News (Updated May 15, 2011)

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African ministers hail HIV therapy progress

(AFP) – 14 May, 2011

ROME — African ministers on Friday hailed a lowering of mother-to-child HIV transmission rates as a result of treatment at a meeting in Rome on Friday, a day after a study found key benefits from early therapy.

"The vertical transmission of the virus from mother to child is reduced from 33.1 percent to 1.5 percent" due to treatment in Malawi , Health Minister Mary Shaba said at the conference hosted by Catholic charity Sant'Egidio.

Marco Impagliazzo, the head of the charity, which operates treatment programmes and testing laboratories in 10 African countries, said: "A generation of children without this illness is being born" thanks to treatment.

The conference brought together health ministers from 18 African countries including several with some of the highest HIV prevalence rates in the world such as Kenya , Malawi , Mozambique , Uganda and Zimbabwe .

A wide-ranging global study released Thursday showed that people with HIV who take antiretrovirals before their health declines have a 96 percent lower risk of transmitting the virus to a partner.

The study, which covered mainly heterosexual couples in Africa, India and the Americas , was hailed by AIDS experts as a "game-changer" that will transform how the disease is managed, 30 years after it first surfaced.

There was no official word at the conference in Rome on prevention through contraception, although Shaba said the Catholic Church had "relaxed" its position on condom use -- a taboo topic in official doctrine.

Angelo Bagnasco, head of the Italian Catholic Church, said: "The best form of prevention is to offer treatment to many."

"There also needs to be a major education effort to change mentalities and cultures and to re-affirm the dignity of human beings," he said.

"A particular sign of hope and of victory over evil are the 14,000 healthy children born from HIV-positive women," he added.

The keynote speech at the conference was given by Maria da Luz Guebuza, wife of Mozambican President Armando Guebuza, who has taken a leading role in promoting HIV/AIDS programmes and women's rights.

Copyright © 2011 AFP.

KENYA : Outrage over "cash for contraception" offer to HIV-positive women

KAKAMEGA, 12 May 2011 (IRIN) - The Kenyan government and rights groups have expressed outrage at a project in western Kenya that is paying HIV-positive women to undergo long-term contraception.

Project Prevention [ http://www.projectprevention.org ], a US-based NGO, offers cash to drug addicts in the US and the UK to undergo long-term contraception or permanent sterilization. In 2010, the project started offering HIV-positive women in western Kenya US$40 to be fitted with intrauterine devices (IUDs), which can prevent pregnancy for over a decade.

The project uses a medical practitioner in the western Kenyan town of Kakamega to insert the IUDs for $7 per woman; so far, 22 women have undergone the procedure.

"There are two issues here; one is using incentives to push women into taking up birth control, and the second is pushing women with HIV to take up long-term birth control irrespective of their reproductive needs," said Agnes Odhiambo of New York-based Human Rights Watch. "All women, including women with HIV, have the right to make informed choices about their reproductive health and that effectively means to use a contraceptive method of their choice, whether long or short term - the key word here is informed choice.

"Giving economic incentives to women with HIV, or any woman for that matter, to undertake long-term contraception is a form of coercion and violates women's reproductive rights and choices," she added.

“Illegal”

According to James Kamau, coordinator of the Kenya Treatment Access Movement, the project was "wrong, immoral and unethical".

He noted that it contradicted provisions against discrimination in the country's HIV and AIDS Prevention and Control Act of 2006. Ministry of Health officials say Project Prevention did not seek the government's authority before beginning its operations, making its activities illegal.

"Someone, somewhere, is sleeping on the job because a project like this cannot and should not be allowed to practise in Kenya ," Kamau said.

South African media reports in May said Project Prevention planned to start similar operations in South Africa .

Defence

Willice Okoth, coordinator of the Kenyan operation, argued that the project's aim was to fill family planning gaps, prevent HIV-related infant deaths and lower the number of orphans in the country.

"HIV has been the longest disaster and only birth control amongst HIV-positive women provides an opportunity to end it," he said. "Why should you give birth to a child who will remain an orphan, or who is likely to die before his or her fifth birthday because the mother had infected them... prevent the suffering before it occurs," Okoth told IRIN/PlusNews.

According to the US Health Policy Initiative [ http://www.healthpolicyinitiative.com/Publications/Documents/1189_1_Kenya_Brief_FINAL_7_12_10_acc.pdf ], there is an unmet family planning need of almost 20 percent among married Kenyan women. The government is working to reduce this gap, and the prevalence of contraceptive use has increased from 39 percent in 1998 to 46 percent a decade later.

