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:

Nomcebo Mkhaliphi posing with girls from the Kwaluseni Infantry Primary School in Eswatini. Courtesy: Nomcebo Mkhaliphi

By Mantoe Phakathi
MBABANE , Jan 21 2020 (IPS)

When 14-year-old Nomcebo Mkhaliphi first noticed the blood discharged from her vagina, she was shocked. Confused, she turned to her older sisters for advice.

“My sisters told me that they were experiencing the same every month and that they used fabric, toilet paper and newspapers as sanitary wear,” recalls the now 45-year-old Mkhaliphi. She had to follow suit and use these materials because she had no money to buy sanitary pads.

Mkhaliphi and her four siblings were single-handedly raised by their father in a poor household in rural Makhonza, south of Eswatini. Mkhaliphi’s parents had separated when she was nine, so conversations about menstruation were never had, both at home and school. 

Recounting her experience with periods invokes sad emotions for Mkhaliphi. She had three significant moments at school where her periods put her at the centre of gossip, bullying and humiliation.

At some point, she stained her tunic, followed by other incidents where a toilet paper and a newspaper she wore in the place of a sanitary pad fell to the ground after getting soaked, right in front of other learners.

“These incidents lowered my self-esteem because other students used my experience to bully me,” says the mother of two boys and a girl.

Instead of dropping out of school like other girls in a similar situation, Mkhaliphi persevered until she completed her high school education. Today, she volunteers her time to teach young girls and boys at schools and communities about menstruation, particularly the stigma associated with periods. She includes boys so that they stop seeing periods as a laughing matter but a natural occurrence for their female peers.

“There’s a lot of stigma associated with menstruation. When a woman is on her periods, she is said to be in ‘cleansing’ something that portrays her as dirty. That’s why in other families a menstruating woman is not allowed to cook, while in some churches they’re not allowed to come closer to the pastor,” Mkhaliphi tells IPS, adding that some churches order women to sit at the back and not participate in the service.

What’s worse, it’s taboo to talk about menstruation because in the Swati culture it has always been portrayed as a secret. This small landlocked southern African nation is the continent’s last monarchy, with a population of just under 1.4 million.

Through her talks, Mkhaliphi is using her story to end the stigma associated with periods and building confidence among girls by giving them the right information about their sexual reproductive health. She also gives talks to primary school children because, she says, it is important to talk to them while they are young.

“Girls open up to me about their own sad stories once they hear about my experience,” she says.

One such girl is Nomthandazo* (14) from a public school in Eswatini’s industrial town, Matsapha, who said she used to abscond from school when on her period because one day the newspaper she was wearing fell off and she was became the target for ridicule at school for a long time.

With no money to buy pads, she pretended to be going to school and would hide from her parents for about a week until her period was over.

“I now use rags. They take long to dry but they’re better than newspapers,” she tells IPS.

Some parents fail to have a conversation with their children about periods. For instance, Temphilo* from rural Sihhoye told her stepmother as soon as she saw blood, thinking that there was something wrong with her. Indeed, there was, according to her stepmother, who beat her up and accused her of having sex.

“I bled for almost a month and she didn’t even take me to hospital because she felt I brought it on myself,” Temphilo tells IPS. After that first irregular period, her periods followed the regular course of lasting 4 to 5 days.

But it took Mkhaliphi to assure her that menstruation is a natural thing that occurs to every woman and she should not be ashamed of herself because of it. So far, Mkhaliphi has reached over 3,000 girls since she started this initiative after she was retrenched from her work as a legal secretary in 2016.

“I get invited to many places where teachers and community leaders ask me to speak to learners and the youth in communities,” she says. “But it’s difficult to reach out to everyone because of lack of financial resources.”

Mkhaliphi has taken the conversation to Twitter, @nomcebo_mkhali where she now raises awareness. Twitter has exposed her to individual donors who contribute pads and a bit of money to support the girls. Given the number of places to visit and girls from poor backgrounds, she needs more assistance.

#Girls deserve #Menstruation dignity #StopTheStigma #Pads @umbrios @YonWumman @Passie_Kracht @TJVRD @RaeUK @Anyechka pic.twitter.com/x2XMou14KJ

— Nomcebo Mkhaliphi (@nomcebo_mkhali) 6 December 2019

“It’s sad that most girls are still using unsafe materials which are not only inadequate for protection but can also lead to diseases,” she says.

The 2017 Eswatini Annual Education Census recorded that 220 girls absconded from school at primary level although the education was free. Reasons were not given for the dropouts but Mkhaliphi says it could partly be lack of sanitary wear.   

“Building the girl’s confidence is not good enough if they won’t have access to the things that will preserve their dignity when they’re menstruating,” says Mkhaliphi.

Chairperson of the Ministry of Health Portfolio Committee in the House of Assembly, Mduduzi Dlamini, concurs with Mkhaliphi.

“It doesn’t make sense that sanitary wear is not provided for free both at school and at community centres,” says Dlamini.

A participant at the recent 25th International Conference on Population Development (ICPD25) in Nairobi, Kenya, he promised that the provision of free sanitary wear to girls was one of the issues that he would push for discussion in parliament.

“What I learnt from the conference is that when girls lack toiletries, like pads, they become vulnerable to sugar daddies who buy them these things,” Dlamini tells IPS. “Some girls end up getting infected with HIV by sugar daddies all because they didn’t have access to pads. Government needs to address this issue.”   

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) “women are disproportionally affected by HIV” in Eswatini – 120,000 of the 190,000 adults living with HIV are women. In addition, “new HIV infections among young women aged 15–24 years were more than quadruple those among young men: 2400 new infections among young women, compared to fewer than 500 among young men”.

So far, Kenya and Botswana are the only African governments on track to offer free sanitary wear by law. 

*Names withheld to protect their identity.

BANGLADESH: Dose of Vigilance Helps Manage HIV, AIDS DHAKA, Nov 3, 2010 (IPS) - It is one of the poorest countries in the world, has a low literacy rate, and is next door to at least two countries that have a considerable portion of their respective populations with HIV and AIDS. Yet even having a large migrant population has not made Bangladesh a hot spot for HIV and AIDS. http://ipsnews.net/news.asp?idnews=53443

By James Reinl
UNITED NATIONS, Jul 24 2019 (IPS)

The global fight against Aids is floundering amid cash shortfalls and spikes in new HIV infections among marginalised groups in developing regions, Gunilla Carlsson, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), said Tuesday.

Speaking with reporters in New York, Carlsson, head of U.N.-led efforts against the pandemic, warned that gains over recent years were under threat, particularly in parts of eastern Europe, central Asia, the Middle East and Africa.

“We are at a precarious point in the response to HIV. Some countries are making impressive gains, while others are experiencing rises in new HIV infections and even Aids-related deaths,” Carlsson said at U.N. headquarters.

“Annual gains are getting smaller and the pace of progress is slowing down.”

More than half of all new HIV infections in 2018 were among drug users, sex workers, men who have sex with men, transgender people, prisoners and the sexual partners of these groups, said Carlsson.

Many of those at-risk groups do not get the treatment they need, she added.

A UNAIDS report released Jul. 16 noted “worrying increases” in these new infections in eastern Europe and central Asia, where HIV cases rose by 29 percent, as well as in the Middle East, North Africa and Latin America.

Global funding for the fight against Aids dropped off markedly in 2018 — by nearly one billion dollars— as international pledges dried up and domestic investments did not grow fast enough to fill the gap.

Only around 19 billion dollars was available for the Aids response in 2018 — some 7.2 billion dollars short of the total 26.2 billion needed by 2020, said Carlsson, describing a “deeply concerning” development.

“Ending Aids will not be possible unless we are investing adequately and smartly, focussing on people first, not diseases, and creating roadmaps for people who are left behind,” said Carlsson.

Some 770,000 people died of Aids globally in 2018 and almost 38 million people were living with the human immunodeficiency virus (HIV) that causes it. The disease is transmitted via infected blood and other bodily fluids.

HIV cannot be cured but the infection can be kept in check by Aids drugs known as antiretrovirals. Around 23.3 million of the 37.9 million people with HIV globally currently get the Aids drugs they need.

Around 1.7 million people were newly infected in 2018, a 16 percent decline since 2010, driven mostly by steady gains in parts of eastern and southern Africa, according to the latest UNAIDS report.

South Africa, for example, has cut new HIV infections by more than 40 percent and Aids-related deaths by around the same proportion since 2010. But the report warns that the disease is still rife in other parts of eastern and southern Africa.

Earlier this month, the aid group Médecins Sans Frontières (MSF) warned that efforts to fight Aids were “stagnating” and that many of the disease-related deaths could be prevented if better care was available.

Dr. Gilles Van Cutsem, head of MSF’s team on HIV and Aids, said that many HIV sufferers turned up at clinics in Congo, Guinea, Malawi and elsewhere with advanced symptoms of a condition that their immune system was unable to fight.

“People arrive very ill, often with severe opportunistic infections such as tuberculosis, cryptococcal meningitis, or Kaposi’s sarcoma,” Van Cutsem said in a statement.

“When they arrive, sometimes it’s too late to save them. They might not have been diagnosed on time or they failed to get access to lifesaving treatment.”

In Zimbabwe, four out of 10 sexually active girls aged 15-19 reported taking an HIV test in the last 12 months. Credit: Jeffrey Moyo/IPS

By Lyndal Rowlands
UNITED NATIONS, Apr 11 2016 (IPS)

Calls for low and middle income countries to contribute an additional 6.1 billion dollars to the global HIV response by 2020 could see some vulnerable groups left behind, said HIV activists meeting at the United Nations last week.

A report recently published by UNAIDS, the Joint United Nations Programme on HIV/AIDS, calls for low and middle income countries to increase their funding for the global HIV response by 6.1 billion by 2020, versus only an additional 2.8 billion requested from wealthy countries.

The proposed changes to funding could affect vulnerable groups, including adolescent girls in Sub-Saharan Africa who now make up 74 percent of new HIV infections in the 15 to 24 age group according to UNAIDS.

Annah Sango, from Zimbabwe, a Youth Advisor with the Global Network for Young People Living with HIV told IPS that these figures partially reflect how hard it is for young women to negotiate safe sex, even within a marriage.

“It leaves young women and girls vulnerable to STIs, vulnerable to unintended pregnancies, vulnerable to HIV, and also vulnerable to gender based violence,” she said.

Some 2000 girls and young women are being infected with HIV in Sub-Saharan Africa each week, Marama Pala Chair of the international community of women living with HIV global told journalists at the UN here last week.

A reduction in resources could see addressing the complex social and cultural causes of the rise in infections among young women in Sub-Saharan Africa become a lesser priority, said Pala.

Javier Hourcade Bellocq of the International HIV/AIDS Alliance who along with Pala co-chairs the civil society task force at the United Nations said that a reliance on domestic funding could see some vulnerable groups left out.

“The overarching question is would a government in Asia or Latin America be able to provide funding for a female sex worker organisation, for advocacy, for a watchdog (group)? — probably not,” said Bellocq.

However Bellocq said that domestic finances are an important part of a sustainable HIV response and that low and middle income countries have already been slowly increasing their investment.

“Often civil society organisations and activists have been perceived as putting pressure on international donors and wealthy and developed countries where in fact it’s not true, most of our work is putting stress on domestic funding,” he said.

Bellocq said that it was important not to presume that all governments with the same income classification had the same capacity to contribute to the HIV and AIDS response.

The classifications do “not reflect income inequalities and internal debt that many middle income countries currently face,” he said.

Jamila Headley, Managing Director of the Health Global Access Project, told IPS that UNAIDS analysis of the fiscal space used to justify the increased financing from low and middle income countries was based on inaccurate information.

For example, she said, “In Malawi the government has just had to cut several health care workers from the budget because they don’t have funds.”

Headley also said that the proposed changes “undercut our efforts to push governments in the West to support as much as they can.”

The Global HIV response has shown “unprecedented mobilization of solidarity across countries,” she said, “we’ve come so far and so to come to this place where we can actually see an end in sight and to then talk about scaling back that solidarity is hugely disappointing to us.”

In a statement provided to IPS, UNAIDS said that its approach is to encourage low and middle income countries to “increase country ownership by increasing domestic spending on HIV.”

“However, the international community ​​has a responsibility to ensure that ​HIV ​programs​ are able to reach the communities that are most vulnerable to HIV​ ​in countries that have the least ability to fully fund a comprehensive HIV response,” the statement said.

Meanwhile Headley said that the proposed changes in funding could affect groups requiring special attention including adolescent girls in Sub-Saharan Africa.

“The rising rates of incidence among women aged 14 to 25 in Sub-Saharan Africa is exactly why we need full funding to support targeted, high impact prevention,” she said.

Pala an indigenous woman from New Zealand living with HIV said that women can sometimes “get lost in the epidemic,” and that the response should be intersectional in nature. But she also said that activism by other more prominent groups affected by HIV has helped women, including herself.

