Wheelchair-bound, her body now skeletal from full blown AIDS, disabled 38-year-old Melisa Chigumba attempts to wave away a swarm of flies hovering around her face as she sits outside her home in Chachacha, a remote area in Shurugwi, 278 kilometers south of the capital, Harare.

Shown in the photo donning a red dress, is Zipha Moyo, a disabled HIV/AIDS activist recently making a presentation Harare, the Zimbabwean capital on the exclusion of People with Disabilities in HIV and AIDS programs. Credit: Jeffrey Moyo/IPS

The couple’s three children, who were born infected with HIV, died in their infancy.

Melisa is a prime example of the millions of people here living with disabilities bearing the brunt of HIV/AIDS.

Her sister-in-law Meagan, according to the Zimbabwean culture is her aunt, now looks after her at their remote home, the only inheritance left for her by her husband.

According to the National Association of Societies for the Care of the Handicapped (NASCOH), Zimbabwe has a population of almost 1.8 million people living with disabilities.

Amongst this population, are the deaf and mute who have not been spared by HIV/AIDS.

This is despite Zimbabwe making huge strides in reducing HIV/AIDS prevalence from 29 per cent in 1997 to approximately 13. 7 per cent now.

Many battling physical disabilities like Melisa here say they have apparently been left out in combating the disease in their circles.

“I have not heard of any efforts being made to help disabled HIV-positive persons like myself. There are no special government programs for us, and just like all able-bodied persons, we also queue for treatment drugs at clinics,” Melisa told IPS.

The HIV/AIDS plight affecting people living with disabilities in this southern African nation worsens at a time the rest of the world commemorated the International Day of Disabled Persons earlier this month.

The global day for the disabled was proclaimed in 1992 by the United Nations and aims to promote an understanding of disability issues and mobilize support for the dignity, rights and well-being of persons with disabilities.
But Zimbabwe’s disabled HIV/AIDS activists claimed there was no assistance in combating the virus.

“Although we are sexually active as well as vulnerable to rape and other forms of sexual abuse, as disabled people we are overlooked in national HIV prevention strategies because policymakers do not regard us as sexually active,” Agness Mapuranga, a Shurugwi-based disabled HIV/AIDS activist living with the virus, told IPS.

“We are the country’s least covered and engaged population by HIV/AIDS service organisations despite the fact that many of us also battle with the virus,” added Mapuranga.

To make matters worse, there are no recorded statistics from the country’s Ministry of Health and Child Care on how many people with disabilities are accessing HIV treatment drugs.

A top government official from the Ministry of Health and Child Care confessed the government’s shortcomings in fighting AIDS amongst people with disabilities.

“Government’s health delivery system lacks policies or programmes to equip HIV/AIDS caregivers with the skills and knowledge needed to effectively assist disabled people in HIV prevention,” the government official, told IPS on condition of anonymity for professional reasons.

Meanwhile, it is Zimbabwe’s hearing and visually impaired population that face the greatest HIV/AIDS threat, according to lobby groups here.

“A glaring example of the worst HIV/AIDS sufferers here are the hearing impaired and the visually impaired, where information is not available in formats accessible to them; that is in sign language and braille. No one can stand up and produce or show a comprehensive program on prevention, treatment and care for these two disability categories,” Farai Mukuta, Advocacy and Knowledge Management Advisor for the Disability, HIV and AIDS Trust (DHAT) and the Deaf Zimbabwe Trust (DZT), told IPS.

DHAT is a non-profit regional organization which was registered in Zimbabwe as a Trust in 2007 with the aim of promoting the rights and capacity building of Persons with Disabilities having cervical cancer, tuberculosis, infected and affected by HIV and AIDS.

Mukuta’s remarks resonate with other pro-disabled lead activists.

“Deaf people are faced with challenges regarding access to information. Sign language is the medium of communication for deaf and hard-of- hearing people and they need information in formats they understand,” Barbra Nyangairi, the DZT Executive Director, told IPS.

Nyangairi’s remarks are true for HIV positive Liberty Hungwe, who is deaf living in Shurugwi’s Tongogara area.

“For me, testing for HIV has been a challenge because service providers do not have sign language, and owing to that, when we went for testing, people like myself were just tested and there was no counselling either post or pre-test counselling, which are barriers for us in accessing HIV/AIDS services,” Hungwe told IPS through the aid of a sign language interpreter.

Based on findings by DHAT, HIV/AIDS challenges affecting people with disabilities stem from commonly held notions among health personnel that handicapped persons are not sexually active.

In a baseline study in 2012, the United Nations noted that Zimbabwe’s people with disabilities often lack confidentiality at HIV/AIDS voluntary counselling and testing centres due to the presence of interpreters.

A 2012 study by the UN said HIV/AIDS and disability was an “emerging issue” and “cause for concern” as people living with disabilities were at greater risk of exposure to HIV infection due to social exclusion and rejection.

“People living with disabilities are at great risk of acquiring HIV, while empirical evidence has also demonstrated that people with sensory impairments – the deaf and the blind – are more vulnerable than others, due to their special communication needs,” the UN report said then.

The UN report also noted the general absence of literature and media images that “incorporate the HIV and AIDS information needs of people with disabilities, especially the deaf and blind.”

Even leading activists for people living with disabilities here agree with the UN.

“The prevailing view in society is that PWDs are not sexually active and do not warrant inclusion in HIV and AIDS interventions. Consequently, there have been no deliberate efforts to address the issue of AIDS among people with disabilities and to incorporate them within the rubric of the national response,” Mukuta, told IPS.

“The reality is that disabled people are just as sexually active as the rest of the society and are even more at risk of infection because of the obvious barriers that they encounter in accessing vital information on HIV/AIDS,” added Mukuta.

Mukuta said Zimbabwe’s success story in combating HIV/AIDS excludes HIV positive people with disabilities (PWDs).

“Our country boasts of the fast falling rates of HIV infections, but in all this, people with disabilities have been systematically sidelined from all HIV and AIDS intervention programmes in the country, on the erroneous assumption that they are not sexually active,” Mukuta told IPS.

Despite the hurdles faced by many disabled HIV positive people like Shurugwi’s speech-impaired Hungwe, other lobby groups here brag they have played their part in combating HIV/AIDS spread among such minority groups.

“As Deaf Zimbabwe Trust, we have trained 20 deaf people as peer educators in order to provide accurate information to the deaf community and we intend to train more peer educators who are deaf so that they can cascade information while we are in the process of creating a support group for people who are deaf and living with AIDS,” Nyangairi told IPS.

But now hit with full blown AIDS, disabled and wheelchair-bound Chigumba is pessimistic.

“I just wait for my time to die and evade this pain,” Chigumba told IPS as she winced with pain.

Writer can be contacted at moyojeffrey@gmail.com

Patient undergoing dialysis treatment at Mulago Hospital in Kampala. Credit: Rebecca Vassie

By Wambi Michael
KAMPALA, Jun 15 2015 (IPS)

Vincent Mugyenyi, a 65-year-old retired pilot from the Ugandan Air Force, has lost count of how many dialysis treatment slots he has had to attend in the eight years he has been fighting chronic kidney disease.

He spends eight hours a week on a dialysis machine in Mulago National Referral Hospital that filters toxins from his blood, performing the functions of healthy kidneys. The ultimate aim of dialysis is to bridge a gap until kidney functions recover or until a transplant is available for patients.

“I used to have a small farm with about one hundred animals. I sold all those animals for treatment because I still needed life. That is how this disease has affected me. It has depleted every resource of mine … land is very important but I have sold mine just to buy life,” Mugyenyi told IPS.

Mugyenyi is both luck and unfortunate. He is one of the minority of Ugandans with chronic kidney disease who has been able to receive dialysis treatment, but he does not qualify for a kidney transplant operation because of his advanced age.“We don’t have sufficient data on the disease. We understand more about HIV, malaria and tuberculosis, because these are diseases with lots of funding behind them. But funding for kidney disease isn’t there. Kidney disease deserves the same level of importance as HIV” – Dr Robert Kalyesubula, nephrologist at Mulago Hospital in Kampala

Chronic kidney disease (CKD) is a growing health burden in Uganda that is affecting the economic, social and physical livelihoods of patients and their family members.

Dr, Simon Peter Eyoku, a kidney disease specialist at Mulago Hospital’s renal unit, told IPS that CKD affects mainly Ugandan adults aged between 20 and 50, and that the commonest causes of kidney diseases in Uganda are HIV-related infections of the kidney, followed by hypertension and diabetes.

The World Health Organisation (WHO) says that with CKD being the 12^th leading cause of deaths worldwide and its incidence growing by around eight percent annually, it is a global public health concern.

Mulago National Referral Hospital is the only public hospital in Uganda treating patients with renal or kidney-related complications and, according to Eyoku, that often places a further burden on patients who have to travel long distances to the dialysis unit.

“I have seen patients migrate from far corners of the country to Kampala because that is where the dialysis machines are. That is how costly this disease can be to patients,” Eyoku told IPS.

A further problem is that the dialysis unit only has 33 haemodialysis machines for a total population of about 36 million people.

When the unit opened almost eight years ago with four dialysis machines, a patient had to pay the equivalent of 500 dollars for a week of dialysis treatment, making the cost of treatment prohibitive.

“Those who could afford it would fall out after selling land, houses, cars and then failing to continue. And at that time, the cost of a transplant was equal to the amount of money you paid in a year for dialysis,” said Eyoku.

In March 2014, the administration of Mulago Hospital decided to reallocate its budget in order to finance the renal unit and brought the cost of a week of treatment down to 40 dollars, but that is still out the reach of most Ugandans.

The hospital is now also offering two free sessions of dialysis, and Eyoku told IPS that this has led to an influx of patients with CKD, “so now we are struggling because we are getting many more patients on dialysis.”

Uganda’s health planners are accused of not giving priority to kidney-related diseases. “I wish we had more specialists managing kidney diseases,” Dr Robert Kalyesubula, one of the four consulting nephrologists at Mulago Hospital, told IPS.

“I wish we had more specialists managing kidney diseases, I wish we had more awareness programmes about kidney disease so that people know about it because it is devastating. I have seen big people break down on being diagnosed with kidney disease. And the pain, because it affects a whole family. If a father gets the disease then the children will not go to school.”

One of the difficulties with kidney disease is that in its early stages it has no specific symptoms so the patients who turn up for treatment are often in the final stages of the disease.

“Patients come in the dying stage,” said Kalyesubula. “You spend 90 percent of your time struggling to keep people alive rather than making them live.”

In addition, said the nephrologist, in Uganda as in the rest of sub-Saharan Africa, the magnitude of CKD is unknown and is not given sufficient importance.

“We don’t have sufficient data on the disease. We understand more about HIV, malaria and tuberculosis, because these are diseases with lots of funding behind them. But funding for kidney disease isn’t there. Kidney disease deserves the same level of importance as HIV. We are ignoring a disease which can be treated in its early stages.”

