http://www.Plusnews.org Updated every day en-gb Sat, 4 Feb 2012 01:44:00 GMT United Nations Integrated Regional Information Networks, http://www.Plusnews.org Fri, 3 Feb 2012 02:02:02 GMT ]]>HARARE, 3 February 2012 (PLUSNEWS) - With global funding for HIV/AIDS on the decline, Zimbabwe's innovative AIDS levy - a 3 percent tax on income - has become a promising source of funding for the country, with a dramatic increase in revenue collected in the past two years. http://www.plusnews.org/report.aspx?ReportID=94786 http://www.plusnews.org/report.aspx?ReportID=94786 HARARE, 3 February 2012 (PLUSNEWS) - With global funding for HIV/AIDS on the decline, Zimbabwe's innovative AIDS levy - a 3 percent tax on income - has become a promising source of funding for the country, with a dramatic increase in revenue collected in the past two years.]]> HARARE, 3 February 2012 (PLUSNEWS) - With global funding for HIV/AIDS on the decline, Zimbabwe's innovative AIDS levy - a 3 percent tax on income - has become a promising source of funding for the country, with a dramatic increase in revenue collected in the past two years. The levy was introduced in 1999 to compensate for declining donor support, but low salaries and the poor performance of industry meant not enough money had been collected - until recently. In its 2010 report on Zimbabwe's progress in implementing the Declaration of Commitment on HIV/AIDS, adopted by the General Assembly in 2001, the government admitted the levy was "essentially non-existent in 2007-2008 due to economic challenges the country was facing". [ http://www.unaids.org/en/dataanalysis/monitoringcountryprogress/2010progressreportssubmittedbycountries/zimbabwe_2010_country_progress_report_en.pdf ] According to the organization’s recently published audited financial statements for the year ending 31 December 2010, a total of US$20.5 million was collected in 2010 against $5.7 million the previous year. Murombedzi Kuchera, chairman of the National AIDS Council Board, attributed the increase to improved revenue flows owing to improved political and economic stability in the country, which has created more jobs in the formal sector and improved tax remittances. Zimbabwe’s economy has witnessed steady growth following the formation of the coalition government of Prime Minister Morgan Tsvangirai and President Robert Mugabe in 2009. “The 259 percent increase in the collections was mainly through the increased capacity utilization by industry and commerce,” Kuchera said in his statement. Although the revenue figures for 2011 have not yet been audited, the National AIDS Council estimates it collected about $25 million. However, the exact figure will be confirmed after the audit by the Comptroller and Auditor-General, which audits all the finances of parastatals, at the end of 2012. “The AIDS Levy is certainly proving to be a good source of funding for the country’s HIV and AIDS response,” National AIDS Council information and communication officer Orirando Manwere told IRIN/PlusNews. “Our projections are that for 2012, with the growing economic stability in the country, we will collect more than $30 million through the funds and even more in 2013. However, this is all largely dependent on economic growth," he added. Although 347,000 people are on antiretroviral (ARV) treatment in the country, another 600,000 need the medication. The treatment gap widened after Zimbabwe adopted the new World Health Organization guidelines that recommend starting treatment earlier. The AIDS levy contributed almost a quarter of the money to purchase ARVs, while 76 percent of the treatment programme was financed by international donors such as the Global Fund to fight AIDS, Tuberculosis and Malaria and the UK Department for International Development. But the country - one of the hardest hit by HIV/AIDS - still needs a lot more funding to cover the "worrying" treatment gap, cautioned HIV/AIDS activist Stanley Takaona. “Many people are dying because they cannot access treatment. Zimbabweans are playing their part to take care of their own by contributing to the AIDS Levy but this is not enough. Government must allocate funds from the fiscus to fund the HIV/AIDS response; it’s their responsibility,” he said. Kumbirai Mafunda, spokesperson for the Zimbabwe Lawyers for Human Rights, warned against complacency. “Yes, the increase in the AIDS Levy is remarkable but we all know it’s not enough... now government has to increase budget allocations to the health sector." st/kn/mw Thu, 2 Feb 2012 02:02:02 GMT ]]>NAIROBI/KINSHASA, 2 February 2012 (PLUSNEWS) - The lives of thousands of HIV-positive people in the Democratic Republic of Congo are at risk as the country faces declining donor funding and a severe shortage of HIV treatment, according to Médecins Sans Frontières. http://www.plusnews.org/report.aspx?ReportID=94781 http://www.plusnews.org/report.aspx?ReportID=94781 NAIROBI/KINSHASA, 2 February 2012 (PLUSNEWS) - The lives of thousands of HIV-positive people in the Democratic Republic of Congo are at risk as the country faces declining donor funding and a severe shortage of HIV treatment, according to Médecins Sans Frontières.]]