“There is a very strong activism from the key populations and we needed that,” she said. “For myself living with HIV if that didn’t happen I wouldn’t have the medication and be alive today.”

A group of children use bottle caps to create the red ribbon that symbolises the fight against AIDS, in one of the awareness-raising activities carried out in Latin America. Credit: UNAIDS Latin America

By Álvaro Queiruga
MONTEVIDEO , Jul 14 2015 (IPS)

The countries of Latin America have partially met the Millennium Development Goal referring to the fight against HIV/AIDS, according to the UNAIDS report on the global epidemic released Tuesday.

“The world has achieved the AIDS targets of Millennium Development Goal 6. The epidemic has been halted and reversed,” U.N. Secretary General Ban Ki-moon wrote in the preface to the report “How AIDS changed everything —“MDG6: 15 years, 15 lessons of hope from the AIDS response”.

Among the advances mentioned by the UNAIDS (Joint United Nations Programme on HIV/AIDS) report was the fact that 47 percent of people over 15 and 54 percent of children under 14 living with HIV/AIDS in Latin America were receiving antiretroviral treatment in 2014 – one of the highest levels of coverage in the world.

The global average is 41 percent for adults and 32 percent for children.“In 2000, AIDS was a death sentence. People who became infected with HIV had just a few years to live….Today, the life expectancy of a person living with HIV who is receiving treatment is the same as that of a person who is not infected with HIV. That is success.” -- UNAIDS report

In some Latin American countries coverage is higher, such as Argentina, Brazil, Colombia, Mexico and Venezuela, the five countries that account for over 75 percent of cases of HIV/AIDS in the region. But in others it is much lower, like Bolivia, where antiretroviral coverage stands at less than 25 percent.

As an example to be followed, the report cites a major regional accomplishment: on Jun. 30 Cuba became the first country in the world to receive validation from the World Health Organisation (WHO) that it had eliminated mother-to-child transmission of HIV/AIDS.

Chile, Costa Rica and Uruguay are set to become the next countries in the region to receive validation, possibly before June 2016, the regional director of UNAIDS for Latin America, César Núñez, said in an interview with IPS from Panama City.

The three pillars of the struggle

The experts, activists and HIV-positive persons consulted by IPS agreed that any effective struggle against the epidemic must be based on three pillars: prevention through early detection and treatment of HIV/AIDS, universal access to antiretroviral therapy, and the reduction of HIV-related stigma and discrimination, which limits access to detection and treatment.

According to UNAIDS, an estimated 70 percent of cases of HIV/AIDS in Latin America have been diagnosed and 47 percent of the patients have begun antiretroviral therapy. Of those in treatment, the virus has been suppressed among 66 percent – in other words, 28 percent of all HIV-positive people in the region.

HIV prevalence in the region stands at 0.4 percent of the population – compared to 0.8 percent globally. But it rises to 25 or 30 percent among trans women involved in sex work, over 10 percent among gays and other men who have sex with men, and six percent among female sex workers.

HIV/AIDS prevention campaigns are continually carried out in Latin America, such as this one launched by Chile’s Health Ministry, which shows a man and a woman who do not fit the stereotypes of HIV-positive persons, and warns that “HIV doesn’t kill; your fear of the test does.” Credit: Chilean government

“HIV is concentrated in sexual diversity communities…who even find it very hard just to have an AIDS test in a health centre when, in the best of cases, they face stigma or discrimination on the streets or in the health centre itself, and in the worst of cases, they face the threat of physical violence,” Núñez said.

Between January 2013 and March 2014 the Inter-American Court of Human Rights received 770 reports of violence (594 murders and 176 serious assaults) motivated by the victim’s sexual orientation or identity or gender expression.

The Court recommended that states document such cases in order to develop policies for protecting the human rights of the lesbian, gay, bisexual, trans and intersexual (LGBTI) population.

“Laws on gender identity, gay marriage, anti-discrimination…are clear examples of legislation that…contribute to reducing discrimination and make it possible for the most affected populations to have access to health systems,” Carlos Falistocco, president of the Horizontal Technical Cooperation Group in Latin America and the Caribbean, which brings together the heads of AIDS programmes in the region, told IPS.

Núñez acknowledged that the region “managed to curb the spread of HIV, but we fell short of reversing the epidemic,” one of the targets of the sixth MDG, which like the other seven are to be met this year, when they will be replaced by the Sustainable Development Goals (SDGs).

There is still a long way to go, as reflected by the number of new HIV infections. Although they were reduced 13 percent from 2000 to 2014, in the last five years there has been little change in the annual number of new cases in the region.

Núñez said “there has been a kind of relaxation in the response. In some cases I think there’s a perception that this isn’t a problem anymore in Latin America, which has not enabled us to channel additional resources or put a higher priority on diagnosing and treating HIV.”

María José Fraga, a representative of the Network of Persons Living with HIV/AIDS in Uruguay, concurs.

“Because HIV has become a chronic disease, like diabetes or hypertension, social concern has died down,” she told IPS. “Today the epidemic is practically not discussed, because it’s not present. And for that reason we keep running into late diagnoses. There is no individual awareness of taking the test, or going to the doctor and asking for it.”

Fraga, 44, has been living with HIV for 24 years. When she was diagnosed in 1990, “there was practically no treatment,” she recalled.

“But that changed astoundingly fast, because by 1995 or 1996 there was already a wide variety of drugs…Back then they waited longer to start treatment. And the guidelines for treatment have gradually changed as more is understood about the disease and how it evolves in people,” she said.

Juan José Meré, a U.N. population fund (UNFPA) HIV/AIDS adviser, told IPS that in the case of Uruguay, “in nearly 40 percent of cases, full-blown AIDS is present by the time they are diagnosed. This can obviously be reverted, and in general it is, but at a high cost to their health.”

According to UNAIDS, in at least half of the countries in the region, 38 percent of people living with HIV had, when they were first tested, full-blown AIDS, which is defined by a CD4 cell count of less than 200 per cubic mm of blood. (CD4 cells are a type of lymphocyte or white blood cell; they are an important part of the immune system.)

WHO and UNAIDS recommend that antiretroviral treatment start when a person’s CD4 cell count falls to 500, when they are still asymptomatic.

“Some countries, like Brazil and Argentina, offer treatment to any diagnosed patient, regardless of the CD4 level,” said Falistocco.

What direction should Latin America take in the future?

“We must base whatever we do on that great message from Secretary General Ban…we can’t leave anyone behind. In the region we can make great progress, especially if we guarantee access to services for the sexual diversity community across the entire continent,” said Núñez.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

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

Less than eight per cent of drug users worldwide have access to a clean syringe programme. Credit: Fahim Siddiqi/IPS

By Thalif Deen
UNITED NATIONS, Feb 26 2015 (IPS)

As the call for the decriminalisation of drugs steadily picks up steam worldwide, a new study by a British charity concludes there has been no significant reduction in the global use of illicit drugs since the creation of three key U.N. anti-drug conventions, the first of which came into force over half a century ago.

“Illicit drugs are now purer, cheaper, and more widely used than ever,” says the report, titled Casualties of War: How the War on Drugs is Harming the World’s Poorest, released Thursday by the London-based Health Poverty Action."This approach hasn’t reduced drug use or managed to control the illicit drug trade. Instead, it keeps drugs profitable and cartels powerful." -- Catherine Martin of Health Poverty Action

The study also cites an opinion poll that shows more than eight in 10 Britons believe the war on drugs cannot be won. And over half favour legalising or decriminalising at least some illicit drugs.

The international treaties to curb drug trafficking include the 1961 Single Convention on Narcotic Drugs, the 1971 Convention on Psychotropic Substances and the 1988 United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances.

But over the last few decades, several countries have either decriminalised drugs, either fully or partially, or adopted liberal drug laws, including the use of marijuana for medical reasons.

These countries include the Netherlands, Portugal, Czech Republic, Uruguay, Argentina, Brazil, Colombia, Guatemala, Ecuador, Honduras and Mexico, among others.

According to the report, the governments of Mexico, Colombia and Guatemala seek open, evidence-based discussion on U.N. drugs policy reform.

And “both the World Health Organisation (WHO) and UNAIDS not only share this view, but have called for the decriminalisation of drugs use.”

Asked if the United Nations was doing enough in the battle against drugs, Catherine Martin, policy officer at Health Poverty Action, told IPS, “The problem is that the U.N. is doing too much of the wrong things, and not enough of the right things.”

She pointed out that an estimated 100 billion dollars worldwide is poured into drug law enforcement every year, driven by U.N. conventions on drug control.

“However, this approach hasn’t reduced drug use or managed to control the illicit drug trade. Instead, it keeps drugs profitable and cartels powerful (fuelling corruption); spurs violent conflict and human rights violations; and disproportionately punishes small-scale drug producers and people who use drugs,” she added.

The report says UK development organisations have largely remained silent, while calls for drugs reform come from Southern counterparts, British tycoon Sir Richard Branson, current and former presidents, Nobel prizewinning economists and ex-U.N. secretary-general Kofi Annan.

The charity urges the UK development sector to demand pro-poor moves as nations prepare for the U.N. general assembly’s special session on drugs next year.

Many non-governmental organisations (NGOs), including British groups, have no lead contact or set process for participating in the session, says the report.

The report claims many small-scale farmers grow and trade drugs in developing countries as their only income source.

And punitive drug policies penalise farmers who do not have access to the land, sufficient resources and infrastructure that they would need to make a sustainable living from other crops.

Alternative crops or development programmes often fail farmers, because they are led by security concerns and ignore poor communities’ needs, the report notes.

The charity argues the militarisation of the war on drugs has triggered and been used to justify murder, mass imprisonment and systematic human rights violations.

The report stresses that criminalising drugs does not reduce use, but spreads disease, deters people from seeking medical treatment and leads to policies that exclude millions of people from vital pain relief.

Less than eight per cent of drug users have access to a clean needle programme, or opioid substitution therapy, and under four per cent of those living with HIV have access to HIV treatment.

In West Africa, people with conditions linked to cancer and AIDS face severe restrictions in access to pain relief drugs, amid feared diversion to illicit markets, according to the study.

Low and middle-income countries have 90 per cent of AIDS patients around the globe and half of the world’s people with cancer, but use only six per cent of morphine given for pain management.

Health Poverty Action states the war on drugs criminalises the poor, and women are worst hit, through disproportionate imprisonment and the loss of livelihoods.

Drug crop eradication devastates the environment and forces producers underground, often to areas with fragile ecosystems.

Asked what the U.N.’s focus should be, Martin told IPS the world body should focus on evidence-based, pro-poor policies that treat illicit drugs as a health issue, not a security matter.

These policies must protect human rights and end the harm that current policies do to the poor and marginalised, she said.

“Drug policy reform should support and fund harm reduction measures, and ensure access to essential medicines for the five billion people worldwide who live in countries where overly strict drug laws limit access to crucial pain medications,” Martin said.

Meanwhile, the report says that drug policy, like climate change or gender, is a cross-cutting issue that affects most aspects of development work: poverty, human rights, health, democracy, the environment.

And current drug policies undermine economic growth and make development work less effective, the report adds.

Edited by Kitty Stapp

The writer can be contacted at thalifdeen@aol.com

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

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

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

By Miriam Gathigah
NAIROBI, Oct 17 2014 (IPS)

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

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

The new treatment targets seek that, by 2020:

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

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

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

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

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

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

An attainable goal

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

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

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

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

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

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

Testing is the first step

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

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

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

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

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

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

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

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

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

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

Finding funding

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

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

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

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

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

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

Edited by: Mercedes Sayagues

Uganda has been hailed as a success story in fighting HIV/AIDS, with prevalence rates dropping from 18 percent in 1992 to 6.4 percent in 2005. But activists fear a new HIV Bill will lead to lead to people shunning testing and treatment. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Aug 21 2014 (IPS)

HIV/AIDS activists are adamant Uganda will not achieve an “AIDS-free generation” now a “backwards” HIV/AIDS Bill criminalising the “wilful and intentional” transmission of the disease has been signed into law.

The act, they say, will lead to people shunning testing and treatment, but will particularly drive sex workers and gay men underground, and make women more vulnerable to domestic violence.

News that the controversial law, adopted unanimously by Parliament on May 13, and assented to by Uganda’s President Yoweri Museveni on Jul 31, broke on social media only this week on Aug. 19.

The bill also allows medical providers to disclose a patient’s HIV status to others without consent and prescribes mandatory testing for pregnant women, their partners, and victims of sexual offences.

Uganda has been hailed as a success story in fighting HIV/AIDS, with prevalence rates dropping from 18 percent in 1992 to 6.4 percent in 2005.

But Museveni went against earlier promises to the Joint United Nations Programme on HIV/AIDS (UNAIDS) executive director and campaigners that he wouldn’t back the punitive law.