Patients who cannot afford to pay the 40 dollars a week for dialysis are treated in ward 4C, and the impression is that they are prisoners condemned to a death sentence with no possibility of appeal.

When IPS visits the ward on a busy afternoon, the scene was one of pathetic chaos, with the few doctors and nurses available rushing round, attending to both adult males and young girls in the same ward.

A male patient in his mid-forties had just died from kidney failure, and at the entrance to the ward, IPS met Rosemary Kyakuhaire, packing the bags of a brother who had died earlier in the day. She said that he had spent three weeks in the ward receiving palliative care because her family could not afford the expensive dialysis treatment.

In Uganda, Kalyesubula told IPS, a person would rather be diagnosed with HIV than kidney disease. “I say that mainly because HIV has a lot of support systems in Uganda. But for kidney disease, you are there on your own.  I have also seen people sell their houses to go for a kidney transplant but you don’t have to do that for HIV/AIDS.”

Provision of CKD treatment in Uganda depends primarily on whether the patient has health insurance or can otherwise afford treatment through taking out loans, selling property or financial support from relatives and friends. There are two private hospitals offering dialysis but only a lucky few can afford them.

Twenty-seven-year old Benon Mulindwa is one of the lucky ones. His employer, the Uganda People’s Defence Force (UPDF), had medical insurance cover for his treatment and transplant costs. He told IPS that without that medical cover, he could not have afforded the 20,000 dollars or so a year for dialysis and another 20,000 dollars for his kidney transplant.

However, Mulindwa received the transplant not in Uganda but in India, with his employer’s medical insurance cover paying for the costs of transport to India and surgery there. He explained that most patients have to look for their own kidney donors at home.

Unlike developed countries which run public kidney donation registries, patients in Uganda have to find potential donors and that, said Kalyesubula, is where one of the difficulties for CKD patients lies.

Because of lack of awareness about the safety of kidney donations, many Ugandans are unwilling to donate a kidney to save the life of one of the growing number of patients on the kidney donation waiting lists.

But that is not the only difficulty, as Mulindwa explained. “It is very difficult because there those who come as thieves, there those who come expecting to be paid a lot of money. I know of one who promised to donate a kidney to one of the patients, but when the money was sent the ‘donor’ disappeared.”

Edited by Phil Harris   

By Lyndal Rowlands and Mercedes Sayagues
UNITED NATIONS, Dec 29 2014 (IPS)

In rural Zambia and Malawi, new mums face long delays finding out if they have passed HIV on to their babies.

Without treatment, a third of babies born with HIV will die before their first birthday and half before their second. Starting treatment within the first 12 weeks of life vastly improves their chances of survival.

But testing babies is not easy in poor countries.

Because mothers pass antibodies to their babies in the womb, the usual adult antibody tests during the first months of life can be inaccurate.

A virological test is needed. But only a handful of central labs can do these in Zambia and Malawi. On the long journey to and from the lab on the back of a motorbike or truck, the blood sample or the result often gets lost.

Some studies suggest that nearly half of tests never reach the clinics or the mothers.

Meanwhile, the new mum returns to her village and she and the baby likely drop out from the clinic’s radar.

Malawi and Zambia each has an estimated one million people living with HIV. In 2012, new HIV infections among children numbered 9,400 in Zambia and 11,000 in Malawi. Just over one third of babies were tested.

The old system couldn’t cope. New ideas and technologies were needed.

Enter UNICEF Innovation with an open source, code-based RapidSMS software: as soon as the lab result is in, the rural clinic’s nurse receives it by SMS on a cell phone or looks it up on the website. In remote villages, a community health worker receives the SMS and alerts the parents.

All information is encoded to ensure privacy and the software includes a web dashboard for reporting and administration.

In Zambia, the turnaround was cut from two or three months down to one month, said Shadrack Omol, deputy representative of UNICEF in Lusaka.

The SMS relaying is part of an antenatal system, Project Mwana (KiSwahili for child), that brings other benefits for all new mums as well.

At the first antenatal visit, the mother’s details are entered in Mwana’s SMS reminder system for alerts on checkups, immunizations, baby weighing and drug refills.

Bundling the HIV component with regular mother and baby care helps avoid stigma and fear of being identified as HIV positive.

In 2011, a Mozambican charity with 22,000 people on ARV treatment tried to build a cellphone database to remind patients of appointments: fearing loss of privacy and stigma, only half gave their cellphone numbers.

In Zambia, Mwana covers 484 clinics in 10 provinces. In Malawi, it has delivered more than 20,000 tests.

The next step, says Emanuel Saka, HIV specialist with UNICEF in Malawi, will be “expanding the geographical coverage and scope of the technology” and targeting adolescents with HIV.

New solutions to old problems

The best solution would be to test babies at the point of care in the rural clinic without any delays. In Mozambique, health workers are trying out a new viral load testing machine that can diagnose young babies in less than one hour.

“This is a great breakthrough,” said Bindiya Meggi, a pharmacist working on this project with the National Institute of Health.

Made by the German company ALERE, the machine is being tried in four sites with the help of the Clinton Health Access Initiative.

“It’s very simple to use,” said Ocean Tobaiwa, a Zimbabwean technician at the trial clinic in Maputo

As the machine is tested, it is adapted to local conditions, such as irregular electricity, black outs, power surges, heat and humidity. German technicians visit regularly to tweak the machines.

At present, babies are tested at one-month of age. A dry blood sample is collected through a heel or finger prick and sent to a central lab for viral load analysis.

Mozambique has only four such labs for a population of 24 million, with some 900,000 HIV positive women, and thousands of kilometers of roads impassable in the rainy season.

Although in theory results should be returned in two weeks, the reality is one month or more. Meanwhile, as in Zambia and Malawi, mother and baby are lost to follow-up.

In Zambia, RapidSMS is the backbone of U-Report, a booming HIV hotline service for young people, which garnered 71,000 users in two years. (see sidebar)

UNICEF Innovation Labs work with universities and the public and private sector to find new solutions to old problems in health, education, and water and sanitation.

“There is so much to do in the area of technology and real time information that hasn’t yet been explored,” Kochi said.

By Davison Mudzingwa
JOHANNESBURG, Dec 23 2014 (IPS)

Lungile Thamela knows how he got infected with HIV: through his reckless choice to have unprotected sex with his partner although he knew she was living with HIV.

He wanted to prove his manhood by having a baby. Instead, he got HIV and was crushed by the burden of self-stigma.

Gendered concepts of masculinity influence how men behave around HIV and within antiretroviral treatment (ART) programs.

As a result, the number of men on ART in South Africa in 2012 was half the number of women.

Why are South African men reluctant to test for HIV, to start and stay on ART, and to join support groups?

Is it that health services are not men-friendly? Is it an idea of masculinity that mandates men to be stoic, to hide pain as a weakness and not to talk about their feelings?

What defines the relationship of men to health services and how can it be improved?

In this video by Davison Mudzingwa, experts and activists like Thamela, analyze the factors that drive men’s gendered vulnerability to HIV in South Africa and suggest ways to reduce it.

SILENT SUFFERING: MEN, MANHOOD AND HIV

By Mercedes Sayagues
Cape Town, Dec 18 2014 (IPS)

Across Africa, men have lower rates than women for HIV testing, antiretroviral treatment enrollment and adherence, viral load suppression and survival.

Generally, of all people on antiretroviral treatment (ART) in Africa, just over one-third are men.

The disparity can be even more dramatic: in South Africa, in 2012, half the number of men were taking the life-saving drugs compared to women: 1.3 million women and 651,000 men.

At the core of this inequality are socially constructed ideas of masculinity. To be a man means being strong, to ignore pain and symptoms. Hospitals are for women and children.

As a result, men test for HIV and start ART late, sometimes too late to beat the virus.

Manhood brings a mix of personal costs and benefits. Among the costs are men’s poor mental and physical health, and their difficulty to talk about their feelings.

It’s not considered macho to share personal problems. This is one reason why men hesitate to join support groups to help them cope with treatment.

Experts recommend setting up men-friendly clinics with opening hours suitable for working men, recruiting male champions to encourage men to join HIV support groups, and routine co-testing of couples at antenatal clinics.

HIV has become the leading cause of death among adolescents in Africa. Credit: Sam Olukoya/IPS

By Sam Olukoya
LAGOS, Nigeria, Dec 15 2014 (IPS)

HIV among teenagers is devastating families in Nigeria and elsewhere in Africa, where AIDS has become the No. 1 killer of adolescents.

Africa accounts for more than 80 per cent of the 2.1 million adolescents living with HIV globally.

Drivers of HIV infection among adolescents include scarce information about sexual reproductive health and HIV, unprotected sex and sexual violence.

Between 2005 and 2012 the global AIDS death toll fell by 30 percent but increased by 50 percent among adolescents, according to the United Nations Joint Programme on HIV/AIDS (UNAIDS).

Late HIV diagnosis, fear of discrimination, low enrolment and adherence to antiretroviral treatment, and absence of specialized health services for HIV positive youths are some of the factors responsible for AIDS related deaths among adolescents in Africa.

Young boy sitting on a wall outside 'Way Home', a UNICEF-assisted shelter providing food, accommodation, literacy trainings and HIV/AIDS-awareness lessons to street children in Odessa, Ukraine. Because of unsafe sex and injecting drug use, street adolescents are one of the groups most at risk of contracting HIV. Credit: UNICEF/G. Pirozzi

By Pavol Stracansky
KIEV, Dec 9 2014 (IPS)

Marginalised communities and civil society groups helping them are warning of a “tragedy” in Eastern Europe and Central Asia (EECA) as international funding for HIV/AIDS and tuberculosis (TB) programmes in the regions is cut back.

The EECA is home to the world’s only growing HIV/AIDS epidemic and is the single most-affected region by the spread of multi-drug resistant TB (MDR-TB). For years, HIV/AIDS and TB programmes in many of its countries have been heavily, or exclusively, reliant on funding from theGlobal Fund to Fight AIDS, TB and Malaria.

But this year has seen the Global Fund move to a new financing model based on national income statistics, under which funding in many EECA countries has already been – or will soon be – heavily cut.“This [reduction in Global Fund financing] could lead to tragedy because governments are not yet ready to take on the responsibility for addressing the HIV/AIDS epidemic. I would like decision-makers to understand that this is not just [about] epidemiological statistics but that our lives and health are at stake” – Viktoria Lintsova of the Eurasian Network of People Who Use Drugs (ENPUD)

Some of those likely to be most heavily affected by the cuts say that the reduction in Global Fund financing is putting essential HIV/AIDS and TB services, and with it lives, at risk.

Viktoria Lintsova of the Eurasian Network of People Who Use Drugs (ENPUD) told IPS: “This could lead to tragedy because governments are not yet ready to take on the responsibility for addressing the HIV/AIDS epidemic. I would like decision-makers to understand that this is not just [about] epidemiological statistics but that our lives and health are at stake.”

At the heart of their concerns are worries over funding for not just medical treatment for existing patients but prevention and other services for at risk and marginalised communities.