The country is also increasing access to services for prevention of mother-to-child HIV transmission (PMTCT) [ http://www.unaids.org/en/dataanalysis/monitoringcountryprogress/2010progressreportssubmittedbycountries/kenya_2010_country_progress_report_en.pdf ]; an estimated 72 percent of HIV-positive pregnant women receive antiretroviral prophylaxis to reduce the risk of HIV transmission to their babies, while more than 3,300 health facilities around the country offer PMTCT services.

"Fine, one would argue that PMTCT has reduced cases of HIV-positive babies but statistics from government show that just 44 percent of deliveries occur in health facilities," said Okoth. "It means many more HIV-positive mothers who do not deliver at the hospital stand the risk of infecting their unborn children. When you look at the intentions of PMTCT, prevention of unintended pregnancies is one of the key pillars."

Poverty, ignorance

Yunia*, a 31-year-old mother of six, says she would have chosen to stop having children as soon as she was diagnosed with HIV four years ago, but had no access to contraceptives. "I didn't want to have a child, but here in the rural area, people cannot advise you because they also don't know. I have had two children since, and one of them died," she told IRIN/PlusNews.

Yunia was happy to take the one-off payment of $40, which she says will help her family income. "I have six children and I could still give birth to more because I am fertile but have nothing to buy food or clothes for them; now if you can get some small money to start a business plus you are helped also to stop giving birth - why not take it?"

Project Prevention gives the money to groups of 10 women for income-generating projects; Yunia and her group have not yet decided on a business venture.

“Wrong way to go”

Senior government officials say, however, that cash incentives targeting a particular group of women is the wrong way address family planning gaps.

"We can't say as a government we have been good at providing family planning needs of women or even men but we are putting measures in place. But it is important to stress that even HIV-positive women have the right to have children if and when they desire. HIV doesn't take that right way, not at all," said Peter Anyang' Nyong'o, Minister for Medical Services.

"Women need reproductive health services - including family planning - but before you give those services, you must educate them and give them a range of choices and then they voluntarily agree to take the one they feel best suited for their case, but to flash money and say take this - no, that is not how to do it," he added.

*Not her real name

ko/kr/mw

UGANDA : Sex workers pay the price for HIV prevention gaps

KAMPALA , 9 May 2011 (IRIN) - Uganda is short on data on HIV among the country's sex workers, but a new study shows that in the capital, Kampala , HIV prevalence among female sex workers could be more than four times the city's average prevalence.

The study, [ http://journals.lww.com/stdjournal/Abstract/2011/04000/HIV_and_Other_Sexually_Transmitted_Infections_in_a.13.aspx ] published in April in the Journal of the American Sexually Transmitted Diseases (STI) Association, recruited 1,027 women from the city's red-light areas, and found 37 percent to be HIV-positive, while 13 percent had gonorrhoea and 10 percent had syphilis.

According to the government, Uganda has an average national prevalence of 6.4 percent; in Kampala , that figure rises to 8.5 percent.

The study recommended HIV prevention interventions, including regular STI screening; voluntary HIV testing and counselling; condom promotion and counselling for reducing alcohol use.

However, according to local NGOs, the illegal nature of the trade makes sex workers difficult to reach with HIV-prevention services. "They plead with us, saying, 'please doctor, is there some way we can get services and not go to the clinic? When we go to the clinics we meet our clients and that spoils our business'," said Henry Kibira, who works with the NGO, InterAid Uganda, in the central Ugandan district of Rakai.

"The problem is that there is no clear framework to deal with the commercial sex workers," said Catherine Nandago of the Uganda chapter of the Alliance of Mayors and Municipal Leaders' Initiative for Community Action on AIDS at the Local Level (AMICALL). "When you approach them they think you are bringing police, who harass them all the time."

She said police harassment - and often rape by law-enforcement officers - was an issue that needed to be urgently addressed.

According to Geoffrey Bwambale, a health worker from South Rwenzori in western Uganda , many sex workers continue to practise even after being diagnosed with HIV. "After testing they know that they are HIV-positive and relocate to other towns. We bump into them when we travel but cannot say anything."

Peer education

One strategy that does seem to be having some success is the use of sex workers as peer educators.

"We involve leaders of commercial sex workers in consultative and planning meetings. This has helped to identify working strategies that ensure ownership and success of planned interventions," said AMICALL's Nandago. "Peer education has proven to be a very effective tool for sensitization and for mobilization of commercial sex workers for HIV/AIDS services like home counselling and testing, anti-retrovirals and other related services.