“This is a populist act,” Kikonyongo Kivumbi of the Uganda Health and Science Press Association (UHSPA-Uganda) told IPS.

“He knows what he’s doing is not the right thing in addressing the general public health concerns in this country.”

Kivumbi pointed out that according to the 2014 UNAIDS Global Progress report, Uganda was now the third country in the world contributing to sustaining the pandemic.

Other campaigners are “heartbroken” and “outraged” after the president approved the HIV Prevention and Control Bill.

The news broke as CSOs were still waiting for an audience with Museveni over the controversial bill, which has been slammed by Uganda’s own AIDS Commission and the AIDS Control programme of the Ministry of Health (MoH).

“Some bad news from Uganda. Please pray for us,” Jacquelyne Alesi, director or programmes at Uganda Network of Young People Living with HIV & AIDS (UNYPA), said in an email to IPS.

The legislation prescribes a maximum 10 years in jail, a fine of about five million Ugandan shillings (1,980 dollars) or both for anyone who “willfully and intentionally transmitting HIV/AIDS to another person”.

Another provision of the law, drafted in 2008, provides for a fine or a maximum five years in jail for those convicted of “attempted transmission”.

According to the 2011 Uganda AIDS Indicator Survey, overall HIV prevalence is higher among women (8.3 percent) than among men (6.1 percent).

“Usually HIV bears the face of a woman,” Dorcas Amoding, policy, advocacy and networking officer for Action Group for Health Human Rights and HIV/AIDS (AGHA-U), told IPS.

“So if she has tested positive and perhaps the husband becomes aware of it…he might treat this as a very negative result as well and she can be attacked.”

Amoding added, “it even brings about a very huge burden in terms of women inheriting property, because some people still think HIV is a death sentence.”

“So if I say ‘I want to have my husband’s property for the children’, people are going to say ‘you’ll die tomorrow, you’re HIV positive.’”

Most LGBT people with HIV/AIDS already “die silently” and many were no longer going for services in the after the passing of the Anti-Homosexual Act, Bernard Ssembatya, from Vinacef Uganda, a sexual health and reproductive NGO focusing on HIV, told IPS. The anti-gay law was, however, declared “null and void” by the constitutional court on a legality earlier this month.

“Some of them are wary of going to health services, some health providers are also scared of delivering services,” Ssembatya said.

There will be “an increase in deaths from HIV, more infections” as a result of the HIV/AIDS law, he warned.

According to AIDS Free World, over 60 countries criminalise the transmission of HIV or the failure to disclose one’s HIV status to sex partners, or both. Global Commission on HIV and the Law members have highlighted Guinea, Senegal and Togo, which they say in recent years have revised existing, or adopted new laws which limit HIV transmission to exceptional cases of wilful transmission.

Guyana also rejected a criminalisation law. In the U.S, 34 states still have HIV specific criminal statutes, however, in May Iowa approved a law revising a HIV specific statute.

Kivumbi pointed out that criminalisation was an “agenda of the U.S. republican right”, who he accused of influencing political and public health appointments in Uganda.

“We need to tell U.S. republican extremists and evangelical Christians to leave managing the HIV pandemic to ourselves,” he said.

“Just because the U.S. gives us money it does not mean [they] can impose their extremist agenda on us.”

Uganda had deliberately chosen to “moralise the pandemic and response, emphasising abstinence at the expense of condom use and other scientifically proven interventions,” Kivumbi said.

“We have had cabinet ministers, parliamentarians and other people at senior government level saying that people who are HIV positive are morally bankrupt,” the activist said.

Kivumbi said there was an “element of politicking” on Museveni’s part in inking his signature on the bill. Uganda will be submitting a “concept note” to the Global Fund to Fight AIDS, Tuberculosis and Malaria on Oct. 15, and wanted to get access to a 90-million-dollar loan from the World Bank that was suspended, he said.

One clause of the HIV/AIDS Bill seeks to set up an AIDS Trust Fund managed by the MoH, with money coming from foreign governments and international agencies, among other means.

Ironically, that loan was put on hold in February, just days after the president approved the Anti-Homosexuality Act.

“I think that the president thought that by signing this law, which [sets up] the AIDS Trust Fund, the World Bank would give him money and the Global Fund would contribute,” said Kivumbi.

“Let the Global Fund and the World Bank not be fooled.

”This law tramples upon basic civil liberties and cannot be acceptable in a free and democratic society that Uganda aspires to be.”

Dianah Nanjeho, a communications consultant at Uganda Network on Law, Ethics and HIV/AIDS (UGANET), which works with a coalition of 40 organisations, told IPS the activists wanted the contentious clauses in the bill to be amended.

“The act in itself is a good act we don’t condemn it, we just want those one, two three things sorted out.”

She said the positive parts of the law were state obligations to provide care and treatment and the establishment of the AIDS Trust Fund.

Nanjeho said CSOs, who are still hoping to meet Museveni, hadn’t ruled out challenging the law in court, and would make a decision on this in the next few days.

“For now we are all weighing all options,” she said.

Edited by: Nalisha Adams

The writer can be contacted on Twitter @amyfallon 

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

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

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

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

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

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

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

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

Source: Nigeria report to UNGASS 2014

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

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

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

Why women avoid testing

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

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

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

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

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

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

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

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

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

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

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

But Nigeria needs more than laws to address the epidemic.

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

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

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

Source: UNAIDS Gap report 2014

Some good news

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

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

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

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

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

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

Edited by: Mercedes Sayagues

“Preventing It Is in Your Hands…World AIDS Day” – image from one of the government campaigns to prevent AIDS in Venezuela. Credit: Venezolana de Televisión

By Humberto Márquez
CARACAS, Jul 30 2014 (IPS)

Venezuela is gearing up to pass a new law to combat discrimination against people living with HIV/AIDS, in a country where the epidemic claims nearly 4,000 lives and infects 11,000 mainly young people every year, including increasing numbers of women.

In the first debate in the single-chamber legislature, where the bill was introduced by ombudswoman Gabriela Ramírez, it received unanimous backing from both the governing majority and the opposition – not a common occurrence in this severely polarised country.

When she presented the “law for the promotion and protection of the right to equality for people with HIV or AIDS and their family members” on Jul. 8, Ramírez said it “gives parliament an opportunity to promote equality and reduce the vulnerability of a segment of the population that has suffered discrimination.”

“HIV-related stigma and discrimination are the main barrier in the fight against this epidemic all around the world,” Alejandra Corao, the Joint United Nations Programme on HIV/AIDS (UNAIDS) official in Venezuela, told IPS.

“The most important thing is that 30 years after the arrival of the epidemic here, the state recognises that discrimination is a serious problem,” Alberto Nieves, director of the non-governmental organisation Citizen Action Against AIDS (ACCSI), told IPS.“The most important thing is that 30 years after the arrival of the epidemic here, the state recognises that discrimination is a serious problem.” -- Alberto Nieves

Ombudswoman Ramírez pointed out that between 1982 and 2013 there were 31,512 officially documented cases of HIV/AIDS in this country. But Nieves believes the current number of cases is as high as the highest UNAIDS estímate – 160,000 cases.

The bill guarantees HIV-positive people equal conditions in terms of the right to work and hold public office, to education, healthcare, culture and sports, the benefits of social programmes, bank loans, confidentiality about their health status and respect for their prívate lives.

It also states that having AIDS cannot be grounds for the suspension of paternity rights, while establishing that families are responsable for caring for and protecting people living with HIV.

The law guarantees equality for young people, because 40 percent of new cases are in the 15-24 age group. It also does so in the case of women, for whom it orders that special care be provided during pregnancy, birth and the postpartum period, as well as for people with disabilities and prisoners.

The bill establishes penalties, disciplinary measures and fines for those found guilty of discrimination.

The idea is to prevent a repeat of situations such as one faced by a schoolteacher in a city in western Venezuela, who remains anonymous at her request. She was fired after a campaign against her was mounted by parents who discovered that she had gone to the AIDS unit in a hospital to undergo exams.

However, the miliary and the police are exempt from the protective provisions against discrimination.

“We do not agree with that exception,” Estevan Colina, an activist with the Venezuelan Network of Positive People, told IPS. “No one should be excluded and we hope for progress on that point when parliament’s Social Development Commission studies it and it goes to the plenary for the second debate,” which will be article by article.

Nieves is confident that the second reading will overturn the military-police exception. But more important, said the head of ACCSI, “is the positive aspect of the law, starting with the unanimous acceptance of a human rights issue by political groups that are so much at loggerheads in Venezuela’s polarised society.”

The law, which NGOs and activists expect to pass this year, will give a boost to anti-AIDS campaigns. The support will be similar in importance to that given by a July 1998 Supreme Court ruling that ordered public health institutions to provide free antiretrovial treatment to all people living with HIV.

In this country of 30 million a total of 43,000 people currently receive free antiretrovirals, equivalent to 73 percent of those requiring treatment, Corao said. The global average is 37 percent and the Latin American average 45 percent, UNAIDS reports.

Venezuela’s public expenditure on HIV/AIDS amounts to 100 million dollar a year, approximately half of which is spent on medication. But NGOs complain that the government effort is undermined by red tape and organisational problems.

“In some regions trained personnel is sometimes lacking to run the HIV/AIDS programme; coordination and transportation between the capital and the regions is deficient; and the pharmaceutical industry declines to take part in public tenders,” Nieves said.

Shortages of antiretrovirals trigger periodic protests by patients, in a country where “scarcity of medicine can range from 35 to 50 percent,” infectious disease specialist Julio Castro, with the local NGO Doctors for Health, told IPS.

Prevention and educational campaigns must also be stepped up, to judge by the rise in new cases: 4,553 in 2004 compared to 11,181 in 2012, according to the Health Ministry. Among women there were 1,408 new cases in 2004 and 2,236 in 2012.

“There is a feminisation of the epidemic, a phenomenon that is not exclusive to Venezuela, because in 2003 one in five HIV-positive people were women, compared to one in three in 2007,” Corao said.

“Women who are increasingly affected are not only sex workers but homemakers, employees and workers, professionals and students. And one of the main problems associated with this is domestic violence,” the UNAIDS representative added.

Another area where the disease is expanding is among adolescents and young people, the age group between 15 and 24 years, “because throughout Latin America there is a perception that the risk has gone down, and kids who did not live through the boom of the epidemic in the 1980s behave as if it were a problem of the past that has already been overcome,” the expert remarked.

In 2013 1.5 million people died of AIDS-related causes worldwide – 35 percent less than the 2.4 million of 2005. But in a report published Jul. 16, UNAIDS stated that of the 35 million people living with HIV around the world, an estimated 19 million are unaware of their HIV-positive status.

Messages of sympathy adorn a street in Melbourne. Credit: Diana G Mendoza/IPS

By Diana Mendoza
MELBOURNE, Jul 25 2014 (IPS)

The 20^th International AIDS Conference concluded today as the first in its history that remembered not just the 39 million people worldwide who have died of AIDS but also those who lost their lives in the crashed MH17 flight carrying six of its delegates, one of whom was the past president of the International AIDS Society (IAS).

The double memorial, however, did not hamper 12,000 scientists, researchers, advocates, lobbyists, and activists from 200 countries, including 800 journalists, from scrutinising a few advances and disturbing setbacks in HIV and AIDS awareness and prevention, treatment to prolong and improve the quality of life of people living with HIV, and compassion and care to those infected and people close to them.

The IAS and the Joint United Nations Programme on HIV/AIDS (UNAIDS) said that globally, there are about 35 million people living with HIV in 2013, but 19 million of them do not know that they have the virus. Also in 2013, around 2.1 million became newly infected, and 1.5 million died of an AIDS-related illness.

"We will not stand idly by when governments, in violation of all human rights principles, are enforcing monstrous laws that only marginalise populations that are already the most vulnerable in society.” -- Francoise Barre-Sinoussi, president of the International AIDS Society (IAS)
But the good news is that HIV transmission has slowed down worldwide, according to Michel Sidibé, executive director of UNAIDS, and that millions of lives are being saved by antiretroviral drugs that suppress and slow down the replication of the virus, but do not eradicate it.

An estimated 13 million people are taking antiretroviral therapy that has resulted in a 20 percent drop in HIV-related deaths between 2009 and 2012. In 2005, there were only 1.3 million who were accessing ART.

Sidibé said at least 28 million people are medically eligible for the drugs. Currently, according to UNAIDS, spending on HIV treatment and prevention is around 19 billion dollars annually, but this needs to be scaled up to at least 22 billion dollars next year.

“We have done more in the last three years than we have done in the previous 25,” said Sidibé, who warned that these advances are disturbed by a few setbacks that are difficult to battle, such as laws against gay people in Africa and the crackdown on intravenous drug users in Russia.

In other countries, new policies have also emerged, criminalising homosexual behaviour and the use of intravenous drugs, and penalising those who engage in sex work.

