as ‘sacrificing a few for the security of many’.”

The U.S. is not the only government to come under fire. Hiromichi Umebayashi, director of the Research Center for Nuclear Weapons Abolition (RECNA) at Nagasaki University, is a leading advocate for a nuclear-free zone in East Asia and a bitter critic of the administration of Japanese Prime Minister Shinzo Abe, which is alleged to be currently pushing the argument that nukes are necessary for national security.

Umebayashi is spearheading a campaign to stop Japan’s latest decision to work closely with the United States, under a nuclear umbrella, on strengthening the country’s national defence capacities.

“North Korea’s nuclear threat in East Asia is used by the Japanese government to push for more military activities. As the only nation to be atom bombed, Japan is making a huge mistake,” the activist told IPS.

Edited by Kanya D’Almeida

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Ethics of ‘Mercy Killing’ Up for Debate in India Mon, 04 Aug 2014 15:39:37 +0000 Neeta Lal The Indian medical community is divided over the issue of euthanasia. Credit: Loz Pycock/CC-BY-SA-2.0

The Indian medical community is divided over the issue of euthanasia. Credit: Loz Pycock/CC-BY-SA-2.0

By Neeta Lal
NEW DELHI, Aug 4 2014 (IPS)

If a terminally ill patient, with scant hope of recovery, pleads for his death to be facilitated, should the doctors comply? Or, if the family of a patient who has been declared brain-dead requests that her life-support system be withdrawn, should their will be respected?

These and many other such fraught questions are currently roiling India as the country debates the moral and legal dimensions of legalising euthanasia or ‘mercy killing’, defined as the painless termination of an incurably sick person’s life in order to relieve them of their suffering, or end a long-term coma.

In response to a petition filed by the New Delhi-based NGO Common Cause, which wants both the right to refuse treatment and the right to die with dignity to be incorporated into law, the Supreme Court has ordered a public debate on the contentious issue after decades of eschewing adjudicating on it.

At the heart of the debate is the case of Aruna Shanbaug, a rape victim who has been lying in a vegetative state in Mumbai’s KEM Hospital since 1973, virtually brain dead.

“It was unbearable to see an athlete like [my brother] live in a vegetative state. One fine day my father made a decision. He went to the hospital and brought my brother home. He died within a month.” -- Sarita, 35, a New Delhi resident
In March 2011, Shanbaug’s friend, journalist Pinki Virani, filed a plea to the Supreme Court to free Shanbaug from the agony of a barely conscious existence, but the apex court denied the petition.

The ruling National Democratic Alliance (NDA) government helmed by Narendra Modi – which came to power this May – has also been firmly opposed to legalising euthanasia.

“The government doesn’t accept euthanasia as a principle,” Attorney General Mukul Rohatgi told the press. “Our stand on euthanasia, in whichever form, is that the court has no jurisdiction to decide this. It’s for Parliament and the legislature to take a call after a thorough debate and taking into account multifarious views.”

Experts say complexities are amplified further by the absence of agreement between lawmakers and public, as well as medical, opinions about the right to life granted by the Indian Constitution.

“Will legalising euthanasia require a Constitutional amendment?” asked Samta Khanna, a Delhi-based legal activist. “And suppose a terminally ill or comatose patient has no close relatives or next of kin, who will take the decision whether or not life support should be withdrawn?”

The lawyer told IPS there were “so many dimensions to this sensitive issue” that it needed to be discussed in close detail before the drafting of a law.

Still, it is not rare for Indian families to opt for euthanasia with full cooperation from physicians. Prohibitive costs of protracted treatment, as well as a desire to end the suffering of a family member, both play a catalytic role in these decisions.

“Even with insurance cover, private hospital care in India burns a deep hole in the pockets of middle-class Indian families,” Dr. Dineshwar Sharma, CEO of the Apollo Hospital in Noida, a city in the northern state of Uttar Pradesh, told IPS.

“And for the poor, for whom life is a daily struggle for survival, treatment costs of a long-suffering patient can be ruinous.”

Stories of small farmers being forced to sell their meager landholdings for treatment are not uncommon. Nor are tales of terminally ill patients from villages being abandoned by their relatives in big hospitals.

The cost of life

Passive euthanasia, defined as the withholding of life-saving medicines or treatment, is also a frequent occurrence, particularly among the poor.