Injection drug use has been identified as the main driver of the HIV/AIDS epidemic in the EECA but HIV/AIDS is also being increasingly spread among men who have sex with men and sex workers – groups which are heavily marginalised because of political and societal attitudes to homosexuality and women.

TB, an equally severe health problem in the EECA, is closely linked to the HIV/AIDS epidemic because co-infection rates are often high.

Throughout the region, prevention and harm reduction services for marginalised groups are provided by civil society groups which rely almost exclusively on international funding.

Sveta McGill, health advocacy officer at international advocacy NGO Results UK, told IPS that the withdrawal of Global Fund funding could see many sick people slip under the health care radar.

She said: “It is affecting services provided by NGOs covering at-risk groups. These ‘low threshold entry’ services, while not necessarily medical interventions, are crucial to keep people from risk groups coming to centres where they get referred to medical institutions to get treatment and can access medical services as well.

“Often, they would not feel comfortable going straight to state health care institutions, and closing down these venues would mean that less people would be referred to state health care institutions.”

Critics point to rising HIV/AIDS infections in Romania in recent years as a sign of what could happen in other EECA countries when the Global Fund cuts back its financing.

The Global Fund ended financing for programmes in the country in 2010. According to data from the Romanian government, since then there has been a dramatic rise in HIV infections among people who use drugs: in 2013, about 30 percent of new HIV cases were linked to injection drug use compared with just three percent in 2010.

Under the Global Fund’s New Financing Model (NFM), the major change is a reduction in financing to middle income countries. Many EECA countries are now classified as middle income and critics say that while the organisation’s goal of looking to prioritise use of finite resources is sensible, national income data does not always accurately reflect the ability of people to access health care services, nor whether a country has the funds for an adequate disease response.

They point to studies showing disease burdens shifting from low income countries to middle income states, and poverty being greatest in middle income countries. Also, most people living with HIV live in middle income countries.

But some have also dismissed as naive the notion that, as the Global Fund wants, national governments will automatically fill the gap in funding left as the Global Fund cuts back its financing.

Many point to the situation in Ukraine as an example highlighting the problems of the NFM.

According to a report from the Open Society Foundations, Global Fund spending on HIV will drop by more than 50 percent for Ukraine between 2014 and 2015. This includes reductions in unit cost spending for people who use drugs by 37 percent, for sex workers by 24 percent and for men who have sex with men by 50 percent.

Meanwhile, the national HIV prevention budget was slashed by 71 percent in 2014 amid political and economic upheaval.

Lintsova, who lives in central Ukraine, told IPS of the problems drug users are currently facing.

She said that not only are there shortages of the right drugs to treat TB in some parts of the country, but that very few drug users have access to them. Places on opiate substitution treatment (OST) programmes are very limited and waiting times to join them long, sometimes fatally so.

“I know two people who died waiting to get on an OST programme,” she told IPS. “And there are other problems like a lack of needle exchange centres in rural areas, in fact a lack of any harm reduction services in small towns, which leads to high rates of HIV in those places.”

She added that without proper funding, the situation would not improve. “The only solution to these problems is financing,” she said.

But other stakeholders have also privately raised fears that a greater government role in fields such as drug procurement could see authorities looking to save money and procuring larger quantities of cheaper TB drugs of worse quality. Meanwhile, local legislation also makes procurement tenders long and difficult, leading, some health care experts predict, to governments running out of stocks of some essential medicines.

It is unclear how governments will deal with the reduction of Global Fund financing. The transition from Global Fund to domestic funding, although widely announced and anticipated, is not going smoothly in all countries.

Many are often unclear when the Global Fund will actually leave because no straightforward timing plan has been set. There are also specific problems in individual states. In Ukraine, in particular, domestic TB funding has been severely affected by the military conflict, struggling economy and currency fluctuation.

Late last month, these growing fears prompted 24 prominent NGOs in the region to send an open letter to the Global Fund warning of their ‘grave concerns’ over the allocation of funding in the region and calling for it to work with local groups and affected communities.

They specifically asked it to look at each country individually, rather than adopt a “one size fits all” approach.

The Global Fund declined to respond when contacted by IPS.

However, drug users who spoke to IPS said there was little hope of an improvement in the region’s HIV/AIDS and TB epidemics if the Global Fund fails to heed NGOs’ warnings.

Lintsova told IPS: “A lack of reaction to our calls could lead to problems accessing prevention and treatment programmes and a deepening of the EECA’s HIV/AIDS and TB epidemics.”

(Edited by Phil Harris)

As AIDS becomes the leading cause of death of adolescents in Africa, empowering youth – especially girls - to make safe life choices and avoid HIV is crucial. Credit: Mercedes Sayagues

By Sam Olukoya
LAGOS, Nigeria, Nov 21 2014 (IPS)

Two years ago, Shola* was kicked out of the family house in Abeokuta, in southwestern Nigeria, after testing HIV-positive at age 13. He was living with his father, his stepmother and their seven children.

“The stepmother insisted that Shola must go because he is likely to infect her children,” Tayo Akinpelu, programme director of Youth’s Future Savers Initiative, told IPS.

“Shola felt as an outcast,” says Akinpelu. Eventually, Shola’s grandparents took him in.

HIV among teenagers is devastating families in Nigeria and elsewhere in Africa, where AIDS has become the leading cause of death among adolescents.

“This is absolutely unacceptable,” says Craig McClure, chief of HIV programmes with the United Nations Children’s Fund (UNICEF), in New York. “What’s more, AIDS-related deaths are decreasing for all age groups except adolescents.”

The global AIDS death toll fell by 30 percent between 2005 and 2012 but increased by 50 percent among adolescents, says a UNICEF report.

Fear of seeking help

One reason for this shocking teen death toll, says Dr. Arjan de Wagt, chief of HIV/AIDS with UNICEF in Abuja, is the low number of adolescents on antiretroviral treatment (ART).

Of the 3.1 million Nigerians living with HIV, half are under 24 years. But only two out of ten HIV positive youth over 15 and just one out of ten under 15 received the lifesaving drugs in 2013, de Wagt told IPS.

Rejection by family and society, as happened to Shola, or fear of rejection, prevents adolescents from seeking help.

“Many HIV positive adolescents are dying in silence because they are too ashamed to access treatment,”’ Blessing Uju, a Lagos-based youth counsellor, told IPS.

“The shame is even bigger for the girls. In Nigeria, if you are HIV positive, the impression is that you are a commercial sex worker,” she says.

Sally* did not tell her parents or siblings when she tested HIV positive four years ago, at age 19.

“At the family level, there is a lot of stigma,” she told IPS.

Although aware of the danger of not taking her medication regularly, Sally often skipped it to avoid being seen with pills at home.

“As a young person, you need a confidant. If you are not strong, you might end up taking your life,” she says.

Teenagers need family help to stay on ART, says Akinpelu.

Shola’s grandparents would normally cook the first meal for the day in the afternoon until Akinpelu explained to them that the pills can cause nausea on an empty stomach and Shola needed a hearty meal earlier.

Uju says that treatment fatigue hits adolescents hard. “Some say they prefer to die than to continue taking their drugs,” she says.

High death toll

Of the 2.1 million adolescents living with HIV worldwide in 2012, more than 80 per cent are in sub-Saharan Africa, according to the United Nations Joint Programme on HIV/AIDS (UNAIDS).

Malawi, with 93,000 HIV positive teenagers, has 6,900 annual AIDS-related adolescent deaths.

The death toll is linked to late diagnosis and starting ART too late, explains Judith Sherman, of UNICEF in Lilongwe.

Malawi’s policy is that all children seen in health facilities should be offered an HIV test. “Unfortunately, this does not happen routinely,” she says.

Teenagers’ adherence to ART is lower than adults, says Sherman, “for a range of reasons like treatment fatigue, depression, fear of stigma, denial and unstable family relationships.”

Tanzania’s estimated 165,000 adolescents living with HIV face similar challenges as their peers in Nigeria and Malawi. (see sidebar)

Allison Jenkins, chief of HIV/AIDS with UNICEF in Tanzania, says that one effective way to help teenagers are clubs.

“Teen clubs improve adherence to treatment, especially among members who attend regularly,” she told IPS.

HIV among teen girls

Alarmingly, adolescent HIV prevalence is highly gendered, with teen girls showing infection rates that UNAIDS calls ”unacceptably high”.

Teen girls aged 15-19 in Mozambique have a prevalence of seven per cent, more than double the boys of the same age. Botswana presents a similar scenario.

Lucy Attah, of the Lagos-based Women and Children Living with HIV & AIDS, blames poverty.

“Girls have to trade sex for money to sustain themselves,” she says. “The pressure for money is higher in the cities where teenage girls compete to get the best mobile phones and clothes.”

Adolescents become sexually active, try drugs and alcohol, feel invulnerable, and experience the social and economic pressures of becoming an adult. HIV and the lack of youth-friendly health services compound the problem, says the UNICEF report.

 “We must do more and do it well, focusing on sub-Saharan Africa and on adolescent girls, where the heaviest burden lies,” says McClure.

*names changed to protect privacy

Edited by Mercedes Sayagues

Testing, treating and suppressing viral load in massive numbers could curb the spread of AIDS by 2020. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Oct 17 2014 (IPS)

Although AIDS has defied science by killing millions of people throughout Africa in the last three decades, HIV experts now believe that they have found the magic numbers to end AIDS as a public health threat in 15 years.

The magic numbers are 90-90-90 and are informed by growing clinical evidence showing that HIV treatment equals prevention because putting people on antiretroviral therapy (ART) reduces new infections.

The new treatment targets seek that, by 2020:

• 90 percent of people living with HIV get diagnosed
• 90 percent of people diagnosed with HIV will be on ART
• 90 percent of people on ART achieve durable viral suppression

The 90-90-90 plan, unveiled by the Joint United Nations Programme on HIV/AIDS (UNAIDS) earlier this year, seeks to halt the spread of HIV by 2020 and to end the epidemic by 2030.

While this is the most ambitious strategy to eliminate HIV yet, experts such as Dr Lucy Matu, director of technical services at the Elizabeth Glaser Paediatric AIDS Foundation in Kenya, says that it can be done.

She told IPS that in Kenya 72 percent of the estimated total number of people living with HIV have been tested, and 76 percent of the 880,000 adults and children diagnosed with HIV were on ART by April 2014.

Kenya will get closer to the 90-90-90 target as it implements the 2013 World Health Organisation (WHO) guidelines, which increased the CD4 count threshold to start ART from 350 to 500, says Matu.

As eligibility for ART becomes broader, she explains, “it will push the number of people on ART up by at least 250,000 to 300,000 to at least 90 percent of those in care, and of course more people will continue to enroll in care.”

An attainable goal

The WHO guidelines build on the clinical benefits of starting ART earlier. Patients stay healthier and avoid opportunistic infections, such as pneumonia, meningitis and TB.

Kenya is not the only country on track to achieving the ambitious 90-90-90 targets. In Botswana, which has a very high adult HIV prevalence, surpassed only by Swaziland globally, more than 70 percent of people living with HIV are on ART.