Activists and experts say these policies help HIV to thrive by driving homosexuals, injecting drug users and male and female sex workers underground, where they have no access to preventative services.

Francoise Barre-Sinoussi, IAS president and chair of the conference who co-won the Nobel Prize for helping discover the virus that causes AIDS, said, “We will not stand idly by when governments, in violation of all human rights principles, are enforcing monstrous laws that only marginalise populations that are already the most vulnerable in society.”

The upsurge of anger was also obvious in the Melbourne Declaration that delegates were urged to sign early on, which demanded tolerance and acceptance of populations under homophobic and prejudiced attack.

The Melbourne Declaration called on governments to repeal repressive laws and end policies that reinforce discriminatory and stigmatising practices that increase the vulnerability to HIV, while also passing laws that actively promote equality.

Organisers believe that over 80 countries enforce unacceptable laws that criminalise people on the basis of sexual orientation and HIV status and recognise that all people are equal members of the human family.

The conference also called on health providers to stop discriminating against people living with HIV or groups at risk of HIV infection or other health threats by violating their ethical obligations to care for and treat people impartially.

Bad news for Asia-Pacific

Another setback is that while HIV infections lessened in number globally, some countries are going the other way. Sharon Lewin, an Australian infectious disease and biomedical research expert who co-chaired the conference with Barre-Sinoussi, said Pakistan, Indonesia and the Philippines are experiencing epidemics in their vulnerable populations with “worryingly high” proportions in 2013.

“While new infections continue to decrease globally, we are unfortunately seeing a very different pattern in Indonesia, Pakistan and the Philippines with increasing numbers of new infections in 2013,” Lewin said during the conference opening.

She cited men who have sex with men (MSM), sex workers, people who inject drugs and transgender persons as the most at-risk populations in the three countries.

This brought the rate of daily new infections in the region to 6,000; 700 are children under 15 while 5,700 were adults. But 33 percent of them were young people aged 15-24.

Aside from Pakistan, Indonesia and the Philippines, she said Thailand and Cambodia are also causes for concern because of their concentrated epidemics in certain populations, while India remains a country with alarmingly high infections, accounting for 51 percent of all AIDS-related deaths in Asia. Indonesia’s new HIV infections, meanwhile, have risen 48 percent since 2005.

Meanwhile, the U.N. predicts that AIDS will no longer exist by 2030. UNAIDS’ Sidibé introduced the “90-90-90 initiative” that aims at reducing new infections by 90 percent, reducing stigma and discrimination by 90 percent, and reducing AIDS-related deaths by 90 percent.

“We aim to bring the epidemic under control so that it no longer poses a public health threat to any population or country. No one must be left behind,” Sidibé stressed.

The conference also saw a few hopeful solutions such as the portable HIV and viral load testing devices presented by pharmaceutical and laboratory companies that joined the exhibitors, and radical approaches to counselling and testing that involve better educated peer counsellors.

The World Health Organisation (WHO) issued consolidated guidelines on HIV prevention, diagnosis, treatment and care designed to assist health providers and policymakers develop HIV programmes that will increase access to HIV testing, treatment and reduce HIV infection in five key populations vulnerable to infection – men who have sex with men (MSM), people who inject drugs, sex workers, transgender people and people in prison and other closed settings – who make up 50 percent of all new infections yearly.

Part of the guidelines recommend that MSM – one of the most at-risk groups for new infections – consider pre-exposure prophylaxis or taking anti-retroviral medication even if they are HIV negative to augment HIV prevention, but they are asked to still used the prescribed prevention measures like condoms and lubricants. The prophylaxis that prevents infection can reduce HIV among MSM by 20 to 25 percent.

(END)

According to an African proverb, “every woman who gives birth has one foot on her grave.” It is time to make this proverb a historical fact and not a present reality. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Jun 27 2014 (IPS)

An African proverb says that every woman who gives birth has one foot on her grave.

Sadly, this is still true today, especially within the context of the AIDS epidemic.

In spite of the huge advances in the prevention of mother to child transmission of HIV (PMTCT) in Africa, experts are concerned that these have not matched other pillars needed to eliminate maternal mortality caused by HIV and AIDS.

Preventing unintended pregnancies among women living HIV, as well as providing contraceptives for women who need them are some of the missing pillars. Another is making motherhood safer for all women.

Pregnant women with HIV die at much higher rates than women without HIV, Mary Pat Kieffer, senior director at Elizabeth Glaser Paediatric AIDS Foundation in Malawi, told IPS.

The risk of pregnancy-related death is six to eight times higher for HIV positive women than their HIV negative counterparts.

Studies have shown that HIV increases maternal mortality directly from the progression of the HIV disease itself, and indirectly through higher rates of sepsis, anaemia and other pregnancy-related conditions.

This is bad news at a big scale. In South Africa alone, up to 310,000 HIV positive women gave birth in 2012, and 110,000 in Mozambique, says the Joint United Nations Programme on HIV/AIDS (UNAIDS).

While all HIV positive women, whether on antiretroviral therapy (ART) or not, are more vulnerable to sepsis and anaemia because of their compromised immune system, Kieffer says that ART does boost the immune system that protects women from infections.

Another problem is that women become infected with HIV during pregnancy at higher rates compared to women who are not pregnant, alerts Kieffer.

Experts attribute this to biological changes in the woman’s reproductive tract, including the increased blood volume and hormonal changes.

In southern African countries, “as many as five percent of pregnant women who tested HIV negative during their second trimester of pregnancy become infected with HIV later in pregnancy or during breastfeeding,” Kieffer told IPS.

Rethinking PMTCT

While ART for prevention of mother to child transmission of HIV is key to reducing maternal mortality, “fighting HIV is about more than pushing ARVs into health systems,” says Kieffer.

In South Africa, where nearly two out of 10 persons aged 15-49 are HIV positive, in spite of universal PMTCT coverage, HIV still accounted for six out of 10 maternal deaths in 2012, according to UNAIDS.

In Lesotho, with an HIV infection rate of 23 percent, four out of 10 maternal deaths are attributed to HIV related complications. In Malawi it is three maternal deaths out of ten, with an HIV infection rate of 11 percent.

Naseem Awl, an HIV specialist with UNICEF in Lesotho, told IPS that “much work remains to be done besides the provision of medicines, and one is ensuring women deliver in a health facility.”

UNICEF statistics show that in Eastern and Southern Africa only four out of 10 pregnant women deliver their babies with the assistance of a skilled health professional.

In Lesotho, while nine out of 10 pregnant women attend at least one antenatal visit, more than half do not deliver in the care of a skilled birth attendant. Mozambique has a similar pattern – and up to 110,000 HIV positive women gave birth here in 2012.

Kieffer believes there is a need to rethink PMTCT, “not just as a way to keep the infant from acquiring HIV but as an essential part of maternal and child health care for all women.”

Sheurges an improvement of health services delivery and health staff attitudes.

“A good number of health workers believe that HIV positive women have no right to get pregnant,” she says. The consequence is that many women show up late for antenatal care or deliver at home.

Protecting young women

Addressing unwanted pregnancies among young women aged 15-24 years is yet another pillar, because they are two to four times more likely to be infected with HIV than men of the same age.

The highest incidence for HIV lies in the 19-24 age group, “when people are sexually active and may not have a single partner. It is also when most women become pregnant for the first time,” says Kieffer.

The two major causes of death for young women are complications of childbirth and HIV, according to the United Nations Population Fund. Because their bodies are not fully mature, they experience more problems with a pregnancy and are at higher risk of HIV infection.

“Young women lack experience with the health system, they may discover their pregnancy late and be afraid to go to the clinic,” Kieffer explains. “They are less emotionally mature and less likely to have a partner that they can rely on for emotional support, either for the pregnancy or the HIV.”

She adds that health workers may not treat young women with care or lack the time to give the extra attention, information and support they need.

Meanwhile, staggering needs for contraceptives present other challenges. In Lesotho, the unmet need for family planning is 23 percent. In Mozambique, 29 percent, says UNAIDS.

Even where contraceptives are available, “ART clinics are overcrowded and overwhelmed, and have resisted putting emphasis on family planning because they did not have the capacity,” says Kieffer.

Dr Chewe Luo, senior adviser on HIV at UNICEF, told IPS that the new ART involving only one pill per day for pregnant women living with HIV will “have a serious impact on AIDS-related maternal and child deaths.”

In addition, the integration of maternal and child health services will result in more women and children reached sooner, and more mothers’ lives saved, she told IPS.

By strengthening all the pillars needed to improve maternal health, the African proverb about mothers having a foot on their graves will become history instead of a grim reality.

Excerpt:

Chronic shortages of antiretroviral drugs endanger the lives of hundreds of thousands of HIV positive Mozambicans. Courtesy: Amos Zacarias

By Amos Zacarias
MAPUTO, Jun 19 2014 (IPS)

Chronic shortages of antiretrovirals across Mozambique are endangering the health and the lives of tens of thousands of HIV positive people on treatment.

Some 454,000 people are on antiretroviral (ARV) treatment, or just under one-third of the 1.6 million Mozambicans living with HIV in 2013, according to government figures.

“Our patients complain they are not receiving the complete dosage of medicines,” says Judite de Jesus Mutote, president of Hi Xikanwe (“we are together,” in the local Shangaan language), a group that assists people on ARV treatment in Maputo.

For ARVs to be effective, the pills must be taken every day at the same time.  Interrupting treatment has serious health consequences.

“Stopping treatment  increases viral load, causes opportunistic infections, and creates resistance to the drug, with the patient needing stronger and more expensive  medicines, which sometimes the country does not have,”  Jose Enrique Zelaya, head of the Joint United Nations Programme on HIV/AIDS (UNAIDS) in Mozambique, told IPS.

Shortages of essential medicines happen intermittently in Mozambique, but the last six months have been especially critical for ARV supply.

Press reports from across the country, but especially the central and northern provinces, tell of people going several times to the clinic, spending time and money only to return empty-handed or with two weeks supply instead of one month’s, or bribing the clinic’s staff to get the drugs.

Rural patients are most affected. “In rural areas, the distances between health clinics and patient’s homes are long, and the roads, problematic,” confirms Zelaya.

In the central province of Sofala, attacks by an armed rebel group has cut the main highway, forcing commercial traffic to drive in convoys under military escort, further disrupting supplies of essential goods like medicines.

But even Maputo, the capital, has not been spared ARV shortages, as Hi Xikanwe members confirm.

Some patients resort to buying the drugs at high prices in the informal markets, with no guarantee of their quality. Many suspect that ARVs from government clinics find their way into markets.

Salmira Ngoni*, an HIV-positive, 26-year-old mother, endured months of erratic supply at the clinic in Ndlavela, in Matola city, 20 kms north of Maputo. In December, she bribed a pharmacist to sell her 15 ARV pills without a prescription for the equivalent of 10 dollars.

In January, a frustrated Ngoni took a more drastic step: she quit the government clinic and enrolled in the DREAM programme for HIV positive people, run by the Catholic Community of Sant’Egidio. DREAM has not experienced ARV shortages.

Erratic drug supply is not new to Mozambique.

“Basically, the problem lies in poor planning from the health ministry and in the process of distribution according to demands,” says Zelaya.

Mutote agrees: “We are told the medicines are stored in the health ministry’s warehouse but the problem is distribution. They lack transport to health clinics.”

Source: Ministry of Health, Mozambique

A 2010 report by the World Health Organisation (WHO) noted Mozambique’s logistical challenges “in procurement, distribution, and storage of medicines and medical products. Poor infrastructure can cause delays and harm the quality of the drugs mainly because of exposure to heat.”

According to WHO, the country’s deficit of health staff affects “the rational use of medicines due to limited capacity in prescribing medicine at clinical level and in distributing it at pharmaceutical level.”

Mozambique had 5.6 pharmaceutical professionals per 100,000 persons in 2010, said the report, one of the lowest ratios among poor countries.

Alarm bells ring

Drug shortages ebb and fall, but their increasing frequency alarms foreign donors, who contribute a large chunk of the health budget for AIDS.

In April, at a press conference, Dutch ambassador Frederique de Man, the focal point for the Health Cooperation Partners, observed “the need for the public to buy medicines from informal vendors because the health units frequently run out of stocks of medicines or receive medicines that are past their expiry dates”.

De Man urged the health ministry to listen to the complaints of people and NGOs, and improve the drug supply chain.

Worryingly, ARV shortages threaten Mozambique’s plan to scale up Option B+,the treatment option recommended by WHO for HIV positive mothers. Option B+ is lifelong provision of ARV therapy to pregnant women regardless of their CD4 count.

In 2013, nearly 85,000 HIV positive pregnant women were given ARVs to prevent transmission to their babies.  Of these, half were enrolled in Option B+. This means they must get a monthly supply of 30 pills for the rest of their lives.

