UN officials say they are worried that the achievements in the HIV/AIDS response are uneven and the most vulnerable are at highest risk. They say the new targets are urgently needed. Credit: Kristin Palitza/IPS

By Alison Kentish
UNITED NATIONS, Jun 9 2021 (IPS)

World leaders, those on the frontlines of the AIDS response, civil society, academics and youth have agreed that there is no way to end AIDS as a public health threat by 2030 without tackling persistent inequalities among marginalised groups.

The leaders on Tuesday adopted a new set of targets to end the epidemic. Called the Global AIDS Strategy 2021-2026, it builds on the 2016 Political Declaration on Ending AIDS, with more ambitious plans to tackle issues like discrimination and criminalisation of same-sex relations.

“The inequalities blocking progress towards ending AIDS emerge when HIV intersects with complex fault lines across social, economic, legal and health systems,” the agreement states.

It contains pledges to decrease the annual number of new HIV infections to below 370,000 and AIDS-related deaths to 250,000 while eliminating new infections among children.

It sets a 2025 target to end HIV-related discrimination in all forms and to bring life-saving HIV treatment to 34 million people.

UN officials say since the first confirmed case of HIV in 1981 there has been significant progress in understanding and responding to the disease. This includes a 61 percent decrease in AIDS-related deaths since a peak in 2004 and ‘dozens of countries’ meeting or surpassing the targets set out to fast-track AIDS response in the 2016 Declaration.

But they are worried that the achievements are uneven and the most vulnerable are at highest risk. They say the new targets are urgently needed.

“The COVID-19 pandemic, conflict, and humanitarian emergencies, have impeded progress as health systems are placed under immense strain, and critical services and supply chains are disrupted,” said Volkan Bozkir, President of the 75th Session of the UN General Assembly. “Tragically stigma and discrimination persist, further isolating those already marginalised.”

Bozkir told the hybrid event that while all forms of inequality must be eliminated, HIV statistics among young women make a compelling case for prioritising an end to gender inequality.

According to UNAIDS, young women are twice as likely to be living with HIV as young men. In 2020, 6 out of every 7 new HIV infections among young people, aged between 15-19 in sub-Saharan Africa, were girls.

“Every girl and every woman must be free to exercise their fundamental human rights, to make their own decisions, to live a life free from fear of gender-based violence and to be treated with dignity and respect. All girls should have equal access to quality education. This is the foundation for a society where women feel safe to take their rightful place in the workplace, public life, politics, and decision-making,” he said.

Yana Panfilova, a 23-year-old Ukrainian woman who was born with HIV appealed to world leaders to help the millions of people with HIV who struggle daily with fear and isolation.

“Millions of people with HIV may have HIV pills, but they live in a world where their families and their societies do not accept them for who they are. I am here today as the voice of 38 million people living with HIV. For some of us, pills are keeping us alive, but we are dying from the pandemics of stigma, discrimination,” she said.

“The AIDS response is still leaving millions behind. LGBTIQ people, sex workers, people who use drugs, migrants and prisoners, teenagers, young people, women and children who also deserve an ordinary life, with the same rights and dignity enjoyed by most people in this hall.”

The Executive Director of UNAIDS Winnie Byanyima stated that HIV rates are not following the course outlined in the 2016 Agreement and warned that as part of the fall-out from the COVID-19 crisis, it is possible to see a resurgent AIDS pandemic.

“The evidence and analysis are clear. Inequalities in power, status, rights and voice are driving the HIV pandemic. Inequalities kill. As the Global AIDS strategy sets out: to end AIDS, we have to end the inequalities which perpetuate it,” Byanyima said.

The UNAIDS Chief said the world should applaud the new measures to confront the AIDS epidemic, adding that the policies and services needed to end AIDS will prove useful in beating COVID-19 and prepare the world for future pandemics.

“We cannot be neutral on inequalities. To get back on track to ending AIDS, we must be deliberate in confronting them. The only alternative is a vicious cycle of injustice, illness, and emergency. The most unrealistic thing we could do now is to imagine we can overcome our crises through minor adjustments or tinkering.”

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Excerpt:

By Jo Baker
LONDON, Jan 7 2016 (IPS)

It is a grim fact that prisoners in most countries suffer from poorer health than non-prisoners, and that their right to health is not always protected. But for certain groups these rights can be even more elusive. Such is the case for women.