All East and Southern African countries are adopting the new guidelines, says Dr Eleanor Gouws-Williams, senior strategic information adviser with UNAIDS.

Rwanda, Uganda, Zambia, Malawi and Swaziland are “finalising their national guidelines while others like South Africa are planning to implement the new guidelines next year,” she told IPS.

Gouws-Williams believes that the 90-90-90 plan is attainable.

90-90-90: the formula that experts believe could write the final chapter on AIDS in 15 years. Courtesy: UNAIDS

Testing is the first step

Only half of all people living with HIV in sub-Saharan Africa have been diagnosed, says UNAIDS, so getting them to test is the first step.

Studies in Kenya and Uganda show that including HIV testing in multi-disease campaigns drove coverage up by 86 percent and 72 percent respectively.

But experts caution that the targets are more than putting loads of people on ART. Attaining viral suppression is key.

“In Rwanda, 83 percent of people receiving ART were found to be virally suppressed after 18 months of therapy,” says Gouws-Williams.

In Zimbabwe, Dr Agnes Mahomva, country director for the Elizabeth Glaser Paediatric AIDS Foundation, told IPS that 90-90-90 is not too ambitious for the Southern African country.

Already, she told IPS, “HIV positive pregnant and breast feeding mothers are universally eligible for ART for life as well as HIV positive children below five years, regardless of their CD4 count.”

While many experts are optimistic that 90-90-90 targets will be met, Ugandan HIV activist Annabel Nkunda says the targets do not necessarily speak to each other.

Nkunda told IPS that many HIV positive people, “when put on treatment, do not adhere to the treatment because of stigma.”

Without a specific target to reduce stigma, she says, “no amount of intervention will get us to zero HIV/AIDS.”

But some experts like Dr Matu disagree: “If you know your status, you are more likely to be put on HIV care. If you are on ART, you are more likely to stay within the health system for follow up.”

Finding funding

While it is still too early to estimate how much countries will spend to make 90-90-90 work, the consensus is that a lot of resources will be needed. Already, some African countries are exploring innovative financing options such as AIDS tax levies and national HIV trust funds.

Gouws-Williams points out that ART has become far more affordable. In Malawi, it costs less than 100 dollars per person per year.

Nonetheless, donor assistance will still be critical, especially for five poor countries where HIV treatment costs exceed five percent of gross domestic product (GDP) – Malawi, Lesotho, Zimbabwe, Mozambique and Burundi.

Matu says that achieving 90-90-90 requires a combination of factors, including a robust health system, good laboratory capabilities, cheaper viral load testing and a strong health work force.

Mahomva adds that a strong community component is needed, “because this is where several bottlenecks such as stigma happen, compromising adherence to HIV treatment.”

In spite of the uphill task ahead, many are optimistic that 90-90-90 will write the final chapter of the AIDS epidemic.

Edited by: Mercedes Sayagues

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)

Deborah (in red), a 14-year-old Rwandan girl who lost her parents when she was young, at Gisimba Memorial Centre orphanage in Kigali. Credit: Amy Fallon/IPS

By Amy Fallon
KIGALI, Jul 11 2014 (IPS)

Every day, 14-year-old Deborah wakes up in an orphanage, goes to school, and comes home to an orphanage. It does not matter when or for how long she leaves the orphanage, she always knows she’ll be back.

“This is where I live, this is my home,” says the teen, sitting at a wooden desk with other children at the Gisimba Memorial Centre orphanage. She has been intensely colouring in a nativity scene of one famous family – Mary, Joseph and baby Jesus.

Deborah had both her parents for only three years, before her mother died. Her father passed away two years later. Both had AIDS. Her four sisters and brothers also live at Gisimba Memorial Centre, in the Nyamirambo quarter of the Rwandan capital.“Decades of research show that orphanages cannot provide the care children to develop to their full potential, leading to attachment disorders and developmental delays that can be physical, intellectual, communication, social and emotional” – communications consultant Annet Birungi

The original Gisimba orphanage was founded by Peter Gisimba and wife Dancilla, and began taking in children, orphaned through a variety of circumstances, in the 1980s. The couple died in the late 1980s. When the orphanage was renamed the Gisimba Memorial Centre in 1990, it was home to 50 children and had reached its capacity.

That was until the 1994 genocide when up to 700 people took shelter in Gisimba. “People were sleeping in the dormitories, outside, everywhere, as long as they were together,” coordinator Elie Munezero tells IPS.

Close to one million Tutsis and moderate Hutus were killed during those bloody 100 days.

Today there are about 125 young people living at the orphanage. “All generations,” explains 50-year-old Munezero. “Babies, infants, adolescents, young adults.” The youngest is two years old. The two eldest are 30. About 40 percent are aged under 16.

Deborah and the other siblings are just some of the estimated 2,171 children today languishing in 29 orphanages across the east African country, says Annet Birungi, a communications consultant for Rwanda’s National Commission for Children (NCC) and UNICEF.

Nine years in an orphanage, in Deborah’s case, does not shock Birungi. She points out the alarming results of the National Survey on Institutional Care, conducted in 2011-2012 by Rwanda’s Ministry of Gender and Family Promotion (MIGEPROF) and groundbreaking NGO Hopes and Homes for Children (HHC). It found thatabout 13.6 percent children living in institutions had been there for more than 15 years.

Staying in institutional care can scar children for a lifetime, with those aged between 0-3 years especially vulnerable.

“Decades of research show that orphanages cannot provide the care children to develop to their full potential, leading to attachment disorders and developmental delays that can be physical, intellectual, communication, social and emotional,” says Birungi, adding that “abuse, neglect, physical and sexual violence, isolation and marginalization are common in orphanages.”

Before colonial rule, there was a culture of treating “every child as your own”, notes Birungi. “Children were for the community and when a mother died, it was a responsibility of aunties and grandparents, family friends to take care of the orphan (s).”

The atrocities of 1994 are said to have left at least half a million children without parents. During and after the genocide,women informally took in children from the opposite ethnic group. Mothers were encouraged to be a “malayika mulinzi” (“guardian angel”). Systems of “kinship and foster care” operated, even if informally.

At the same, this was when most of the orphanages that exist today appeared but most of them lack exit plans for children who have grown up in them.

Meanwhile, the belief that children are better off in institutions than in families has also kept some children in care, says Birungi, and while there is no denying that some centres are able to provide shelter, food, clothing, health and education, they cannot offer the love of a family.

Today, there is no power and no water in Gisimba. Both have been cut off because the bills have remained unpaid, says Munezero. “Nothing is good,” he adds in despair.

A major issue with children being cared for in institutions is that some may still have living members of their family.  “You could be calling a child an orphan but he’s not,” Munezero admits.

The African Child Policy Forum (ACPF), an independent, not-for-profit, institution has reported that the majority of so-called “orphans” adopted from Africa by foreigners have at least one parent still alive.

International adoption was temporarily suspended by Rwanda in August 2010, to allow the country work on implementation of the 1993 Hague Convention on Protection of Children and Cooperation in Respect of Intercountry Adoption, which calls on states to consider national solutions before international adoption.

Birungi says the government wants to revive the culture of “treating every child as your own”. NCC is currently working with HHC to reintegrate those living at Gisimba back into families.

An NCC-trained psycho-social team is in the final stages of the reintegration process and Gisimba will be transformed into a primary school to benefit children in the surrounding area, according to Birungi. On July 10, HHC announced that the first of five children had been moved out of Home of Hope, another Kigali institution.

HHC’s country director in Rwanda, Claudine Nyinawagaga, says a number of alternative care services are available for children in the country, including “kinship care”, when a young person is placed with extended family, neighbours or friends.

But national adoption is yet to be fully implemented and since HCC started the closure of the first Rwandan institution in 2011, only one child has fully undergone the domestic adoption process. NCC-drafted guidelines on domestic and international adoption are awaiting approval by Rwanda’s Cabinet.

“Several meetings with local authorities revealed that the general population and local authorities do not have enough information about adoption,” Nyinawagaga tells IPS. “This is likely to be addressed through the approval of the adoption guidelines, and the sensitisation of the community.”

So, for the time being, Deborah remains in an institution.

“I like singing and drumming,” she says, when asked what she likes doing in her spare time. “We have a small choir that I’m in.”

Despite her plight, she is ambitious and looking forward to her future: “to work in an industry, and make fruit juice and yoghurt.”

Nadezdha Tolokonnikova and Maria Alyokhina (fourth and fifth from the right) with activists from the Andrei Rylkov Foundation for Health and Social Justice in Moscow marking the United Nations International Day Against Drug Abuse and Illicit Trafficking with calls for reform of Russia's hard-line drug policies. Credit: Andrei Rylkov Foundation

By Pavol Stracansky
MOSCOW, Jun 26 2014 (IPS)

A protest in Moscow Thursday marking the U.N. International Day Against Drug Abuse and Illicit Trafficking has highlighted the ‘torture’ drug users are put through in the Russian criminal justice system.

Nadezhda Tolokonnikova and Maria Alyokhina, members of the Pussy Riot Group who were controversially jailed for performing in a Moscow cathedral in 2012, spoke in the Russian capital to highlight the plight of drug users in Russia.

Joining protestors in more than 80 cities around the world demanding drug policy reforms, they attacked what they said was their country’s “cruel and inhuman” treatment of drug users.

Describing a litany of rights abuses against drug users, including torture and beatings by police and prison warders, they said Russian authorities viewed imprisonment as a “cure for drug dependency”.“Similar to xenophobia and homophobia, narcophobia has become a protective cloak for the authorities .... Creating an image of the enemy, the subhuman, the zombie, and reinforcing that image in the public consciousness justifies the inhuman treatment of drug dependent people in our country” – Nadezhda Tolokonnikova and Maria Alyokhina, members of the Pussy Riot punk rock group

“People who use drugs are outcasts – they are despised, hated, accused of all problems, and criminalised. Similar to xenophobia and homophobia, narcophobia has become a protective cloak for the authorities…. Creating an image of the enemy, the subhuman, the zombie, and reinforcing that image in the public consciousness justifies the inhuman treatment of drug dependent people in our country,” they said.

“Russia’s drug policy is built on torture. Humiliation and violation of human dignity – thisis what drug dependent people face everywhere, from hospitals to prisons and other state facilities,” they added.

Russia takes a hard-line approach to drug use, implementing repressive drugs legislation, including lengthy jail terms for possession of even tiny amounts of hard drugs.

Drug users say they are also targeted by police: official figures show that one in six of the Russian prison population is a drug user and, according to other surveys, just under 30 percent of drug users have been arrested at some point since they started using drugs.

They say they also regularly have confessions extracted from them or are coerced into helping officers as they go into withdrawal in detention – a charge police deny.

There is a complete lack of relevant medical services for drug users in temporary holding facilities and pre-trial detention centres and even painkillers are rarely given to addicts going into withdrawal.

