The Russian capital, Moscow. The country has one of the world’s worst HIV/AIDS epidemics with new infections rising at a rate of 10-15 percent per year and at least 1.2 million people infected. Credit: Ed Holt/IPS

By Ed Holt
BRATISLAVA, May 19 2020 (IPS)

In Russia, which has one of the world’s worst HIV/AIDS epidemics, an already fragile healthcare system is buckling under the pressure of dealing with COVID-19.

The country has the second-highest number of reported coronavirus infections (as of May 19), hundreds of hospitals have reported outbreaks and death rates among doctors and other frontline health workers have been far above that in other countries.

It also has one of the world’s worst HIV/AIDS epidemics with new infections rising at a rate of 10-15 percent per year and at least 1.2 million people infected.

According to a statement from Joint United Nations Programme on HIV/AIDS (UNAIDS), more than 100 of the country’s AIDS prevention and control centres have been “mobilised to support the country’s fight against COVID-19“.

While health officials assured that quality care for those with HIV continues, as resources are stretched to keep the COVID-19 in check, those working with people living with HIV (PLWHIV) say they have experienced problems.

Speaking on condition of anonymity, one source told IPS: “There are people trapped in one part of Russia but not registered as living there because of the lockdowns. This means they cannot get their medication.

“Then there are migrant workers who normally bring their meds with them, then go back home after a few months to get their refill. They cannot get them now. Or there is a single mother who cannot leave their kids at home to get their medicine. So, volunteers deliver them to these people’s doors.”

Sources told IPS that local community groups and volunteers have also resorted to making illicit arrangements with doctors to deliver ARVs to people who need them.

“This is not something that is openly talked about because the people involved in this should not be doing this, but doctors realise they have no other choice or people could die,” one source said.

Disruptions to treatment for PLWHIV can be fatal. If a person adheres to treatment, their HIV viral load drops to an undetectable level. But if ARV treatment is not regular, a person’s viral load rises, affecting their health and potentially eventually leading to death. Even minor interruptions can affect the health of PLWHIV.

Although the World Health Organisation has said there is no evidence that the risk of infection or complications of COVID-19 is any different among PLWHIV who are clinically and immunologically stable on antiretroviral treatment compared with the general population, it is thought that people who have compromised immune systems are at greater risk of suffering severe illness from COVID-19.

Lockdowns across the country have also made it difficult for people in at-risk groups, such as drug users and sex workers, among others, to access harm reduction services.

Some facilities which provided treatments for drug users have been repurposed to deal with COVID-19 and it has also been decreed that drug users can only get treatment for drug dependency if they are in an acute condition.

There are concerns that these limits on the availability of treatment for drug users could push them into more risky drug-taking behaviour and put them in more danger of contracting HIV.

Anya Sarang, President of the Moscow-based Andrey Rylkov Foundation (ARF), a grass-roots organisation with a mission to promote and develop humane drug policy, told IPS: “But what is defined as an acute condition? These [drug users] are among the most vulnerable people in society at the moment and they cannot get help.”

Job losses during the crisis have also had an impact, driving some into poverty.

Sex workers are among some of those who have suffered most financially during the pandemic.

“They are having a very hard time. Many have lost all their work, and then lost their homes, and are now struggling to even eat, let alone get HIV medicines,” a senior worker at one NGO working with PLWHIV told IPS.

Meanwhile, Enji Shagieva, secretary of the Russian Forum of Sex Workers (RFSW), wrote for the AFEW health rights organisation earlier this month outlining the risk that many face.

“Organisations working with sex workers have cancelled outreach visits to places where sex workers still continue their activities, at their own risk. HIV testing and the distribution of condoms have been stopped. Sex workers still need condoms…,” she said.

Amid these problems, though, networks of local organisations and activists are working to ensure vital services are still being provided for PLWHIV and at-risk groups.

Russian NGOs explained to IPS how they had adapted to lockdown restrictions to find ways to continue providing harm reduction services, including providing clean needles and syringes for drug users to lessen the risk of contracting HIV.

Sarang said: “We normally went out for three or four hours every night and set up a mobile point where people could come and get needles etc. but we had to stop that during lockdown.”

“But we have managed to carry on using existing community networks in our city for needles/ HIV test distribution, increasing digital outreach, and case management, for example taking people to pick up their medicine,” she added.

Shannon Hader, Deputy Executive Director, Programme, UNAIDS, told IPS: “COVID-19 raises more challenges for HIV treatment and service provision, but the issue is how countries and partners meet these challenges.”

Hader said HIV treatment and prevention delivery systems already in place in many developing nations could be altered to meet current challenges: “There are opportunities for innovation and flexibility in service models for HIV which mean that those services need not be interrupted. We can put services into the hands of the people that need them themselves.”

“I am optimistic that if there is the political will, then developing countries will be able to come up with solutions and that there will not be a competition [for healthcare resources] between HIV and COVID-19,” said Hader.

Meanwhile, ARF is also running support groups through social media and regularly collecting feedback from at-risk communities to talk to people and help them where possible.

“All we are doing is trying to help people that need it wherever we can,” Sarang said.

Excerpt:

Doctor Khalishwayo, a traditional healer in the Shiselweni Region, in southern Eswatini, distributes HIV Self-Test Kits to his clients to get more people to know their status. Credit: Mantoe Phakathi/IPS

By Mantoe Phakathi
MBABANE, Mar 26 2020 (IPS)

Doctor Khalishwayo is a traditional healer based in Nhlangano, a town in the Shiselweni Region, in southern Eswatini. His clients are people who consult him when they are suffering from different ailments. And he in turn diagnoses them using divine methods.

“But as a traditional healer, there are certain things that I can’t see,” Khalishwayo told IPS, adding, “I can’t tell whether a client is infected with HIV or TB.”

He is one of the eight traditional healers in the region who are distributing HIV Self-Test Kits to their clients to get more people to know their status.

This is an initiative by the NGO, Médecins Sans Frontières (MSF), in collaboration with the Ministry of Health. Traditional healers were trained on the role they can play in curbing the spread of HIV and TB by encouraging their clients to get an HIV test.

• Eswatini continues to have the highest HIV prevalence in the world.
• TB remains the main AIDS opportunistic disease in the country with the HIV/TB coinfection at 84 percent, according to the 2009 National TB Programme report.

Before the training,Khalishwayo did not encourage his clients to test for HIV because, he said, he felt that it was not his place.

“Besides, traditional healers were not involved in the response against HIV/AIDS,” said Khalishwayo. Each traditional healer received 50 kits to distribute within a period of six months.

Singaphi Mngomezulu, another traditional healer, said they learnt from the training that some people with AIDS-related illnesses and TB may present with symptoms of people who have been “bewitched”.

“Some people come to us with mental illnesses in such that makes one believe that they’re possessed with demons,” said Mngomezulu. “I learnt that AIDS and TB symptoms can affect the brain.”

In the past, he said, he did not have the knowledge and could not advise clients to also seek medical attention.

The involvement of traditional healers is one of the country’s efforts to accelerate the response against HIV/AIDS. 

A few years ago, HIV incidence decreased by almost half – at 44 percent – among the age group of 18 to 49 years. These are results of the 2016/17 2^nd Swaziland HIV Incidence Measurement Survey (SHIMS2).

• SHIMS2 also states that the country made significant progress towards achieving the United Nations 90-90-90 target. This is an ambitious call for countries to ensure that, by 2020, 90 percent of people who live with HIV know their status, 90 percent of diagnosed cases receive Antiretroviral Therapy (ART) and 90 percent of those on ART have viral suppression.
• So far, Eswatini has achieved 85-87-92.

Despite this progress, SHIMS2 found that HIV testing is generally low among men compared to women. Moreover, younger women are having sex with older men who infect them and, in turn, they pass on the virus to their peers.

“It is for that reason that we had to target the men because unfortunately don’t like to go to health facilities,” said Muhle Dlamini, the programme manager at Eswatini HIV Programme (SNAP).

Dlamini also said the government had introduced the kits to target hard-to-reach populations including those who are far from testing centres.   

“Men fall under the hard-to-reach category because they don’t visit health facilities,” said Dlamini. 

Médecins Sans Frontières (MSF) head of mission to Eswatini, Dr Bernhard Kerschberger, says it is a good strategy to raise awareness of HIV testing by involving traditional healers. Credit: Mantoe Phakathi/IPS

MSF saw this as a good strategy to also raise awareness among traditional healers, said the head of mission to Eswatini, Dr. Bernhard Kerschberger. The kits though are not exclusively for men, and women were also given them if they want to be tested.

“As MSF we asked the Ministry of Health if we could include traditional healers in distributing the kits to clients who might benefit and they agreed,” said Kerschberger.

Each kit has easy-to-follow instructions and, if a person tests positive, a client is encouraged to visit a health facility for confirmation after which treatment can be initiated.

“There is no official link between the traditional healer and health facility but the kit is used to help in identifying clients who might need to go to the facility for HIV/TB services,” he said.

He said this is a research project that would establish if using traditional healers to reach people who are not accessible through the routine healthcare system is a viable option.

Within a period of six months, he said, a total of 80 kits were distributed and, of these, 14 percent were screened to be HIV-positive cases.

“The most important thing was that traditional healers appreciated that HIV cannot be cured by them and that they have to refer their clients to health facilities,” said Kerschberger.

He said one of the groups that the government utilised to distribute the kits were rural health motivators but men were not receptive because of the stigma associated with HIV/AIDS in the communities.

“That’s why we decided to involve the traditional healers because they are trusted by their clients and they approach them from a safe space. However, we discovered that women are almost half the people who see traditional healers,” he said. 

This research could lead to a better working relationship between the Ministry of Health and traditional healers in the response against HIV/AIDS.

By Webster Mavhu
HARARE, Mar 5 2020 (IPS)

Women are the face of HIV in Africa, yet four of every 10 persons living with HIV in East and Southern Africa are men. Despite higher rates of HIV infection among women, more men living with HIV are dying.

Men are often left behind by programs that aim to reduce HIV rates as well as those providing HIV treatment.

Global HIV targets are that by December 2020, 90% of all people living with HIV will know their status, 90% of those HIV positive are on treatment and, 90% of those on treatment have reduced replication of the virus in their body.

Some African countries are on track to achieve these targets because programs for women are doing so well. Unfortunately, men in many settings are far from achieving these targets.

The Joint United Nations Programme on HIV and AIDS (UNAIDS) report shows that globally, less than half of men living with HIV are on treatment, compared to 60% of women. Data from 30 African countries also show that, across all age groups except 45-49 years, men are much less likely than women to have ever taken an HIV test.

In response to HIV testing and treatment gaps between men and women, the U.S. President’s Emergency Plan for AIDS Relief emphasizes the need for an acceleration of strategies to reach men under 35 years.

Webster Mavhu. Credit: Natasha Sweeney.

For more than a decade, I have been researching why men in sub-Saharan Africa do not take up HIV services even though they are aware that they need to take the necessary steps to either prevent HIV or ensure it does not eventually kill them. I recently visited four African countries – Lesotho, Malawi, Tanzania, Zimbabwe – to explore why men act against their own best interests.

One issue that came out in all countries is that men believe that the body and mind ought to be resilient. They consider ‘submission’ to the healthcare system as necessary only when the body can no longer hold out, or when men are certain they are no longer in control of their health and fate. A fisherman in Tanzania summed it up as: “A man is like a car which only goes to the garage when it has broken down.”

Men want to be seen as being in control, but HIV – considered a serious, life-long condition – undermines this image, with the result that men want to avoid knowing they have it.

HIV programs therefore need to change the narrative around HIV for example by repositioning HIV testing and treatment as acts that allow men to regain control of their health and fate more broadly.

Another concern voiced by men is that programs are largely based at clinics, but men rarely visit clinics. Programs need to take services to where men are.

We implemented HIV self-testing in three African countries and found that it increased HIV testing among men. Men liked that they were in ‘control’ of the testing process and that they were the first to know the result, which is different from when a health worker does the testing.

Global HIV targets are that by December 2020, 90% of all people living with HIV will know their status, 90% of those HIV positive are on treatment and, 90% of those on treatment have reduced replication of the virus in their body

But self-testing requires a second test to confirm a possible positive result, so programs need to consider how to make confirmatory testing easily accessible for men who self-test positive. 

It is also important to ensure that men who test HIV-positive access treatment. Large numbers of HIV-positive men choose not to seek treatment nor stick to treatment plans once started. An innovative way to address barriers to treatment access has been the use of community medication refill groups, where groups of individuals who are doing well on HIV treatment take turns to collect medication for each other, reducing the need to go to the clinic regularly.

Another barrier for some men is fear that others may learn their HIV status, which can mean they prefer to collect medication from male community health workers, and in secret. 

While some argue that too many resources have been channeled to HIV and it is now time to focus on other conditions, HIV has provided huge learning which can be adapted by other programs. Better still, health systems (including community-based approaches) developed for HIV prevention and care can be combined with those for non-communicable diseases (e.g. diabetes, hypertension) and implemented alongside each other.

I am not arguing for less focus on women. But all that focus and hard work will be undone if we do not also focus on men. To do that, we need to use targeted approaches that take into account men’s particular concerns about privacy, self-determination (control) and need for flexibility.

At stake is more than simply reaching global goals. At stake is the health and well-being of millions of African men.

Webster Mavhu is a linguist-turned social scientist and public health practitioner who has been conducting research to inform programming for the past 15 years. He is an @aspennewvoices fellow. Follow him on twitter @webstermavhu

Credit: WHO/ F. Tanggol.

By Ifeanyi Nsofor
ABUJA, Nov 30 2019 (IPS)

Three years ago, I led an evaluation of an HIV project that focused on increasing access to quality care and supporting services for people living with HIV in Nigeria. It also aimed to reduce HIV-related stigma and discrimination.

The project achieved these goals by strengthening support groups, using homebased care services for sick persons and providing Savings and Loans Association membership to improve the livelihoods of persons living with HIV. These outcomes point to the power of community in managing HIV.

The first of December is celebrated globally as World AIDS Day. The theme of the 2019 celebration is, “communities make the difference“. This reminds us to re-focus on the power of community as we try to end the HIV pandemic.

Based UNAIDS 2018 global data, 37.9 million people were living with HIV/AIDS. There were 1.7 million new HIV infections. Fifty-four percent of these new infections occurred among key populations such as men who have sex with men, transgender folks and sex workers.

The first of December is celebrated globally as World AIDS Day. The theme of the 2019 celebration is, "communities make the difference". This reminds us to re-focus on the power of community as we try to end the HIV pandemic

The risk of acquiring HIV was 22 times higher among men who have sex with men; 22 times higher among people who inject drugs; 21 times higher for sex workers and 12 times higher for transgender people.

Weekly, about 6,000 young women aged 15–24 years become infected with HIV. In sub-Saharan Africa, 80% of new infections among adolescents aged 15–19 years are in girls. Young women aged 15–24 years are twice as likely to be living with HIV than men. Eighteen percent of pregnant women living with HIV did not have access to drugs that would prevent transmission of HIV to their newborns.

People living with HIV face many forms of discrimination when they try to get help. In Southwest Georgia in the U.S., people living with HIV travel long distances out of the area to access their HIV care for fear of being stigmatized.

In the United Arab Emirates, while citizens have free access to HIV treatment, non-nationals prisoners are denied HIV treatment and kept in isolation.  However, some face more inequities than others. Key populations, adolescent girls and pregnant women are examples. These communities should be prioritized in the addressing HIV.

Here are four ways to bolster community efforts to ensure equity.

First, eliminate mother-to-child transmission of HIV through peer programs. Governments, UNAIDS and all partners working in HIV should draw lessons from a country such as Cuba that has eliminated mother-to-child transmission of HIV and Syphilis.

For instance, Cuba’s achievement is based on a universal healthcare system which integrates maternal and child health programs with programs for HIV and sexually transmitted infections. In addition, community of mothers living with HIV called Mentor Mothers can improve uptake of PMTCT services.

Mentor Mothers provide peer support to pregnant women who have HIV. A study in Zimbabwe showed that Mentor Mothers improved retention in PMTCT services and led to positive behaviour change among HIV-positive pregnant women.

Second, integrate HIV/AIDS programming into youth-friendly clinics that provide reproductive health services to women aged 15-24 years. These youth-friendly clinics should be safe spaces, non-judgmental and without discrimination.

South Africa has high burdens of women living with HIV -above 62% of adults living with HIV in South Africa are women, or 4.7 million people. In South Africa, mobile technology locally known as Ringa Nathi (talk to us in Zulu) is used to provide confidential youth-friendly HIV services through WhatsApp-based support groups of 10 youths.

It is a platform for judgement-free discussions while improving knowledge on importance of adherence to HIV treatment and living positively with HIV.

Third, prioritise HIV services for high-risk populations such as men who have sex with men, transgender people, sex workers and injection drug users. Too often, they face barriers and discrimination to receiving help and this must end.

In this light, South Africa has established its first transgender healthcare facility at the Wits Reproductive Health Institute.

In Malawi, a country with one of world’s highest HIV prevalence rates, sex workers are stigmatized and often experience violence. International NGO Médecins Sans Frontières (MSF) provides HIV counselling and testing services to sex workers.

Fourth, communities must protect the rights of high-risk populations, period. Throughout the 40 years of the HIV pandemic, these populations have faced discrimination and at times been removed from the mainstream of HIV programming.

Stringent homophobic laws across Africa prevent gay men from accessing life-saving antiretroviral drugs. A study of 45,000 gay men in 28 African countries including Kenya, Malawi and Nigeria found that only 25% were taking their HIV drugs.