"Many are able to negotiate for condoms; they used to say, 'men give us small money - 5,000 shillings [US$2] - for protected sex, and 10 times that amount for unprotected sex'," she added. "But now they say, 'even if he gives me all that money, I want to protect myself’."

The challenge, Nandago added, was that the peer educators often decided to change locations in search of more money, so the training was a constant process.

The government reports that sex workers, their clients and partners of clients contribute 10 percent of new infections in Uganda . According a 2009 HIV Prevention Response and Modes of Transmission Analysis report [ http://siteresources.worldbank.org/INTHIVAIDS/Resources/375798-1103037153392/UgandaMoTCountrySynthesisReport7April09.pdf ] by UNAIDS and the Uganda AIDS Commission, special programmes for commercial sex workers and their clients are not of a large scale, nor comprehensive.

en/kr/mw

MALAWI : Queer Malawi lifts the gay curtain

JOHANNESBURG , 11 May 2011 (IRIN) - Africa is generally not a safe place to have a same-sex relationship - you can be shunned by society, beaten up, thrown in jail, or worse. In Malawi you can get 14 years in prison with hard labour.

In a bold move, Malawi’s Centre for the Development of People (CEDEP) and South Africa’s Gay and Lesbian Memory in Action (GALA) have collected the stories of 12 lesbian, gay, bisexual, and transgender (LGBT) women and men and published them in a book, Queer Malawi.

The book was compiled in the shadow of the high-profile 2010 trial of Tiwonge Chimbalanga and Steven Monjeza, two Malawian men charged with sodomy and indecency after they became engaged to be married in December 2009. The couple were found guilty but later released on condition that they have no further contact. [ http://www.irinnews.org/report.aspx?ReportId=88663 ]

Fear is a theme that runs through the stories in Queer Malawi - fear of not being accepted by family and community, of violence and arrest. Human rights activists noted that the trial heightened anxiety in Malawi ’s underground LGBT community and compromised HIV prevention efforts among men who have sex with men (MSM).

“There is the painful story of Tiwonge Chimbalanga and Steven Monjeza, who were arrested because they were very much in love,” wrote “Shy Amanda”, a gay man using a pseudonym, as do the other authors in Queer Malawi.

“My boyfriend and I… are afraid to stay together - we only visit on weekends. When I see a policeman passing by my home I fear that maybe today they are coming to take me.”

Many African countries, including Nigeria , Uganda , Zambia and Malawi , have banned same-sex relationships, with the legislation sometimes being interpreted so as to leave individuals without adequate protection by the law and open to beatings and arrests.

In the case of lesbians, such legislation has sometimes led to “corrective rape”, in which men rape lesbians in the violently mistaken belief that this will “turn them straight”.

HIV/AIDS outreach

A foreword penned by the Coalition of African Lesbians provides a context for the stories in Queer Malawi and insight into the complex dynamics in the LGBT community, including the divisions between its men and women.

Africa ’s lesbian, bisexual and transgender women remain largely invisible, and the activism and funds for addressing their needs, especially those related to health, are slight in comparison with the money allocated to assisting MSM.

The complex underlying dynamics of aid and HIV often influence advocacy of the LGBT community’s needs. In a highly politicised and often deeply religious context, funders and managers often link outreach programme to this population to human rights and health.

Gay, bisexual and transgender men have been at greater risk of contracting HIV through anal sex, and many funders and programmes identify them as a priority group, despite cries from the lesbian community that their low risk of HIV does not mean they are at no risk, especially with a rising level of corrective rape. [ http://www.plusnews.org/Report.aspx?ReportId=85268 ] [

http://www.irinnews.org/Report.aspx?ReportID=85277 ]

Lesbian women find it hard to stand together, because we do not have any resources or an organization that represents us,” wrote Takia.  “There is one organization that does education for gays - they only support men loving men.”

After the international publicity of the Malawi court case, even HIV prevention programming aimed at MSM was compromised, as this group went further underground out of fear of arrest, CEDEP said. [

http://www.irinnews.org/report.aspx?ReportId=88663 ]

The 12 voices heard in Queer Malawi all tell a love story - young love; unrequited love, heartache and acceptance of ourselves and the often rocky terrain that is love. The book also aims to dispel the negative stereotypes often attached to homosexuals.

These are business owners, church-goers and breadwinners; women who move outside of gender norms, men who strive to portray positive male role models to their children, including HIV-positive orphans in their care.

The book is not without unsettling aspects. Multiple concurrent partnerships - a driver of HIV infection in southern Africa - and cross-generational sex feature in almost half the stories. Two of the 12 writers recall that their first sexual experience was with a family member.