Drug users in prison face particular hardship. Conditions for all prisoners are poor with hygiene often bad, cells massively overcrowded and brutality and disease rife. But drug users are especially vulnerable.

Anya Sarang, head of the Moscow-based Andrei Rylkov Foundation for Health and Social Justice, which works to raise awareness of drug problems, told IPS: “Russian prison is torture in itself with prisoners not given basic medical infection control, nutrition etc., and general human rights violations. But drug users are more vulnerable than other prisoners.

“For instance many are HIV positive, but not only are there problems getting their medicine or starting them on treatment because they are not given necessary immune system checks in some cases, but their diet is poor and there is always the risk of infections, such as tuberculosis.”

Tuberculosis (TB) is a major problem in Russian prisons, according to the World Health Organisation (WHO) and other bodies. Studies have shown that a person with HIV is 25 times more likely to contract TB in a Russian prison than outside one.

But the risk of potentially deadly infections is only one problem facing drug users in prisons. As in many jails across the world, drugs are smuggled in and traded between inmates, giving users, some of whom may never have tried hard drugs, access to substances like heroin and experience of dangerous drug-taking methods.

Campaigners say that this is further evidence of how the criminalisation of drug use only perpetuates and worsens drug problems.

Michel Kazatchkine, UN Special Envoy for HIV/AIDS in Eastern Europe and Central Asia, told IPS: “We know from studies that contact with the criminal justice system is associated with increased injection drug use and other similar behaviour, among other problems. Putting drug users in prisons …. is making things worse not just in prisons but also for communities when they are released from prison.”

Activists point to how opioid substituition therapy (OST) for people in custody or prison has been successfully implemented in some Western states.

But the practice is completely banned in Russia, despite being widely implemented in many countries around the world, recommended by the World Health Organisation (WHO), and having been proved to be successful in helping halt the spread of HIV/AIDS.

Russia has one of the world’s fastest growing HIV/AIDS epidemics – there were 78,000 new HIV cases registered last year, up from 69,000 in 2012 and 62,000 in 2011 – which the Joint United Nations Programme on HIV and AIDS (UNAIDS) and other bodies say has been historically driven by injection drug use.

Drug use in the country is growing equally rapidly. According to figures from the country’s Federal Drug Control Service (FSKN) there were an estimated 8.5 million drug addicts in 2013 – up from 2.5 million since 2010. The service says up to 100,000 people die each year in Russia from drug abuse. It is also the world’s largest heroin consumer.

Tolokonnikova and Alyokhina said only a reform of drug policy including decriminalisation would improve the situation in prisons.

But Russian authorities show no sign of lifting the OST ban nor improving the very limited harm reduction services which exist in the country and FSKN officials have made a number of public statements in recent months reaffirming their commitment to hard-line drugs policies.

Kazatchine told IPS: “I don’t see any sign of Russia’s approach to drugs softening. What I am seeing is a toughening of the way Russian society looks at marginalised groups, such as drug users, men who have sex with men, LGBT people, etc. The climate has toughened and Russia is de facto criminalising drug use and recession.”

This, critics say, has left Russian drug users in a terrible position in society. Sergey Votyagov Executive Director of the Eurasian HRM Reduction Network (EHRN), told IPS that they were “one of the most stigmatised and under-served populations” in the country.

Meanwhile, the devastation wrought by Russia’s drugs policies has been seen clearly in its newest territory. Just days before Thursday’s protest in Moscow, campaigners in Ukraine had raised the alarm over the fate of drug users in Crimea following its recent annexation.

OST is available in Ukraine and had been provided to 800 people in Crimea. But as part of Russia, Moscow ordered OST programmes there shut down at the start of May.

A mission by the Council of Europe to Crimea which ended last month reported that at least 20 people had died following the cessation of the programmes and at least 50 more had migrated to the Ukrainian mainland, while a few had gone to Russia for detoxification and rehabilitation treatment.

Those who remained spoke of having to deal with intimidation by new authorities and, in some cases, losing their jobs because of either worsening health or their status as former OST patients being made public.

Some who have fled the peninsula described the fear and desperation among drug users still there.

Speaking at an event organised by the International HIV/AIDS Alliance in Ukraine in Kiev earlier this month, one woman, Oksana, who left the day after her OST treatment had stopped, said:  “I might have died if I had stayed in Crimea.

“I am disabled, I have had a stroke and I know very well how it feels to be left without therapy and help. Those who could not leave Crimea are in terrible conditions. Some of them are already dead, others have chosen suicide.”

There is little hope that things in Crimea will change any time in the foreseeable future. Earlier this month, Sergei Donich, deputy prime minister in the Crimean government, told local media that OST was ineffective and was being pushed by pharmaceutical firms who stood to gain from it.

Kazatchine described the situation on the peninsula as a “tragedy”, adding that it was unlikely there would not be more deaths among drug users.

He told IPS: “Evidence shows that OST reduces mortality, it prevents overdoses among drug users. I think it is inevitable that [with no more OST] more drug users will die.”

Lack of awareness among youth on risks of HIV infections needs to be addressed quickly to stem the disease from spreading, the National HIV Strategic Plan Sri Lanka 2013–2017 has warned. Credit: Amantha Perera/IPS.

By Amantha Perera
COLOMBO, Feb 2 2014 (IPS)

Four thousand HIV infections in a population of 20 million should not be a difficult figure to manage. But experts in Sri Lanka say social customs and strict laws are hindering them from carrying out prevention and awareness campaigns among high-risk groups.

Despite impressively low national infection rates, there are signs that the spread of HIV – which can lead to AIDS – has increased among these groups, most of which face ostracism, they say.

Sri Lanka, an Indian Ocean island nation, is considered a low HIV prevalence country, according to official statistics. Going by the latest data of the National AIDS Prevention Programme, there are little over 1,800 HIV infected in the country, of which the majority is male, at 1,080.For Sri Lanka’s high-risk groups, time is ticking away.

Even if undetected cases were to be factored in, the overall case load is estimated to be around 4,000, Susantha Liyanage, director of the programme, told IPS.

Liyanage, however, warned that these low figures could be hiding a much more explosive and complex situation – the risk of an epidemic within high-risk groups. “There is a very real chance that there are higher infection rates among high risk groups. We are already seeing such a trend,” he told IPS.

A similar warning came in the Sri Lanka National HIV Strategic Plan 2013-2017 released last year. “Certain socio-economic and behavioural factors noticed in the country may ignite an epidemic in the future,” it said.

Among the risk groups identified in the plan were men who have sex with men, youth aged between 15 and 25, intravenous drug users and the offspring of HIV positive parents.

Experts say while HIV awareness has grown in Sri Lanka, fighting the spread of the disease within high-risk groups is being stymied by legal and social strictures.

“Under Sri Lankan law, homosexuality and drug use are criminal offences, making it extremely difficult to work openly with these groups,” Milinda Rajapaksha, working director at National Youth Services Council, told IPS.

Liyanage said the situation is similar for commercial sex workers, identified as yet another high-risk group.

“With all of these groups we have to be discreet and use intermediary organisations to conduct awareness and prevention programmes,” he said.

Of the known infections, 80 percent are due to unprotected sexual activity and 4.4 percent due to parent to child transmission.

Liyanage said despite the presence of a free island-wide prenatal care service carried out by the Ministry of Health, HIV screening of pregnant mothers was still very poor.

The National HIV Strategic Plan said in 2011 only three percent of all pregnant women had been tested for HIV, even though over 95 percent of pregnancies in the country had access to prenatal care.

Another astonishing detail is, of the known infections, 20 percent is in the age group of 15 to 25. A little over five years back, this age group made up less than six percent of known infections.

Liyanage said the increase in infections among the youth was a grave concern. “It indicates that awareness programmes are not effective among the youth.”

Last November a new intra-ministerial committee was formed, with Liyanage at its head, to draft new recommendations to slow down the spread of the disease among youth.

Sri Lanka also lacks sex education at the secondary school level.

Rajapaksha from the National Youth Council said lack of awareness was becoming a serious problem as more and more youth became sexually active. The official said Sri Lanka’s health policy was yet to recognise youth as a special category, making it difficult to target health risks within the group.

A new National Youth Policy scheduled for release in February recommends that this anomaly be rectified.

Rajapaksha said homosexual men were particularly at risk since social conventions stigmatised them severely. He said in urban areas, especially in the Western Province, activists and groups were helping gay groups but such work was extremely difficult in rural areas.

“On top of this there is hardly any chance of conducting large-scale public awareness campaigns aimed at these groups – the public backlash will be too much,” he said.

Asela, a gay man who works with homosexual groups, said all meetings conducted by his group were limited to a very closed group and there were hardly any public programmes.

“If you are in the network, help is readily available. But we do not carry out any programmes aimed at the general public whereby gay men or women unknown to us can reach us,” he said.

According to research, there are between 30,000 and 40,000 men having sex with men in Sri Lanka. HIV infections within the group have shown a steady increase in the last five years. In 2009, a year after surveillance of the group began, infections were 0.48 percent of overall cases. The rate was 0.9 percent in 2011 and it is currently 12.3 percent.

The group also showed a high number of sexual partners and at least a quarter indicated they had sexual liaisons with women as well.

For Sri Lanka’s high-risk groups, time is ticking away.

A social worker providing clean syringes to injection drug users in Dnipropetrovsk in eastern Ukraine. Credit: International HIV/AIDS Alliance Ukraine.

By Pavol Stracansky
KIEV, Jan 25 2014 (IPS)

Groups battling one of the world’s worst HIV/AIDS epidemics say their task may get “catastrophically” harder following the introduction of controversial laws in Ukraine in response to months of anti-government protests.

Among legislation introduced this week – dubbed a “charter for oppression” by some international rights groups – is a new law forcing NGOs that receive foreign funding to register as “foreign agents” or face hefty fines and closure.For many years Ukraine has had one of the world’s fastest growing HIV/AIDS epidemics.

Copied almost exactly from similar legislation introduced recently in Russia, the law not only puts a label with derogatory Cold War connotations on civil society groups, but, crucially for many, also forces them to pay tax on foreign income.

For organisations in the front line of response to the country’s raging HIV/AIDS epidemic, this could spell disaster.

Pavel Skala, a senior policy manager at the International HIV/AIDS Alliance in Ukraine, the largest NGO in the country working on tackling the disease, told IPS: “The new law will be catastrophic for local NGOs, making things harder for organisations working with HIV/AIDS sufferers and providing harm reduction services. The HIV/AIDS epidemic in Ukraine would only get worse.”

For many years Ukraine has had one of the world’s fastest-growing HIV/AIDS epidemics, according to United Nations figures, and currently has the highest rate of HIV infection in Europe.

Successive governments have been criticised over their approach to the disease. Local and international health groups have highlighted poor and muddled policy and inadequate funding while there have also been accusations of corruption and incompetence leading to shortages of life-saving anti-retroviral drugs.

According to UNAIDS, the Joint U.N. Programme on HIV/AIDS, less than 40 percent of people with HIV in Ukraine receive anti-retroviral drugs. For comparison, the rate in some sub-Saharan African countries is around 80 percent.