Therefore, the courts must rise to the occasion and protect the rights of key populations. Consequently, a High Court in Zimbabwe recently ordered the Minister of Home Affairs and the police to pay a trans woman $400,000 as compensation for her unlawful arrest in 2004.

One key lesson I learnt from leading the evaluation of the HIV intervention in Nigeria is that, “If you want to go quickly, go alone. If you want to go far, go together”. Therefore, no community of people living with HIV should be left behind. However, to ensure equity, some communities should be brought to the same level as others and the journey continued.

Excerpt:

By Ifeanyi Nsofor
ABUJA, Oct 7 2019 (IPS)

As a Public Health Doctor, I often meet people who experience stigma simply because they live with HIV. One person who still haunts me is a woman who is HIV positive and when she was in labor, a midwife would not help her. Instead she shouted at her to just push out the baby and then she stood far away from the bedside, disgusted by the woman’s HIV status.  No one should go through such stigma at a vulnerable situation when they are about to birth life.

Another lady I met was denied university admission because she is HIV positive. She was screened for HIV without her consent, her HIV-positive status was disclosed publicly, and she was asked to leave the private university.

This is not okay. All forms of HIV-related stigma must stop. When people experience stigma and discrimination they may be afraid or ashamed to access HIV services. This fear of stigma has far-reaching implications – it could cause people to delay being tested and knowing their HIV status and getting help, before it’s too late.

Globally, there are approximately 37.9 million people living with HIV, with 770,000 deaths, based on 2018 data. In 2018, there were 1.7 new HIV infections. Seventy-five million people have been infected by HIV since the epidemic began and 32 million have died as a result. HIV-related stigma can have serious consequences.

These are ways to deal with it.

Americans wrongly believe that HIV can be transmitted through sharing glass (27%); touching toilet seat (17%); and swimming in a pool with someone who is HIV positive (11%)

First, government across the globe should increase investments in health education to improve people’s knowledge of HIV and its modes of transmission. It should not be taken for granted that people are aware.

For instance, according to a survey of Americans by the Kaiser Family Foundation, Americans wrongly believe that HIV can be transmitted through sharing glass (27%); touching toilet seat (17%); and swimming in a pool with someone who is HIV positive (11%). Instead, one can get HIV when there is contact with body fluids such as blood, semen, vaginal fluids and breast milk.

Targeted information should be deployed on platforms where people congregate and interact. Social media platforms such as Facebook, Instagram, Twitter and WhatsApp serve this purpose and should be used. Globally, there about 3.5 billion social media users – an estimated than 2.7 billion of these are Facebook users.

In 2016 at peak of the Zika virus epidemic in Brazil, Facebook pulled anonymized posts about conversations on Zika virus. This was shared with UNICEF to design a campaign that provided the right information for individuals to protect themselves against Zika virus. Facebook can replicate the same to tackle misinformation about HIV and reduce stigma.

Second, enforce HIV antidiscrimination laws to deter offenders from discriminating against people living with HIV. For instance, In 2015, the Nigerian President Jonathan signed the HIV/AIDS Anti-Discrimination law.

One of the objectives of the law is to help more Nigerians to seek testing, treatment and care services without fear of facing stigma and discrimination. The law does not permit HIV screening as a prerequisite for employment and school admissions.

There are fines of $1400 for individuals and $5,700 for institutions who violate the law. The fines could come with prison term of up to one year in addition to these fines. Although not as robust as Nigeria’s HIV antidiscrimination law, Ghana’s patient’s charter protects individuals from discrimination based on type of illness.

Third, end the discrimination against key populations like men who have sex with men, sex workers and transgender people as this discourages them from accessing care, pushes them underground and increases their risk of transmitting HIV.

Globally, these populations account for 54% of new HIV infections – 88% in Western and central Europe and North America; 95% in Middle East and North Africa; and 64% in Western and central Africa.

Compared to non-key populations, the risk of acquiring HIV is 22 times higher among men who have sex with men and injection drugs users; 21 times higher among sex workers and 12 times higher for transgender people.

Specific changes include ending discriminatory laws. Countries including Algeria, Morocco, Nigeria, Pakistan, Kenya, Zambia and others criminalize LGBT folks and that needs to change. Further, transgender people are harmed and killed without consequences for the perpetrators.

For example,  recently, a black transgender woman was burned to death in Florida. Therefore, donors must keep working with governments to repeal these laws and punish those who perpetrate violence against key populations.

The Former Wales rugby captain, Gareth Thomas’ revelation this month that he is HIV positive because someone threatened to blackmail him, shows that no one is immune to stigma. As long as new HIV infections occur, governments, donors, private sector and communities must continue work to end HIV-related stigma and discrimination.

Excerpt:

Members of Zimbabwe’s Khoisan tribe perform a traditional dance during an HIV/AIDS awareness campaign conducted by Tsoro-O-Tso San, a development trust that aids the tribe. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
TSHOLOTSHO, Zimbabwe, Aug 31 2017 (IPS)

Sixty-seven-year-old Hloniphani Sidingo gives a broad smile while popping out through the gate of a clinic in her village, as she heads home clutching containers of anti-retroviral pills.

The first Bantu people to dwell in present-day Zimbabwe, the Khoisan, also known as the Bushmen or Basagwa, populate remote areas of southern Africa, particularly Angola, Botswana, Namibia, South Africa, Zambia and Zimbabwe.

Here, the Khoisan community is found in Matabeleland North’s Tsholotsho district, where many like Sidingo are domiciled. Other Khoisans live in Plumtree in this country’s Matabeleland South province.

Now, with the word spreading far and wide about AIDS awareness, many Khoisans like Sidingo have joined the fight against the disease. And thanks to the Zimbabwean government’s anti-retroviral initiative, she is still alive more than 16 years after she tested positive for HIV.

“I’m so happy. I’m happy I continue to receive my share of treatment pills from government and this keeps me going,” Sidingo told IPS.

“AIDS killed my husband and my children – five of them,” she said. “I’m not taking chances because I want to survive. My husband back in the days didn’t trust community health workers when they approached us urging us to embrace HIV/AIDS tests and get treatment if we have the disease. Ntungwa, my husband, actually thought health workers were up to no good and avoided them, resulting even in our children, who also later died of AIDS, doing like their father,” added Sidingo.

Meanwhile, organisations catering for the welfare of the Khoisan here say the dread and shame surrounding HIV/AIDS is fading among members of the tribe.

“The Khoisan now understand the existence of the (AIDS) virus and almost all who are infected are on ARVs,” Davy Ndlovu, Programmes Manager for Tsoro-O-Tso San, a development trust that aids Khoisan people in Zimbabwe, told IPS.

But while success stories are there to be told about the ancient tribe’s strides in combatting HIV/AIDS, a combination of poverty and ignorance has sometimes disrupted ARV treatment.

“As you might be aware, the San are a poor people and when the nursing staff here once told them not to take the medication on an empty stomach, this was interpreted in that when one had no food for that day, one would not take his or her medication. Due to this ignorance, a number of Khoisan people living with AIDS have lost their lives,” Ndlovu said.

While the tribe now embraces ARV medication, they still face the burden of having to walk long distances to access treatment, according to Tsoro-O-Tso San.

“The other issue has to do with reviews where people are expected to travel to the nearest hospital, which is about 15 to 20 kilometres away. When they fail to raise transport money, they just stay and miss the review,” said Ndlovu.

Despite such hurdles, for Khoisans living with HIV like Sidingo, fighting the disease has become top priority.

“I have learnt to adhere to taking my medication consistently. Many people in my community now understand the importance of getting tested for HIV,” Sidingo told IPS.

Ndlovu said like Sidingo, many Khoisans now live with HIV and are trying to cope with the virus like everybody else, in  a country where 1.2 million people are living with HIV/AIDS, according to UNAIDS.

To Ndlovu, “They (the Khoisan) are no longer discriminated against in the AIDS battle.”

Of the 2,500 Khoisan people domiciled in Zimbabwe, approximately 800 of them now live with HIV/AIDS, about a third of the population, according to Tsoro-O-Tso San.

Meanwhile, the rush to get tested for HIV/AIDS amongst Zimbabwe’s Khoisan tribe comes at a time the tribe stands accused of engaging in careless sex habits, exposing the tribe to the ravages of AIDS.

“The biggest threat is that the San still practice casual sex with no protection at all. Sex among the San is a pastime to be enjoyed and you still find people sharing girlfriends – young and old do this,” Ndlovu of the Tsoro-O-Tso San told IPS.

“Organisations like Medicine Sen Frontiers (MSF) have worked with the Khoisan tribe on issues related to HIV/AIDS. A number of the Khoisans, both male and female, the youths in particular, have been trained as peer HIV/AIDS educators with the intention to teach people issues related to HIV/AIDS prevention, safe sex, and treatment,” said Ndlovu.

The Zimbabwean government’s National Aids Council fosters also HIV/AIDS awareness campaigns amongst the country’s ancient tribe, according to Tsoro-O-Tso San.

To do this, NAC works in conjunction with the country’s Ministry of Health to provide anti-retroviral drugs to the minority tribe, a gesture that has put smiles on many HIV-positive Khoisans like Sidingo.

“Back in the years, as the Khoisan we thought our people were being bewitched as we saw them succumbing to AIDS, but thanks to the treatment, we have started to live on even with the virus,” Sidingo told IPS.

Jovia, who died on Apr. 29, 2016, suffered from both HIV/AIDS and cervical cancer, a deadly combination affecting thousands of women in Uganda. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Uganda, Jul 25 2016 (IPS)

Lying on a dirty bed in a crowded, squalid hostel in Kampala, emaciated Jovia, 29, managed a weak smile as a doctor delivered her a small green bottle containing a liquid.

“I’m so happy they’ve brought the morphine,” the mother told IPS, just about the only words she could get out during what would be the last weeks of her life. “It controls my pain and makes my life more bearable.”“As long as radiotherapy is not available in Uganda many more patients will die.” -- Dr. Anne Merriman

Jovia was suffering from both HIV/AIDS and cervical cancer, a deadly combination affecting thousands of women in Uganda. While the east African country had huge success in the battle against the HIV virus in the 1990s, cervical and other cancers are the new health crises gripping the developing nation. One in 500 Ugandans suffers from cancer. But only five per cent of patients will get any form of treatment, facing an often tortuous death.

Thanks to Hospice Africa Uganda (HAU), founded 23 years ago by the 2014 Nobel Peace Prize Nominee, British-born Dr. Anne Merriman, patients like Jovia are given not only affordable pain-controlling oral liquid morphine, but comfort, hope and dignity in their last days.

At 81, Dr. Merriman is credited with introducing palliative care to Africa. HAU has cared for a total of 27,000 seriously ill and dying people since 1993, the vast majority with the morphine made at its Kampala headquarters for just two dollars a bottle, with government funding.

In Uganda, cancer is usually diagnosed quite late, due to poor screening and lack of health services. According to the country’s Uganda Cancer Institute (UCI), 80 per cent of sufferers die because of late diagnosis.

For patients like Jovia, who passed away peacefully on Apr. 29, leaving a daughter, 14, radiotherapy can cure or extend life when treated in early stages.

A tray of morphine at Hospice Africa Uganda. Credit: Amy Fallon/IPS

But in early April, Uganda’s only radiotherapy machine broke beyond repair. It was used by about 30,000 cancer patients annually. Since then, thousands in need of radiotherapy to cure their cancer, or extend their lives, have been left without vital treatment.

The Ugandan government had purchased a new machine, worth a reported 500,000 dollars, three years ago, but it could not be delivered as special bunkers needed to house the machine had to be built.

Facing an uproar from within Uganda at the lack of radiotherapy services, the government promised a new bunker would be built within six months. Aga Khan University Hospital in Nairobi, Kenya, offered free treatment for 400 Ugandan cancer patients. The plan was that they would be sent there by the Ugandan government through the UCI.

But more than three months later there is still huge confusion and contradictory reports and statements about the delivery of this promise, and controversy over the delay in getting desperate patients. Despite repeated requests for clarification the UCI nor Uganda’s ministry of health are able to state exactly how many patients – if indeed any – have yet been sent to Kenya for treatment.

Christine Namulindwa, UCI’s public relations officer, pointed out patients going to Nairobi have to go through an “evaluation”, and be approved by a board.

“So far we’ve submitted 15 names to the ministry of health and more are yet to be submitted,” she said last month. The pledge for free treatment from Aga Khan did not cover the cost of transporting patients and upkeep while in Nairobi, she said.

She said there were “patients who are still waiting” and referred IPS to the health ministry for further questions.

On July 1, Professor Anthony Mbonye, Acting Director General of Health services, told IPS via email the ministry of health had “received a budget for supporting patients to Aga Khan and will provide transport and funds for maintenance”.

A lawyer had “cleared a memorandum of understanding between Aga Khan and UCI,” he said.

“The radiotherapy machine was bought, but the bunker is yet to be rehabilitated. In two months’ time the machine will be installed and services will resume.”

Stories in East African papers in early July reported that the “long wait” was “over” for patients, after Aga Khan signed an MOU with UCI, allowing 400 out of 17,000 patients to “receive treatment”. But they did not give a date for when they would go to Kenya.

Another report said only tumour patients with chances of survival, but including those suffering breast and cervical cancer, would be transported to Kenya using government vans. It said accommodation and other support services were being organised by Uganda’s High Commission in Nairobi, and 20 patients have been approved to go. But again it gave no specific date for their transportation.

Two of seven patients have been treated at Aga Khan not through the UCI and the Ugandan government, but through a partnership with HAU and Road to Care, a programme developed by Canadian doctor Joda Kuk. He set up scheme in 2011 after he witnessed women with cervical cancer in rural areas of Uganda needing desperate assistance to get to Kampala for radiotherapy.

Mary Birungi and Mary Gahoire, a mother of three, both from western Uganda, returned home the week of July 21 after travelling to Kenya by road, being housed by Road to Care and completing radiotherapy treatment there. They are now back with their families.

Two more patients are in the middle of treatment this week and and two more will travel to Kenya. The seventh patient is due to go there in the first week of August.

Dr. Anne Merriman pleaded with the Ugandan government to do all in its power to complete the building of the new bunkers so the new radiotherapy machine can be commissioned as soon as possible.

“We are so happy that under Road to Care seven of our patients will be treated in Kenya, but this is just a drop in the ocean,” she said. “The need is huge. There has been so much confusion since the machine broke down, causing huge stress to patients and families. “

“As long as radiotherapy is not available in Uganda many more patients will die.”

On July 23, Professor Mbyonye told IPS that “some” patients have gone to Kenya and had already come back through the agreement between the health ministry and Aga Khan, but couldn’t give more details.

For many though, it’s too late.

Vesta Kefeza, 49, a mother of seven, has advanced cervical cancer. Lying on a mattress on the ground of her one-room home in Namugongo slum, Kampala, she is immobile, as her leg has ballooned due to a complication from the cancer.

She has been on HAU’s programme since 2011 and is administered morphine by their nurses. Uganda became the first country in the world to allow nurses to prescribe the drug in 2004. The hospice team also provides food and spiritual support.

In June, thanks to a donation from Ireland, Kefeza received a wheelchair, allowing her to get out into the fresh air and go to church.

“Until then I lay in bed all day,” she said. “I thank God for my blessings. I am lucky to have HAU caring for me.”

Dorcus Auma weaving sisal fronds into a basket. Her Kenyan women's group has helped provide income to care for her grandchildren, orphaned by HIV/AIDS. Credit: Charles Karis/IPS

By Charles Karis
NAIROBI, Jun 27 2016 (IPS)

Seventy-three-year-old Dorcus Auma effortlessly weaves sisal fronds into a beautiful basket as she walks the tiny path that snakes up a hill. She wound up her farm work early because today, Thursday, she is required to attend her women’s group gathering at the secretary’s homestead.

Except for their eye-catching light blue dresses and silky head scarfs, they would pass for ordinary village women. They are part of the Kagwa Women’s Group in the remotest part of Homa Bay County in Kenya’s lake region.

A recent county profile of HIV/AIDS prevalence by the National AIDS Control Council (NACC) revealed that Homa Bay County leads Kenya in HIV prevalence, standing at 25.7 percent.

Auma joined the group in 2008 when the care of her three grandchildren was thrust upon her shoulders.

“HIV/AIDS robbed me of my three children, leaving me with the burden of having to take care of three children left in a vulnerable condition,” says Auma.

With no steady income to provide for their basic needs, she joined other women who shared the same predicament.

UNAIDS says that microfinance can play a big role in helping households affected by the HIV/AIDS pandemic, and the women’s group at Homa Bay has proved this to be true.

Composed of 28 members, it started as a merry-go-round, which is a self-help group that helps women to save money. The group is supported by World Vision through an initiative to enhance target households through cooperatives.

“Within economic strengthening we are trying to help the families to get economically empowered through the locally available resources. This is a group of old women, they are all grandmas, and they had already started doing their own merry go-rounds. We came in with training on village savings and loaning, which is a simplified model of the savings at the rural level – it’s like a rural bank,” says Jedidah Mwendwa, a technical specialist with APHIA II Plus (pdf), one of the implementing organizations.

Most of the members are grandmothers whose children died from HIV/AIDS, and hence were left to fend for their grandchildren.

“Since the grannies cannot engage in vigorous economic activities, they were introduced into saving and loaning at their own level. They agreed to raise monies for saving and loaning among themselves through locally available resources like making ropes, baskets and mats,” says Mwendwa.

“When they meet on Thursdays, they collect all their material contributions. One of their members is sent to the nearby market, which is Oyugis, a distance of 61km, to go sell their products and the following week, the money that came from the market is what is saved for each specific member,” says Mwendwa.