At the book’s launch in December 2010 in Johannesburg , South Africa , GALA and CEDEP indicated their intention to release the book in Malawi , but IRIN/PlusNews was unable to ascertain from GALA whether this had occurred. For more information on Queer Malawi, go to go to www.gala.co.za

llg/he/kn

VIETNAM : Compulsory drug treatment centres "counterproductive"

HANOI , 9 May 2011 (IRIN) - International health experts criticize Vietnam ’s estimated 70 compulsory drug treatment centres.

The centres are part of a government strategy aimed at "correcting the illegal behaviours of drug use and sex work”, according to UNAIDS.

They are believed to hold 20,000-70,000 drug addicts and/or former sex workers, said a Hanoi-based health expert familiar with Vietnam ’s drug treatment procedures.

Vietnam ’s compulsory treatment centres “are counterproductive on every single level,” said Simon Baldwin, a former senior technical officer for HIV and drugs, at the US NGO Family Health International, [ http://www.fhi.org/ ] which is working on drug treatment in Vietnam .

More than 90 percent of injecting drug users held at these centres relapse into drug addiction upon release, according to UNAIDS.

Beneficiaries at the centres, which began opening in the mid-2000s, are supposed to receive counselling, health checks, and vocational training to assist recovery and prevent relapse. But according to health experts, employees are not trained to treat drug addiction, and the fear of being sent to the centres encourages drug users to go underground.

Stigma

When Vietnamese heroin addicts leave compulsory treatment centres, they face a “palpable and substantial” societal stigma against drug use, said Robert Ali of the World Health Organization’s (WHO) Collaborating Centre for Research into the Treatment of Drug and Alcohol Problems.

Vietnam has made significant drug policy reforms since the mid-1990s, but most Vietnamese citizens and officials still see drug addiction as a “moral weakness” or “social evil” rather than a medical disease with a social dimension, Ali said.

Health experts say compulsory treatment centres coupled with widespread social stigma around drugs make it difficult for outreach workers to access the most vulnerable drug-user populations.

“The people who use drugs are a very marginalized and vulnerable population,” said Ali. “One of the challenges for Vietnam is recasting and understanding what drug addiction is and being more accepting of people in the [drug-using] community.”

Nguyen Thi Huynh, former chief of the Harm Reduction Department, Vietnam Administration of HIV/AIDS Control, said tolerance for drug addiction in Vietnam had improved over the last 20 years as a result of government interventions: “We have done a lot of outreach on television programmers, and the understanding of Vietnamese citizens about HIV and drug-use issues has changed a lot. The stigma is not as bad as it was before.”

Methadone clinics opened

In the shadow of its controversial compulsory treatment centres, Vietnam has since 2008 opened 13 methadone clinics for heroin addicts.

The clinics will not replace the treatment centres but health experts hope Vietnam will move away from the compulsory treatment model towards a holistic drug treatment model which includes voluntary methadone treatment.

Methadone, a substitution therapy used to treat opioid dependence, helps assuage withdrawal symptoms for heroin addiction and prevent the spread of HIV among injecting drug users.

“Methadone treatment in Vietnam appears to be modelled on best practices,” said WHO’s Ali. “Individuals can determine whether they want to be in treatment, and they’re provided with good clinical support and guidance.”

Health experts commend Vietnam ’s methadone clinics as a positive step forward in drug-treatment policy, but the government’s motives for introducing the clinics remain controversial.

“The government has rolled them out more out of concern over HIV/AIDS than for the lives of drug users themselves,” said a Hanoi-based methadone expert who preferred anonymity.

Roughly a quarter of a million people are HIV-positive in Vietnam, and the figure is rising, according to a 2010 presentation by Kevin P. Mulvey, a substance abuse treatment adviser at the US embassy in Hanoi. Health experts say Vietnam ’s rate of HIV infection among injecting drug users, which UNAIDS reports is 57 percent, is among the highest in South Asia .

Vietnam ’s methadone clinics receive support from the US President's Emergency Plan for AIDS Relief (PEPFAR).

More than 2,000 patients were receiving methadone treatment across Vietnam in September, according to a 2010 presentation by Nguyen Thi Minh Tam, deputy head of the Harm Reduction Department, Vietnam Administration of HIV/AIDS Control.

Roughly 80,000 patients will receive methadone treatment at a minimum of 245 sites by 2015, according to a November decree by the Vietnamese health minister, Nguyen Quoc Trieu.

Hong Kong and Thailand implemented methadone treatment programmes in the 1970s. China and Malaysia followed suit in the mid-2000s, and Cambodia opened a pilot methadone clinic in September.

mi/dm/cb

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