Jo Baker

For me, this was starkly illustrated during a visit to the clinic of a large women’s jail in the southern Philippines. Here, a very thin woman lay curled and still on a narrow wooden bench. Her hands were cradling her taut, bloated stomach, her eyes tightly closed. The nurse explained that she was an addict, arrested while heavily pregnant for drug possession (a sentence that keeps the country’s women’s jails lamentably stocked), and that her baby had died days earlier in a government hospital because of a condition related to her drug use, after a complicated labour. Being understaffed and short on medicine and beds in the prison, the best treatment she could offer the woman on her return, as she faced her withdrawal, post-labour pain, grief, separation from family, and possible years awaiting trial, were paracetamol, kind words and a bench. Hers would be a particular and gendered kind of purgatory.

In speaking with imprisoned women and healthcare practitioners across five countries, our research team commonly found harmful responses and barriers to healthcare that existed because the inmates were women. These included women who were imprisoned in Jordan while recovering from brutal gender-based violence (including honour crimes and rape), without adequate treatment or rehabilitation; women who prepared for and recovered from childbirth in dirty rooms with little more than substandard prison rations, water and soap; and women who were isolated and punished because of attempts to self-harm or commit suicide. “One girl used the edge of a seafood shell on her wrists,” recounted an inmate in the Philippines. “They scolded her. If you want to die, go ahead, do it now!”

These responses are of course unlikely to be particular only to these countries.

International standards (including the Bangkok Rules) now recognize that because women commonly face certain risk factors and backgrounds, they require a gender-specific framework for healthcare. More women than men suffer from particular diseases, including HIV, hepatitis and some cancers. They have differing sexual and reproductive health (SRH) needs, including those relating for example, to birth, abortion and the menopause. They are more susceptible to particular mental health problems. Studies have found self-harm in prison to be up to ten times higher among women than among men, and suicide to also be proportionally higher. This list goes on.

Women (especially those in conflict with the law) are also, crucially, more likely to have been victims of sustained gender-based violence and sexual abuse. Yet prisons, which are increasingly taking in women, are rarely equipped to respond to these forms of trauma. As I was told quietly by one prison healthcare worker, gesturing to a courtyard of around 20 women. “Almost all the women here are mothers, and a lot have maltreatment and molestation in their histories. I can look around and count more than ten women who have been raped. Some have been prostituted by their families. Then drug use comes in and makes it a vicious cycle.”

These and other cultural factors lead to a different sense of shame, which can also work as a barrier to healthcare. For example inmates in Jordan, Zambia and the Philippines told me that they often avoided reporting urinary tract infections and SRH problems to male health staff. Yet some prisons for women don’t employ female doctors, and these issues remain unrecognized, and sometimes debilitating.

My research findings with DIGNITY (see our comparative study here) therefore stress the urgent need for every prison and place of detention to follow a framework for healthcare that is gender-responsive and trauma-informed – one that treats women’s specific health needs, and trains staff accordingly. In just a few facilities did we find gestures towards this.

But not all gender-sensitive health responses are medical. The traditional prison model – designed as a harsh criminal justice response to violent men – remains the basis for many institutions detaining groups that are neither violent, nor male. In the facilities where women told me of harsh disciplinary structures, negative relationships between staff and inmates, and their isolation from caring relationships, they tended to report very low morale, forms of depression, and other signs of serious struggle, such as self harm and hunger strike. This was markedly different in facilities (such the one described here in Albania) that connected the women with the outside community – particularly their children – and gave them tools to cope, learn, communicate and prepare for the future.

Meanwhile, exercise is known to be important to health and morale, and is a right of prisoners under international law (see the Mandela Rules). Yet only in one of five countries, the Philippines, were detained women encouraged and able to exercise every day. In the other countries, exercise and sports facilities of some kind were common only in prisons for men.

Many of our findings on health fell in line with those observed by the former UN Special Rapporteur on Violence Against Women in her 2013 report on women’s incarceration, and they indicated clear and harmful examples of discrimination. Yet in reviewing issues raised by UN treaty body reports, we found women’s health to largely be a gap: UN experts are not giving this area consideration.

The human rights of these women entitle them to better, and must be championed, internationally and in their own countries. As once said by Dostoevsky, society must be judged by the way that it treats its prisoners. Or rather, and as told to me by one mother and survivor of domestic violence, sentenced to life in a Zambian prison: “If you’ve offended, certain things you must accept. But I don’t deserve to pass through some of these things. I came to prison healthy. I’m not intending to leave sick.”

(End)

Excerpt:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Writer can be contacted at moyojeffrey@gmail.com

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

By Wambi Michael
KAMPALA, Jun 15 2015 (IPS)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Edited by Phil Harris   

Children having a daily lunch meal at a kindergarten in a poor community in Salvador, Bahia. Brazil's National School Feeding Programme is an example of one of the far-reaching programmes implemented in line with the Millennium Development Goals (MDGs). Credit: Carolina Montenegro/WFP

By Daniel Balaban
BRASILIA, Jan 29 2015 (IPS)

With the current Millennium Development Goals (MDGs) expiring at the end of this year to be replaced by the Sustainable Development Goals (SDGs) which will set priorities for the next fifteen years, 2015 will be a crucial year for the future of global development.