The savings are rotated to individual members on an annual basis, and since they do not have a secure place to keep the money, they usually loan out the entire collected amount to members who return it with one percent interest.

“Since I joined this group, my life has changed. I have been able to engage in sustainable farming. My grandchildren have a reason to smile as they have nutritious food on the table,” says Auma, as she gives instructions to her eldest grandchild, a 16-year-old girl, on how to separate the sisal strands.

Initially, local people were a bit reluctant to attend the HIV caretaker training sessions because of the real stigma associated with the illness, but most have come around, and their efforts are paying off.

“We offer to the group and school clubs sensitization on adherence and nutrition,” says Rose Anyango, a social worker in the county. “The women and the children are responding well and the stigma no longer exists. Through village savings and loaning they are able to feed their children as well as educate them.”

The group has seen immediate successes in behavior, attitudes and practices regarding cultural dictates and inclusion of people living with HIV/AIDS in development activities. Women are now actively taking the lead in economic empowerment, enabling them to support their families.

The group now plans to increase to increase its impact by involving more members from the surrounding community, which will go a long way in not only empowering of locals but also reduce the stigma of HIV/AIDS.

By Jomo Kwame Sundaram
ROME, Dec 11 2015 (IPS)

The latest estimates are that over two billion people in the world suffer some micronutrient deficiencies, often referred to as “hidden hunger.” The main sustainable solution is to ensure adequate public health interventions, including clean water, sanitation and hygiene as well as healthy, diverse diets for all.

Jomo Kwame Sundaram. Credit: FAO

In the short term, however, it will be necessary to provide supplements of vitamins, minerals and trace elements to those especially vulnerable, e.g. due to displacement and emergency situations. There is a general consensus that such needs of pregnant and lactating mothers should be especially prioritized due to the intergenerational consequences of child stunting for such reasons.

Developing countries should be able to affordably access locally produced or imported generics of the vitamin and mineral supplements they require. Many current options associated with public-private partnership will instead strengthen the vested interests of the lucrative, large and fast-growing industry for nutrition supplements.

The need for supplementation to address urgent, short-term micronutrient deficiencies should qualify as part of the public health exception to the Trade-Related Aspects of Intellectual Property Rights (TRIPs) rules of the World Trade Organization (WTO). This has not been fully recognized ostensibly because people do not drop dead immediately due to “hidden hunger.”

TRIPS and generics production for developing countries

Under the TRIPS agreement, intellectual property rights (IPRs) — for copyright, trademark, geographical indication, industrial designs and patents — are extended to all signatory countries. Patents, most relevant to public health and access to medicines, give twenty years of protection to inventions.

In the current language, there are no explicit provisions for generic production of patented nutrition supplements. However, there is supposed to be a great deal of flexibility on the basis of public health needs, which could be extended to minerals and vitamins for supplementation.

The TRIPS Agreement provides space for countries taking measures to protect public health. Under Article 31, countries can issue compulsory licenses allowing firms or individuals to produce generic copies of patented products or processes for the domestic market without the owner’s consent in “case of a national emergency or other circumstances of extreme urgency or in cases of public non-commercial use.” The government can also determine adequate payment to the IPR holder.

At the Doha WTO conference in 2001 launching the Doha Development Round of trade negotiations, the Declaration on the TRIPS Agreement and Public Health affirmed the right of countries to protect public health, enable access to medicines, and determine the criteria for issuing a compulsory license. It emphasized that each country “has the right to grant compulsory licenses” and “the right to determine what constitutes a national health emergency or other circumstances of extreme urgency.”

This new text corrected the false impression that some health emergency was needed to justify compulsory licensing. It also spelt out that “public health crises, including those relating to HIV/AIDS, tuberculosis, malaria and other epidemics, can represent a national emergency or other circumstances of extreme urgency.”

Technology transfer

Under Article 66.2 of TRIPS, developed country governments are obliged to actively promote technology transfer in establishing manufacturing capabilities for patented processes in developing countries. The 2001 Declaration also reaffirmed the developed countries’ commitment to provide incentives to their corporations to enable technology transfer to the least developed countries. This was part of the original bargain for developing countries to provide protection of IPRs.

Developing countries also have the right to import generics if they lack manufacturing capabilities. A 2003 waiver allows countries unable to domestically produce pharmaceuticals to import them instead. Hence, under compulsory licensing, such countries can import externally produced patented drugs. Thus, while compulsory licensing allows countries to import cheaper generics from countries already producing them, to take advantage of TRIPS Agreement flexibility, countries need to legislate accordingly.

However, exemptions to pharmaceutical patent protection to the least developed countries, enabling them to import without issuing a compulsory license, were only extended until 2016. The upcoming Nairobi WTO ministerial should extend this exemption beyond next year.

While there appears to be legal space under TRIPS for developing countries to use compulsory licensing, they have effectively be prevented from doing this by complicated rules and procedural requirements. Consequently, use of compulsory licensing by developing countries has been largely limited to HIV/AIDS medicines, and almost exclusively used by middle-income countries. LDCs have not issued any compulsory licenses while the total number of applications has declined significantly in the last decade.

Needed actions

Existing TRIPS texts do not preclude compulsory licensing for local generic production in developing countries. However, extension of the right to use compulsory licensing and other such flexibilities to vitamin and mineral supplements is not explicit. While explicit permission is given to AIDs, malaria, tuberculosis and epidemics, even this is rarely used.

In light of the foregoing, the following revisions to WTO provisions to protect developing countries’ right to produce generic vitamin and mineral supplements should be introduced. This will also be in line with the July 2015 Addis Ababa Action Agenda’s commitment to facilitate technology transfer:

• Developing appropriate model legislation to facilitate development of the national legislation needed for compulsory licensing, etc.
• Provide free legal services to developing country governments interested in accessing TRIPS facilities.
• Identify and investigate relevant national vitamin and mineral supplement production needs in partnership with other governments to enable developed countries to meet their technology transfer obligations.

Developing countries need to act to overcome three major constraints to issuing compulsory licenses and bypassing patent legislation for public health. First, the governments must be strong enough to withstand business and political pressures. Second, it is necessary to have enabling legislation in place. Third, these countries need to have production capacity and distribution arrangements in place.
Also, the UN system should offer appropriate technical expertise to advance progress.

(End)

Excerpt:

At night, groups of people from the lesbian, gay, bisexual, transsexual and intersex (LGBTI) community gather in meeting spots like this one in the El Vedado neighbourhood in Havana, Cuba. Others go to cruising spots for quick anonymous sex. Credit: Jorge Luis Baños/IPS

By Ivet González
HAVANA, Nov 13 2015 (IPS)

When night falls, young men can be seen sitting on a dismantled bus stop on a remote hill far from the centre of the Cuban capital. Later they climb uphill to have sex with other men in the thick forest.

“On my way home from work, I go by that place, and I always see people gathered at the old bus stop,” 36-year-old biologist Daniel Hernández told IPS. The spot he was talking about is near the Calixto García Hospital in Havana’s El Vedado neighbourhood.

“People have lost their inhibitions. I can see they’re more out in the open in that area, where everyone knows why people go there. They’re not so afraid anymore,” said Hernández, who is himself gay and says he has occasionally gone there and to similar gay cruising spots in Havana.

Remote, isolated spots in Cuba’s cities, like forests, coastal areas or abandoned buildings, are colonised at night by men seeking quick anonymous sex with other men.

These cruising spots, known here as “potajeras”, represent a challenge for the work of prevention of HIV/AIDS, say activists, researchers and men who have sex with men (MSM) who spoke to IPS.

“I have witnessed unprotected group sex. All kinds of people go there, and not everyone has an awareness about the epidemic,” said Hernández, who described the potajeras as “key to the spread” of HIV/AIDS.

In his view, gay meeting places are necessary, but “not the remote spots that exist, where people are extremely unprotected due to the risk of infection and violence.”

The HIV/AIDS adult prevalence rate is low – just 0.1 percent, or 19,500 people – in this Caribbean island nation of 11.2 million people, up from 16,479 in late 2013.

MSM make up 70 percent of those living with HIV/AIDS. But women represent a growing proportion: 21 percent today, up from 18.5 percent in 2013, according to official figures.

Curbing the slow steady growth of new cases is a challenge that requires a greater prevention effort in this socialist island nation where healthcare is free and universal, including antiretroviral treatment for people living with HIV/AIDS.

The good news is that on Jun. 30, Cuba became the first country across the globe to receive World Health Organisation (WHO) validation for eliminating mother-to-child transmission of HIV and syphilis.

“In health promotion interventions we emphasise the risks of having sex in a place without minimum conditions,” said Avelino Matos, coordinator of community work with the MSM-Cuba Project, a network of 1,800 volunteer health promoters who have been working for 15 years to prevent the spread of HIV/AIDS among the most vulnerable segment of society.

In these remote areas, “there’s no light and people are nervous, so it’s impossible to negotiate the use of a condom,” Matos told IPS.

The entrance to a nightclub in Havana’s El Vedado neighbourhood, which offers drag queen shows and is a meeting place for people from the lesbian, gay, bisexual, transsexual and intersex (LGBTI) community. Credit: Jorge Luis Baños/IPS

The project, which falls under the umbrella of Cuba’s National Center for the Prevention of STDs and HIV/AIDS and is active in all 15 provinces, monitors MSM cruising and gathering spots, with an emphasis on the 49 municipalities that have top priority because they have the highest HIV/AIDS rates.

Matos described gay hangouts or socialising places – by contrast with cruising spots – as public spaces where MSM gather to meet each other, chat, and arrange dates.

He said the project’s health promoters are present around the country, although the ones in the capital are the best-known.

According to Matos, the project’s prevention work does get results, and today is using new strategies, targeting gay meeting spots in parks and on city street corners and in the growing number of gay bars, cafes and private parties.

But he lamented that they barely reach the potajeras, although in some provinces ingenious interventions have been carried out.

In the daytime, activists hang bags of condoms on tree branches, for example, in cruising spots in the central province of Villa Clara and the eastern provinces of Holguín and Granma.

And in a shantytown in the western province of Mayabeque, the project provided training in health promotion to two-seater bicycle taxi drivers, the form of transportation used to reach the cruising spots. The drivers were also given condoms, to hand out to their passengers.

Matos said it is difficult to reach bisexual men with HIV/AIDS prevention messages, because they face more prejudice than homosexuals. “That’s why they are less likely to admit to their sexual orientation; many hide their meetings with men and maintain relationships with women,” he said.

Homophobia is a major factor contributing to the spread of HIV and others STDs in the cruising sites.

“These are places in the here and now. But with this I don’t mean that everyone who engages in cruising has unprotected sex,” said Jorge Carrasco, a young journalist who in 2013 reported on the main cruising spots in Havana, such as the Playa del Chivo beach and areas around the Calixto García Hospital.

“Because of the anonymity, a lot of sick people feel better there, because they can have quick sex without the need to talk about their lives with the other person,” said the 25-year-old reporter, who defends these places as “cultural spaces” that are legal under Cuba’s current laws.

Carrasco warned of other dangers in these places, where assaults and even murders are reported, as well as police abuses. “The police, instead of only arresting the thieves, also arrest the homosexuals,” said the reporter, who recommended more training for the national police.

Amaya Álvarez, a legal adviser at the governmental National Sex Education Centre (CENESEX), told IPS that “the largest number of legal complaints by the homosexual and transgender population in the meeting places are in response to the interaction with law enforcement bodies like the police.”

For that reason, she said, CENESEX organises awareness-raising workshops for police officers.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

Significant numbers of women, such as members of the Mt Hagen Handicraft Group in the Highlands region of Papua New Guinea, have been impacted by HIV/AIDS with consequences including widowhood and hardship. Credit: Catherine Wilson/IPS

By Catherine Wilson
GOROKA, Papua New Guinea, Aug 11 2015 (IPS)

It has only been six months since Iveti, 37, lost her husband of 18 years, but already she is facing hardship and worry about the future.

Similar to many married women in the rural highlands region of Papua New Guinea, a southwest Pacific Island state of seven million people, she stayed at home to look after their two children, a daughter aged 11 and a son now in his early twenties, while her husband’s income paid for the family’s needs.

“There was always food to serve to my children, but now the man who provided the food has gone. On the days we don’t have food I make ice-blocks and sell them at the market for 20 or 30 kina [seven to 10 dollars]." -- Iveti, a 37-year-old widow
“I worry about food; I worry about bills and the children. I worry about the relatives who come and visit to mourn with us, because we have to kill a pig [for a feast] or give them something. Who is going to come and say they have the money for all this?” Iveti frets as she sits in her modest home on the outskirts of Goroka, a town in Eastern Highlands Province.

She is surrounded by her children, and her husband’s mother and sister who also live with her.

“There was always food there to serve my children, but now the man who provided the food has gone. On the days we don’t have food I make ice-blocks and sell them at the market. We get 20 kina (seven dollars) or 30 kina (10 dollars). Every two days we pay about 20 kina for the power and with the 10 kina (about 3.60 dollars) which is left, we buy a tin of fish.

“My daughter goes to school and we budget 4 kina (just over a dollar) for her lunch,” she continued.

There is a diversity of widows’ experiences in Papua New Guinea. Those who have completed secondary or tertiary education and have an independent source of income are in a strong socio-economic position to look after themselves and their children.

However, more than 80 percent of the population resides in rural areas where many women have limited access to education and employment.

Female literacy in the Eastern Highlands, for example, is about 36.5 percent. Gender inequality in the country is exacerbated by social practices, such as early and forced marriage, bride price and widespread domestic and sexual violence experienced by two-thirds of women in the country.

While there are no accurate statistics available about widows in Papua New Guinea, the national Widows Association claims that most have been in widowhood for between five and 30 years.

For women in the highlands, the risk of losing a husband is increased due to the prevalence of tribal warfare. Outbreaks of fighting between different clan groups can be triggered by disputes over landownership or pigs, the most prized livestock, or ‘payback’ for a wrong committed against a community.

And, in most cases, the death of a male warrior plunges the wife and children into a precarious existence.

Families are also being impacted by the HIV/AIDS epidemic. By 2010, 31,609 cases of the virus had been reported with the highest prevalence of 0.91 percent recorded in the Highlands, slightly higher than the national rate of 0.8 percent, which is estimated to have decreased to about 0.7 percent last year.

When a husband dies, the widow and children usually have the right to remain on the husband’s land and property. But this is often not the case if AIDS, which is accompanied by social stigma, has been the cause of death.

Agatha Omanefa, Women’s Project Officer at Eastern Highlands Family Voice, a non-governmental organisation dedicated to counselling and supporting families, told IPS that while extended families were traditionally very protective of vulnerable members, she had witnessed rising cases of brothers of the deceased husband making moves to claim the land.

When “the husband’s relatives come in to share the properties the widow becomes a loser with her children […]. Sometimes they come up with stories, history, such as: ‘you are from there, your husband is from here’ and then she [the widow] needs someone to support her to secure the land,” she explained.

“It is having a big impact on widows’ lives, especially when they have small children. So they often keep little food gardens to try and maintain the children’s welfare as well as themselves.”

Families in Papua New Guinea are traditionally large with up to eight or 10 offspring, and the struggle includes paying for children to complete education, especially to secondary level. Female headed households are several times more likely to be below the absolute poverty line, according to government reports.

But one of the greatest threats to a widow’s welfare is the risk of being accused of sorcery. In nearby Simbu Province, women aged 40-65 years are six times more likely than men to be blamed for using witchcraft to cause a death or misfortune in the community, reports Oxfam, and the consequences, including torture and murder, can be tragic.

“There is growing concern that sorcery accusations that lead to killings, injuries or exile are often economically or personally motivated and used to deprive women of their land or property,” the United Nations Special Rapporteur on Violence against Women, Rashida Manjoo, reported in 2013.

Widows with sons, however, have a source of protection.

“In our culture in the Highlands, when you have a son, no-one will chase you out, because you will gain strength from your son, but if a woman does not bear any child then she is more vulnerable,” Irish Kokara, treasurer of the Eastern Highlands Provincial Council of Women, explained.

President Jenny Gunure added that there was also a lack of awareness about women’s rights and the law at the village level, a situation the women’s council is working to rectify through a bottom-up education programme aimed at rural women, which was begun last year.

However, Kokara believes that the risk of violence will not diminish until the behaviour of young men, who often perpetrate such crimes as part of vigilante gangs, is addressed.

“It is the youths who take drugs, like marijuana, who are the ones burning the women and hanging them on trees. So we need to change the youths first, then we can change the community,” she declared.

In recent weeks widows across the country have called through the local media for the government to introduce legislation to better support recognition of their rights.

Edited by Kanya D’Almeida

Providing pregnant mothers with antiretroviral medicines can reduce the risk of HIV transmission from 45 percent to just one percent, according to the World Health Organisation (WHO). Credit: Jeffrey Moyo/IPS

By Kanya D'Almeida
UNITED NATIONS, Jun 30 2015 (IPS)

In 2013, an estimated 240,000 children were born with HIV. This was an improvement from 2009, when 400,000 babies tested positive for the infection, but still a far cry from the global target of reducing total child infections to 40,000 by 2015.

Bucking the global trend, one small island nation has made gigantic strides towards the 2015 goal. That country is Cuba, and in 2013 it recorded just two babies born with HIV.

Today, Cuba has become the first country in the world to receive validation from the World Health Organisation (WHO) that it has eliminated mother-to-child transmission of HIV and syphilis.

Executive Director of UNAIDS Michel Sidibé said in a press release today, “This is a celebration for Cuba and a celebration for children and families everywhere. It shows that ending the AIDS epidemic is possible and we expect Cuba to be the first of many countries coming forward to seek validation that they have ended their epidemics among children.”