> NAIROBI/KINSHASA, 2 February 2012 (PLUSNEWS) - The lives of thousands of HIV-positive people in the Democratic Republic of Congo (DRC) are at risk as the country faces declining donor funding and a severe shortage of HIV treatment, according to Médecins Sans Frontières (MSF). MSF recently launched [ http://www.msf.org/msf/articles/2012/01/85-of-aids-patients-deprived-of-treatment-in-drc.cfm ] a year-long advocacy campaign to raise awareness of the DRC's HIV crisis. "The problem is quite old in the DRC; the country has always been minimized by donors who have not seen it as a priority, mainly because HIV prevalence is relatively low at between 3 and 4 percent," Thierry Dethier, advocacy manager for MSF Belgium in the DRC, told IRIN/PlusNews. "But look at the indicators: more than one million people are living with HIV, 350,000 of whom qualify for ARVs [antiretrovirals] but only 44,000 - or 15 percent - are on ARVs." Dwindling funds Dethier said the main reason for the ARV crisis was the end of six years of World Bank funding [ http://www.irinnews.org/report.aspx?reportid=88718 ] in 2011. International health financing mechanism UNITAID, which provides funding for paediatric and second-line ARVs, is also ending its funding to the DRC in December 2012; the cancellation of Round 11 funding by the Global Fund to fight AIDS, Tuberculosis and Malaria is only likely to worsen the situation. Seventy-five percent of HIV funding in the DRC is from the Global Fund, 25 percent is from UNITAID through the Clinton Health Access Initiative - which provides funding for paediatric ARVs and second-line ARVS - and from the US President's Emergency Plan for AIDS Relief (PEPFAR), which funds prevention of mother-to-child HIV transmission. "The country is currently using funds from round seven and eight of the Global Fund; these funds are due to be consolidated but have also been cut - round seven by 30 percent... round eight may also be cut," Dethier said. "We expect that the consolidated funds will last through 2014, after which there is no funding for DRC." The DRC did not qualify for funding under the Global Fund’s ninth and 10th round. At risk According to the director of an NGO in the capital, Kinshasa, who preferred anonymity, funding problems mean many of his patients' lives are at risk. "In Kinshasa alone we have shut two out of the three health centres we used to run, a situation which leaves us [caring] for only 1,800 out of 3,000 people living with HIV," he told IRIN/PlusNews. "Today we are running the one remaining health centre for HIV-positive people by charging each of them US$5 per month. "When the funding was available patients could come for checking whenever they were feeling unwell... we do give them treatment but today we receive them once a month unless their health condition has deteriorated," he added. "We are now appealing to the government to intervene in filling the gap that Global Fund is leaving in funding interventions for people living with HIV." Dethier noted that there were also problems with HIV testing. "Since there is no treatment people feel it's pointless to test," he said. "As many as 15,000 people have tested HIV-positive and qualify for treatment but are not receiving it," he said. Outlook The Global Fund says it is reviewing a request for continued funding, and no life-saving programmes will be cut as a result of funding shortages. "In terms of future additional funding, Round 11 was cancelled and replaced by a transitional funding mechanism that will allow countries to apply for funding for essential services for continuation of prevention, treatment and/or care services currently financed by the Global Fund," said Marcela Rojo, Global Fund spokeswoman. "Countries that face significant programme disruption between January 1 2012 and March 31 2014 may apply for up to two years of funding. "This means that no recipient will be forced to suspend any essential services as a consequence of the round 11 cancellation," she added. According to Rojo, with Phase 2 funding, the country aims to scale up treatment to 67,000 people by end-2014. MSF's Dethier noted that other donors would have to step up their funding. "With funding from the Global Fund, only 15 percent of people have access to ARVs, so we need others to contribute and we need the existing partners - UNITAID and PEPFAR - to honour their commitments to the people they are already supporting and to expand their programmes," he