Thirty-six-year-old Naina, the wife of Manik Ram, a farmer whose family withdrew life support for him after two years of brain hemorrhaging and confinement to the bed, told IPS, “In the beginning, we were hopeful that my husband would recover. So we sold our small agricultural plot. Then went the household furniture followed by all my jewelry.

“But gradually, we realised the futility of spending money on my comatose husband as doctors were clear he wouldn’t ever recover. I asked the doctors to release my husband so we could take him home. After all, I had four young kids to look after as well.”

Ram was then brought home where he breathed his last after three weeks. “I’m still under a heavy debt but as we don’t have to pay hefty hospital bills any more, I’m hoping things will gradually get back to normal,” she said.

Such tales are not unique in this country of 1.2 billion people.

Sarita, 35, whose young brother Mukesh was paralysed from the neck downwards in a motorcycle crash in 2011 in New Delhi, recounts the days of horror the family lived through after he was hospitalised.

“My mother had to sell off all her gold ornaments. My wedding was also put on hold because the hospital bills for my brother were phenomenal,” she told IPS.

“It was unbearable to see an athlete like him live in a vegetative state. One fine day my father made a decision. He went to the hospital and brought my brother home. He died within a month.”

Still, the Indian medical fraternity’s views over the matter are splintered.

While some doctors oppose it, calling it “murder”, others believe that extenuating circumstances make a case for passive euthanasia.

“Family members should be at liberty to decide whether to withdraw the life-support system from a patient if there is no hope of revival,” Dr. Rajendra Prasad, medical director of the Indian Head Injury Foundation, told IPS.

“Several patients die because of a lack of such systems,” he said. “However, active euthanasia, in which the terminally ill are killed [by lethal injection] should be prohibited.”

The anti-euthanasia lobby contends that doctors have a moral responsibility to keep their patients alive, as enshrined in the Hippocratic Oath.

“The line dividing euthanasia from murder is a fine one, and legalising euthanasia might result in an abuse of law, unfairly targeting the poor and disabled, and create incentives for insurance companies to terminate lives in order to save money,” according to Dr. Sanjay Dheer, an oncologist at Max Healthcare in New Delhi.

“There should be a system of checks and balances to review such situations on a case-to-case basis so that both doctors and families can take an informed decision,” added Dr. Sumit Ray, vice chairperson of critical care medicine at the Sir Ganga Ram Hospital in New Delhi.

“Just like most hospitals have a panel to certify whether a person is brain dead or not, a similar panel for euthanasia should be in place,” he told IPS.

Doctors say there is mounting pressure on them as most big hospitals are getting at least three to four such requests from families per week.

Worsening the situation is the crisis in the Indian health sector where a dearth of doctors and hospital beds is forcing the medical community to reconsider huge investment in patients who are unlikely to live.

According to the 12th Five-Year Plan, the doctor-patient ratio is 45 per 100,000, against the desirable ratio of 85 per 100,0000.

Similarly, the number of nurses and midwives is only 75 per 100,000, compared to the goal of 255 per 100,000 patients. The crisis is worse in rural areas, which are especially poorly served.

Euthanasia as a concept isn’t new to India. Seers and sages have for centuries practiced yogic concepts like samadhi, nirvana and santhara, voluntarily opting for death at a particular stage in life, or to escape terminal illness. But successive governments of ‘modern’ India have been reluctant to draft these ancient practices into law.

Until Indian courts make a firm decision on the issue, those forced to make life-or-death choices for their loved ones say they will be plagued by confusion and guilt.

Edited by Kanya D’Almeida


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Nigeria Wakes Up to its AIDS Threat Mon, 04 Aug 2014 07:07:25 +0000 Sam Olukoya Nigeria accounts for one third of all new infections among children in the 20 worst hit countries in sub-Saharan Africa. Credit: Sam Olukoya/IPS

Nigeria accounts for one third of all new infections among children in the 20 worst hit countries in sub-Saharan Africa. Credit: Sam Olukoya/IPS

By Sam Olukoya
LAGOS, Nigeria, Aug 4 2014 (IPS)

Tope Tayo’s marriage broke up 11 years ago after she tested positive for HIV. Her angry and embarrassed husband took away their only child. Three months later, when the one year old boy tested positive, the husband dumped him with Tayo and absconded.

 “He abandoned us as if we had committed a crime but I told him HIV is not a crime,” Tayo told IPS.

She was jobless and the husband paid no maintenance. “I walked the streets crying, I was living on charity,” Tayo recalls.