Every single year, over 1.4 million women living with HIV become pregnant. Without proper treatment, they run a 15-45 percent chance of transmitting the virus to their kids – during pregnancy, labour, delivery or breastfeeding.

But if both mother and child receive proper antiretroviral treatment, the risk of transmission falls to just one percent.

Since 2010, the Pan American Health Organisation (PAHO), which serves as the Regional Office for the Americas of the WHO, has been working with its partners in Cuba and other states in the region to roll out a comprehensive programme to eliminate mother-to-child transmission of both HIV and syphilis.

This process has involved improving early access to prenatal care, testing for pregnant women and their partners, caesarean deliveries and substitution of breastfeeding.

Such services were undertaken and provided within the larger framework of equitable access and universal healthcare, in which maternal and child health is integrated with programmes to combat sexually transmitted diseases.

“Cuba’s success demonstrates that universal access and universal health coverage are feasible and indeed are the key to success, even against challenges as daunting as HIV,” PAHO Director Carissa F. Etienne said in a statement on Jun. 30.

“Cuba’s achievement today provides inspiration for other countries to advance towards elimination of mother-to-child transmission of HIV and syphilis,” she added.

WHO and its partners first published comprehensive guidelines on the processes and criteria for validation of eliminating mother-to-child transmissions in 2014.

Because treatment and prevention can never be 100 percent effective, ‘elimination’ is defined as “a reduction of transmission to such a low level that it no longer constitutes a public health problem”, according to PAHO.

In March of 2015, a group of international experts visited Cuba to assess its progress towards the elimination target, and spent five days visiting health clinics, labs and government institutions interviewing a range of experts and other stakeholders.

Comprised of experts from 10 countries including Argentina, Japan and Zambia, the mission considered a number of indicators – all of which must be met for at least one year – including confirming that new child infections as a result of mother-to-child transmissions are less than 50 cases per 100,000 live births.

Other indicators, which must be met for at least two years in order to receive validation, include ascertaining that more than 95 percent of HIV-positive women know their status, receive at least one ante-natal visit, and receive antiretroviral drugs.

“Eliminating transmission of a virus is one of the greatest public health achievements possible,” WHO Director-General Margaret Chan announced on Jun. 30.

“This is a major victory in our long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation,” she added.

According to the World AIDS Day 2014 Report, there were 35 million people living with HIV/AIDS in 2013. Since the start of the epidemic in the 1980s, 39 million people have died of AIDS-related illnesses and close to 78 million have become infected with HIV.

Thanks to sustained local and global efforts to fight the epidemic, the death toll has fallen significantly in the past decade, from 2.4 million deaths in 2005 to 1.5 million in 2013, representing a 35-percent decline.

New infections have also declined by an estimated 38 percent since 2001, from 3.4 million to 2.1 million in 2013.

Among children, new infections have fallen from an estimated 580,000 in 2001 to 240,000 in 2013. If more countries emulate Cuba’s example, the international community will be closer to its 2015 goals, and the ultimate goal of eliminating AIDS altogether.

Edited by Kitty Stapp

HIV-positive women gather in Kathmandu, Nepal for a skills training. Credit: Bhuwan Sharma/IPS

By Thalif Deen
UNITED NATIONS, Jun 5 2015 (IPS)

The United Nations has expressed confidence that the Asia-Pacific region, with almost five million people living with HIV, is politically committed towards the elimination of the deadly disease AIDS.

Michel Sidibé, executive director of UNAIDS, said the Asia-Pacific region is moving the world forward into new frontiers of development. "Our region has broken many barriers and saved countless lives, showing how developing countries can share responsibility, cooperate and take the lead in ending AIDS." -- Dr. Shamshad Akhtar

“You have all the right tools in your hands, beginning with political commitment. I challenge you to be the first region to end the AIDS epidemic,” he told a meeting in Bangkok.

According to the latest figures, new HIV infections have declined since 2001 and more than 1.6 million people were receiving anti-retroviral treatment by June 2014.

At the 71st session of the U.N. Economic and Social Commission for Asia and the Pacific (ESCAP) in the Thai capital Friday, political leaders and high level officials from 50 countries and territories in the region endorsed the Report of the Asia-Pacific Intergovernmental Meeting on HIV and AIDS.

The new framework identifies three areas of action. The first area is supported by ESCAP and focuses on continuing national reviews and consultations to address legal and policy barriers for ensuring universal access to HIV prevention, treatment, care and support.

The second area calls for national reviews and consultations on ensuring access to affordable drugs and medicines.

The third area promotes the development of national HIV investment cases and plans to ensure sustainable financing of the AIDS response.

Addressing the meeting, Dr. Shamshad Akhtar, U.N. Under-Secretary-General and Executive Secretary of ESCAP, said “less than halfway through 2015, with renewed vigour, governments at the highest level have committed to meet [several] regional challenges, [including that] of HIV and AIDS.”

“Our region has broken many barriers and saved countless lives, showing how developing countries can share responsibility, cooperate and take the lead in ending AIDS,” he added.

Frank Bainimarama, the prime minister of Fiji and chair of the 71st session, said: “The framework is a road map for countries on how best to accelerate their efforts in the HIV response. It will help shape the future of the HIV response in the Asia-Pacific region beyond 2015.”

In the past 10 years, at least 56 countries have either stabilised or reduced new HIV infections by more than 25 percent, according to the United Nations.

Globally, new HIV infections have been reduced by nearly 20 percent and new HIV infections among babies have dropped by 25 percent—a significant step towards achieving virtual elimination of mother-to-child transmission of HIV by 2015.

In 2011, the world commemorated 30 years of AIDS and the AIDS response.

In June 1981, scientists in the United States reported the first clinical evidence of a disease that would later become known as acquired immunodeficiency syndrome or AIDS.

Its cause, the human immunodeficiency virus (HIV), was identified in 1983.

And according to the United Nations, 30 years later the AIDS epidemic has spread to every corner of the world and more than 60 million people have been infected with HIV.

Edited by Kitty Stapp

The writer can be contacted at thalifdeen@aol.com

Prof Grace Irimu shows IPS a drip feed bag and a copy of Kenya’s ‘Basic Paediatric Protocols’ as she explains the importance of intravenous treatment in saving the lives of young children affected by acute watery diarrhoea. Credit: Miriam Gathigah/IPS

By Miriam Gathigah
NAIROBI, May 23 2015 (IPS)

Acute watery diarrhoea is a major killer of young children but misunderstanding over the benefits of fluid treatment is preventing many Kenyan parents from resorting to this life-saving technique and threatening to reverse the strides that the country has made in child health.

The 2014 Kenya Demographic and Health Survey, released in April this year, reports that the country’s under-five mortality rate fell to 52 deaths per 1,000 live births in 2014, down from the 74 deaths in 2008-09, but still far from the 32 per 1,000 live births targeted under the Millennium Development Goals (MDGs).“Parents must … understand that rapid fluid treatment is life-saving for children diagnosed with shock or poor blood circulation due to diarrhoea” – Prof Grace Irimu, Associate Professor of Paediatrics, University of Nairobi

The primary treatment for acute watery diarrhoea is rehydration, administered intravenously in the most severe cases of very young children suffering from shock after losing excessively high quantities of body fluids. A fluid bolus – or rapid liquid dose – delivered directly through an intravenous drip allows a much faster delivery than oral rehydration.

However, notes nurse Esther Mayaka at the Jamii Clinic in Mathare, Nairobi, “parents of children brought to hospital with acute watery diarrhoea are refusing to have them put on [drip] fluid treatment and this is a major concern because diarrhoea is a leading killer among children and giving fluids is still the main solution.”

She told IPS that the ongoing rains and floods in many parts of the country “have created a comeback for diseases like cholera whose most telling sign is watery diarrhoea which needs to be managed with fluids.”

In February this year, Kenya’s Director of Medical Services, Dr Nicholas Muraguri, issued a cholera outbreak alert following an increase in cases of acute watery diarrhoea in several counties, including Homa Bay, Migori and Nairobi.

According to Prof Grace Irimu, Associate Professor of Paediatrics at the University of Nairobi, the reluctance to resort to drip fluid treatment has arisen due to misunderstanding generated by a Fluid Expansion As Supportive Therapy (FEAST) study in 2011 to establish whether the bolus technique was the best practice to use among children diagnosed with shock.

The FEAST study, which was conducted among children in Kenya, Tanzania and Uganda, found that fluid boluses increased 48-hour mortality in critically-ill children with poor blood circulation or shock in these resource-limited settings in Africa, but Irimu told IPS that the study excluded diarrhoea and only studied illnesses associated with fever, such malaria and sepsis.

“Parents must therefore understand that rapid fluid treatment is life-saving for children diagnosed with shock or poor blood circulation due to diarrhoea,” she said.

The Kenya Paediatric Association is also trying to set the record straight and, in a statement shared with IPS, the association reiterated that “diarrhoea complicated by severe dehydration is one of the biggest killers of children globally.”

According to the paediatrics association, the FEAST study excluded children with diarrhoea and dehydration because “the value of giving fluids in this group is well known. Giving appropriate fluid therapy is essential.”

Prof Irimu told IPS that the FEAST study had led to a revision of the ‘Basic Paediatric Protocols’, Kenya’s national guidelines for paediatric care, and clauses that address the treatment of diarrhoea were also revised.

Previously, a child diagnosed with shock as a result of diarrhoea would be given fluids in three cycles, every 15 minutes depending on the response. Now, the child receives the fluids in two cycles and if there is no response, health providers are advised to proceed to slower fluid administration where the child is given the amount that the body needs, depending on the level of dehydration.

Meanwhile, the country continues to make strides in dealing with HIV/AIDS – another critical health issue covered by the MDGs – among children. Studies show that the number of children with HIV aged between 18 months and 14 years fell from 184,000 in 2007 to 104,000 in 2012, according to the most recent Kenya Aids Indicator Survey.

However, Prof Joseph Karanja, a reproductive health and HIV/AIDs expert in Nairobi, says that the country can still do better because “through available antiretroviral drugs as a preventive measure among HIV positive mothers, HIV transmission to the infant can be reduced to as low as one percent.”

Dr Pauline Samia, a paediatric neurologist and a board member of the Kenya Paediatric Association, says that there is also a commitment to address conditions that challenge the management of HIV among children such as epilepsy.

“Though research in this area is limited, an estimated 6.7 percent of children with HIV also have epilepsy, with at least 50 percent of children with HIV having central nervous system problems such as delayed development, behavioural challenges and convulsions,” she observes.

Regarding progress in other MDGs, some progress has been made in reducing the prevalence of underweight children less than five years of age, one of the goals set for eradicating extreme hunger and poverty.

The 2014 Kenya Demographic and Health Survey reports that not only has childhood malnutrition declined significantly, from 35 percent in 2008 to the current 26 percent, but the prevalence of underweight children also decreased from 16 percent in 2008 to 11 percent in 2014.

On the front of improving maternal health, the survey says that while maternal mortality remains high at 488 deaths in every 100,000 live births, in the past five years more than three in five births (61 percent) took place in healthcare facilities, a marked improvement compared with the 43 percent in 2008.

Edited by Phil Harris   

Slums in a Kenyan shanty town. Africa has more than 570 million slum-dwellers, according to UN-Habitat, with over half of the urban population (61.7 percent) living in slums. Photo credit: Colin Crowley/CC BY 2.0 via Wikimedia Commons

By Jeffrey Moyo
HARARE, May 22 2015 (IPS)

Nompumelelo Tshabalala, 41, emerges from her dwarf ‘shack’ made up of rusty metal sheets and falls short of bumping into this reporter as she bends down to avoid knocking her head against the top part of her makeshift door frame.

“This has been my home for the past 16 years and I have lived here with my husband until his death in 2008 and now with my four children still in this two-roomed shack,” she told IPS.

Tshabalala lives in Diepkloof township in Johannesburg, South Africa, in a densely populated informal settlement – a euphemism for slums, where an estimated 15 million of the country’s approximately 52 million people live, according to UN-Habitat, the U.N. agency for human settlements.

Neighbouring Zimbabwe has an estimated 835,000 people living in informal settlements, according to Homeless International, a British non-governmental organisation focusing on urban poverty issues. “Local authorities in African countries should strike a balance in developing both rural and urban areas, creating employment so that people stop flocking to cities in huge numbers in search of jobs” – Precious Shumba, Harare Residents Trust

“Slum-dwelling here in Africa has become normal, a trend to live with, which is difficult to combat owing to numerous factors ranging from political corruption to economic inequalities necessitated by the growing gap between the rich and the poor,” Gilbert Nyaningwe, an independent development expert from Zimbabwe, told IPS.

Overall, out of an estimated population of 1.1 billion people, Africa has more than 570 million slum-dwellers, reports UN-Habitat, with over half of the urban population (61.7 percent) living in slums. Worldwide, notes the U.N. agency, the number of slum-dwellers now stands at 863 million and is set to shoot up to 889 million by 2020.

Development agencies in Africa say slum-dwelling remains a continental trend despite the U.N. Millennium Development Goals targets compelling all countries globally to achieve a significant improvement in the lives of at least 100 million slum dwellers by 2020.

According to the United Nations, that 100 million target “was met well in advance of the 2020 deadline”, and in African countries such as Egypt, Libya and Morocco the total number of urban slum dwellers has almost been halved, Tunisia has eradicated them completely, and Ghana, Senegal and Uganda have made steady progress, reducing their slum populations by up to 20 percent.

However, sub-Saharan Africa continues to have the highest rate of “slum incidence” of any major world region, with millions of people living in settlements characterised by some combination of overcrowding, tenuous dwelling structures, and poor or no access to adequate water and sanitation facilities.

Hector Mutharika, a retired economist in late Malawian President Kamuzu Banda’s government, blamed poor service delivery for the increase in slums in Africa.

“The increasing numbers of slum dwellers in Africa is due to poor service delivery here by local authorities which more often than not worry most about filling their pockets from local authorities’ coffers instead of channelling proper housing facilities to poor people, which then pushes homeless individuals into building slum settlements anywhere,” Mutharika told IPS.

For Rwandan civil society activist Otapiya Gundurama, the roots of the problem go far back in time. “Shanty homes in Africa are a result of the continent’s urban infrastructure set up during colonial rule at which time housing and economic diversification were limited, with everything related to urban governance centralised, while towns and cities were established to enhance the lifestyles and interests of a minority,” Gundurama told IPS.

Some opposition politicians in Africa, like Gilbert Dzikiti, president of Zimbabwe’s opposition Democratic Assembly for Restoration and Empowerment (DARE), see the trend of growing slums here as a result of government failure. “The perpetual rise of slum settlements in Africa testifies to persistent failure by governments here to invest in both rural and urban development,” Dzikiti told IPS.

African civil society leaders blame rising unemployment on the continent for the continuing rise in the number of slums. “Be it in cities or remote areas, slums in Africa are a result of huge numbers of jobless people who hardly have the means to upgrade their own dwellings,” Precious Shumba, director of the Harare Residents Trust in Zimbabwe, told IPS.

In order to reverse the trend of growing slums across the continent, Shumba said, “local authorities in African countries should strike a balance in developing both rural and urban areas, creating employment so that people stop flocking to cities in huge numbers in search of jobs.”

African slum-dwellers like South Africa’s Tshabalala accuse city authorities of ignoring the mushrooming of informal settlements for selfish reasons.

“Slums here are sources of cheap labour that keeps the wheels of industry turning, which is why local authorities are not concerned about our living standards because they [local authorities] are getting more and more revenue from firms thriving on our sweat,” Tshabalala told IPS.

Meanwhile, rising slum settlements in Africa are also having a knock-on effect for other development goals in the education and health sectors for example.

“The United Nations Millennium Development Goal of universal attainment of primary education for all by the end of this year is certainly set to be missed by a number of countries here in Africa, especially as many of these sprouting slum settlements have no schools to help the children growing in the communities get any education,” a senior official in Zimbabwe’s Ministry of Primary and Secondary Education told IPS on the condition of anonymity for professional reasons.

At the same time, “there are often no toilets, no water and no clinics in most slum-dwelling areas here, exposing people to diseases, consequently derailing the MDG of halting the spread of HIV/AIDS and other diseases in informal settlements,” Owen Dliwayo of the Youth Dialogue Action Network, a lobby group in Zimbabwe, told IPS.

Edited by Phil Harris   

Distributing condoms in prisons and schools has set off a heated debate, rendering the fight against HIV/AIDS a challenge ahead of this year's U.N. deadline for nations to halt its spread. Credit: Jeffrey Moyo/ IPS

By Jeffrey Moyo
HARARE, Mar 28 2015 (IPS)

Tatenda Chivata, a 16-year old from Zimbabwe’s Mutoko rural district, was suspended from school for an entire three-month academic term after he was found with a used condom stashed in his schoolbag.

Regerai Chigodora, a 34-year-old prisoner at a jail in Harare, had his 36-year sentence stretched to 45 years after he was caught with used condoms in prison early this year.

With restrictions blocking the distribution of condoms in schools and prisons in Africa, health experts say the continent’s opportunity to halt the spread of HIV/AIDS in line with the U.N. Millennium Development Goals may be squandered,

“It will be hard for Africa to win the war against HIV/AIDS if certain groups of people like students and prisoners are being skipped from preventive measures,” Tamasha Nyerere, an independent HIV/AIDS counsellor based in Dar es Salaam, the Tanzanian capital, told IPS.