said. "The government aims to have 160,000 people on ARVs by 2014, which means putting roughly 3,500 people on ARVs per month - with money, this can be done." kr/pc/mw Thu, 2 Feb 2012 02:02:02 GMT ]]>NAIROBI/JOHANNESBURG, 2 February 2012 (PLUSNEWS) - The appointment of a new general manager, Gabriel Jaramillo, at the Global Fund to fight AIDS, Malaria and Tuberculosis could be a "turning point" for the troubled organization, which has suffered from a funding crisis and allegations of corruption. http://www.plusnews.org/report.aspx?ReportID=94777 http://www.plusnews.org/report.aspx?ReportID=94777 NAIROBI/JOHANNESBURG, 2 February 2012 (PLUSNEWS) - The appointment of a new general manager, Gabriel Jaramillo, at the Global Fund to fight AIDS, Malaria and Tuberculosis could be a "turning point" for the troubled organization, which has suffered from a funding crisis and allegations of corruption.]]> NAIROBI/JOHANNESBURG, 2 February 2012 (PLUSNEWS) - The appointment of a new general manager, Gabriel Jaramillo, at the Global Fund to fight AIDS, Malaria and Tuberculosis could be a "turning point" for the troubled organization, which has suffered from a funding crisis and allegations of corruption. Jaramillo, a former CEO of Spain's Sovereign Bank and special adviser to the Office of the Special Envoy for Malaria of the UN Secretary-General, was a member of an independent panel set up in March 2011 [ http://www.theglobalfund.org/en/highlevelpanel/compositon ] to investigate the Global Fund's fiduciary controls and oversight mechanisms after allegations of grant fraud in several recipient countries. Among other things, the panel recommended [ http://www.theglobalfund.org/documents/highlevelpanel/HighLevelPanel_IndependentReviewPanelOnFiduciaryControlsAndOversightMechanisms_Report_en ] the Fund strengthen its internal governance, improve its risk management and "get serious about results". The appointment of Jamarillo was quickly followed by an announcement by Global Fund executive director Michel Kazatchkine that he could not continue under "these circumstances" and that he planned to resign in mid-March. Kazatchkine, who has been with the Fund for 10 years, was reappointed as executive director for a second three-year term in January 2011. But soon after, the Fund's Office of the Inspector General began uncovering fraud among recipients in countries such as Mali, Mauritania and Zambia. As a consequence of this and negative reports by international media, donors, including Germany, Ireland and Sweden, suspended funding. Faced with declining donor support and a credibility crisis, the board endorsed a new strategy and announced the cancellation of its 11th round of grants at a meeting in Accra, Ghana, in November 2011. The board also reportedly [ http://www.lemonde.fr/planete/article/2012/01/24/demission-de-michel-kazatchkine-patron-du-fonds-mondial-contre-le-sida_1633931_3244.html ] demanded Kazatchkine's resignation - but he refused. It then decided to appoint a general manager and reduce Kazatchkine's responsibilities. "When problems pile up and the buzz and press get so bad, it is inevitable that leadership will be held responsible. I suppose the Global Fund board decided that the costs associated with a leadership transition during a crisis are lower than the benefits from a fresh face and new strategy," Amanda Glassman, director of global health policy and research at the Centre for Global Development, told IRIN/PlusNews. Fixing the Fund "The appointment of the general manager is a turning point for the Global Fund and hopefully in nine to 12 months the Fund will hire a new executive director with experience in managing large complex financial systems, who also completely understands the larger role that the Fund has to play," said Bernard Rivers, executive director of Aidspan, an independent watchdog of the Global Fund. Glassman believes that current features of the Global Fund's structure probably exacerbated the crisis. "The Fund's performance-based funding model relies on self-reports and a non-transparent decision-making process on disbursements... I am very worried about the current emphasis on audit and fiduciary oversight as the ‘solution’ to the misuse and corruption issues in low-income countries. “I would rather see the Fund tie money to measurable improvements in performance and forget about checking the receipts for every condom," she added. This has been backed up by the High-Level Independent Review Panel, which found that “the culture of the Global Fund has become one driven by the measurement of documentation, and not by health impact”. [ http://www.globalfund.org/en ] But for Asia Russell, director of international policy for activist group HealthGap, it all comes down to money - or lack of it. "Not because of alleged management issues, or a