The runaway man who abandons his HIV positive wife and children is a common feature in Nigeria, says Rosemary Hua, coordinator of the First Step Action for Children, an organisation that advocates for child rights.

“Fathers withdraw their support because they feel there is no need to invest in a child that is likely to die young,” Hua told IPS.

Nigeria’s HIV infection rate of 3.2 percent appears low in comparison to southern Africa’s, but with a population of 173 million, it translates into huge numbers – 3.4 million Nigerians lived with HIV in 2013.

Source: Nigeria report to UNGASS 2014

Source: Nigeria report to UNGASS 2014

Of these, 430,000 are children under 14, according to a recent report of the Joint United Nations Programme on HIV/AIDS (UNAIDS). Nigeria accounts for one third of all new infections among children in the 20 worst hit countries in sub-Saharan Africa.

Fast Facts About AIDS in Nigeria in 2013
173 million population
3.2 % HIV prevalence
3.4 million Nigerians live with HIV
51,000 new child infections
220,000 new infections among all ages
190,000 HIV positive pregnant women
52,500 HIV positive pregnant women receive ARVs
70% of HIV positive pregnant women do not receive ARVs
47, 300 children on ARVs, or 12% of all infected children
593,000 people on ARVs, or 21% of all infected people
210,000 AIDS-related deaths
Little decline in deaths between 2005-2013
Source: UNAIDS 2014

The report says Nigeria faces “the triple threat of high HIV burden, low treatment coverage and no or little decline in new HIV infections.”

Moreover, the national HIV rate conceals sharp disparities among the 36 states: in four, prevalence ranges from eight to 15 percent.

Why women avoid testing

Tayo and her son have been taking antiretroviral drugs for the last 11 years. They are lucky. Fewer than 600,000 Nigerians are on treatment, or 20 percent of those who need it.

Low treatment coverage perpetuates misconceptions and stigma, as Tayo’s story show.

Abandonment usually translates into economic hardship. Half of women are unemployed in Nigeria.

“The desperation to take care of herself and her child could drive an HIV positive woman into sexual activities to raise money and this could further spread HIV,” says Lucy Attah, a gender activist who lives with HIV. She is executive director of Women and Children of Hope Foundation, which helps HIV positive women, and where IPS met Tayo.

Tayo told IPS she avoided testing for HIV while pregnant. Nigerian public hospitals do routine HIV testing of pregnant women but fear of discrimination if found positive led Tayo to a private hospital where testing was not required.

“It is the biggest regret of my life,” she told IPS.

One reason that pregnant women shun testing, says Hua, is health workers’  “lack of professionalism by not keeping HIV results confidential.”

“At times we had to transfer patients to other hospitals far from where they live because of the disclosure of their HIV status,” she told IPS.

Some health workers avoid any contact with HIV positive women because they mistakenly believe they can contract the virus by mere touching, says Attah.

“On the surface, it seems there is a lot of awareness among health workers but in reality there is a lot of stigma,” says Attah.

An anti-discrimination and confidentiality law has been approved by both houses and is waiting for President Goodluck Jonathan to sign it.

But Nigeria needs more than laws to address the epidemic.

In 2012, UNAIDS described the country’s response as “stagnant” and requiring “a massive effort.”

Nigeria accounts for 13 percent of all HIV positive people and 19 percent of all AIDS-related deaths in sub-Saharan Africa, according to UNAIDS.

Only Chad ranks lower than Nigeria in treatment coverage of HIV positive pregnant women. (see graph)

Source: UNAIDS Gap report 2014

Source: UNAIDS Gap report 2014

Some good news

Since that damning description, the government has taken bold steps to reduce transmission from mothers to babies (PMTCT) among the 12-worst hit states.

PMTCT coverage went up to by 27 percent in 2013, a significant increase from 19 percent in 2012, according to the United Nations Children’s Fund (UNICEF).

Some states doubled or tripled the number of clinics providing HIV services, bringing the number of PMTCT sites to 2,216 – still far from the 16,400 required for adequate coverage.

The annual number of new child infections went down from 60,000 in 2012 to 51,000 in 2013.

But, with two in three pregnant women shunning antenatal care, the challenge will be reaching them through improvement of services and outreach.

“We must go to them instead of waiting for them to come to the health facility,” Arjan de Wagt, chief for children and HIV with UNICEF in Nigeria, told IPS. “Otherwise, children will continue dying of AIDS unnecessarily.”

Edited by: Mercedes Sayagues

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