Human rights activists in Zimbabwe say more cases of youths like Chivata and prisoners like Chigodora may be going unreported in countries where condom use in jails and schools is anathema.With restrictions blocking the distribution of condoms in schools and prisons in Africa, health experts say the continent’s opportunity to halt the spread of HIV/AIDS in line with the U.N. Millennium Development Goals may be squandered.

“It’s indeed disturbing how hard we have worked as Africa to fight against the spread of HIV/AIDS yet we have not been so pragmatic in our bid to institute preventive measures in schools and jails, where most of our African governments have vehemently refused to allow condoms to be distributed with the common excuse that they promote homosexuality in jails and sexual immorality in schools,” Elvis Chuma, a gay activist in Zimbabwe’s capital Harare, told IPS.

Zimbabwean prisoner Chigodora agreed, telling IPS that “whether or not authorities here like it, homosexuality is rife in jails and even if we may smuggle in condoms to use secretly, if you get caught like in my case, you will be in for serious trouble.”

Schoolchildren in Africa like Zimbabwe’s Chivata have to contend with secret use of condoms in school. Their only crime is that they are underage, said Chivata.

“I’m serving a suspension from school because I was caught with a condom I used during sex with my girlfriend, but the same teachers teach us about use of protection if we get tempted to engage in sex. Now I’m wondering if I was wrong using a condom. Perhaps I could have gone undetected if I had opted to have unprotected sex,” he told IPS.

Under Zimbabwe’s Legal Age of Majority Act, any Zimbabwean under the age of 18 years is a minor, while a person between the age of 16 years and 18 years is defined as a young person under the Children’s Protection and Adoption Act.

Sodomy is also a punishable offence in Zimbabwe, which rights activists say, makes it difficult for this Southern African nation and other African nations to distribute condoms in prisons.

“African countries like Zimbabwe are being cornered by their own laws which bar them from dishing out condoms to prisoners and school children,” Tonderai Zivhu, chairperson of the Open Association of People Living with HIV/AIDS, a lobby group in Masvingo, Zimbabwe’s oldest town, told IPS.

South Africa and Namibia may be the only two out of Africa’s 54 countries that have adopted HIV/AIDS preventive measures in schools and jails.

In 2007, South Africa’s new Children’s Act came into effect, giving children 12 years and older the right to obtain contraceptives. The country’s Department of Correctional Services also provides condoms to inmates.

In Namibia, the country’s policy on HIV/AIDS states that all convicted prisoners awaiting trial and inmates are entitled to have access to the same HIV-related prevention information, education, voluntary counselling and testing, means of prevention, treatment, care and support as is available to the general population.

Other African countries, however, seem unclear about their position on condoms use in jails and schools.

Last year, the government of Rwanda confirmed the prevalence of homosexuality in prisons, but was non-committal on whether or not it would start distributing condoms in its correctional facilities.

This year, Zimbabwe’s Primary and Secondary Education Minister Lazarus Dokora told parliament that parents were free to pack condoms for their children in their schoolbags, but that the government would not allow them to be openly distributed at schools.

“We must say children are in school to learn and be initiated for certain life skills, and when it comes to condoms, you are the guardian of your child and you must have an intimate connection with your child so that when you pack their school luggage and prepare their books you can also pack condoms,” Dokora had said.

This laissez-faire approach has incensed certain African indigenous pro-culture activists who have been vocal in their calls against condom distribution in prisons and schools.

“Distributing condoms in prisons and in schools will render African governments accomplices to the commission of the crime of sodomy and sexual immorality among school-going children, which is against our cultural values and norms as Africans,” Bupe Mwansa, head of the Culture and Traditions Conservation Association in Zambia, an indigenous pro-culture lobby group, told IPS.

According to the World Health Organisation (WHO), an estimated 3.2 million children lived with HIV at the end of 2013, mostly in sub-Saharan Africa, with approximately 145,000 HIV-positive children from Zimbabwe.

The Zimbabwe National Statistics Agency (ZimStat) states that Zimbabwe has a total of 18,000 prisoners, with 28 percent of these living with HIV and AIDS.

In South Africa, an estimated 41.4 percent of that country’s 166,267 prisoners are also living with HIV/AIDS, based on statistics from the Ministry of Health there, despite the country being the only African nation that does not outlaw homosexuality.

Although other African governments admit there are sexual activities going on in schools and prisons, they remain hesitant to allow condom distribution in them.

“School children engage in premarital and often unprotected sex, yes we know, and prisoners also have unprotected anal sex, but presently there is nothing we can do as government to address these challenges because our laws do not allow underage children to engage in sex while homosexual, now rife in our jails, is also unlawful,” a top Zimbabwean government official speaking on the condition of anonymity told PS.

But for human rights doctors like Nomalanga Zwane in Johannesburg, fighting HIV/AIDS in schools and jails requires drastic measures.

“If school kids are left on their own with the belief that they are not engaging in sex because they are barred by being underage, we are fighting a losing battle against HIV/AIDS because the same school pupils will spread the disease even outside school while prison inmates with no access to condoms will also one day come out of jail and further spread the disease,” Zwane told IPS.

Zimbabwe’s ex-convicts like 37-year-old Jimson Gwatidzo, now an ardent campaigner for the distribution of condoms in jails after he contracted HIV in jail, sees no credible reason why some African governments forbid condoms in prisons “in the face of rampant rape-induced HIV/AIDS infections behind prison walls.”

“It is time for governments across Africa to scrap anti-sodomy laws to allow for the distribution of condoms in prisons and be able to fight HIV/AIDS spread in jails without legal barriers,” Gwatidzo told IPS.

Edited by Lisa Vives/Phil Harris    

Many specialist doctors and nurses in Africa are migrating to greener pastures, leaving cancer patients with few options. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Feb 13 2015 (IPS)

Hidden by the struggles to defeat Ebola, malaria and drug-resistant tuberculosis, a silent killer has been moving across the African continent, superseding infections of HIV and AIDS.

World Cancer Day commemorated on Feb. 4 may have come and gone, but the spread of cancer in Africa has been worrying global health organisations and experts year round. The continent, they fear, is ill-prepared for another health crisis of enormous proportions.

By 2020, according to the World Health Organisation (WHO), approximately 16 million new cases of cancer are anticipated worldwide, with 70 percent of them in developing countries. Africa and Asia are not spared.“Africa is at a crossroads in the face of rising cancer cases, with the disease proving to be more deadly than HIV/AIDS and it is worsening at a time when the continent faces a serious shortage of cancer specialists,” Menzisi Thabane, private oncologist in South Africa’s Eastern Cape Province

“Africa is at a crossroads in the face of rising cancer cases, with the disease proving to be more deadly than HIV/AIDS and it is worsening at a time when the continent faces a serious shortage of cancer specialists,” Menzisi Thabane, a private oncologist in South Africa’s Eastern Cape Province, told IPS.

“Africa and its leaders have failed to recognise cancer as a high-priority health problem despite millions of people succumbing to the disease,” added Thabane.

Most of Africa’s 2,000 plus languages have no word for cancer. The common perception in both developing and developed countries is that it is a disease of the wealthy world, where high-fat, processed-food diets, alcohol, smoking and sedentary lifestyles fuel tumour growth.

While many cancers are linked to unhealthy diets and smoking, a large number – particularly in Africa – are caused by infections like hepatitis B and C which can lead to liver cancer and the human papillomavirus (HPV) that causes almost all cervical cancers.

An HPV vaccine treatment costs 350 dollars for three doses over six months in most sub-Saharan African countries, whereas in Zimbabwe radiotherapy costs between 3,000 and 4,000 dollars for a whole session.

A study published in 2011 found that since 1980 new cervical cancer case numbers and deaths dropped substantially in rich countries, but increased dramatically in Africa and other poor regions. Overall, 76 percent of new cervical cancer cases are in developing regions, and sub-Saharan Africa already has 22 percent of all cervical cancer cases worldwide.

According to Zimbabwe’s Ministry of Health and Child Care, the country only has four oncologists catering to over 7,000 cancer patients nationwide. “The shortage of cancer doctors stands as an impediment to comprehensive treatment and care for cancer patients here,” Dr Prosper Chonzi, director of Health Services in the Zimbabwean capital, Harare, told IPS.

The shortage of cancer specialists is also seen in West Africa.

Last year, The Vanguard, a Nigerian newspaper, reported that there were an estimated 60 oncologists serving over 300 million people in the West African sub-region with fewer than 20 oncologists serving 160 million Nigerians. Ghana has only seven for 24 million people, Burkina Faso two and Cote D’Ivoire just one. Sierra Leone has more than six million people and no cancer doctors.

Across the continent in Kenya, cancer accounts for approximately 18,000 deaths annually, with up to 60 percent of fatalities occurring among people who are in the most productive years of their life. Men are most commonly diagnosed with prostate or oesophageal cancer, and women are most frequently affected by breast and cervical cancer.

Zimbabwe’s health activists blame the absence of cancer education for the upsurge of fatal cases in the African nation. “Very few people, including government, consider cancer a real threat to the health delivery system,” Agnes Matutu, director of the Zimbabwe Cancer Alliance, an anti-cancer lobby group here, told IPS.

Melody Hamandishe, a retired government nutritionist, told IPS she blamed imported genetically modified foods. This contributes to cancer, she said, as does the abuse of alcohol, often causing liver cancer.

In Zambia, anti-cancer activists accuse the government of not prioritising the fight against the disease. “People are perishing in huge numbers because of cancer here in Zambia while government is seized with fighting HIV/AIDS,” Kitana Phiri, a cervical cancer survivor, now a devoted anti-cancer activist based in the Zambian capital, Lusaka, told IPS.

In Tanzania, cancer is also wreaking havoc. A January 2014 report by the Ocean Road Cancer Institute (ORCI), the only specialised facility for cancer treatment in this east African nation, said there are 100 new patients in every 100,000 population out of the country’s population of 45 million.

Finally, in Namibia, uranium workers were reported to have elevated rates of cancers and other illnesses after working in one of Africa’s largest mines.

Rio Tinto’s Rössing uranium mine extracts millions of tonnes of rock a year for the mineral. “Most workers stated that they are not informed about their health conditions and do not know if they have been exposed to radiation or not. Some workers said they consulted a private doctor to get a second opinion,” say researchers at Earthlife Namibia and the Labour Resource and Research Institute who collaborated in a study.

“The older workers all said they know miners dying of cancers and other illnesses. Many of these are now retired and many have already died of cancers,” says the study report.

Cancer is not beyond us in terms of cancer control and reducing the impact of the disease, declared the Cancer Association of South Africa (CANSA) on World Cancer Day this year.

“The global cancer epidemic is huge and set to rise,” said Elize Jourbert, head of CANSA. “In South Africa, more than 100 000 are diagnosed annually. This day helps us spread the word and raise the profile of cancer”.

Under the tagline ‘Not beyond us’, World Cancer Day in South Africa focused on taking a positive and proactive approach to the fight against cancer, highlighting that solutions do exist regarding cancer care and early detection and that they are within reach.

Meanwhile, Ellen Awuah-Darko, the 75-year-old founder of the Accra-based Jead Foundation for breast cancer, says it was her personal experience of finding a breast lump and ending up paying tens of thousands of dollars to be treated in the United States that made her start to push for change.

“In America I had to put down 70,000 dollars before they’d even talk to me,” she said in an interview with Reuters. “I was lucky, I could afford it after my husband died and left me money, but I thought ‘why should I get treatment when others can’t’.”

Now, every Wednesday, Awuah-Darko goes with healthcare workers into communities in the Eastern Region of Ghana to offer women a simple breast examination and show them how to check themselves.

“Early detection can save your life,” she said. “I want everybody to know that. It’s not something people should be ashamed of or embarrassed about.”

Edited by Lisa Vives/Phil Harris    

Outspoken artist Edison Liburd, in St. John's, Antigua. Credit: Desmond Brown/IPS

By Desmond Brown
ST. JOHN'S, Antigua, Feb 10 2015 (IPS)

At 49 years old, Edison Liburd has established himself as one of Antigua and Barbuda’s most recognisable artists. But Liburd was not always in the spotlight. In fact, you could say he was a man in hiding.

“I have been infected with the HIV virus for about 24 years. I got my first HIV test done in February of 1993 at the Allen Pavilion Hospital in Manhattan New York,” Liburd told IPS."Equity and social justice are very important as we respond to the HIV/AIDS epidemic. HIV is as much a social and developmental disease as a medical one." -- Eleanor Frederick

“I can remember that day vividly. I felt like the earth had been removed from beneath me when I was handed the results of the test.”

HIV/AIDS first emerged in the 1980s, and now, more than three decades later, stigma associated with the disease has persisted. Liburd pointed to that sigma as the main reason why he concealed his HIV status for as long as he did.

“I hid my status for years from family. I told a few friends, but most people who I knew did not know anything about my health condition. It was fear of being ostracised that kept me from disclosing my status,” he said.

“In Antigua, HIV infected individuals still have to face job insecurity – first to be fired and last to be hired. Stigma and discrimination is still high because many still think themselves superior to individuals who are infected.

“Somehow they think themselves better than, but I believe that it is when infected individuals become empowered by taking hold of their health and indispensable to nation building that this will take a huge bite out of discrimination. People will begin to see you differently,” Liburd said.

The Caribbean is one of the most heavily affected regions in the world, with adult HIV prevalence about one percent higher than in any other region outside sub-Saharan Africa.

The HIV pandemic in the Caribbean is fuelled by a range of social and economic inequalities and is sustained by high levels of stigma, discrimination against the most at-risk and marginalised populations and persistent gender inequality, violence and homophobia.

HIV in the Caribbean is mostly concentrated in and around networks of men who have sex with men. Social stigma, however, has kept the epidemic among men who have sex with men hidden and unacknowledged. There is also a notable burden of infection among injecting drug users, sex workers and the clients of sex workers.

The main mode of transmission in the Caribbean is unprotected heterosexual intercourse – paid or otherwise. Sex between men is also thought to be a significant factor in several countries, although due to social stigma, this is mainly denied.

The level of stigma and discrimination suffered by those infected and affected by the virus in the Caribbean helps drive the epidemic underground. This makes it difficult to reach many groups.

After facing the worst of his fears, being hospitalised and getting close to death’s door, Liburd has “resolved to fight back against the discrimination by increasing my capacity to help others in every way through my gift of art and my voice on and in the media, in church and otherwise.

“This has really been a powerhouse for me. I have become more confident and bold when faced with opposition. It has and is still more than ever being a source of inspiration and encouragement for many who hear my story, both infected and non-infected alike.”

Executive director of the Antigua and Barbuda HIV/AIDS Network (ABHAN), Eleanor Frederick, said individuals living with HIV face many challenges such as unemployment, homelessness, and in some cases, they are abandoned by their families.

She said there are also other issues that are faced by some individuals “such as stigma, discrimination, resource shortage and social marginalisation” depending on the community with which they identify such as sexuality, gender, commercial sex workers, men who have sex with men, drug users and prisoners.

“Many individuals are reluctant to start treatment because of the myths and stories about HIV and AIDS,” Frederick told IPS. “Healthcare providers, peers and treatment navigators can help individuals to understand, the barriers and how to overcome them.”

ABHAN has a Peer/Buddy HIV Treatment Adherence Programmme which recruits, monitors and retains patients into treatment and care and ensures that they adhere to their treatment regimen. It also delivers a comprehensive package of services, including case management, leading to decreased risky sexual behaviour, improved immune system functioning, and general health improvement.

“The programme provides direct support services by specially trained ABHAN and American University of Antigua Medical School (AUA) student volunteers, in the form of social interaction, emotional support, monitoring of medication adherence, and facilitation of health care concerns to persons living with HIV and AIDS, and to members of their families,” Frederick told IPS.

At the country level, she said while there is legislation which specifically addresses the treatment of employees living with HIV/AIDS, it is not always followed.

“A pilot programme was undertaken in 2012. The intention was to encourage the implementation and observance of the standards set out in the International Labour Organisation (ILO) code of practice on HIV/AIDS and the world of work, the ILO Recommendation No. 200 as well as the National Tripartite Workplace Policy on HIV and AIDS in Antigua and Barbuda; based on the universal human rights standards applicable to HIV and the world of work,” Frederick explained.

“Individuals have lost their jobs because of their HIV status and others have been asked to take an HIV test when it was suspected that they were possibly infected.”

The ABHAN executive director said HIV should be everyone’s concern, because “HIV does not discriminate, and knows no borders.”

She added that “equity and social justice are very important as we respond to the HIV/AIDS epidemic. HIV is as much a social and developmental disease as a medical one.

“Therefore, I would like to encourage everyone to help improve the quality of life for people with HIV and AIDS and increase compassion for them and their loved ones by providing vital human services for those in need of it based on a philosophy of non-judgmental support as practiced by ABHAN.”

Edited by Kitty Stapp

Social worker in the flat of a drug addict in Donetsk doing outreach work. Drug addicts, like other marginalised groups, including Roma, are victims of the collapse of the health system in East Ukraine. Credit: Natalia Kravchuk/International HIV/AIDS Alliance Ukraine©

By Pavol Stracansky
KIEV, Jan 28 2015 (IPS)

With international organisations warning that East Ukraine is on the brink of a humanitarian catastrophe as its health system collapses, marginalised groups are among those facing the greatest struggle to access even basic health care in the war-torn region.

The conflict between pro-Russian separatists and Ukrainian forces has affected more than five million people, with 1.4 million classified by the World Health Organisation (WHO) and human rights bodies as “highly vulnerable” because of displacement, lack of income and a breakdown of essential services, including health care.

Fighting and accompanying measures imposed by both sides have led to medical supplies being severely interrupted or cut off entirely, hospitals destroyed or battling constant water and power cuts, and crippling staff shortages at health facilities as medical staff flee the fighting.