Meanwhile, despite the epidemic having been historically driven by injection drug use – there are an estimated 290,000 injecting drug users in the East European state – authorities have been either hostile to, or reluctant to adopt, harm reduction practices that have been hailed a success in helping halt the spread of HIV/AIDS in many Western states.

The government’s approach to the disease has already had consequences for how its spread is tackled. When it was discovered that the government in 2004 had paid more than 25 times the market price for anti-retroviral drugs, the Global Fund to Fight AIDS, Tuberculosis and Malaria started to channel much of its funding to civil society groups.

This has led to the front line response to HIV/AIDS among high-risk groups such as drug addicts and sex workers being taken up by third sector groups.

These organisations have focused on prevention programmes, including harm prevention.

These services already seem to have had some success. In 2012, for the first time, the rate of new HIV infections in Ukraine dropped. This was put down to the widespread implementation of harm reduction programmes.

But provision of these services may now be at risk.

Under current national legislation, Global Fund financing is exempt from any taxation. But there are doubts that this will continue to be the case following the introduction of the new “foreign agent” law.

The International HIV/AIDS Alliance Ukraine implements the largest HIV prevention programme in the Eastern Europe and Central Asia region, supporting 170,000 drug users in more than 300 cities through its own services and those of more than 170 partner organisations across the country it helps finance.

The organisation is registered as a charity and, as such, should be free of any tax on its own funding from the Global Fund. But many of its partners, which are sub-recipients of that money, are civil society groups and will be forced to register as foreign agents.

The International HIV/AIDS Alliance Ukraine has told IPS that under the new laws it will not be able to pass on Global Fund financing to its local partners as the subsequent taxes would force them to close.

UNAIDS country coordinator for Ukraine, Jacek Tyszko, told IPS: “We are very concerned about this [new legislation]. It is potentially a very negative development for the situation in the country because so much of the HIV/AIDS response is carried out by civil society in the Ukraine.

“The problem is that …money from the Global Fund should be tax free but the law is unclear and so there is now doubt. We have spoken to partners in the Ukrainian Health Ministry and they are all of the opinion that the Global Fund money will still be tax free. But they are not the only ones involved.”

Since September last year, the International HIV/AIDS Alliance in Ukraine has been battling tax and customs officials over duties it claims authorities are wrongly trying to impose on its import of syringes. It argues that it should be exempt under laws related to Global Fund financing and its activities as a specific healthcare provider.

As the dispute has dragged on, millions of syringes remain impounded and have to be stored at a special facility at the Alliance’s cost.

This does not bode well for certain state bodies’ approach to the group under the foreign agent law.

“There have already been problems with the tax authorities over taxes for the import of syringes and it looks like the Ukrainian tax authorities are unwilling to make any exceptions. Now we fear there may be further problems with this [Global Fund money],” said Tyszko.

But even if civil society groups working on the front line of the HIV/AIDS response in Ukraine find some way to carry on without vital foreign funding, the new law will still hinder their work, said Skala.

He told IPS: “Organisations will be marked out as foreign agents, seen as spies, and the legislation will give law, tax and other government authorities the opportunity to carry out checks on these organisations when they want and try and change what they do.

“Social workers may be targeted by authorities, there will be a hostile atmosphere for them to work in, and people at these organisations will be afraid. Everything would be harder for them.”

This appears to be the case already. The International HIV/AIDS Alliance Ukraine told IPS its partners are already worried, with at least one having been contacted by the state security service and questioned about their funding.

Healthcare systems in Eastern Europe and Central Asia remain woefully unable to cope with HIV/AIDS as the region’s raging epidemic – the fastest growing in the world – takes on a new dimension, a senior UN official has told IPS.

Until now the Eastern Europe and Central Asia (EECA) epidemic had been driven by injection drug use. But data and anecdotal evidence has shown a strong rise in the spread of the disease through heterosexual transmission as well as via men who have sex with men – potentially throwing up a new set of challenges for governments and healthcare ministers.

But, says the UN Secretary General’s Special Envoy on HIV/AIDS in Eastern Europe and Central Asia, Michel Kazatchkine, until a new approach to treating the disease is taken in countries worst affected by it, the response to the epidemic will continue to be poor and largely ineffective."In some countries it will probably take a wave of deaths, or the death of someone famous or a prominent member of the Church for anything to change.”

He told IPS: “HIV/AIDS in Eastern Europe and Central Asia needs to be taken out of the medical ghetto which it is in at the moment.

“Regardless of whether it is driven by heterosexual transmission or drug-injection, I am afraid that until the disease gets visibility and health systems get geared up to take it on, it will not be dealt with properly. In some countries it will probably take a wave of deaths, or the death of someone famous or a prominent member of the Church for anything to change.”

For many years Eastern Europe and Central Asia has had the world’s fastest growing HIV/AIDS epidemic. The estimated number of people with HIV has grown by 140 percent in the past ten years, according to UN figures. Russia has 70 percent of all people living with HIV in the region and together with the Ukraine accounts for 90 percent of the region’s HIV infection cases.

The epidemic remains primarily linked with injection drug use with over 35 percent of case reports in the region associated with drug use.

But in the last five years, there has been a marked increase in heterosexual transmission which now accounts for 30 percent of reported cases, according to Kazatchkine. Much of this is believed to be between male drug users and women.

However, the exposure route of 40 percent of infections in the region is classified as ‘unknown’. It is thought that most of these are among men who have sex with men.

Discrimination, persecution and stigmatisation of homosexuals, drug users and people with HIV/AIDS means that it is impossible to collect accurate data on the spread of the disease.

Gay men are often fearful of admitting to doctors how they became infected and instead say that they contracted it through heterosexual sex. Drug users, who can face long prison sentences in some countries in the region, do the same.

Recent legislation banning the promotion of same sex partnerships and long-standing travel restrictions in some parts of the region for people with HIV have only further marginalised groups in which the disease is spreading rapidly.

This presents a major problem in effectively dealing with the epidemic, say doctors, as it adds to existing barriers to the prevention and treatment of the disease.

Prof. Jens Lundgren of the European Aids Clinical Society (EACS) told IPS:

“What we know is that any policies, anywhere in the world, which are introduced and which marginalise or stigmatise people with HIV are counter-productive to treating the disease.

“A good, rational health policy is one that involves a clear view of a disease’s epidemiology – where, in what communities and how it is being spread.”

This comes on top of what has been repeatedly criticised by international bodies as a continuingly poor healthcare response to the disease in many countries.

Access to anti-retroviral treatment is very low – with as little as eight percent of all those in need of it being able to obtain it in Russia, for example.

Systematic care of those diagnosed with the disease is also inadequate.

“One of the problems in Russia is that there is no integration of a patient with HIV into the primary health care system,” said Kazatchkine. “When someone is diagnosed they are simply referred to a special centre and passed on. It is as if they are something to be got rid of. No one follows up on them and they are essentially forgotten.”

There are fears that news of the changing nature of the epidemic’s spread could be used by some authorities to push their own political agendas on how to deal with the epidemic.

International bodies have urged countries in the region to adopt harm reduction programmes, including needle exchanges and drug substitution therapy, which are recommended best practice in the West as a front-line measure to help prevent the spread of the disease.

While some countries, notably the Ukraine, have had some success in rolling out these programmes and helping bring down new infection rates, others, such as Russia, are apathetic or even hostile to harm reduction.

Drug substitution therapy is illegal in Russia as political and medical authorities refuse to sanction it and there are no state needle exchange programmes.

The vast majority of funding for prevention programmes has come from foreign organisations, but some of these have left the country as its regime has become more authoritarian.

Some of the few organisations in Russia offering harm reduction services, such as the Humanitarian Action NGO in St Petersburg, have told IPS of the problems drug users face in accessing harm reduction programmes and of the difficulties they have in providing them, from almost absent funding to hostile police and societal attitudes.

That the disease is being spread more and more by sexual behaviour could provide ammunition to those who argue harm reduction programmes are a waste of resources.

“There are some authorities in the region which take every opportunity to use something that takes attention away from the need for continued harm reduction strategies and programmes and I fear the fact there is a rising heterosexual spread of the disease could be instrumentalised to attack harm reduction programmes among drug users,” Kazatchkine told IPS.

This would further hamper efforts to combat the epidemic as injection drug use is expected to remain the main route of transmission of HIV in the region for some time to come.

“There will continue to be an increase in sexual transmission while the epidemic among drug users will not slow down,” said Kazatchkine.

As a hepatitis C pandemic rages among drug users and threatens the lives of millions around the world, a group of high-level leaders called today on governments to reform their drug policies and raise awareness about the public health threat of hepatitis C.

Sharing needles among injecting drug users is the main driver of the spread of hepatitis C in Eastern Europe and Central Asia. Credit: Lauri Rantala/CC by 2.0

In a major new report, the Global Commission on Drug Policy, which includes former presidents, high-ranking United Nations (U.N.) officials and human rights activists, says that punitive drugs laws and repressive policies are helping spread what the World Health Organisation has described as a “viral time-bomb”.

Michel Kazatchkine, the U.N. secretary-general’s special envoy on HIV/AIDS in Eastern Europe and Central Asia, told IPS, “We need to see drug policies changed, funding moved away from the war on drugs and into public health approaches that maximise hepatitis C prevention and care.” He added that raising awareness of the issue was just as important.

The WHO estimates that at least 350,000 people die annually from diseases related to hepatitis C, which causes chronic liver damage.

According to the report, of the estimated 16 million people who inject drugs around the world, about 10 million are living with hepatitis C. In some of the countries with the harshest drug policies, over 90 percent of people who inject drugs have hepatitis C."[Hepatitis C] needs to be taken as seriously as the HIV/AIDS epidemic among drug users."
-- Michel Kazatchkine

The highest numbers are reported in China (1.6 million people), the Russian Federation (1.3 million) and the United States (1.5 million).

“The urgency of the situation cannot be overemphasised,” Kazatchkine stressed. “This needs to be taken as seriously as the HIV/AIDS epidemic among drug users.”

A failed war on drugs

The Global Commission and other advocates for drug law reform have long campaigned to end to the decades-long “war on drugs”, claiming that not only has it wasted vast sums of money and countless human lives, but it has also destroyed communities and utterly failed to halt the multibillion dollar illicit drug trade. The group has also highlighted its catastrophic public health implications.

In a report last year, the commission showed how repressive anti-drug legislation and policies, including long-term jail sentences for minor drug offences and the failure to introduce or properly support harm reduction programmes, marginalised and criminalised drug users, ultimately helping to fuel an HIV/AIDS epidemic.

This phenomenon has been seen most clearly in Eastern Europe and Central Asia – the only region in the world where new HIV infection rates continue to rise – where the sharing of needles among injecting drug users is the main driver of the disease’s spread.

The commission also said that harm reduction programmes, such as needle-exchanges, opioid substitution therapy and support networks for drug users could essentially reverse the HIV/AIDS epidemic in regions such as Eastern Europe.