“It is crucial to keep these women on treatment but it is not easy due to long distances between clinics and communities,” said Guillermo Marquez, HIV specialist with the United Nations Children’s Fund in Maputo.

With 56,000 new infections among women in 2012, the needs for ARV treatment will continue to grow.

Concerning children, 12,600 were newly infected in 2013, according to government figures – an improvement over the previous year’s figure of 14,000 new child infections.

Mozambique aims to reduce the number of HIV infections among children to fewer than five percent by 2015.

But Zelaya doubts this goal can be reached in time. “To achieve it, the medicines must be available, otherwise it is impossible.”

*Name withheld to protect privacy

Excerpt:

A Swazi mother with her baby. In July Swaziland will roll out Option B+, the latest treatment recommended by the World Health Organisation for HIV positive mothers. Credit: Mantoe Phakathi/IPS

By Mantoe Phakathi
MBABANE, Jun 5 2014 (IPS)

For months, Nonkululeko Msibi could not find her voice each time she wanted to share the news to her husband. She had learned that she was infected with HIV at the age of 16 when delivering her firstborn baby at Swaziland’s Mbabane Government Hospital.

“Although I was shocked by the news, I accepted it,” Msibi told IPS. “But the most difficult part was breaking the news to my husband.”

Her biggest fear was to be thrown out of their marital home should he believe that she had brought HIV into the family.

Despite being put on antiretroviral treatment (ART) at the baby’s birth and living two kms away from the clinic, where she could easily refill her prescriptions, her daughter contracted HIV, possibly through breast milk.

“Because I did not disclose my status, I failed to convince my mother-in-law that I had to breastfeed exclusively,” said Msibi.

Her second baby is also HIV positive because, she says, the clinic failed to give her nevirapine, although the nurses knew her status.  “I don’t know why this happened,” she said.

Born and bred at rural Motshane, about 15 kilometres from the capital city of Mbabane, Msibi dropped out of school in Grade 3 and got married at the age of 15 when five months pregnant. A product of a broken family, with both her parents deceased, marriage is the most important thing in her life.

“There must be someone to look after you and your children, especially if you’re unemployed like me,” said Msibi.

So, when she received the HIV diagnosis, she imagined her world falling apart, did not tell anyone and did not follow ART properly.

But she is not the only woman in this kind of dilemma.

“We realised that some women do not return to health centres within the stipulated timelines,” said researcher Thandeka Dlamini. She and other researchers set out to find why married women start ART late or drop out.

Their study, conducted by MarxART, a project by the Swaziland National AIDS Programme (SNAP), found “distinct socio-cultural challenges faced by women before initiating ART that result in specific gendered decision making patterns.”

This matters because in July Swaziland will roll out Option B+, the latest treatment recommended by the World Health Organisation for HIV positive mothers. Option B+ consists of lifelong provision of ART to pregnant women, regardless of their CD4 count. CD4s, or helper cells, fight infections in the body.

Since last year, Option B+ has been provided to 600 women to test feasibility, acceptance and clinic readiness. Soon it will be offered to the four out of ten pregnant women who are HIV positive. Among these, women aged 30-34 showed the highest prevalence – more than half were HIV positive in 2010.

Gendered decisions

Although Swazi women have better health-seeking behaviour than men, they find it hard to deal with HIV because of socio-cultural barriers, says the study. Many HIV positive married women live in a dilemma between obeying their husbands or following the advice of the health workers

According to Dlamini, in this conservative country, where women were considered minors until not long ago, wives must obey their husbands, even if they oppose ART or prefer traditional medicine.

Dlamini said an HIV diagnosis threatens married women’s sense of security because they fear being cast out by their spouses or in-laws.

“Submission might result in death, revolt can result in life, but threatens the loss of dignity and the refuge found in a marriage, and can bring shame when a marriage fails,” said a 25-year-old married woman quoted in the study.

National HIV prevalence is 26 percent among people aged 15-49, and 5,600 women were newly infected with HIV in 2012, according to the United Nations. Two thirds of infections are among women aged 25 and over – in their married, childbearing years.

Although the 2007 Swaziland Demographic and Health Survey reports that both married and single women have a high HIV prevalence, they are faced with different choices when it comes to ART. Single women can take a decision on their own; married women can’t.

Dr Velephi Okello, senior medical officer at SNAP, said the findings will help strengthen its HIV communications strategy.

“This study has helped us understand why women are either dropping out or initiating ART late,” said Okello.

The 2013 Global Report of the Joint United Nations Programme on HIV/AIDS (UNAIDS) shows that nine out of ten Swazis remain on ART after a year. But Okello said one dropout is one too many.

“We need to understand the barriers they encounter at social level so that we help them stay on treatment,” said Okello.

Dlamini recommends empowering married women with skills to negotiate access to ART, and researching how some women successfully navigate this tricky situation.

One such woman is Msibi, now 24, who is on treatment together with her husband.

“When my firstborn fell seriously ill, I realised I had to disclose,” she said.

Counselling from health workers helped her find the voice to break her silence. Msibi approached her mother-in-law, who already suspected that the child was HIV positive. An HIV test confirmed her fears.

“But that made it easy for me to disclose to my husband, who found it difficult to accept at first, but eventually he did,” she said. Later he trained as an HIV/AIDS counsellor at the local clinic, and the couple now helps each other follow ART carefully.

Excerpt:

Afraid of losing playmates, children hide their HIV positive status from their peers. Credit: Busani Bafana/IPS

By Busani Bafana
BULAWAYO, Apr 3 2014 (IPS)

Three years ago, Robert Ngwenya* and his father got into a heated argument over medication. Ngwenya, then aged 15, refused to continue swallowing the nausea-provoking pills he had been taking since he was 12 years old, and flushed them down the toilet. 

During the argument, Ngwenya understood he had been born HIV positive, had been taking antiretrovirals (ARV) and not vitamins and anti-allergenics, and that his father too lived with the virus and the guilt of having infected him.

“This is unfair, what did I do to deserve this?” Ngwenya laments.

Ngwenya lives in the high density suburb of Pumula in Bulawayo, Zimbabwe’s second city, with his father, a car mechanic, and his younger brother, who is HIV negative. His mother died when Nwengya was 10 and his father never remarried.

Ngwenya’s life was all planned: finish high school, get a degree in information technology, find a job and buy a car. Not any more. After the revelation, he is no longer the same outgoing teenager whose company brought smiles to friends and family.

“How do I tell my friends? How do I start a relationship knowing someone will have to carry my burden?” he asks.

Like Ngwenya’s father, other HIV positive parents, weighed down by guilt, find it hard to tell their children they were infected at birth.

How and who tells a child or teenager that they will live with the virus for the rest of their lives?

Hard choices

Thanks to ARV therapy, increasing numbers of HIV infected children are living to adolescence. In 2012, Zimbabwe had 180,000 children aged 0-15 and 1.2 million people aged 15 and above living with HIV, says the Joint United Nations Programme on HIV/AIDS (UNAIDS).

“As these children grow and surpass the immediate threat of death, the issue of informing them of their HIV status arises,” says a study on teenagers born with the virus in Zimbabwe.

Disclosing to adolescents is different from telling younger children and requires tailored, age-appropriate guidelines, says the study.

Adolescents aged 16-20 interviewed for the study preferred to be told by health care workers at clinics, with the presence of family.

“Disclosure to this age group in a healthcare setting may help overcome some of the barriers associated with caregivers disclosing in the home environment and make the HIV status seem more credible to an adolescent,” reports the study.

Zivai Mupambireyi, a researcher with the Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) and co-author of a 2013 study of HIV positive children aged 11-13 in Zimbabwe, told IPS that children prefer to learn about their HIV status at the clinic because they believe health workers give them more and better information than their carers.

Children reported that their carers delayed disclosure, concealed information and lied about the pills.

“Most of these children were looked after by non-biological carers, as their parents were the first generation of AIDS patients and died before ARVs,” Mupambireyi explains.

Whether it is parents overwhelmed by guilt or carers distressed by the enormity of the revelation, telling adolescents they are HIV positive is fraught with pain and ambivalence.

Mupambireyi found that HIV positive children believe that disclosing to peers will expose them to discrimination. Although this often was not the case, fearing a loss of social interaction and friendship, children hide their HIV status.

“Although HIV status disclosure is noble and recommended, children’s concerns and fears around disclosure must be addressed before they are encouraged to disclose,” says Mupambireyi.

Health workers, parents and educators are tongue-tied as to the timing and best method of disclosing HIV status to youth.

Building trust

Definate Nhamo is the coordinator of Shaping the Health of Adolescents in Zimbabwe (SHAZ), a research and intervention project. One offshoot, SHAZ for Positives, reaches more than 700 youth living with HIV in Chitungwiza, a suburb of Harare, the capital.

Nhamo told IPS that the best age to disclose HIV status is probably around nine or 10 years, before puberty, and preferably in the presence of parents, guardians or a counsellor.

“When the child is younger, she is trusting, and will grow up knowing she must take the ARVs religiously,” says Nhamo.

SHAZ for Positives members agree that knowing their status early helps kids accept their condition and learn to be open about it, Nhamo told IPS.

Some adults tell children the ARV pills are for tuberculosis, without realising that children can google it. “Teenagers just stop taking their ARVs and do not tell their parents because they feel they are more informed since they have access to the internet,” observes Nhamo.

A young female participant in the SHAZ study, who did not want to be identified, tells IPS that her mother, distressed at having infected her, never told her the truth. At age 17, the girl took a routine HIV test and tested positive. Since she had never had sex, she confronted her mother and learned that her two siblings were HIV negative but she had been born positive.

“I was angry and frustrated. If my mother had told me earlier, I could have accepted my status better,” she says.

Zvandiri, meaning “what I am” in the Shona language, is a support group that helps adolescents deal with HIV.

In 2013, Zvandiri produced a catchy song and DVD, How to Dance, with cool young people spiritedly belting out their hopes and fears: “I too have dreams of a better life, that someone will love me as I am.”

They sing, “how to dance in the storm”.

* Not his real name

Excerpt:

During shortages of antiretrovirals due to strikes by health staff, Lucia Wakonyo resorted to self-medication. Credit: Miriam Gathigah/IPS

By Miriam Gathigah
NAIROBI, Jan 29 2014 (IPS)

In early January 2008, during the violence that rocked Kenya after disputed general elections, a man knocked at Lucia Wakonyo’s gate at Mathare Valley, in the sprawling Mathare slum. 

“He was calling out for my neighbour and I told him my neighbour was not in. He pleaded to give him refuge,” Wakonyo told IPS.

When Wakonyo opened the gate, “he threw me to the ground and raped me,” she said. Two months later, she discovered she was pregnant and infected with HIV. Wakonyo never attended an antenatal clinic and delivered an HIV positive baby with a traditional birth attendant.“They get tested for HIV but they do not go back for the results." -- Reproductive health expert Dr Joachim Osur

Her next pregnancy was very different. In 2012, Wakonyo delivered an HIV negative baby, after attending antenatal care and being put on prevention of mother-to-child transmission treatment (PMTCT).

Wakonyo and her baby benefitted from Kenya’s successful drive to extend PMTCT, which nearly halved new infections among children between 2009 and 2011.

But, worryingly, the drive is losing impetus. PMTCT coverage fell by 20 percent in 2011-2012, says the Progress Report 2013 of the Joint United Nations Programme on HIV/AIDS (UNAIDS).

“Five out of 10 pregnant women living with HIV do not receive antiretroviral medicines to prevent mother-to-child transmission,” Rangaiyan Gurumurthy, UNAIDS Senior Strategic Information Advisor in Nairobi, told IPS.

Gurumurthy explained that this figure excludes the 11 percent of HIV positive pregnant women on a regimen of a single dose of Nevirapine, which is not as effective as combination drug therapies.

The result is an estimated 13,000 children newly infected with HIV in 2012. Kenya’s seroprevalence rate is six percent and in moderate decline, according to UNAIDS.

Experts agree on the main reason behind the reduction in PMTCP – disruptions in the health services.

In December 2011, doctors went on strike to pressure the government to put more money into health care. In March 2012, nurses staged a two-week long strike, and five months later doctors again went on strike for nearly three weeks. More strikes took place in 2013.

During the strikes, Wakonyo resorted to self-medication, taking any antiretrovirals that she could find as well as traditional medicines, although aware this could lead to resistance to ARVs.

“Indeed, PMTCT uptake may have reduced but only during the strikes of doctors and nurses, as well as due to test kits stockouts,” said Dr. Simon Mueke, acting senior director of Medical Services at the Ministry of Health. “But overall, PMTCT uptake has been on the rise.”

George Omondi, from the local advocacy group Women Fighting AIDS in Kenya (WOFAK), agrees. “The PMTCT programme has been so successful that the country has shifted from P to E. We no longer talk about prevention of mother to child transmission but elimination – eMTCT,” he told IPS.