As a country with an outstanding performance in reaching the MDGs, Brazil can play an important role in shaping and achieving the SDGs.

Extensive consultations with governments and civil society have been held in recent years, and consensus around many issues has been established and channelled into a series of documents that will now guide the final deliberations on the exact content of the SDGs. September 2015 has been set as deadline for their endorsement by U.N. member states.

Daniel Balaban, Director of WFP’s Centre of Excellence against Hunger. Credit: Carolina Montenegro/WFP

A Working Group has identified 17 goals encompassing issues such as poverty, hunger, education, climate change and access to justice. While some of these topics were already covered by the MDG framework, there is a new set of goals with emphasis on the preservation of natural resources and more sustainable living conditions, meant to reverse contemporary trends of overuse of resources and destruction of ecosystems.

As governments quickly move to adopt the SDGs, they must capitalise on what has been achieved with the MDGs to secure new targets that will go beyond the lowest common denominator.

Brazil has a compelling track record in achieving the current MDGs, and it can use its experience to influence the final negotiations of the SDGs towards ambitious targets.

The country has already reached four of the eight targets – eradication of extreme poverty and hunger, achieving universal primary education, promoting gender equality and combating HIV – and it is likely to achieve the remaining targets by the end of the MDG deadline.“As governments quickly move to adopt the SDGs, they must capitalise on what has been achieved with the MDGs to secure new targets that will go beyond the lowest common denominator”

Through a set of innovative and coordinated policies, Brazil has tackled these different areas and demonstrated that it is possible to radically decrease poverty and hunger within a decade, giving special attention to the most vulnerable groups.

The National School Feeding Programme, for example, is one of the far-reaching programmes implemented so far. In 2009, the existing policy was upgraded to recognise school feeding as a right, whereby all students of public schools are entitled to adequate and healthy meals, prepared by nutritionists and in accordance with local traditions.

At least 30 percent of the food used to prepare these meals must be procured from local producers, with incentives to the purchase of organic produce.

The programme also devotes additional resources to schools with students of traditional populations, often exposed to food insecurity.

Another feature of the policy is the participation of civil society through local school feeding councils, which oversee the implementation of the programme, as well as financial reports produced by municipalities.

Altogether, the programme tackles a wide range of issues, combining action to combat hunger, ensure adequate nutrition (including of the most vulnerable groups), support local farmers and involve civil society, in line with principles of inclusion, equity and sustainability, which are also guiding principles of the future SDGs.

It is a good example of how the incorporation of innovative features to existing policies can result in more inclusion and sustainability while optimising resources.

As it occupies a more prominent role on the world stage, Brazil has been active in promoting such policies in multilateral fora, in addition to investing in South-South cooperation to assist countries to achieve similar advances.

The WFP Centre of Excellence against Hunger is the result of such engagement. In the past three years, the Centre been supporting over 30 countries to learn from the Brazilian experience in combating hunger and poverty.

Brazil is now in a position to showcase tangible initiatives during the SDGs negotiations to prove that through strong political commitment it is possible to build programmes with impact on a range of areas.

Such multi-sectorial action and articulation will be required if countries around the globe are determined to tackle humanity’s most urgent needs related to hunger, adequate living standards for excluded populations, and development, while reversing the trend of climate change and unsustainable use of natural resources.

The world is at a crossroads for ensuring sustainability. If the right choices are not made now, future generations will pay the price. However daunting the task may be, this is the moment to do it.

Edited by Phil Harris   

The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, IPS – Inter Press Service. 

* Daniel Balaban, an economist, is the Director of World Food Programme’s (WFP) Centre of Excellence against Hunger. He has also led the Brazilian national school feeding programme as President of the National Fund for Education Development (FNDE), which feeds 47 million children in school each year. In 2003, he served as the Special Advisor to the Secretary of the Council of Economic and Social Development under the Presidency of the Federative Republic of Brazil.

Excerpt:

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

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

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

But testing babies is not easy in poor countries.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

New solutions to old problems

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

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

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

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

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

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

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

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

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

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

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

By Davison Mudzingwa
JOHANNESBURG, Dec 23 2014 (IPS)

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

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

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

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

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

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

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

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

SILENT SUFFERING: MEN, MANHOOD AND HIV

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Pavol Stracansky
KIEV, Dec 9 2014 (IPS)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Global Fund declined to respond when contacted by IPS.