Hepatitis, like HIV, can be spread by blood-to-blood contact and, globally, most HIV-infected people who inject drugs are also infected with hepatitis C.

Ignoring numbers

While the HIV/AIDS public health threat has received significant attention, the spread of hepatitis C, which is three times more prevalent than HIV among drug users, has been dangerously ignored.

“I hate to compare HIV/AIDS and hepatitis C and say one is worse than the other, but when you look at the overall absolute numbers, such as infections and so on among the drug-using community, they are even higher,” Kazatchkine told IPS.

He pointed to “an overall lack of awareness of the hepatitis C problem at all levels – from governments…to parts of the medical community and among drug users themselves”.

“There has been great awareness of HIV/AIDS over the years because of public campaigns, celebrity support and so on but that has been lacking where hepatitis C is concerned. The silence on this issue needs to be broken,” Kazatchkine added.

The report stressed that while harm reduction services can effectively prevent hepatitis C transmission among people who inject drugs, prevention can only be achieved if such services are accessible and delivered early and at the required scale.

In many places with severe hepatitis problems, access to these resources is severely limited, and where people do have access, quality is often poor.

The report highlighted how harm reduction programmes aimed at fighting the spread of the disease had been successful in Scotland. But it also showed that similar schemes in Lithuania – which has an 80 percent infection rate among drug users – were being accessed by only a tiny fraction of those who needed them.

People working to promote harm reduction and who are in daily contact with drug users at drop-in centres around Eastern Europe – which has one of the highest hepatitis C infection rates among drug users in the world – are pessimistic about the outlook for control of the disease in the region.

“It will definitely get worse before it gets any better,” said Dasha Ocheret of the Eurasian Harm Reduction Network.

She told IPS, “Given the high prevalence of up to 95 percent [among drug users] in the region, the more than 10-year history of the epidemic and almost no access to treatment, it is going to get worse.”

“There will be more deaths and higher infection rates among young injection drug users,” Ocheret believed.

The negotiations launched this week for a Free Trade Agreement (FTA) between Thailand and the European Union have raised concerns among both Thai and European non-governmental organisations, who fear that EU demands could have a negative impact on Thailand’s progressive public health policies.

Launched during Thai Prime Minister Yingluck Shinawatra’s visit to Brussels on Mar. 6, the negotiations will include the Trade Related Aspects of Intellectual Property Rights (TRIPS) agreement, an international accord that lays down rules for dealing with intellectual property such as branded medicine. If the EU pushes the interests of its pharmaceutical companies, access to generic drugs in Thailand could be at risk, according to some NGOs and European parliamentarians.

“The interest of big pharmaceutical companies is to have a higher price for their medicine, and the interest of a state such as Thailand is to have access to generic medicine that is cheaper, so there’s a real issue,” Leila Bodeux, a Brussels-based spokesperson for Oxfam told IPS.

“It’s very important to consider that Thailand has made a great deal of effort to improve its public health system and now has a universal health scheme. But for the scheme to function well, it has to rely on affordable medicine.”

Oxfam and other groups including Dutch-based Health Action International (HAI) and Action Against AIDS Germany say that excessive intellectual property protection and enforcement can restrict makers of generic drugs. The consequence is that market monopolies are propped up, with high prices for medicine, thus “affecting access to affordable treatment.”

Thailand has gained international admiration for its public health programme which is based on providing inexpensive medicine to its population, says Oxfam, which works to eliminate poverty around the world. In the treatment of HIV/AIDS, the Asian country has managed to provide antiretroviral therapy (ART) to 80 percent of those living with the disease.

The fact that most ART drugs are produced by India for other developing countries has reduced the treatment’s cost enormously.

But activists say that these advances could be rolled back by the Free Trade Agreement, particularly if the EU introduces “investor-state dispute provisions” in the FTA.

NGO leaders point to the case of U.S. pharmaceutical giant Eli Lilly & Co. which has brought a lawsuit against Canada under the North American free trade agreement, demanding 100 million dollars in compensation for Canadian court rulings that stripped the company of its patent for medicine used to treat attention-deficit disorder. Thailand could find itself in a similar position to Canada if makers of generic drugs are seen to infringe existing patents, warn NGOs.

“We are particularly worried that the EU will push to have intellectual property provisions that go beyond the TRIPS agreement,” said Bodeux. Such provisions, known as TRIPS-plus, may have the support of multinational drug firms but would be detrimental to the Thai public health budget, Oxfam says.

Bodeux told IPS that the EU may try to seek a longer “patent term” for drugs than the current 20 years agreed under World Trade Organisation rules. In addition, the EU may request “data exclusivity” provisions, which means that Thailand would not be able to give out certain clinical trial information during a specified time frame.

The European Commission says that the launch of FTA negotiations “marks an important step in EU-Thai relations, already strengthened by a Partnership and Cooperation Agreement.”

The Commission stated that the aim “is to conclude a comprehensive agreement covering tariffs, non-tariff barriers and other trade related issues such as services, investment, procurement, regulatory issues, competition, and sustainable development.”

It adds that the FTA with Thailand “should deliver substantial economic gains and put the EU on a par with partners who have already concluded FTAs with Thailand (China, India, Japan, Korea, Australia and New Zealand).” The first negotiating round is expected to take place possibly in May, before the summer break.

Like the NGOs, some members of the European Parliament (MEPs) are keeping a close eye on the negotiations and the aspects of the FTA that could have a harmful impact. Franziska Keller, German MEP from the Green alliance, told IPS that she shared the concerns of civil society organisations.

“I completely agree that the government of Thailand should not let itself get into TRIPS-plus talks,” she said. “I also think that the EU should absolutely not force TRIPS. Medicine is an important part of Thailand’s budget and if generic medicine cannot be used, cannot be produced, this is going to be much more expensive for the Thai government.”

Realising what is at stake, demonstrators in Thailand have recently tried to draw attention to how the FTA may affect the cost of medicine and agricultural products in the country. They say the government has not adequately consulted with civil society in the talks on the multi-billion-dollar bilateral trade.

“The IP provisions, the enforcement measures and the investment chapter are all areas where the stakes are really high,” said Tessel Mellema, policy advisor for Health Action International.

She told IPS that Thailand may feel pressured to give concessions because of the impending expiration of its general system of trade preferences with the EU, due to end in early 2015. But Mellema said NGOs want Thailand to have “political room” to negotiate without pressure from the EU.

Thailand is the EU’s third largest trading partner in the Association of Southeast Asian Nations (ASEAN), and the EU is also Thailand’s third biggest trading partner. According to the European commission, trade between the bloc and Thailand reached nearly 32 billion euros last year.

It says that the EU is one of the biggest investors in Thailand with investment stocks valued at more than 14 billion euros in 2011.

EU exports comprise mainly high-tech products including machinery and electrical appliances, pharmaceutical products, vehicles, precious metals and optical instruments, the Commission said, while imports from Thailand include machinery and electrical appliances, foodstuffs, vehicles, precious metals, pearls, and plastics and rubber. (END)

By Julia Kallas
UNITED NATIONS, Dec 1 2012 (IPS)

When Shorai Chitongo founded Ray of Hope, a support group for female survivors of domestic violence in 2005, she discovered that three-quarters of the survivors in the group were HIV-positive.

Shorai Chitongo, founder of Ray of Hope, a support group for survivors of domestic violence, and a national leader of the Groots Zimbabwe Home-Based Care Alliance. Photo courtesy of Ms. Chitongo

“Women’s assertiveness and high self-esteem are important ingredients to fight HIV/AIDS,” Chitongo, a grassroots leader who fights to empower and protect communities in Zimbabwe and is a national leader of the Groots Zimbabwe Home-Based Care Alliance, told IPS. Domestic violence directly increases chances of sexually transmitted infections that expose women to HIV.

“If women are assertive enough, they are able to negotiate safe sex as equal partners and not as subordinates,” Chitongo explained.

IPS correspondent Julia Kallas spoke with Chitongo about the links between sexual violence and HIV/AIDS and how women’s grassroots efforts can promote HIV care and support.

Q: In 2005, your domestic violence case captured national media attention and sympathy. What spurred you to found Ray of Hope? What kind of program does Ray of Hope have to support HIV-positive women?

A: The formation of Ray of Hope dates back to 2005, when l saw a documentary on a local TV program and learned that the organisation Girl Child Network was offering loans to women under its Community Empowerment and Development Program.

Perceiving this as my only opportunity to disentangle myself from the jaws of domestic violence, which l thought was a result of economic dependency on my husband, l decided to approach GCN. The staff there referred me to a woman named Betty Makoni, as they felt that my case was too dangerous for them, since my husband was violent and lawless.

Betty was greatly touched by my story and that of my three children, who ended up on the streets while l was in hiding for one and a half years in neighbouring Botswana. Previously, I had unsuccessfully approached various women’s organisations and law enforcers but had lost hope. Not even my close relatives were afraid to shelter me in their homes. But Betty offered me sanctuary in rural Mutasa.

While I was living there, a local woman was brutally murdered by her husband in full view of their three children. This incident made me realise that l was not the only survivor of domestic violence; there were other cases out there that went unreported. With Betty’s support, l gained the courage to mobilise other women survivors of domestic violence to form a support group, which provided the space to talk about their concerns away from their male-dominated homes.

The result was an influx of women with shocking stories of abuse. Women travelled more than 30 kilometres bare-footed just to pour out what had burdened them for years. Most disturbing about these desperate women was that they did not bear domestic violence alone but with their children. Sadly, their children were the major reason for their silently enduring abusive and life-threatening relationships.

These meetings transformed the women. They went from being silent victims to a group that was determined to change their lives.

During one of our meetings, we discovered that three-quarters of the women in our group, which had over 100 members, were HIV-positive and that almost all members of the group were in primary and secondary community care work. We then agreed that every program that we were going to implement should mainstream HIV/AIDS.

Q: As a representative of caregivers as a leader of the Groots Zimbabwe Home-Based Care Alliance, what do you believe is needed to improve women and girls’ access to HIV prevention information, technologies, and services by 2015?

A: What is required is the formulation of deliberate policies at national level to provide women with access to information technology relevant for the dissemination of HIV/AIDS information. Creating information centres in rural and peri-urban rural areas would help to give women this access. People should also organise themselves into groups and seek access to computers and other IT facilities.

HIV/AIDS information should cross all women’s groups: political, social, religious, economic and cultural. Education in our country should focus on promoting knowledge of relevant information to deal with HIV/ AIDS, especially in rural areas where literacy rates are lower.

(Click here to watch a video of Chitongo and other members of the Home-based Care Alliance sharing personal stories about the work they do.)

Q: What message would you like to pass to the international community on World AIDS day?

A: While the world accepts and appreciates that HIV/AIDS is a universal problem, it also has to recognise that some social groups are predisposed to catching it due to social, economic and cultural conditions. The more disempowered one is culturally, socially and economically, the more one is exposed to infection.

The world’s attention should now focus on addressing social inequalities on the basis of gender, religion and economics so everybody has equal access to the means through which HIV/AIDS can be combated.