A complete lack of vaccines is threatening outbreaks of diseases such as polio and measles, while there are concerns for HIV/AIDS and TB sufferers as supplies of vital medicines dry up and disease monitoring becomes almost impossible.Fighting and accompanying measures imposed by both sides have led to medical supplies being severely interrupted or cut off entirely, hospitals destroyed or battling constant water and power cuts, and crippling staff shortages at health facilities as medical staff flee the fighting.

Massive internal displacement because of the conflict – latest U.N. estimates are of 700,000 internally displaced persons (IDPs) with the figure rising by as much as 100,000 per week – has also left hundreds of thousands living in sometimes desperate and unhygienic conditions, creating a further health risk and the chance that infectious diseases, such as TB, will spread.

But while there is a threat to healthcare provision from collapsing resources, some in the region are facing extra barriers to accessing health care.

Ukraine has one of the worst HIV/AIDS epidemics in the world and the spread of the disease has been fuelled mainly by injection drug use. But, unlike in many Eastern European states, the country has been running for more than a decade an internationally lauded range of harm reduction programmes which have been credited with checking the disease’s spread.

These have included opioid substitution therapy (OST) programmes available to drug users across the country. These are particularly important in East Ukraine because the majority of Ukraine’s injection drug users come from the Luhansk and Donetsk regions.

But local and international organisations working with drug users say that addicts’ access to life-saving treatment in those areas has come under increasing pressure since the start of the conflict and that it could be cut off entirely within weeks as supplies of methadone and buprenorphine used in the treatment run out and cannot be replaced.

The International HIV/AIDS Alliance Ukraine which runs many OST centres as well as other harm reduction programmes, has said that stocks of antiretroviral drugs, OST and other life-saving treatments will have run out by  February.  More than 300 OST patients in Donetsk and Luhansk have lost access to treatment since the conflict began, while a further 550 patients on methadone will run out of drugs soon if emergency supplies cannot be delivered.

U.N. officials in close contact with international organisations helping drug users as well as doctors in Donetsk have confirmed to IPS that clinics have only a few weeks’ worth of stocks of methadone left.

One doctor in Donetsk working on an OST programme, who asked not to be named, told IPS:  “There are serious problems with medicine supplies. The last shipments came in September last year and some patients have already had to finish their treatments. Many had been on it for a decade and in that time had forged new lives, put their, sometimes criminal, past behind them and had families. It was absolutely tragic for them when they stopped.”

It is unclear what will happen to all those no longer able to access OST treatment. Doctors say some have gone into detoxification, while others have moved to other cities in safer areas of Ukraine in the hope of continuing OST.

But with 60 percent of those receiving OST also being HIV positive, according to the Donetsk doctor, and reports that many are now turning to illicit drugs and needle-sharing again as access to OST is cut off, there are concerns that the disease, along with Hepatitis C which is rife among injection drug users, and tuberculosis, could be spread, and that the lives of many drug users will again be at risk.

OST patient Andriy Klinemko, who was forced to flee Donetsk with his wife when their house was destroyed in bombing last summer and who is now in Dnipropetrovsk in central Ukraine, told IPS: “OST patients in East Ukraine are being forced to move, but not all of them can and even those that make it to other regions may not be able to continue OST because there is no money left to run such programmes. It’s a bad situation and at the moment I really can’t see any way it’s going to get better.”

But drug users are not the only marginalised community struggling to access health care.

Historically, the estimated 400,000-strong Roma community in Ukraine has, like Roma in many other Eastern European states, faced widespread discrimination in society, including in employment and education.

They have also always had limited access to healthcare because many Roma lack official ID documentation which makes it difficult for many to obtain official health care, while widespread poverty also means services and medicines which require any payment are also inaccessible to most. Meanwhile, many Roma settlements are in remote locations, far away from the nearest health centres.

Dr Dorit Nitzan, head of the WHO’s Ukraine Office, told IPS: “Even before the conflict, Roma in Ukraine had limited access to curative and preventive health service. As a result, Roma children have extremely low vaccination coverage. Moreover, rates of tuberculosis and other communicable and non-communicable diseases are higher among Roma than in the general population.”

Discrimination is also a problem. Zola Kondur of the Chiricli Roma rights group in Ukraine, told IPS: “In terms of healthcare, Roma are among the most vulnerable in the country. They are treated badly because of their ethnicity.”

However, the problems for Roma have dramatically worsened since the conflict began. Some human rights groups have said that since the separatist regimes took power in the region, Roma have faced systematic violent and sometimes fatal repression.

According to a report this month of an international mission to monitor human rights

by the Kharkiv Human Rights Protection Group, Roma living in separatist-controlled areas have been “subjected to open aggression from militants ….[who] have carried out real ethnic cleansing” against them. Many have fled and become IDPs, subsequently facing health struggles.

Dr Nitzan said: “As in every crisis, if not given special attention, marginalised and vulnerable groups are at higher risk. In Ukraine, many Roma lack civil documentation, and thus cannot be registered as internally displaced persons and are not included in the provision of any health services.

“Moreover, their inability to pay ‘out-of-pocket’ limits their ability to procure medication and/or services. Compounding this is that many Roma IDPs are residing at the margins of society, in remote geographical locations, where no services are available. All of these factors make health services inaccessible to Roma.”

Local rights groups say that Roma who have managed to flee to safe areas have often ended up homeless and starving after facing problems accessing aid because of a dismissive attitude from volunteers and staff at social institutions, while their lack of identification documents also prevented them from accessing any official help.

However, even those who have managed to find treatment have sometimes faced further problems.

Kondur told IPS: “In one case a Roma family moved from Kramatorsk to Kharkiv. A little boy had a heart problem brought on by the stress of the fighting and he was taken to hospital. One night, a group of young people broke the window of the boy’s hospital room, shouting ‘Gypsies get out’. The boy had a heart attack.”

Edited by Phil Harris

Caring for MDR-TB patients at home or even at taking them to hospitals is a challenge for relatives, especially as the disease is uncertain to completely go away after treatment. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Jan 25 2015 (IPS)

About eight years ago, 44-year-old Tilda Chihota was struck with tuberculosis which kept her bed-ridden for over six months at her rural home in Zimbabwe’s Mwenezi district, 144 kilometres southwest of Masvingo, the country’s oldest town.

Although Chihota later recovered after receiving treatment at a local district hospital here, early this year, she was once again struck with the same ailment. This time is came with increased severity in the form of multi-drug-resistant tuberculosis (MDR-TB).“MDR-TB cases will continue to increase and worsen as long as the backlog of TB cases keeps increasing." -- Dr. Charles Sandy

MDR-TB occurs when a strain of TB bacteria becomes resistant to two or more “first-line” antibiotic drugs prescribed to combat standard TB.

According to the Ministry of Health and Child Welfare, cases of MDR-TB nearly doubled from 156 in 2011 to 244 cases in 2013. This was despite the fact that notifications for ordinary TB drastically declined from 47,000 in 2010 to 38,367 in 2012.

“I am HIV-positive, but because I defaulted on taking treatment drugs, doctors have diagnosed me with MDR-TB,” Chihota told IPS.

Cases of MDR-TB like Chihota’s are common among people who are living with HIV/AIDS, according to the United Nations AIDS organisation (UNAIDS). Close to 80 percent of TB patients in the care of Doctors Without Borders are co-infected with HIV/AIDS.

“The best way of avoiding MDR-TB is prevention through strict adherence to prescribed treatment by the health provider,” Dr. Charles Sandy, deputy director for the AIDS and TB unit in Zimbabwe’s Health ministry, told IPS.

According to the World Health Organisation (WHO), it takes longer to treat MDR-TB, which can only be cured with the use of very expensive second line drugs that often cause serious side effects.

These include nausea, vomiting and permanent deafness, which often deters patients from finishing their treatment course. On average, patients need to take between 12 and 15 tablets daily for two years, which cost about 5,000 dollars for the entire course.

“The treatment drugs required per each MDR-TB patient are quite expensive and involve the use of quantities of resources enough to treat more than 100 TB patients, which is a strain on government’s public health sector,” Everson Murwira, a local health inspector based in Gweru, a town 222 kilometres west of Harare, the Zimbabwean capital, told IPS.

Medical doctors also point out a litany of many other factors fuelling rising cases of MDR-TB here.

“Food insecurity, large numbers of Zimbabwe’s population living in destitution, lack of balanced diet and crowded and often poorly ventilated homes in both the countryside and high density suburbs in cities leads to TB patients not recovering, but rather further suffering from MDR-TB,” Tinashe Chauke, a private medical doctor often treating TB patients in Masvingo, told IPS.

Chauke added that because most Zimbabweans are poor, “they can hardly afford to visit doctors for regular medical check-ups, resulting in most former TB patients falling prey to MDR-TB.”

But government could be doing more to combat TB.

At last year’s World TB Day commemorations, Health Minister Dr. David Parirenyatwa expressed concern at the number of missed TB cases here, saying that based on WHO projections, Zimbabwe missed 30,000 TB cases in 2013 alone.

“We continue to miss TB cases because of stigma and lack of awareness in the community and limitations in access to health services as well as the quality of health services,” Dr. Parirenyatwa said at the time. World Tuberculosis Day falls on Mar. 24 each year.

Médecins Sans Frontières (MSF or Doctors without Borders in English) says direct observed treatment is the best model to manage MDR-TB.

“Direct observed treatment of MDR-TB patients in their homes by their loved ones is the best option, but in Zimbabwe, only doctors and nurses can inject patients and nobody else, which creates a challenge for patients,” an MSF medical doctor in Harare, speaking on the condition of anonymity, told IPS.

With the help of MSF two years ago, 3,200 patients in Zimbabwe were placed under treatment for TB while 63 patients were treated of MDR-TB.

Government cooperation with MSF, however, has been spotty. In a recent case, an MSF clinic in Beitbridge district near the South African border that treated HIV/AIDS and TB was forced to close after government officials accused the clinic of meddling in politics.

According to MSF, Zimbabwe trails behind other countries in Southern Africa in its response to TB. Diagnostics need improving and treatment needs to be decentralised to community levels, the health agency said in a recent report.

A 2010 UNICEF report revealed that 78 percent of Zimbabwe’s 13 million people were living in ‘absolute poverty’, following which the WHO global tuberculosis report of 2012 placed Zimbabwe’s estimated TB incidence per capita at 603 per 100,000 population.

“Besides inadequate medical facilities, there are also many cases where sick people have needlessly died because they could not access medical attention due to bad or nonexistent roads,” said Edmond Kabarapate, the village head of Kafurambanje Village, said in a recent press interview.

Although Zimbabwe has made significant strides in reducing HIV/AIDS infections to 15.6 percent from 16 percent in 2007, according to the United Nations Development Programme (UNDP), it is still a sad story for this country as it contends with the menace of MDR-TB.

“MDR-TB cases will continue to increase and worsen as long as the backlog of TB cases keeps increasing,” Dr. Sandy told IPS.

Evident of Dr Sandy’s sentiments, the 2009 WHO Global TB Control Report rated Zimbabwe as having the fourth highest incidence of TB in the world. In 2012, the WHO reported that the Southern African nation was amongst 22 countries referred to as the TB “high burden” countries.

Caught up in difficult health situations, especially MDR-TB, many Zimbabweans like Chihota are unsure whether or not they will live after contracting the disease.

“Whether for better or for worse, with the MDR-TB that is wasting me away, taking the complex treatment prescribed to me, I am still very uncertain about what the future holds in as far as my state of health and even my survival is concerned,” Chihota told IPS.

Edited by Lisa Vives

Many children under 15 in Zimbabwe discover their HIV status only when they fall critically ill later in life. Credit: Jeffrey Moyo/ IPS

By Jeffrey Moyo
HARARE, Jan 17 2015 (IPS)

Fifty-one-year-old Mateline Msipa is living with HIV. Her 17-year-old daughter, born after Msipa was diagnosed with the virus, may also have it, but she has never been tested.

“My daughter is not aware of my HIV status and with the stigma associated with the disease, it is hard for me to now open up to her about my status,” Msipa told IPS.“Talk of rejection, talk of stigma and discrimination about HIV-positive people here has rendered me confused on whether or not I should get tested for HIV/AIDS, although I don’t know what killed my parents." -- 13-year-old Tracey Chihumwe

Msipa’s daughter says she has never attempted to undergo an HIV test despite Zimbabwe’s revised testing guidelines allowing children of her age to get one without parental consent.

“I have no reason to get tested for HIV because I have never engaged in sexual intercourse before,” the 17-year-old told IPS.

Figures show that thousands of children in Zimbabwe are infected with HIV – presenting a major battlefield for government efforts to defeat the spread of HIV /AIDS nationwide.

The U.N. agency UNAIDS estimates that nearly 200,000 children from birth to age 14 have the virus but are not in treatment because they have not been properly tested. It is a trend that researchers term “suboptimal” counseling and testing in that southern African country.

“Children often get tested for HIV [only] when they fall critically ill, which usually doesn’t save them from dying,” Letwin Zindove, an independent health expert who works as an HIV/AIDS counselor here, told IPS.

The new estimate threatens to dash the southern African nation’s effort to meet a U.N. goal of reversing the incidence of infection in the population by 2015.

Older children – between six and 15 – who might have acquired HIV at birth are especially vulnerable to a major outbreak of full-blown AIDS. A study last year by the London School of Hygiene and Tropical Medicine found this group received inadequate access to provider-initiated HIV testing and counselling by primary care-givers.

Lack of clear national standards for HIV/AIDS testing leads to confusion and missed diagnoses in some cases. Credit: Jeffrey Moyo/ IPS

The study found health-care workers were reluctant to offer testing which could expose the child to abuse if he or she tested positive. On top of this, long waiting periods for appointments also hindered routine testing and counseling.

Last year, Zimbabwe launched its revised national guidelines for HIV testing and counselling with special emphasis on couples, children and adolescents as it stepped up efforts to halt the spread of the virus ahead of the 2015 deadline of the U.N. Millennium Development Goals (MDGs).

Under these guidelines, a child aged 16 years or older is eligible to give full consent for HIV testing and counselling.

However, the study found that many healthcare workers don’t fully understand the new guidelines.

“They expressed confusion about the age at which a child could choose to test him/herself, what type of caregivers qualified as legal guardians, and whether guardians had to undergo testing themselves first,” it said.

The appearance of a slow-progressing HIV disease among children has also contributed to dangerous delays in testing. New research has found that a substantial number of HIV-infected children survive to older adulthood. Delaying testing and diagnosis until symptoms appear results in a high risk of chronic complications such as stunting and organ damage.

Under the U.N.’s MDG Target 6A, countries should have halted new infections and begun to reverse the spread of HIV/AIDS by 2015.

Zimbabwe’s numbers of HIV incidence may be high (14.7 percent of adults) but the numbers are higher yet in South Africa (17.8 percent), Botswana (23 percent), Lesotho (23.6 percent), and Swaziland 25.9 percent.

Countries with low numbers are Mali, Guinea, Burkina Faso, Benin, Sudan, Senegal, Niger, Mauritania and Somalia – ranging from 1.0 percent to 0.7 percent.

While most countries are achieving a measure of success towards the U.N. goal, two have been a major health care disappointment.

Uganda, once hailed as a Cinderella success story, and Chad have seen a rise in infections. It is a disappointing turnaround from the 1990s when an aggressive public awareness campaign that urged medical treatment and monogamous sexual relationships led to a precipitous drop in infection rates in Uganda.

In 2012, H.I.V. infection rates in Uganda were seen to have increased to 7.3 percent from 6.4 percent in 2005. Over roughly the same period, the United States, through its AIDS prevention strategy known as Pepfar, or the President’s Emergency Plan for AIDS Relief, spent 1.7 billion dollars in Uganda to fight AIDS.

Activists say children are not immune to the deep-rooted stigma surrounding HIV/AIDS here — another barrier to testing.

“Zimbabweans are one huge community, closely-knit, and once a child is tested for HIV, it becomes difficult for it to remain confidential, resulting in any child tested becoming exposed to stigma,” Sifiso Mhofu, an affiliate of the Zimbabwe National Network of People living with HIV, told IPS.

This problem is very real for orphans like 13-year-old Tracey Chihumwe (not her real name) from Mabvuku, a high-density suburb of Harare, the Zimbabwean capital.

“Talk of rejection, talk of stigma and discrimination about HIV-positive people here has rendered me confused on whether or not I should get tested for HIV/AIDS, although I don’t know what killed my parents,” Chihumwe told IPS.

The Zimbabwean government is now struggling to ensure to that 85 percent of the population – including children and adolescents – knows their HIV status by the end of this year, in a desperate bid to meet the MDGs deadline in December.

But this will not be an easy task.

“Despite revised guidelines of HIV testing for children, pockets of resistance to get children tested for the virus exist from children themselves, parents and guardians as well,” a top government official, who requested to remain anonymous for professional reasons, told IPS.

Edited by Lisa Vives and Kitty Stapp

The view from a red-light district in India, where some three million sex workers are caught in the middle of a debate on legalisation. Credit: bengarrison/CC-BY-SA-2.0

By Neeta Lal
NEW DELHI, Jan 16 2015 (IPS)

Thirty-six-year-old Chameli Devi, a sex worker operating out of New Delhi’s G.B. Road – Asia’s largest red-light district, housing an estimated 12,000 of India’s three million sex workers – is an unhappy woman these days.

A contentious debate over the sex trade in India, following a call for legalisation by the National Commission for Women (NCW) – a state-run body that advises the government on women-related policy matters – has Devi worried.