Moving forward

UNAIDS points out that Kenya is taking steps to strengthen PMTCT, such as providing free maternity services, scaling up its Mentor Mother programme nationwide and boosting support for exclusive breastfeeding among HIV positive nursing mothers.

Reproductive health expert Dr. Joachim Osur observes that “you cannot improve PMTCT coverage if maternal health services are not improved. Nationwide, only about 41 percent of women deliver in hospital.”

In Nyanza and Western provinces, he added, only a quarter of women deliver under the care of trained health attendants. “When a woman delivers at home, she cannot access the full PMTCT treatment,” he explained.

Another problem is getting all pregnant women tested for HIV. Out of the estimated 1.5 million pregnancies that occur every year in Kenya, between 87,000 and 100,000 test HIV positive

“Not every woman at antenatal care accepts to be tested for HIV. The reasons for avoiding the HIV test are multiple but stigma remains key,” Osur said. “Unfortunately, health workers cannot force the test on women, it is their right to accept or refuse.”

Some pregnant women visit the clinic only once. “They get tested for HIV but they do not go back for the results,” said Osur.

In spite of these challenges, WOFAK’s Omondi remains optimistic that a reduction of HIV transmission among breastfeeding mothers to less than five percent and a 90 percent reduction in mother to child HIV transmission rates by 2015 is a realistic goal.

“The waiver of maternity fees in all public hospitals since June [2013] will have a positive effect on maternal health in general,” he said. “But there is need for community awareness around HIV. Many women stay away from PMTCT services for fear of stigmatisation.”

AIDS experts remain concerned over the continued unrest in the health sector and have urged the government and health professionals to settle outstanding issues over remuneration, and thus ensure that doctors and nurses are at hand when needed and that fewer babies are born with the virus.

With a new generation of HIV treatments available, mothers on Option B+ need only take one pill per day. Credit: Jennifer McKellar/IPS

By Wambi Michael
KAMPALA, Nov 27 2013 (IPS)

Uganda has gotten plenty of kudos and some criticism over its roll out of the new antiretroviral therapy for pregnant women and their babies, known as Option B +.

Recommended by the World Health Organisation in June 2012, Option B+ consists in life-long provision of ARV therapy to pregnant women regardless of their CD4 count. CD4s, or helper cells, fight infections in the body.

Before, under Options A and B, mother and baby were given ARVs during pregnancy and breastfeeding. Only women with CD4 counts under 350 were prescribed ARVs for life – but CD4-counting machines are expensive and scarce in Africa.

Uganda has done remarkably well. Over 70 percent of all health facilities offer Option B+ and it overshot its target of 35,000 women on treatment in the first year, reaching 50,000 by October 2013.

“We are overwhelmed by the roll out so far,” said Godfrey Esiru, national coordinator of prevention of mother-to-child transmission (PMTCT) at the Ministry of Health. “It is the cheapest option for a country with limited resources for the health sector.”

Uganda’s seroprevalence is seven percent, or some 1.5 million people, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

AIDS activists welcomed the roll out but voiced some concerns.

“Option B+ denies a pregnant woman the right to decide whether to join the service or not,” said Dorothy Namutamba of the International Community of Women Living with HIV/AIDs in Eastern Africa (ICWEA).

This criticism featured prominently in the focus groups organised by ICWEA in 2012 to discuss the experiences of women with Option B+ in Uganda and Malawi.

“The names Option A, B and B+ imply that pregnant women who test positive for HIV are being given a range of options to choose from, whereas in reality it is the government that chooses which option to implement,” reads the ICWEA report on the focus groups.

Young HIV positive women may not want to start lifelong ARV treatment when they still feel healthy, although the regime is simplified to one pill a day. Over time, about two out of 10 people on treatment develop resistance to ARVs and must switch to more expensive second or third-line drugs.

Activist Mulani Birimumaso and his wife have lived with HIV for 15 years. Their two daughters are HIV negative thanks to PMTCT services available in Uganda since 2001.

He worries about couples sharing the pills at home. “They have initiated Option B+ without considering that there are other HIV positive people in homes other than mothers,” he told IPS. “The husbands also need those drugs.”

The focus groups noted the risk of domestic violence arising from the inequity in treatment access for husbands.

Another concern is ARV stock outs and dependence on donor funding. Uganda plans to put 240,000 people on treatment in 2014, Musa Bugundu, UNAIDS country coordinator, told IPS.

“Of these, 190,000 will be funded by the Americans and the remaining 50,000 by the Global Fund,” he said. “Is that the way to go? We have a serious problem.”

Proscovia Ayo, of the Tororo Forum of People Living with HIV Networks in eastern Uganda, points out that the roll out has ignored the need for family planning as part of PMTCT.

“You find a mother delivering every two years, yet she is on ARV treatment. We thought Option B+ would resolve that, but it has not,” she said.

Some critics say that Option B+ could be a potential incentive to get pregnant and gain access to the three-drugs-in-one-pill daily treatment.

Cellphones and men

Shafik Malende, a researcher in a study on implementation of Option B+ in northern Gulu district, found it requires strong family cooperation.

“Engagement of communities would greatly enhance Option B+ because they would ensure adherence and follow up,” said Malende.

A study at Mulago National Referrral Hospital in Kampala in late 2012 found that out of 190 women on Option B+, only 20 percent picked up their CD4 count results.

“High rates of loss to follow-up mean increased risk of treatment failure, drug resistance and disease progression for the woman,” Namutamba explained.

These concerns are being addressed as the program is implemented across the country, Godfrey Esiru told IPS. Now, each clinic is getting a cellphone to track mothers on treatment.

He admitted some weaknesses in male involvement, but added that increased use of village health teams and peer mothers groups will encourage men to support their wives.

One advantage of Option B+ is that HIV positive pregnant women are put on treatment without a CD4 count.  “We could not move this fast with the other options because we don’t have enough CD4 machines,” Esiru explained.

Yet, looking beyond birth, women on treatment will need regular CD4 counts and viral load tests to monitor their health. Activist Augustine Sebuma, who has lived with HIV for 20 years, wondered how health workers will monitor mothers on Option B+ when their clinics lack CD4 counting machines.

“We strongly support Option B+,” reads a statement by ICWEA. “But we are gravely concerned … about two major early challenges, loss to follow-up and weak engagement of communities, which will lead to weak demand for this service.”

In Zimbabwe, four out of 10 sexually active girls aged 15-19 reported taking an HIV test in the last 12 months. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Nov 21 2013 (IPS)

Seventeen-year-old Natalie Mlambo* has two good reasons to get tested for HIV. She has two boyfriends and has unprotected sex with them. One is a high school classmate. The other is older, works in a bank, and can afford to give Mlambo small gifts and some money.

“Yes, I sleep with both,” Mlambo told IPS. And, since she has sex only with them, they have stopped using condoms, she explained.

But Mlambo is terrified of getting an HIV test. “I’m afraid,” she said. “It is better to stay in the dark than to know I’m facing death; treatment doesn’t eliminate the disease.”

Mlambo, a final year high school student from Harare’s Kuwadzana high density suburb, is not unique – neither in engaging in transactional sex and having multiple sexual partners, nor in fearing an HIV test.

Felicia Chingundu, an activist with Shingai-Batanai HIV/AIDS support group in Masvingo, a town 300 kms southeast from Harare, sees teen resistance daily.

“Teenagers engage in risky sexual behaviour but you hardly see them at testing centres,” Chingundu told IPS.

Zimbabwe set up early and robust prevention programmes in the 1990s that are credited with bringing the prevalence rate down from 24 percent in 2001 – one of the highest in the world – to less than 15 percent in 2012, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). Although a series of political and economic crisis after 2000 clipped many programmes, AIDS awareness is widespread.

One result is that more than half of young people aged 15-24 have comprehensive knowledge about AIDS, according to the 2011 Demographic Health Survey (DHS), a figure higher than the regional average. However, knowledge does not necessarily translate into action.

The Ministry of Health has set up mobile testing facilities that visit schools and testing centres in clinics. But young people say the centres are not youth-friendly.

“Most teenagers stay away from these places, saying they are congested with adults,” said Mavis Chigara, coordinator of the Young People AIDS Network in Zimbabwe’s Mwenezi district, in Masvingo Province.

In 2012, her organisation surveyed 12,500 young people in the district; only five percent had tested for HIV. 

“Testing for HIV amounts to seeking a death warrant, and taking ARVs is a lifelong burden,” said 19-year-old Terrence Changara, from Harare’s low-income suburb of Highfield.

Stigma plays a role. In spite of a widespread epidemic and massive treatment programmes and information campaigns, pockets of discrimination remain.

“My two boyfriends speak mockingly about people who suffer from HIV/AIDS,” said Mlambo. Their attitude indicates they must be AIDS-free, she explained, or they would otherwise be kinder.

The 2011 DHS found prevalence rates of nearly four percent for young males and just over six percent for young females. Census data estimates 3.1 million youth aged 15-24 in the country.

 Benefits of testing

Testing can be scary, and disclosing to a counsellor that one engaged in risky sex may be embarrassing, but the advantages are many.

“It is important for young people to know their HIV status because it will enable them to start treatment early and improve their health,” said Judith Sherman, HIV/AIDS specialist for the U.N. Children’s Fund in Zimbabwe.

“For older adolescents, it will reduce the risk of passing on the virus to another person,” she added. “Finally, it helps adolescents who do not have HIV to keep themselves from being infected.”

In spite of fear, four out of 10 sexually active girls aged 15-19 reported taking an HIV test in the last 12 months, according to the DHS. But one frequent reason for testing is that the girls got pregnant and are attending antenatal clinics.

“Going for HIV testing is rare among teenagers,” said Mandy Chiwawa, an AIDS counsellor in Harare. “They really need support to get tested.”

Nonetheless, more people aged 15-24 are testing, compared to the 2006 DHS. The percentage of sexually active young males who have tested tripled to 23 percent, while females increased five-fold to 45 percent.  This is higher than the regional average of 22 per cent for females and 14 percent for males.

Still a long way to go, still many Mlambos who need help to overcome their fear, but the trend is encouraging.

*Not her real name

A health worker explains the sexual transmission of infections at the family planning clinic in Yopougon. ARV shortages and long waits discourage women from starting or staying on treatment. Credit: Kristin Palitza/IPS

By Fulgence Zamblé
ABIDJAN, Côte d’Ivoire, Nov 8 2013 (IPS)

At the Cocody-Anono community health centre, south-east of the Ivorian economic capital of Abidjan, Bertine Bahi* regularly attends awareness sessions on Preventing Mother-to-Child Transmission (PMTCT) for women living with HIV.

Bahi tested positive in her third month of pregnancy. In October, the 32-year-old was five months pregnant and still had not revealed her HIV status to her husband.

“Despite the midwife’s advice, it is difficult to tell my husband.  If I do, I will be thrown out of my home,” Bahi says. “For now, when I can get hold of antiretrovirals (ARVs), I take them in secret.”

Suzanne Asseman*, a 37-year-old housewife from Agboville in southern Côte d’Ivoire, learned she was HIV-positive in June 2012. She has to travel to Abidjan, 80 kms away, for the ARVs that keep her healthy.

This is not easy because Asseman is seven months pregnant. When she finally received her ARV pills for October, she had missed five weeks of treatment.  ARVs must be taken regularly every day or their efficiency is compromised.

Asseman has always waited one or two weeks to get her medication, but this time the wait was longer. Now she has doubts about her treatment. 

“I was reluctant to go on ARVs. Where I live, the medication has expired by the time it gets there,” she confides to IPS. “I think I would rather stop taking the drugs than keep up all the running around.”

Rolande Yao, a social worker in the PMTCT centre in Attécoubé in central Abidjan, says that stigmatisation is increasing, and the frequent disruptions in ARV supply create yet more difficulties for patients.

Three out of 10 pregnant women living with HIV in Côte d’Ivoire miss out on PMTCT, says the Joint United Nations Programme on HIV/AIDS (UNAIDS) in its 2013 Progress Report on the Global Plan.

Testing pregnant women for HIV often puts a strain on couples’ relationships.

“When a man is told his wife is HIV-positive, often he suspects her of being unfaithful,” says Yao. “He may refuse to be tested and reject his wife.”

Yao estimates that seven out of 10 women experience rejection and that, despite intervention by medical staff, many husbands refuse to take them back.

Fear of rejection prompts pregnant women who have tested positive to change their health centre or to keep silent. Others become lost to the medical system, avoiding antenatal medical care and risking passing the virus to their babies, Yao adds.

According to Cyriaque Ako, coordinator of the M2C (Mother to Child) project, many of these lost cases make their way to traditional healers.

M2C works in Yopougon, the country’s most populous community, near Abidjan, where women prefer to go to healers and many do not know about PMTCT, explains Ako. The project, now in its second year, aims to link women from 15,000 poor households to health and HIV testing centres.