Q: Is there a close link between HIV/AIDS and domestic violence in Zimbabwe?

A: Yes. HIV-positive women are at great risk of all forms of domestic violence. The situation becomes even more complex when they fall chronically ill because their husbands neglect them or send them back to relatives to be cared for or to die, but in most cases their relatives will not accept them.

In addition, women are blamed for bringing HIV home, so they are constantly shunned, stigmatised, violently divorced and in some cases sent away. HIV-positive women also encounter violence when negotiating with their partners for safe and protected sex.

Dietary requirements for HIV positive women also normally result in conflict and misunderstanding, which then lead to violence, and their decision to cease childbearing leads to domestic violence as well.

Q: What needs to be done to help women make safe sex choices and breaki the norm of constantly submitting to men’s sexual whims?

A: Knowledge creates power, assertiveness and high self-esteem. It is necessary to deliberately focus on female empowerment through education so that women approach problems with confidence. If women become more aware of their rights, they will approach the problem of submitting to men’s whims with more vigour to resolve it.

In addition, enacting policies giving equal opportunity in social and economic life regardless of gender will build women’s assertiveness. Men have the advantage of power behind them, but give women equal access to that power and they will not submit to men’s whims.

Excerpt:

New HIV infections among Romanian drug users have grown exponentially over the past couple of years, from three to five cases annually between 2007 and 2009, to 98 just in the first half of 2012.

The year 2011 saw 129 new cases of HIV among injecting drug users after 12 new cases had been registered in 2010. Injecting drugs has now become the second most common way to contract the virus in Romania (the first is heterosexual transmission), after being a negligible cause of infections for most of the post-socialist period.

International and national groups working for HIV prevention expect the emerging epidemic to expand over the next years, despite causes for the rise in cases being relatively easy to pin down.

For one, there has been a significant change in drug consumption patterns. In Romania, the vast majority of injecting drug users live in capital Bucharest. There were over 19,000 so-called problem drug users (who inject drugs or regularly use opioids, cocaine or amphetamines) in the city in 2010, in a total population of almost two million.

Bucharest users had been traditionally injecting heroin but have more recently switched to amphetamine-type stimulants – mostly synthetic cathinones such as mephedrone. In 2009, 97 percent of users reported heroin as the main drug of injection; in 2010 already 30 percent of users were injecting synthetic amphetamines.

Since 2008, Romania has seen a boom in the market for legal highs. While the authorities were struggling to understand the phenomenon and outlaw the synthetic substances one by one, numerous injecting users had switched already from heroin to the new drugs because of the perceived safety behind their legality and easier availability. A ‘heroin drought’ hitting Europe in 2010 because of lower opium production in Afghanistan may have played its indirect role as well, though causality is difficult to establish.

The injecting synthetic drugs available on the Romanian market require on average twice as high frequency of injection as heroin, meaning that users need more syringes and are likely to share more.

Importantly, while this change was happening on the drugs market, the number of syringes distributed through needle exchange programmes halved between 2009 and 2010 and remains low to date. In 2009, organisations working with drug users distributed 1.7 million syringes to Romanian users, while in 2010 only 965,000 were given out. According to the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA), 3.6 million syringes would be needed in Bucharest only to keep the risk of infectious diseases spread low.

In Romania, needle exchange programmes were set up and funded by international donors such as the United Nations, the Global Fund (to Fight AIDS, Tuberculosis and Malaria), or the Open Society Foundation. But as Romania started to be categorised as a better off country by donors, foreign funds dried up. For instance, the halting of grants from the Global Fund in 2010 was directly related to Romania’s being classified as an upper middle income country by the World Bank.

European Union regional funds, still used by local NGOs for some programmes, reportedly come with bureaucratic burdens often too big. For one, groups accessing these funds say that administrative tasks keep staff away from social work on the ground; additionally, disbursement of these EU funds requires submitting personal data of the beneficiaries, which may deter some users from seeking help in a country where drug use is heavily criminalised.

While international funding is getting increasingly harder to access, Romanian authorities are not stepping in to fill the gap.

The Romanian Ministry of Health is at the moment in charge of detoxification programmes in the country. The Ministry and the National Anti-Drug Agency also run in total seven opiate replacement centers across the country, which handle around 1,200 patients; in 2011, in Bucharest, only 9 percent of injecting drug users were covered by the available opiate treatments. However, authorities have so far failed to recognise the importance of financing syringes.

“The spike in HIV in Romania demonstrates a troubling dynamic we are expecting to see across Central and Eastern Europe, which is the withdrawal of international support for HIV programmes without any assurance that national governments will pick up the slack,” says Daniel Wolfe, director of the International Harm Reduction Development Programme at the Open Society Foundation.

“There was a fantasy that EU accession would help ensure the same kind of health protection and social support in countries like Romania that the richer EU countries have,” Wolfe told IPS. “But while some small support for programmes for drug users have come from EU social funds, these have been inadequate to the need and excluded support for the sterile injection equipment that is the core of HIV prevention efforts.”

Neither the Ministry of Health nor the Municipality of Bucharest, which share responsibility for HIV prevention among and care for drug users in Bucharest, responded to requests from IPS to comment on how they plan to deal with the emerging epidemic.

According to Valentin Simionov from the Romanian Harm Reduction Network, an advocacy group working on HIV prevention and care, while HIV prevention policies in place in Romania look well on paper, implementation has been disastruous.

“Romanian authorities are ignoring public health,” says Simionov. “When they say that they do not have money for needle exchange programmes, we would rather answer that this is a case of bad management of public resources.

“We have estimated that it would cost the Romanian state four million euros annually to fully support needle exchange programmes covering 9,000 injecting drug users, from purchase of syringes to their safe disposal,” Simionov told IPS. “It’s common knowledge that this is the price that the Romanian state pays for one kilometre of highway in some cases, so how can they say the money does not exist? In reality, it is all a matter of setting the right priorities.”

Patients attending Opiate Substitution Therapy at a clinic in the eastern Ukrainian region of Dnipropetrovsk. Credit: International HIV/AIDS Alliance in Ukraine.

By Pavol Stracansky
KIEV, Sep 3 2012 (IPS)

Despite pledges from governments across Eastern Europe and Central Asia to fight HIV/AIDS – one of the eight Millennium Development Goals – the region has the world’s fastest-growing HIV epidemic.

Punitive drug policies, discrimination and problems with access to medicines and important therapy are all driving an epidemic which is unlikely to be contained, world experts say, until governments in countries with the worst problems change key policies and approaches to the disease.

Daniel Wolfe, director of the International Harm Reduction Development Programme at the Open Society Foundations, told IPS: “In most post-Soviet countries, where HIV remains concentrated among injecting drug users, harsh policies and discrimination in healthcare settings continue to cripple the AIDS response.”

Figures showing the extent of the region’s problems with the disease make grim reading. According to the World Health Organisation (WHO), while HIV infection rates are actually falling globally, Eastern Europe and Central Asia (EECA) is seeing the reverse.

The WHO says that there were 170,000 new HIV infections in the region in 2011. New infections have risen 22 percent in the EECA since 2005, and there is no sign of a slowdown.

Injection drug use has been identified as fuelling the epidemic – accounting for up to 70 percent of new infections, according to the WHO.

Activists say the key to tackling the epidemic lies first and foremost in combating the injecting drug use problem, but that official and unofficial stances towards drugs and their users are stopping the problem being effectively tackled, or are even making it worse.

Dasha Ocheret of the Eurasian Harm Reduction Network, told IPS: “Punitive drug policies have to be stopped. People are afraid to get treatment for fear of criminal prosecution or problems with the police in other forms and there are situations where people would rather risk getting HIV than go somewhere like a needle exchange centre.”

Russia and the Ukraine are widely seen as facing the greatest problems, with official policies in the former being blamed for hindering the fight against HIV/AIDS in other countries in the region too.

Opiate-substitution therapy (OST), a treatment for drug users in which methadone or buprenorphine are provided to heroin users, which is standard practice in much of the rest of the world, is banned by law in Russia. Public promotion of its use is punishable by jail.

Critics of methadone treatment in Russia argue that it keeps patients in addiction, while others claim western countries want the treatment offered in Russia for commercial gain. They also warn that methadone would probably end up being sold on the black market, sparking another drug problem.

But with Russia emerging in recent years as a major donor in the EECA region, it is also exporting its policies, including on OST, along with its money, and there are fears this could lead to OST programmes being shelved or restricted in other states.

“Russia is a serious regional player and its policy on drugs, like its policies on other drugs, influence policies in other countries in the region,” said Ocheret.

UNAIDS officials have publicly said that the spread of HIV among injecting drug users could be largely stopped if OST, combined with needle exchange programmes, were offered.

This is a view backed up by groups such as Harm Reduction International, which told IPS that huge differences – up to 30 percent – in prevalence rates of HIV among injecting drug users in western countries and Russia is down to the provision of OST and needle exchange programmes.

But even in EECA countries where needle exchange and OST schemes are on offer, there are often serious problems with access to them.

In many EECA countries government officials continue to question their effectiveness and refuse to support them financially, leaving programmes relying on donor support.

This can limit the coverage, scale and subsequent effectiveness of such programmes, and, because such funding is rarely indefinite, creates fear among those on them that their access to OST could be suddenly cut off if a programme closes.

But a greater problem is the active persecution of those trying to access schemes.

Many drug users across the region, where lengthy jail sentences for possession of even the tiniest amounts of drugs – for instance the residue in a used syringe handed in at a needle exchange centre – are the norm, have reported being beaten, tortured, blackmailed or even falsely imprisoned by police.

A spokesman for the International HIV/AIDS Alliance in Ukraine, where OST and needle exchange schemes ostensibly have government backing, told IPS: “Physical and other intimidation towards drug users is routine police practice.

“Drug users, sex workers, and service providers have spoken of how police have extorted money and information from drug users through severe beatings, electric shocks, partial suffocation with gas masks, and threats of rape.

“They have also reported that police planted drugs in their homes or on their persons, and used this as evidence to arrest or abuse them.”

Discrimination of drug users also extends to the provision of antiretroviral (ARV) drugs.

The International HIV/AIDS Alliance in Ukraine told IPS that denying drug users ARV drugs was a “common problem”, although there is no way of officially proving it.

The Eurasian Harm Reduction Network also told IPS similar incidents had been reported in Russia.

The WHO estimates that only 23 percent of people who are eligible for HIV drugs in the EECA actually receive them. The figure in sub-Saharan Africa is more than double that.

Local groups working to combat the disease say until Western healthcare approaches to HIV/AIDS treatment and prevention are adopted, the region is unlikely to get the epidemic under control.

Ocheret told IPS: “Countries like Poland, for instance, introduced western healthcare practices on HIV/AIDS, including OST, in the 1990s when it had a difficult problem with HIV/AIDS and by doing so managed to get the problem under control.

“In many EECA countries these programmes remain in perpetual ‘pilot’ stages and have never developed further.”