“In wealthier countries, many women genuinely choose this trade due to better income prospects and opportunities. But in India, every woman who enters this trade has invariably been coerced into it by a trafficker, her family or her husband." -- Sarita, a 43-year-old sex worker in New Delhi
She feels that merely issuing licences or permits to people of her ilk will not lead to the improvement of the unhealthy and, at times, dangerous conditions under which commercialised prostitution functions.

According to U.N. reports, about 70 percent of sex workers in India are abused by their clients and the police. Abuse, say activists, is often under-reported by sex workers due to a lack of knowledge of their basic rights.

“Most of us don’t take to the flesh trade out of choice but are sold by criminal mafias to brothels. The move to regulate our business will only end up giving immunity to the pimps and brothels to buy or sell poor women like us while increasing trafficking of young women and children,” Devi told IPS.

A recent study conducted by the Indian philanthropic non-profit Dasra found that roughly half of trafficking victims are adolescent girls, while the average age of sex workers has dropped from 14-16, to 10-14, “because young girls are believed to have a lower risk of carrying a sexually transmitted disease”.

“Most victims come from rural areas, over 70 percent are illiterate, and almost half reported that their families earned just about one dollar [per day],” the report stated.

Other studies have found that most sex workers in India are form the lower castes, communities that are routinely subjected to violence and exploitation in a highly stratified society.

It is unsurprising, then, that scores of women trapped in the trade remain highly opposed to legalization.

Sarita, 43, another sex worker, feels that while there may be a sound argument for legalisation in richer countries like the USA, or even China, such a system is ill-suited to India.

“In wealthier countries, many women genuinely choose this trade due to better income prospects and opportunities. But in India, every woman who enters this trade has invariably been coerced into it by a trafficker, her family or her husband,” she asserted. “So the dynamics of our society are very different.”

Curbing the flourishing sex trade

A 2014 study, ‘Economics Behind Forced Labour Trafficking’, spearheaded by Indian Nobel Peace Prize-winner Kailash Satyarthi, contains some of the most up-to-date data on the flourishing sex trade.

“The figures are shocking…In India alone, the money generated through [the] sex trade so far stands at a whopping 343 billion dollars. Research confirms that several agencies such as traffickers, brothel owners, money lenders, law enforcement officials, lawyers, judiciary and to a certain level even the victims of CSE (commercial sexual exploitation) eventually receive money for participation,” Satyarthi said in the study.

According to a 2009 United Nations report, sex trafficking is the commonest form of human trafficking in the world, making it the largest slave trade; about 79 percent of all human trafficking is for sex work and it is the fastest growing criminal industry globally.

Countries that have legalised prostitution are not much better off. The Netherlands, which legalised prostitution in 2000, continues to grapple with human traffickers smuggling women into the country’s brothels, point out non-profits working in the area.

With the legalisation debate gaining traction, public opinion in India is also splintered over the issue. Those who favour the move feel that it will whittle down harassment, legal intimidation, entrapment and exploitation of sex workers.

NCW Chairperson Lalitha Kumaramangalam, who set the ball rolling with her suggestion that the trade be brought under state control last month, feels that such a step will ensure better living conditions for women engaged in commercial sex work.

She contends it will reducing trafficking of both girls and women and improve the health conditions of sex workers who are presently forced to serve clients in unhygienic conditions and without condoms, which has caused HIV and other sexually transmitted diseases to spread.

In fact health care experts extend some of the strongest arguments in favour of legalising prostitution, or regulating it. They feel that the rapid spread of HIV/AIDS across the world, especially in Asia and Africa, can be checked by bringing the business under the state umbrella as this will help health workers to better educate those in the trade about condom usage and basic hygiene.

Safer sex work or a massive bureaucracy?

Opponents of legalisation, however, are wary of the consequences of adding layers of regulation to India’s massive bureaucracy. They fear that government intervention could trigger harassment of the very people it seeks to protect.

“Legalising prostitution is legalising the profiteers of the sex-industry and their customers,” Ranjana Kumari, director for the New Delhi-based think tank Centre for Social Research, told IPS.

“It means rape of poor, lower-caste women with impunity. Not only that, it will make India a world magnet for sex trafficking and sex tourism.”

Donna M. Hughes, professor of Women’s Studies at the University of Rhode Island, writes in her essay ‘Prostitution: Causes and Solutions’ that legalisation does not reduce prostitution or trafficking.

“In fact,” she writes, “both activities increase because men can legally buy sex acts, and pimps and brothel keepers can legally sell and profit from them … In the Netherlands, since legalisation, there has been an increase in the use of children in prostitution.”

Activists working with sex workers are also deeply divided over the issue. While Dr S. Jana, who launched the 65,000-strong sex workers’ forum — Durbar Mahila Samanwaya Committee — based out of the eastern Indian state of West Bengal, has supported the legalisation call, others fear that it will further embolden traffickers and the prostitution mafia.

“Indian law and government policies have failed to protect sex workers due to the loopholes in law which makes them vulnerable to abuse. If the trade is legalised, the situation will worsen,” Meena Seshu, a feminist activist and founder of SANGRAM, a voluntary organisation working in the field of HIV control based in Sangli, a city in the western state of Maharashtra, told IPS.

Legalisation, adds the activist, could also scupper attempts by many women’s organisations and NGOs to rehabilitate women and children forced into prostitution.

“The state should formulate policies and schemes for the rehabilitation of sex workers who are coming out of this commercial sexual exploitation. This will offer a better solution to this complex problem,” Seshu contends.

Edited by Kanya D’Almeida

Zimbabwe has criminalised gay relationships, striking fear into the hearts of many gays like these two walking side by side in the country’s capital, because they are being left out in strategies to combat HIV/AIDS. Credit: Jeffrey Moyo

By Jeffrey Moyo
HARARE, Dec 18 2014 (IPS)

Despite a mandate to eradicate HIV/AIDS under the U.N. Millennium Development Goals (MDGs), Zimbabwe has done little or nothing to reduce the rate of infection among vulnerable gays and lesbians, say activists here.

The MDGs are eight goals agreed to by all U.N. member states and all leading international development institutions to be achieved by the target date of 2015. These goals range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education.

Gays and lesbians activists here say more needs to be done because population groups such as men who have sex with men and transgender people remain at the periphery of the country’s intervention strategies.

“In as far as combatting HIV/AIDS is concerned, there are no national programmes targeted for minority groups or interventions that can easily be accessible by the LGBTI (lesbian, gay, bisexual, transgender and intersex) community on prevention and care within the public healthcare system,”Samuel Matsikure, Programme Manager of Gays and Lesbians of Zimbabwe (GALZ), told IPS.“Whether the Zimbabwean government likes it or not, it has to face the reality that gays and lesbians exist and should therefore cater for their HIV/AIDS needs in emerging with strategies to combat HIV/AIDS just like it does for all other citizens, for how do we end the scourge if we ignore another group of people who will certainly spread the disease” – civil society activist Trust Mhindo

“There are knowledge gaps of healthcare workers on the needs and best methods on prevention, treatment and care for the HIV-positive LGBTI individuals,” adds Matsikure.

GALZ is a voluntary association founded in 1990 to serve the needs and interests of LGBTI persons in Zimbabwe, pushing for social tolerance of sexual minorities.

But 24 years after GALZ was founded, Zimbabwe’s Sexual Offences Act still criminalises homosexuality. According to Section 4.78 of Zimbabwe’s new constitution, persons of the same sex are prohibited from consensual sex or marrying each other.

Civil society activists say the Zimbabwean government has to accept the reality that gays and lesbians exist.

“Whether the Zimbabwean government likes it or not, it has to face the reality that gays and lesbians exist and should therefore cater for their HIV/AIDS needs in emerging with strategies to combat HIV/AIDS just like it does for all other citizens, for how do we end the scourge if we ignore another group of people who will certainly spread the disease,” Trust Mhindo, a civil society activist, told IPS.

HIV/AIDS activists here rather want the legislation on gays and lesbians changed. “We need to fight for a change of laws so that gays and lesbians are given recognition, without which fighting HIV/AIDS among LGBTI will remain futile,” Benjamin Mazhindu, Chairperson of the Zimbabwe National Network for People Living with HIV (ZNPP+), told IPS.

Globally halting the spread of HIV/AIDS by 2015 is part of the U.N. MDGs, but with members of the LGBTI sidelined in fighting the disease in Zimbabwe, the battle may be far from over.

“Most healthcare facilities in Zimbabwe are not friendly to LGBTI persons, hindering disclosures of ailments like anal STIs [sexually transmitted infections]while sexual and reproductive health information for the LGBTI community is non-existent, creating a vacuum with healthcare facilities for minorities,” GALZ director Chester Samba told IPS.

“If you today walk into any government healthcare centre, be sure not to find any information or literature on gays and lesbians in as far as HIV/AIDS is concerned,” he added.

And for many Zimbabwean gays like 23-year-old Hillary Tembo, living with HIV/AIDS amounts to a death sentence because he fears accessing medical help from government healthcare centres.

“I’m HIV-positive and ridden with STI-related sores in my anus and truly I’m afraid to show this to health workers, fearing victimisation owing to my sexuality,” Tembo told IPS.

But Zimbabwean Health Minister David Parirenyatwa told IPS: “When a person visits a healthcare centre, nothing is asked about one’s sexual orientation.”

According to Samba, although there are no reported cases of HIV-positive LGBTI people being denied antiretroviral treatment on account of their sexual orientation, “there is need for a national HIV/AIDS response to address the barriers preventing members of the LGBTI community from accessing services that address their HIV/AIDS health care needs, including access to information that is relevant to them.”

However, faced with a constitution forbidding gay relations, government here finds it an uphill task to consider a group of people that it constitutionally does not recognise in combatting HIV/AIDS.

“We can’t arm-twist our supreme law which does not condone homosexuality to fit in to the needs of a small group of people who are disobeying the law,” a top government official, speaking on the condition of anonymity, told IPS.

And for gays and lesbians in this Southern African nation, whether the U.N. MDGs matter or not, to them suffering may continue as long as they remain a forgotten lot in fighting HIV/AIDS.

“As homosexuality is illegal in Zimbabwe, it is difficult for prevention programmes to reach men who have sex with men (MSM) and all MSMs living with HIV/AIDS are often unable to access HIV treatment, care and support,” Samba told IPS.

Asked how many HIV-positive LGBTI persons there were in Zimbabwe, the GALZ director said that he could not give figures because “there are no mechanisms at national level to capture data based on one’s sexual orientation.”

However, in its yet-to-be published 2014 research on the impact of HIV/AIDS on LGBTI persons, GALZ says that of the 393 MSMs tested for HIV/AIDS this year, 23.5 percent were found positive while of the 179 women having sex with women (WSWs) tested for HIV/AIDS, 32.6 percent were found positive in Zimbabwe.

According to the National Aids Council in Zimbabwe (NAC),1.24 million people in the country are living with HIV/AIDS, which is approximately 15 percent of the country’s over 13 million people. LGBTI persons are part of this percentage.

Statistics from the Zimbabwe National Statistics Agency this year show that LGBTI persons in Zimbabwe contribute about four percent of the people living with HIV/AIDS.

With a membership of 6,000 gays and lesbians, GALZ says 15 percent of these are living with HIV/AIDS, with five of its members having succumbed to HIV/AIDS since January. The organisation claims that it normally loses 5 to 10 people each year. “Statistics we have so far are of GALZ-affiliated members, not representative of the national statistics,” said the GALZ director.

For many HIV-positive Zimbabwean gays like Tembo, as the world rushes towards the deadline for attainment of the U.N. MDGs, without clearly defined strategies to fight HIV/AIDS within the LGBTI community, the war against the scourge may be far from over.

“How can we triumph over HIV/AIDS when among the LGBTI community we are without strategies from government to combat the disease?” Tembo asked rhetorically.

(Edited by Lisa Vives/Phil Harris)

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.

Faced with starvation, hordes of jobless Zimbabweans in towns and cities here have turned to vending on streets pavements to put food on their tables. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Dec 9 2014 (IPS)

As unemployment deepens across this Southern African nation and as the country battles to achieve the United Nations Millennium Development Goals (MDGs) ahead of the December 2015 deadline, thousands of urban Zimbabweans here are facing starvation.

The MDGs are eight goals agreed to by all U.N. member states and all leading international development institutions to be achieved by the target date of 2015. These goals range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education.

Zimbabwe has a total population of just over 13 million people, according to the 2012 National Census – of these, 67 percent now live in rural areas while 33 percent live in urban areas.

According to the Poverty, Income, Consumption and Expenditure Survey report for 2011-2012 from the Zimbabwe Statistical Agency (ZIMSTAT), 30.4 percent of rural people in Zimbabwe are “extremely poor” – and are also people facing starvation – compared with 5.6 percent in urban areas.“The current inability of the economy to address people’s basic needs is leading to hunger in most urban households, with almost none of urban residents in Zimbabwe being able to afford three meals a day nowadays” – Philip Bohwasi, chairperson of Zimbabwe’s Council of Social Workers

Social workers find the stay of urban dwellers in Zimbabwe’s cities justifiable, but ridden with hardships.

“Remaining in towns and cities for many here is better than living in the countryside as every slightest job opportunity often starts in urban areas in spite of the expensive living conditions in towns and cities,” independent social worker Tracey Ngirazi told IPS.

According to Philip Bohwasi, chairperson of Zimbabwe’s Council of Social Workers, urban starvation is being caused by loss of jobs – the World Food Programme (WFP) estimates unemployment in Zimbabwe to be at 60 percent of the country’s total population.

“The current inability of the economy to address people’s basic needs is leading to hunger in most urban households, with almost none of urban residents in Zimbabwe affording three meals a day nowadays,” Bohwasi told IPS.

True to Bohwasi’s words, for many Zimbabwean urban residents like unemployed 39-year-old qualified accountant Josphat Madyira from the Zimbabwean capital Harare, starvation has become order of the day.

“Food stores are filled to the brim with groceries, but most of us here are jobless and therefore have no money to consistently buy very basic foodstuffs, resulting in us having mostly one meal per day,” Madyira told IPS.

Madyira lost his job at a local shoe manufacturing company after it shut down operations owing to the country’s deepening liquidity crunch, thanks to a failing economy here that has rendered millions of people jobless.

Asked how city dwellers like him are surviving, Madyira said: “People who are jobless like me have resorted to vending on streets pavements, selling anything we can lay our hands on as we battle to put food on our tables.”

The donor community, which often extends food aid to impoverished rural households, has rarely done the same in towns and cities here despite hunger now taking its toll on the urban population, according to civil society activists.

“Whether in cities or remote areas, hunger in Zimbabwe is equally ravaging ordinary people and most of the donor community has for long directed food aid to the countryside, rarely paying attention to towns and cities, which are also now succumbing to famine,” Catherine Mukwapati, director of the Youth Dialogue Action Network civil society organisation, told IPS.

Apparently failing to combat hunger in line with the MDGs, over the years Zimbabwe has not made great strides in eradicating extreme poverty and hunger due to the economic decline that has persisted since 2000.

As a result, earlier this year, the U.N. Children’s Fund (UNICEF), in partnership with the Zimbabwean government, extended its monthly cash pay-out scheme to urban areas.

Under this scheme, which started at the peak of Zimbabwe’s economic crisis in 2008, families living on less than 1.25 dollars a day receive a monthly pay-out of between 10 and 20 dollars, depending on the number of family members.

Economists and development experts here say that achieving the MDGs without food on people’s tables, especially in cities whose inhabitants are fast falling prey to growing hunger, is going to be a nightmare, if not highly impossible for Zimbabwe.

“Be it in cities or rural areas, Zimbabwe still has a lot of people living on less than 1.25 dollars a day, which is the global index measure of extreme poverty, a clear indication that as a country we are far from successfully combating hunger and poverty in line with the U.N. MDGs whose global deadline for world countries to achieve is next year,” independent development expert Obvious Sibanda told IPS.

According to the 2013 Human Development Index of the U.N. Development Programmer (UNDP), Zimbabwe is a low-income, food-deficit country, ranked 156 out of 187 countries globally and UNDP says that currently 72 percent of Zimbabweans live below the national poverty line.

Although hunger is now hammering people in both urban and rural areas, government sources also recognise that the pinch is being felt more by urban dwellers.

“The decline in formal employment, mostly in towns and cities, with many workers engaged in poorly remunerated informal jobs, has a direct bearing on both poverty and hunger, which is on a sharp rise in urban areas,” a top government economist, who declined to be named, admitted to IPS.

For the many hunger-stricken Madyiras in Zimbabwe’s towns and cities, meeting the MDGS by the end of next year matters little.

“Defeating starvation is far from me without decent and stable employment and whether or not my country fulfils the MDGs, it may be of no immediate result to many people like me,” Madyira told IPS.

(Edited by Phil Harris)

A billboard in Freetown, Sierra Leone, urging people to go to hospital to be tested for HIV. Ebola has stopped people from doing that. Credit: Lansana Fofana/IPS

By Lansana Fofana
FREETOWN, Dec 1 2014 (IPS)

The outbreak of the deadly Ebola epidemic in Sierra Leone has dwarfed the campaign against HIV/AIDS, to the extent that patients no longer go to hospitals and treatment centres out of fear of contracting the Ebola virus.