The HIV prevalence rate is 3.2 percent in this West African country with a population of 20 million, which struggles to contain the epidemic and care for its estimated 450,000 HIV positive people, according to UNAIDS.

Some modest progress is visible. UNAIDS points out a decline in the number of children newly infected every year, down from 6,700 in 2009 to 5,000 in 2012. “Declining, but not rapidly enough,” says the Progress Report.

However, AIDS non-governmental organisations (NGOs) complain that since the end of the 2011 to 2012 post-electoral crises, people living with HIV seem to have been abandoned. The NGOs have regularly sounded the alarm on the repeated ARV supply disruptions.

One of the main causes of the ARV shortage has been the collapse of the health system over a decade-long political crisis, starting with an armed rebellion in the north and west of the country and simmering into post-electoral conflict.

During this period, the international community imposed arms and trade embargoes on Ivorian ports – Abidjan and San Pedro – in order to force former president Laurent Gbagbo to leave power after his electoral defeat. Medicines ordered from Europe could no longer be delivered to Côte d’Ivoire. In addition, many health facilities were looted and closed temporarily during the fighting, according to the NGOs.

Yaya Coulibaly, president of the Ivorian Network of People Living with HIV, which is known by its French acronym RIP+, says “community advisors and prescribing doctors have to lie to patients because there are not enough ARVs at the government pharmacy.” Even the basic ARV Nevirapine, which is prescribed for PMTCT, is in short supply, he says.

Coulibaly explains that at times ARVs are available in abundance in certain health centres but in short supply in others, pointing to a distribution problem. At the Ministry of Health, he adds, a revamp of the government pharmacy is underway to improve ARV distribution. This will help mothers like Asseman and Bahi stay on treatment and healthy.

*Not their real names

Cameroon has shown only a moderate decline in new HIV infections, according to the Joint United Nations Programme on HIV/AIDS. Credit: Nastasya Tay/IPS

By Dorine Ekwe
YAOUNDÉ, Oct 29 2013 (IPS)

With a wide smile Beatrice M.* says that she lives by the motto “life is short and beautiful — live it to the full.” The 20-year-old, HIV-positive mother refuses to be defeated by her new circumstances.

Beatrice, a second year anthropology student at the University of Yaounde I, found out she was pregnant and HIV-positive when she was 18.

“When the doctor broke the news, I thought my life was over. But my gynaecologist put me on Zidolan [an anti-retroviral treatment] to prevent mother-to-child infection and told me things would be fine,” she tells IPS. Her doctor was right and her now two-year-old daughter is HIV-negative.

Looking into the distance, with her hands crossed on her lap, she recalls: “The pregnancy was not wanted. My boyfriend asked me to have an abortion, but I refused. When I told him about my HIV status, he said he had gone for testing and was HIV-negative. Then he left me.” She was five months pregnant at the time.

Beatrice believes that her 25-year-old boyfriend — a fellow student at the same university — infected her. She says that she was a virgin when they met.

According to Flavien Ndonko, an anthropologist at the German International Cooperation Agency or GIZ, an alarming 20 to 30 percent of Cameroonian girls aged 15 to 24 years have unwanted pregnancies.

The 2013 Joint United Nations Programme on HIV/AIDS (UNAIDS) report on the global AIDS epidemic states that around 600,000 people or 4.2 percent of Cameroon’s population of 19 million are HIV-positive. Women and youth are the worst affected groups. This West African nation is among UNAIDS’ 20 priority countries on the continent, and has shown only a moderate decline in new infections.

Beatrice learned about these statistics after finding out her status. “During our relationship, we never thought of contraception or AIDS. I had heard of them, but I didn’t feel they had anything to do with me.” During high school, she had not been interested in attending the Education for Life and Love (ELL) programmes, a life skills course given in high schools across the country.

Social worker Arlette Ngon says that the country needs a new approach to raising awareness. “Apart from science courses, the ELL programme is the only time when sexually transmitted infections and AIDS are discussed in depth at school. The message doesn’t seem to getting through to the youth.”

Yvonne Oku, from the National Network of Aunties’ Associations (RENATA), believes that much more should be done to bring down the rate of new infections. RENATA, a non-governmental organisation, educates youth on how to prevent teenage pregnancy and HIV through “aunties,” who are young mothers trained in health matters.

Aubin Ondoa, an anthropologist, explains to IPS that the major risk factor for young girls is early sexual activity combined with a glaring lack of information. According to the U.N. Population Fund, the average age of the first sexual encounter in Cameroon is 15.8 years, while one out of three girls aged 20 to 24 years is a mother before the age of 18.

“Furthermore, young girls are prime targets for older men who give them money,” Ondoa adds.

For many ill-informed young women with little or no income, the consequences of unprotected sex are pregnancy and HIV.

Beatrice now uses condoms with her partner. She is in a relationship with a high school teacher who is HIV-negative, knows her status and wants to marry her. But she has refused, fearing that she may infect him. She worries that if they get married they will no longer use condoms.

Positive Generation — an anti-AIDS organisation created in 1998, which has 60 members who are mostly students — has been a source of support for Beatrice. The group has helped her to come to terms with living with HIV.

The young woman has decided to keep her status a secret. “My parents are not ready; I prefer to leave them in the dark. I am afraid of the stigma,” she says.

Because she lives with her two sisters, she has to be very secretive so they do not discover her status. “I am very discreet. It would be difficult if someone found out that I take medicine at specific times,” she confides.

She even brings her child, who lives with her parents in a village in the west of the country, all the way to the capital Yaoundé for medical check ups. In the village, she says, “there is no such thing as medical confidentiality.”

In Cameroon, antiretroviral medication is free; she only has to pay for the bi-annual blood count and CD4 tests, which cost about 34 dollars. “It would be difficult if I had to pay for everything,” she says. Patients in remote areas are not as lucky. They often have to travel 44 km on foot, through a forest, to get to a healthcare centre.

Beatrice is proud of her little girl and would like to have more children, but she wishes that healthcare staff had a more professional attitude.

“I tore during childbirth, but the midwife refused to suture me. She also refused to take my child for routine tests,” says with tears in her eyes.

For her, this behaviour is nothing more than a form of stigmatisation and is one thing she does not need in her quest to live her life to the full.

*Not her real name.

From Apr. 1, the South African Department of Health introduced fixed-dose ARVs. Activists and health professionals have welcomed the FDAs as easier and more convenient for patients. Credit: Nastasya Tay/IPS

By Melany Bendix
CAPE TOWN, South Africa, May 6 2013 (IPS)

“If I don’t have my pills, I don’t know what will happen. I will probably get sick again, very sick. Maybe I will die this time,” says Xoliswa Mbana* as she readies her four young children for school in the impoverished informal settlement of Masiphumelele, in Cape Town, South Africa.

Two years ago Mbana, who was diagnosed HIV-positive in 2008, had a CD4 count of less than 200. Dangerously ill, she was convinced by nurses at her local clinic to begin antiretroviral (ARV) treatment.

“I didn’t trust the muti (a Zulu word for traditional medicine) at first because I had heard a lot of bad things about them. But I was dying; I had no choice. When I started to feel better I was so happy. The government must please not take my happiness away from me,” the 42-year-old tells IPS.

Mbana, who is among the 5.5 to 5.9 million South Africans the Joint United Nations Programme on HIV/AIDS estimates are living with the disease, is referring to her fear of being cut off from her life-saving pills. It is a fear that is not unwarranted.

Last May she was forced off treatment for three weeks because her local clinic ran out of ARV drugs. It was one of hundreds of distribution points across six of South Africa’s provinces that were struck by a serious supply shortage, the most recent of several stockouts that have plagued the state-funded ARV treatment programme since its launch in 2004.

It is the South African Department of Health’s (DoH) shaky ARV supply track record that has treatment activists sounding alarm bells over the Apr. 1 introduction of fixed-dose ARVs (FDAs).

Until now, state-funded ARV treatment has comprised three different pills taken at different times during the day. The new FDA combines the three key agents from these pills in a single pill that only needs to be taken once a day.

Although welcoming the FDAs as easier and more convenient for patients, activists and health professionals alike have warned that a stockout of the drug could have a catastrophic effect on the country’s public HIV/AIDS treatment programme — the largest of its kind in the world.

“With the individual ARV drugs, if there is a shortage of one ARV then people can still take the other two drugs, though it’s not ideal. However, if there’s a stockout of the fixed-dose pill, then patients will have no recourse,” Mark Heywood, executive director of health and social justice advocacy group Section 27, tells IPS.

Dr. Kevin Rebe of the Anova Health Institute, which runs the Health4Men programme focusing on HIV prevention and treatment, agrees.

“The risk of FDAs is that there isn’t really a good fall-back,” he tells IPS.

He points out that even a few missed doses could result in resistance to treatment: “You need to get 95 out of every 100 doses right, otherwise you risk treatment failing and the patient would then have to move on to a different, possibly more complex and more costly, treatment. So if there is a stockout (of FDAs), the implications could be severe.”

Professor Linda Gail Bekker, deputy director of the Desmond Tutu HIV Centre at the University of Cape Town, adds that a stockout could be a “serious health hazard” for dangerously ill people who have just started ARV treatment — people like Mbana, who could have died if there had been a stockout when she first began treatment in 2010.

Bekker is equally concerned that stockouts could set back hard-won gains in convincing HIV positive people to begin treatment and to then stick to a strict drug regimen.

“We really have to indoctrinate HIV infected patients on ARVs to be adherent. When non-adherence is then imposed on the patient through no fault of their own, this is very frustrating and alarming for patients,” she tells IPS.

Reducing the risks

Bekker believes the risks of an FDA stockout could be mitigated by accurately predicting the demand and ensuring adequate supply. While acknowledging this is easier said than done, she insists that strict supply management is the only way to ensure the success of the new FDA treatment regime.

“It is no mean feat to have started this large number of people on life-saving therapy and to then ensure they keep getting it for the rest of their lives. But we must do it and we must do it right.”

Rebe also stresses the importance of getting the FDA supply chain right and says the DoH’s initial plan looks promising.

“They seem to have been quite smart about it all, especially by introducing FDAs in phases: first for pregnant women, then patients on TB treatment, then those newly starting ARV treatment. Only once all these people are on FDAs will the others be moved over. This phased approach alone will go a long way in avoiding a stockout.”

Rebe points out that the DoH has also split the 2013/2014 FDA tender into multiple contracts. “This is good because if one supplier runs out the others should be able to pick up the shortfall,” he explains.

Joe Maila, DoH spokesperson, says bringing in additional suppliers would be considered only if the three current suppliers — Mylan, Cipla and Aspen — could not meet the demand.

Supply and demand is being monitored and managed at weekly meetings with both suppliers and provincial health authorities, he adds, enabling the department to “detect supply problems early and intervene.”

Importantly, Maila tells IPS, the department has stockpiled FDAs “as buffer stocks to alleviate shortages when these occur.”

Multiple benefits

The introduction of FDAs is also expected to significantly reduce the state’s annual bill for HIV/AIDS treatment.

The previous combination treatment cost around R120 (13.4 dollars) per person per month, whereas the cost of the new FDA is currently R93 (10.38 dollars) per month. With 1.9 million patients currently on state-funded ARV treatment, a saving of R27 (three dollars) per person per month is significant.

“The 2013 tender estimated that 30 million packs (of FDAs) will be purchased over two years, which will translate into an estimated saving of R810 million (90.5 million dollars),” Maila says.

Cost is just one of the many benefits of FDAs, which has convinced Rebe that the pros of this form of treatment far outweigh the cons.

“The three agents in the single-dose pills are the best we have right now…It’s also well proven that reducing the number of pills and the daily dosage is key to patients adhering to treatment regimens.”

A quick and easy single-dose pill is something Mbana is looking forward to when FDAs are eventually rolled out to her clinic in Masiphumelele. But for her, ensuring a steady supply of life-saving pills is more important than convenience.

“I don’t care if I have to take one tablet only one time a day or many tablets over the day, just as long as I have tablets to take.”

*First name changed on request

U.N. delegates listen to a high-level heads of agencies panel at the 57th Commission on the Status of Women (CSW). Credit: Lusha Chen/IPS

By Marzieh Goudarzi
UNITED NATIONS, Mar 6 2013 (IPS)

U.N. agency heads gathered Tuesday to reassert their unified commitment to ending the epidemic of violence against women and girls, and bringing justice and healing to survivors.

Grim statistics underscore the urgency of this issue: 70 percent of women worldwide report experiencing physical and/or sexual violence, 50 percent of reported sexual assaults are committed against girls under 16 years of age, and 603 million women live in countries where domestic violence has not been criminalised.

Secretary-General Ban Ki-Moon articulated another fact: “Too many women and girls face intimidation and physical and sexual abuse often from those who should care for and respect them most – fathers, husbands, brothers, teachers, colleagues, and supervisors.”

Tuesday’s forum transpired as a part of the 57th Commission on the Status of Women (CSW), whose primary theme is the elimination of violence against women and girls.