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

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

(Edited by Phil Harris)

Gender inequalities drive the disproportionate rate of HIV infection among young South African women aged 15 to 24. Credit: Mercedes Sayagues/IPS

By Nqabomzi Bikitsha
JOHANNESBURG, Dec 1 2014 (IPS)

When she found out that she had human immunodeficiency virus (HIV), Thabisile Mkhize (not her real name) was scared.

She knew little about the virus that had been living in her body since birth and did not know whom to ask. Her mother had just died and she lived with her grandmother in rural KwaZulu Natal, where the HIV prevalence is the highest in South Africa, at 17 percent.

Today, at the age of 16,  Mkhize is an enthusiastic peer educator at her school,  discussing HIV prevention, safe sex and sexual rights. “I want young women to be safe, to make healthy sexual choices,“ she told IPS.South Africa has a perfect storm of early sexual debut, inter-generational sex, little HIV knowledge, violence, and gender and economic inequalities that lead young women aged between 15 and 24 to have a disproportionately high rate of HIV infection

South Africa has a perfect storm of early sexual debut, inter-generational sex, little HIV knowledge, violence, and gender and economic inequalities that lead young women aged between 15 and 24 to have a disproportionately high rate of HIV infection.

They account for one-quarter of new HIV infections and 14 percent of the country’s 6.4 million people living with HIV, according to the ‘South African National HIV Prevalence, Incidence and Behaviour Survey’.

Alarmingly, HIV incidence – the number of new  infections per year – among women aged between 15 and 24 is more than four times higher than among their male peers.

Professor Sinead Delany-Moretlwe, director for research at Wits Reproductive Health and HIV Institute (Wits RHI) in Johannesburg, describes the factors that put young women at higher risk.

“Structural drivers – gender, social and economic inequalities – interact in a number of ways and influence behaviour such as choice of sexual partner and condom use,” she said.

Explaining that young women find it difficult to protect themselves against HIV, she noted that they “end up with controlling partners and fail to negotiate condom use or are forced to have sex.”

Tumi Molebatse, a 20-year-old student from Soweto, is an example. Years ago she had an HIV test and would like to have another with her boyfriend of two years, or at least to have safe sex.  “But my boyfriend will think I am cheating on him if I ask for condoms,” she told IPS.  “He supports me financially so it’s better to not bring it up.”

In South Africa, one of the most unequal countries in the world, relationships with older men often pen the way for young women’s social mobility and material comfort.

According to Kerry Mangold from the South African National AIDS Council, inter-generational and transactional sex increase the risk of infection because older men have higher HIV rates than young men.

“It’s not rare to see a young girl sleep with an older man for food or a little bit of money,“ said Mkhize. “Young women aspire to have nice things in life but they don’t have money, they don’t have jobs, and they go for partners who can provide those things.”

According to the ‘South African National HIV Prevalence, Incidence and Behaviour Survey’, one-third of girls aged between 15 and 19 reported a partner five years or more their senior.

Risk and choices

“At its most extreme, gender inequality manifests as gender-based violence,” says Delany-Moretlwe.

In South Africa, young women who experienced intimate partner violence were 50 percent more likely to have acquired HIV than women who had not suffered violence, according to the UNAIDS Gap Report.

Despite decades of awareness campaigns, less than one-third of young women know how to prevent HIV.

Mkhize says that many girls hear about sex and HIV from friends and teachers, and often  the information is wrong. “I know girls who believe you cannot get HIV if you boyfriend has just come back from circumcision school and so they have sex without a condom,” she told IPS.

Mangold would like to see “an enabling environment for young women to make their own choices and reduce their risk.”

Since last year, the ZAZI initiative has been trying to do just that. A sassy campaign, ZAZI (from the Nguni words for “know yourself”) builds knowledge around sexual health through social media, video clips, poetry readings, street murals, music and fun activities that boost girls’ sense of self-worth.

“We hope to discourage them from opting for relationships with older men for material gain and give them confidence to negotiate condom use,” ZAZI advocacy manager Sara Chitambo told IPS.

ZAZI’s motto is “finding your inner strength”. On its website, girls can look up practical advice on what to do if they are raped, where to find contraception and how to prevent HIV.

(Edited by Mercedes Sayagues and Phil Harris)

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

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

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

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

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

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

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

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

Fear of seeking help

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

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

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

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

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

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

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

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

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

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

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

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

High death toll

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

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

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

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

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

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

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

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

HIV among teen girls

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

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

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

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

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

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

*names changed to protect privacy

Edited by Mercedes Sayagues