“It is a big challenge for us. HIV/AIDS patients now fear going to hospitals for treatment and our workers, who are also government health officials, are also afraid of contacting patients for fear of being infected,” Abubakar Koroma, Director of Communications at the National AIDS Secretariat, told IPS.“HIV/AIDS patients now fear going to hospitals for treatment and our workers, who are also government health officials, are also afraid of contacting patients for fear of being infected” – Abubakar Koroma, Director of Communications, Sierra Leone’s National AIDS Secretariat

Sierra Leone records one of the lowest HIV/AIDS prevalence rates in the West African region. For over five years, the country has managed to stabilise the figures at 1.5 percent, out of a population of 6 million, mainly because of massive countrywide awareness raising. The authorities also offer free medicines and treatment to people living with HIV/AIDS.

But all this may be reversed if the Ebola crisis is not contained soon.

Before the outbreak of the Ebola crisis in Sierra Leone in April, one key area of success in the fight against HIV/AIDS had been in curtailing mother-to-child transmission. Today, however, there are concerns that it may surge again because pregnant women are now reluctant to go to hospitals for treatment.

In 2004, the prevalence rate among pregnant women was 4.9 percent but, just before the Ebola in April this year, the figure had dropped to 3.2 percent.

According to Koroma, “between January and now, that service [for pregnant women] has dropped by 80 percent. We are worried that the Ebola crisis may worsen the situation.” From the point of view of those already living with HIV/AIDS, this is already happening.

Idrissa Songo, Executive Director of the Network of HIV Positives in Sierra Leone (NETHIPS) advocacy group, says that its members fear going to hospitals for care and treatment and that they are constrained by what he described as a cut in the support they were receiving from donors and humanitarian organisations before the outbreak of Ebola.

“Donors and other philanthropists have turned their attention away from the fight against HIV/AIDS,” he said. “Now it’s all about Ebola. Most organisations have diverted their funding to the fight against Ebola and this is badly affecting our activities.”

Songo added that the core activities of NETHIPS, which include community awareness raising and training of members in care and prevention, have all come to a standstill because of the government’s ban on all public gatherings following the Ebola outbreak.

Given the current crisis, the National Aids Secretariat and the Ministry of Health have set up telephone hotlines to connect with people suffering from HIV/AIDS. The aim is to be able to trace and locate them and then get treatment to them. At the same time, HIV/AIDS patients are now receiving a quarterly supply of the drugs they need, compared with the monthly dosage they were receiving before Ebola struck.

According to Songo, these measures are working because “that way, our members, who fear going to hospitals and treatment centres, can stay at home and take their medication. We know it is risky to go to treatment centres nowadays because of the possibility of contracting Ebola, another killer disease,” Songo told IPS.

Notwithstanding the Ebola crisis, Ministry of Health officials say that they have not lost sight of the fight against HIV/AIDS.

Jonathan Abass Kamara, Public Relations Officer at the Ministry of Health, told IPS that attention is still focused on the fight against HIV/AIDS. “Even though Ebola has taken centre-stage, the Ministry is still very much focused on the fight against HIV/AIDS. We supply drugs to patients regularly and we try our best to give care and attention to them,” Kamara told IPS.

However, while Sierra Leone has made tremendous progress in the fight against HIV/AIDS and its success in this fight surpasses that of almost all countries in the West Africa region, it may well find it difficult to maintain its achievements in this sector if the Ebola epidemic is not brought under control.

(Edited by Phil Harris)

Monica Wambui, 37, who is deaf, receives HIV/AIDS information in sign language. Wambui was among more than 40 people with disabilities who attended a workshop organised by the USAID-funded APHIAplus Nuru ya Bonde project in Nakuru, Kenya. Credit: USAID/George Obanyi

By Rashmi Chopra
NEW YORK, Nov 28 2014 (IPS)

Jane is a young Zambian mother with a physical disability in Lusaka, who uses a wheelchair to get around. She does not let clinics without ramps or without wheelchair accessible toilets and equipment stop her from claiming her right to health care, including HIV prevention services.

“You have to go the clinic to test yourself, to know your status – you have to force yourself, even crawling, so that the government can see that the clinics are not user-friendly,” she told Human Rights Watch.Faith, 25, a deaf, HIV-positive woman in Zambia, lost her hearing when she contracted cerebral malaria at the age of five. Faith did not know about HIV prevention until she tested positive in 2012.

In local communities, legislatures and at the United Nations, people with disabilities like Jane are demanding their right to equal access to HIV services. Not only on Dec. 1, World AIDS Day, but every day.

This week we also observe the international day of persons with disabilities. This coincidence of the calendar is not a coincidence for millions of people with disabilities around the globe who may have never received any information on HIV and are unable to access HIV prevention, treatment and care services.

Yet they are at increased risk of HIV infection because of discrimination in schooling, poverty and greater risk of physical and sexual violence.

Faith, 25, a deaf, HIV-positive woman in Zambia, lost her hearing when she contracted cerebral malaria at the age of five. She dropped out of school after only a few years because her family could not afford the transportation costs to send her there, and in any case did not believe she would benefit from schooling.

Today, Faith cannot read and communicates through a mix of formal sign language and informal signs that are understood and translated by her brother.

Faith did not know about HIV prevention until she tested positive in 2012. HIV prevention meetings in her local community are not conducted in sign language. And even if Faith had been able to continue her schooling, she likely would not have learned about HIV because of the lack of accessible materials and peer-based HIV prevention programmes for children with disabilities.

Faith found out that she was HIV-positive after giving birth to her daughter, who is also HIV-positive. Her husband is abusive and often absent. Faith relies on her mother to accompany her to appointments for antiretroviral medication and to help her understand information about care and treatment for her and her baby. There is usually no sign language interpreter at the clinic she visits.

A healthcare worker at her clinic told Faith and her mother that someone like Faith should not be allowed to have any more children.

But these barriers, and stigmatising attitudes, are starting to change.

In its 2014 ‘Gap Report’, UNAIDS recognised people with disabilities as one of the 12 vulnerable populations left behind by the AIDS response.

In Zambia, where more than one in 10 adults are living with HIV, and a similar number of people are estimated to have a disability, the government could recognise people with disabilities as a key population within the national HIV response, who should be prioritised for targeted action.

A disability-inclusive approach to HIV policies and national strategic plans is critical for countries in eastern and southern Africa, which remain the epicentre of the HIV pandemic.

Disabled persons’ organisations (DPOs) as well as other disability and health organisations in the region are also working hard to promote and develop inclusive and targeted HIV and sexual and reproductive health services.

Zambia Deaf Youth and Women (ZDYW), a local organisation from the Copperbelt province for example, has been supporting training of deaf counselors to provide peer-based HIV testing services in the region.

This year the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in Zambia will recognise a number of ‘PEPFAR Champions’ who are promoting equal access to HIV services for people with disabilities.

This is a good start, but more needs to be done, and quicker, to draw broader attention to the needs of individuals with disabilities in HIV services and to integrate HIV issues within all disability work. This requires resources, specific budgetary provisions, donor funding allocations and data collection on disability.

The Zambian HIV/TB activist and advocate for disability rights, Winstone Zulu, would have turned 50 this year that marks half a centenary of Zambia’s independence. In this week that recognises both the global AIDS pandemic and the more than one billion people worldwide who have a disability, Zambia should honor his and others’ struggle for equal access to HIV services, and implement inclusive HIV services as a priority, to ensure that people with disabilities such as Jane and Faith no longer remain invisible in the fight against HIV.

Edited by Kitty Stapp

Excerpt:

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

Displaced women flee fighting by boat to Mingkaman, Awerial County, Lakes State, South Sudan.. Only one out of 10 HIV positive mothers can get the drugs needed to avoid infecting her baby. Credit: Mackenzie Knowles-Coursin/IPS

By Charlton Doki
JUBA, Nov 14 2014 (IPS)

Dressed in a flowered African print kitenge and a blue head scarf, Sabur Samson, 27, sits pensively at the HIV centre at Maridi Civil Hospital in South Sudan’s Western Equatoria state. 

Today she paid 20 South Sudanese pounds (about six dollars) for a bodaboda (motorbike taxi) ride to the centre and will have to skimp on food in the next days.

She will be hungry and few will help her in the village, although she is blind and a single mother of two children.

“Many people fear to come close because they fear they will contract HIV,” she told IPS.

Seated next to her, Khamis Mongo, 32, has lived with HIV for five years now and has suffered similar rejection. “Some people don’t want to eat from the same plate with me,” he says.

Mongo and Samson are among nearly 1,000 HIV positive people receiving care at the centre, of whom 250 are in antiretroviral therapy (ART). They are lucky: in South Sudan, just one out of 10 people needing ART gets it.

The clinic sees patients coming from as far as 100 kilometres.

“So many patients are dying because they can’t afford transport to collect their medicine here,” clinical officer Suzie Luka told IPS.

A one-way, 80 km bodaboda trip from Ibba to Maridi costs 150 South Sudanese pounds (47 dollars).

The challenges in Maridi are a microcosm of those that the world’s newest country, South Sudan, faces in containing the HIV epidemic.

Newly independent from north Sudan in 2011, and emerging from Africa’s longest civil war over 21 years with one of the world’s lowest human development statistics, South Sudan plunged again into fighting in December 2013.

The national HIV prevalence rate is under three percent and rising steadily, according to the Joint United Nations Programme for HIV/AIDS (UNAIDS).

This translates into 150,000 people living with HIV in a country whose social fabric and physical infrastructure was destroyed by successive wars.

 “Moving corpses”

Evelyn Letio, from the South Sudan Network of People Living with HIV, describes poor access, quality and continuity of health services, underpinned by denial of the disease and high stigma and discrimination, especially against women.

“Community leaders will hurriedly accept a divorce if it’s the woman who is positive and force her to leave the man’s house,” says Letio.”If it’s the man who is positive, they won’t allow the woman to leave the house so she can take care of him.”

Despite denial by government officials, discrimination is rampant within the civil service, she adds:  “People who have disclosed to be HIV positive are laid off and called ’moving corpses’.”

Inadequate financial, infrastructural and human resources limit efforts to expand HIV services.  The national HIV plan has an 80 percent funding shortfall.

Mongo and Sanson told IPS that the Maridi clinic often runs out of drugs and they have to return days later. Other times, staff has not been paid for months and stays away.

“Treatment has been tricky,” acknowledges Habib Daffalla Awongo, director general for programme coordination at South Sudan AIDS Commission.

According to UNAIDS, just 22 centres provided ART before the new outbreak of violence.

Last December, the ART centres in Bor, Malakal and Bentiu, capitals of the states worst hit by fighting, had to close. The whereabouts of 1,140 patients are unknown. Most likely they have interrupted ART, endangering their lives.

War and AIDS

Forty thousand people living with HIV have been directly affected by the recent violence, according to the United Nations. The new fighting reversed the gains made in HIV services since independence. 

“We have lost many HIV positive people during the conflict, some died in the fighting and others migrated to peaceful areas,” said Awongo.

By U.N. counts,  the new conflict has displaced 1.9 million people.

In Juba, the capital, camps with long rows of white tents have sprung up to shelter some 31,000 displaced people.

Among them is Taban Khamis*, who escaped fighting in the key oil city of Bentiu, 1,000 kms north of Juba. He has interrupted ART and fears his health will soon worsen but he will not go to the camp’s HV clinic for fear of stigma.

“The camp is crowded and there is no privacy,” he told IPS. “Everyone will know that I have HIV.”

Prevalence of HIV and sexually transmitted infections “dramatically increases in camps”, says a study by the HIV/AIDS Alliance.

Awongo is aware of this problem. “We encourage people to come out of the camps to facility points where they can access services but this is not making a difference,” he says.

*Name changed to protect his privacy

Edited by: Mercedes Sayagues

Gender inequalities explain why prevention is failing to contain HIV infection among young women in East and Southern Africa. UNAIDS calls for a major effort to reduce their risk of infection. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Nov 7 2014 (IPS)

Experts are raising alarm that years of HIV interventions throughout Africa have failed to stop infection among young women 15 to 24 years old.

“Prevention is failing for young women,” says Lillian Mworeko, HIV expert with International Community of Women Living with HIV in Eastern Africa, based in Uganda.

Among women in East and Southern Africa, four out of ten new HIV infections among women aged 15 years and over happen among  those aged 15 to 24, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Worryingly, HIV infection rates among young women are double or triple those of their male peers. In South Africa, the HIV prevalence of 18 percent among women aged 20-24 is three times higher than in men of the same age. 

Equally alarming are surveys showing that fewer than two in ten young women know their HIV status.

Experts attribute this high HIV prevalence to gender inequalities, violence against women, limited access to health care, education and jobs, and health systems that do not address the needs of youth.

Biology does not help. Teenage girls’ immature genital tract is more prone to abrasions during sex, opening entry points for the virus, Dr Milly Muchai told IPS.

Muchai, a reproductive health expert in Kenya, says it is not just sex that drives HIV infections among young women but the age of the male sexual partner.

“The risk increases steadily with male partners aged 20 years and over,” she explains.

Older men are more likely to have HIV than teenage boys. The Kenya AIDS Indicator Survey 2012 shows that male HIV prevalence remains low and stable until the age of 24, when it shoots up significantly.

Due to intergenerational sex, women in this region are acquiring HIV five to seven years earlier than men, says Muchai, because these relationships are characterised by multiple sexual partners and low condom use. In transactional sex, the young woman receiving gifts or money loses power to negotiate safe sex.

But Kenya is not a unique scenario.

Shocking figures

In Swaziland, Lesotho and Botswana, more than one in 10 females aged 15 to 24 are living with HIV, according to UNAIDS.

Dr Gang Sun, UNAIDS country director in Botswana, says that, in spite of the country’s remarkable progress in reduction of new infections and treatment, HIV is still a girls’ and women’s epidemic due to gender inequality and unequal power dynamics.

Among Batswana youth aged 20 to 24 years, HIV infection among women triples that of men, nearly 15 percent compared to 5 percent, he says.

Mary Pat Kieffer, senior director at Elizabeth Glaser Paediatric AIDS Foundation in Malawi, told IPS that as teenage girls become older, the risk of infection rises.

In Swaziland, HIV prevalence is six percent for girls aged 15 to 17 but rises to a whopping 43 percent by age 24.

Source: UNICEF

A package of interventions

Kieffer says that many of the issues – poverty, lack of secondary education, few jobs, rape and intimate partner violence – that underpin the unacceptably high HIV prevalence among young women are bigger than what HIV programs alone can address.

Mworeko observes major gaps in reproductive and sexual health services for young people, when they are neither children nor adults, in the region.

“Whether it is prevention, treatment, care and support services, young people do not have a youth friendly corner,” she says.

Paska Kinuthia, youth officer with UNAIDS in South Africa, told IPS that sexuality education needs to be strengthened in schools across the region.

“The regional average of comprehensive knowledge of HIV and AIDS stands at 41 percent for young men and 33 percent for young women,” he says.

Experts agree there is no one single solution to protect young women and a combination of interventions is needed.

Addressing restrictive laws on the age of consent for HIV testing and for access to sexual and reproductive health services would be a good place to start, experts say.

Promoting gender equality and providing jobs for young people are part of the solution, says Sun.

In Tanzania, HIV infection among girls more than triples between 15-19 and 20-24 years.

This fact, says Allison Jenkins, chief of HIV/AIDS with the United Nations Children’s Fund in Dar es Salaam, underlines “the importance of orienting HIV prevention and economic livelihoods interventions during her transition to adulthood.”

For all these reasons, UNAIDS is calling for “a major movement to protect adolescent girls and young women from HIV infection.”

Edited by: Mercedes Sayagues

Every day, eleven Mozambican women die of cervical cancer. That is 4,000 every year. It is the most frequent cancer among women aged 15-44 and the biggest killer of women among all cancers. Credit: Mercedes Sayagues/IPS

By Mercedes Sayagues
MAPUTO, Oct 31 2014 (IPS)

Mozambique is reeling under the twin burden of HIV and cervical cancer. Eleven women die of cervical cancer every day, or 4,000 a year. Yet this cancer is preventable and treatable, if caught early.

Among African countries, Mozambique vies neck and neck with Malawi for the saddest statistics.

Mozambique has the highest cervical cancer cumulative risk and mortality – seven out of 100 newborn girls will develop this cancer and five will die from it.

Malawi is first in incidence (new cases per year), with Mozambique tailing second.

Cervical cancer is caused by the Human Papilloma Virus (HPV), a common virus with 40 types. Many people carry it dormant and often it goes away by itself. But two types of HPV cause cervical cancer.

HIV and HPV are deadly allies. HPV infection doubles the risk of acquiring HIV while HIV hastens progression of cervical cancer.

Some numbers will give an idea of Mozambique’s burden:

• 7.3 million women over age 15, who can potentially acquire HPV through sex.
• 820,000 women over age 15 living with HIV. Cervical cancer advances quickly with a weak immune system.
• 4,000 deaths of cervical cancer a year, not counting those who die at home, undiagnosed, untreated and unreported

Step by step, health authorities are tackling the problem with a three-pronged strategy: information for prevention, routine screening for detection, and better treatment.

There is even talk of bringing radio therapy equipment and training technicians. In terminal stages, radio therapy shrinks cancer and reducing excruciating pain.

Routine screening for this cancer is now offered with family planning services. Diagnosis and treatment via cryotherapy (freezing) can be done in one visit. The Ministry of Health hopes to cover all districts by 2017.

The mass media campaign had a tireless advocate in the former First Lady, Maria da Luz Guebuza. The Association for the Fight against Cancer, a volunteer group, has multiplied its outreach and helps patients at the oncology wards of main hospitals.

Information is dispelling the perception of cervical cancer as “the neighbour’s disease”, brought upon women by a neighbour’s curse or by witchcraft.

The situation is still dire; needs outpace resources, both human and financial. But it is a great improvement over just three years ago, when only a handful of clinics offered screening, and millions of women had never heard about HPV and cervical cancer at all.