It opened with remarks from the secretary-general and continued with a panel of high-level U.N. agency representatives, including Michelle Bachelet, executive director of U.N. Women, and Irina Bokova, director-general of the U.N. Educational, Scientific, and Cultural Organisation (UNESCO).

Bachelet stressed the importance of the diverse contributions of U.N. agencies to the efforts of the CSW.

“Whether we’re talking about UNESCO through education, UNDP (U.N. Development Programme) through government cooperation, UNFPA (U.N. Population Fund) through the promotion of sexual and reproductive health and rights, or UNICEF (U.N. Children’s Fund) through protecting the rights of children, this work is making a difference on the ground,” she said.

UN Heads of Agencies Forum on Violence Against Women and Girls from IPS Inter Press Service on Vimeo.

Also represented were the Office of the High Commissioner for Human Rights (OHCHR), World Health Organisation (WHO), International Labor Organisation (ILO), U.N. Office on Drugs and Crime (UNODC), and U.N. Joint Programme on HIV and AIDS (UNAIDS).

Perhaps the strongest message of this forum was its unified and indisputable affirmation of violence against women and girls as a priority on the international human rights agenda.

The long struggle for recognition of violence against women as a human rights issue first achieved serious global attention at the 1993 World Conference on Human Rights in Vienna, quickly followed by the General Assembly Declaration on the Elimination of Violence against Women.

Commenting on the development of the issue at the U.N., Bokova told IPS that today, “there is a lot more awareness, commitment, and concrete action… But of course we are not there at all – it’s just the beginning.”

UNICEF Deputy Executive Director Geeta Rao Gupta added, “I can tell you that over this past decade, the amount of attention that this issue has received internationally would not have happened if the U.N. had not taken a leadership position.”

“I think the major difference is that it has become a public issue. (Violence against women) is not tolerated in the way it was before,” Rebeca Grynspan, associate sdministrator of UNDP, told IPS.

“Having acknowledged that, I think that we have not had the accelerated progress that we expected,” she said. “Many times we are pedaling to stay in the same place and not go backward. That’s why I really welcome the fact that this issue has come again to the table of the CSW.”

A recent milestone was the 2010 establishment of U.N. Women, which last year provided capacity-building for stronger legislation and provision of services to survivors of violence in 57 countries.

U.N. Women manages the secretary-general’s campaign, United to End Violence Against Women, and works with U.N. Habitat and UNICEF on the Global Safe Cities Initiative, striving to make urban spaces violence-free for women and girls.

Speaking on behalf of UNESCO, Bokova stated, “Raising awareness and changing the environment through education is crucial. We have to go deep to the root of the violence,” explaining the need to instill within youth the idea that violence is not a “normal” part of life.

UNESCO has created international guidelines on sexuality education, HIV education, gender equality in education, and guidelines for teachers on stopping violence in schools.

Research shows that violence is a major threat to girls’ education, causing poor attendance and forcing many to drop out of school – another reason why the issue is high among UNESCO’s priorities.

Grynspan argued that violence against women is also a dangerous obstacle to global productivity, currently preventing seven in 10 women from achieving their greatest potential contribution to society and the economy by making them more likely to be absent from or quit school and work; violence also costs society in terms of health and legal services for victims, she explained.

Grynspan cited the 2010-2011 Human Development Report, which showed 49 percent loss in human development due to gender inequality. “There is one thing that will bring productivity up and cost down,” she said, “and that is ending violence against women.”

Director-General Margaret Chan spoke via video on the WHO’s commitment to combating this violence and discussed the wide range of health repercussions women face, including injuries to organs/tissues, unwanted pregnancies, unsafe abortions, premature birth, maternal mortality, psychological trauma, and increased risk of sexually-transmitted diseases, such as HIV.

Deputy Executive Director Anne-Birgitte Albrectsen of UNFPA and Regional Director of UNAIDS Sheila Tlou reiterated the extremely detrimental effects of violence against women on the battle against AIDS, which has come too far to be stopped now.

Across the panel, representatives recognised the wide range of causes and perpetuators of the violence against women.

They made references to cultural practices of early, forced marriages of girls and female genital mutilation; they pointed to cultural norms that shame women as victims, discourage seeking help, and normalise violence in domestic, educational, and work settings; they discussed the vulnerability of women in conflict and post-conflict societies, where rape often becomes a weapon.

Recognising the vast majority of women both on the panel and in the audience, the representatives also called for greater engagement of men and boys and male ownership of the issues.

As Grynspan noted, with her fellow panelists nodding in agreement, “We are still, by and large, talking to ourselves.”

While India has drastically reduced the spread of HIV over the past decade, new strains of the virus that cause acquired immunodeficiency syndrome (AIDS) are troubling medical scientists in this country.

The Joint United Nations Programme on HIV and AIDS, or UNAIDS, in its 2012 report, praises India for doing “particularly well” in halving the number of newly affected adults between 2000 and 2009.

But India – home to 2.4 million people living with HIV, one million of whom are on anti-retroviral (ARV) therapy – will need to pay attention to the proven fact that the Human Immunodeficiency Virus Type I (HIV-1), the most common and pathogenic strain of the virus, has been undergoing a process of fairly rapid viral evolution.

Of the various genetic families, HIV-1 subtype C is responsible for nearly 99 percent of infections in India and has a significant presence in China, South Africa and Brazil as well.

Now, scientists working at the Jawaharlal Nehru Centre for Advanced Scientific Research (JNCASR) in Bangalore have found a family of five new strains of HIV-1 subtype C, two of which appear to be outstripping the standard viral strain.

“The study is the first of its kind to identify that a major family of HIV-1 is undergoing evolutionary modification,” Prof. Ranga Udaya Kumar of the molecular biology and genetics unit at JNCASR told IPS.

Kumar said that although the studies at the Centre do not show the new strains to be “more pathogenic”, there are reasons to believe that they are “more infectious”.

The results of the JNCASR study were first published by the American Society for Biochemistry and Molecular Biology in the Nov. 6 edition of the peer-reviewed Journal of Biological Chemistry.

“The new viral strains appear to contain a stronger viral promoter,” said Mahesh Bachu, who led the team of researchers at JNCASR. A promoter is a region of DNA that codes for whichever protein the cell is trying to produce. In other words, a virus with a stronger promoter is expected to produce more ‘daughter viruses’ and spread faster in a host population.

“Importantly, in the laboratory experiments the new HIV strains were found to be making more daughter viruses compared to the standard viral strains,” Bachu said.

Retroviruses that cause AIDS reproduce by transcribing their ribonucleic acid (RNA) into DNA using an enzyme called reverse transcriptase. The resultant DNA inserts itself into a host cell’s DNA and is reproduced along with the cell and its daughters.

“In addition to making more daughter viruses, people infected with the new HIV strains seem to contain more virus in their blood,” Bachu told IPS, adding that data for the study was generated from 165 samples gleaned from hospitals in diverse parts of the country.

Collaborators in the study included the YRG Centre for AIDS Research and Education (YRG CARE) in Chennai; St John’s National Academy of Health Sciences, Bangalore; the National Institute of Mental Health and Neurological Sciences, Bangalore; and the All-India Institute of Medical Sciences (AIIMS) in New Delhi.

The clinical findings have been substantiated by laboratory experiments using viral, immune and molecular strategies, Bachu said. “A similar process of viral evolution has also been observed in South Africa, China and southern Brazil – countries that have the same family of HIV-1.”

Significantly, when Bachu and his team first observed the new strains, during earlier studies conducted from 2000 to 2003, their prevalence was quite low – approximately one to two percent of each of the five variants.

A decade later, the prevalence of three of the five new HIV-1 groups had multiplied, with one group increasing from two percent during the 2000-2003 period to 20-30 percent in 2010-2011.

According to Bachu, it is important that subjects infected with the newer 4-kappaB strains show more plasma virus in their blood than those infected with the existing 3-kappaB HIV strain.

“It is possible that a higher viral load permits an enhanced transmission advantage to 4-kappaB strains of HIV, contributing to successful spread of the new viruses,” Bachu said.

“The findings raise several questions with serious implications for viral fitness, evolution and disease management,” according to Kumar. “The most important of these concerns is the possibility of the new HIV strains altering the landscape of HIV demographics in India.”

Both Kumar and Bachu caution, however, that the JNCASR “data should be considered only as suggestive and not conclusive”.

JNCASR and its collaborators are now conducting observational clinical studies to determine if the new HIV strains are more infectious than the existing one.

“It is for clinical scientists to see if the new strains of HIV are likely to cause rapid disease progression to AIDS,” Dr. Nagalingeswaran Kumarasamy, chief medical officer at YRG Care, told IPS.

Kumarsamy said that, as things currently stand, there is no cause for alarm. “We need to further study the new strains and see, for example, if there is a need to start ARV therapy earlier than usual.”

India may be famous for the Taj Mahal, its religious ceremonies, Bollywood films and one of the highest economic growth rates in recent years. But more importantly, India has had a positive global impact through its supply of vast quantities of low-cost, good-quality generic medicines, which have saved or prolonged millions of lives.

Many people go to India to buy life-saving generic medicines from pharmacies and bring these back in suitcases to give to close relatives who cannot afford the expensive branded original products.

A decade ago, the Indian pharmaceutical company Cipla produced generic HIV/AIDS drugs that could treat a patient for 300 dollars a year, far cheaper than the branded product’s cost of 10,000 dollars per patient a year. Today the Indian generic version is even cheaper, below 80 dollars.

Martin Khor. Credit: Nic Paget-Clarke.

This has enabled millions more AIDS patients to be treated, since India supplies 70 percent of the HIV/AIDS drugs obtained by the United Nations Children’s Fund (UNICEF), the Global Fund and the William J. Clinton Foundation for developing countries.

A further 75-80 percent of medicines (not only for AIDS) distributed by the International Dispensary Association to developing countries come from India. No wonder India has been termed the ‘pharmacy of the developing world’.

In January 2012, the Indian Drug Manufacturers’ Association (IDMA), comprised of 700 drug-manufacturing member companies, celebrated its 50th anniversary, by toasting the industry’s high growth, wide range of medicines, and its contribution to safe, affordable drugs.

But there are also many factors that may hinder the continuation of the country’s role as chief supplier of medicines to developing countries.

A main factor of the industry’s success was the government’s decision, back in 1970, to exclude pharmaceutical drugs from product patents.

This paved the way for local companies to produce generic versions of expensive foreign drugs and within a few decades they had taken over 80 percent of the domestic market, while also supplying cheap medicines abroad.

The situation took a negative turn when the intellectual property agreement, known as TRIPS, was established in 1995 together with the World Trade Organisation, which disallowed countries from excluding medicines from patentability.

However, TRIPS allowed individual countries to determine the criteria for an invention that can be granted a patent. Furthermore, TRIPS gave governments the ability to grant a compulsory licence to local companies to produce the patented products, if their requests to patent owners for a voluntary licence did not succeed.

To implement its TRIPS obligations, India passed changes to its patent law in 2005 so that drugs could now be patented. However, the new law also contained flexibilities such as strict criteria for patentability (trivial changes to a patent-expired product would not qualify for a new patent); allowance for public opposition to a patent application before a decision is made; and compulsory licencing.

India has one of the best patent laws in the world that still gives some space to its producers to make generic drugs. But it is also true that the old policy space has been eroded because many new drugs have, since 2005, been patented by multinational companies that are selling them at exorbitant prices.

Indian companies can no longer make their own generic versions of these new medicines unless they successfully apply to the government for compulsory licences, a most cumbersome process; or unless they obtain a licence from the patent-owning multinational, which comes with stringent conditions, especially for export.

Another worry is that India is negotiating a free trade agreement (FTA) with the European Union. Such agreements usually contain provisions such as data exclusivity and extension of the patent term, which prevents or hinders generic production.

Finally, six Indian companies were recently bought up by large foreign firms. If this trend continues, the Indian drug market may be dominated by multinationals again. It is uncertain whether they will continue to supply the developing world with cheap generic medicines when this may be in conflict with their own branded products.

International health organisations such as UNAIDS, UNITAID and Doctors Without Borders have raised their serious concerns that these recent trends may threaten India’s role as the chief supplier of affordable medicines to Africa and other developing countries.

Millions will die if India cannot produce the new HIV/AIDS medicines in the future –it is a matter of life and death, said Michel Sidibe, executive director of UNAIDS, during a visit to India last year.

Thus, a strategy is needed that involves the government and the drug companies, which ensures that the local drug industry continues to thrive; that it produces not only existing medicines but also new medicines even if they are patented; and that they are supplied at cheap prices not only in India but to the developing world.

That was the sobering message that emerged during IDMA’s 50th anniversary conference in January, even in the midst of congratulations on the achievements of the past. (END/COPYRIGHT IPS)

* Martin Khor is the executive director of the South Centre in Geneva.

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