loss of confidence or any other red herring that has been raised - it was because there was not enough money; and that happened because donors said one thing during the most recent replenishment meeting at the UN in New York, but then did a totally different thing." The issue was not the credibility of the Global Fund, which has some of the most open and transparent mechanisms for identifying and responding to corruption and fraud - "much stronger than other bilateral funders, for example", Russell told IRIN/PlusNews by email. Funding pledges The Saudi government announced at end-January that it would provide US$25 million in 2013, while the Bill & Melinda Gates Foundation gave a $750 million promissory note. But this still falls short of what the organization needs to meet its demands. "The leadership change could lead to increased efficiency and impact if key reform measures are taken and results (not spending) are measured more rigorously," Glassman suggested. In his resignation letter, Kazatchkine acknowledged that in the current economic climate, "the emergency approaches of the past decade are giving way to concerns about how to ensure long-term sustainability, while at the same time, efficiency is becoming a dominant measure of success”. Jamarillo's first day at the Global Fund is 1 February and he is expected to oversee a process of transformation recommended by the high-level panel that will move the Fund response from an emergency to a sustainable one. A lot is at stake: by 2010, the Fund was disbursing $3.5 billion annually. It was responsible for supporting about 40 percent of all HIV treatment in developing countries and much of the care in middle-income nations such as China and India. More than two-thirds of all global malaria prevention and treatment and three-quarters of all tuberculosis efforts now depend on it. Activists have already thrown down a challenge for the former banker. "First on his to-do list should be holding an emergency donor conference so that affected countries can apply for new grants and expand life-saving treatment this year," said Tido von Schoen-Angerer, executive director of the Médecins Sans Frontières Access Campaign. "To speak like a doctor, I am cautiously optimistic about the future of the Global Fund. The patient has had severe indigestion but there is a good chance of recovery," Rivers told IRIN/PlusNews. kr/kn/mw Wed, 1 Feb 2012 02:02:02 GMT ]]>ARUSHA, 1 February 2012 (PLUSNEWS) - A pilot community programme to improve TB detection in northern Tanzania has shown good results and could be replicated nationwide as the country seeks to improve its TB treatment and prevention systems. http://www.plusnews.org/report.aspx?ReportID=94771 http://www.plusnews.org/report.aspx?ReportID=94771 ARUSHA, 1 February 2012 (PLUSNEWS) - A pilot community programme to improve TB detection in northern Tanzania has shown good results and could be replicated nationwide as the country seeks to improve its TB treatment and prevention systems.]]> ARUSHA, 1 February 2012 (PLUSNEWS) - A pilot community programme to improve TB detection in northern Tanzania has shown good results and could be replicated nationwide as the country seeks to improve its TB treatment and prevention systems. Tanzania has been battling TB for years, a struggle intensified by the parallel HIV epidemic; approximately 47 percent of new adult cases in the country are HIV-positive. Without proper treatment, about nine in 10 people living with HIV who become ill with active TB will die within two to three months, according to UNAIDS [ http://data.unaids.org/pub/PressRelease/2010/20100722_pr_tb_en.pdf ]. The programme, which ran from April to September 2011, systemized the way suspected TB cases were reported and handled. It encouraged healthcare professionals to work closely with community leaders to raise awareness of symptoms at every opportunity, such as at village meetings. It also used posters and slogans to make sure high-risk groups were aware of symptoms. This produced more patient referrals to health centres for diagnosis, treatment and follow-up care. Another crucial part of the TB pilot project was the creation of a "cough register" in each area, recording who was referred to a healthcare professional for further testing, by whom and the results of that referral. Management Science for Health collaborated with the NGO, PATH, and the National Tuberculosis and Leprosy Programme, with financial support from the US Agency for International Development, at 12 health facilities in northern Tanzania's Arusha and Meru district councils. A crucial tenet of the programme was emphasising that TB and HIV treatment must be done "hand in hand". Results "In both districts the standard operating procedure intervention has improved TB case notification in children and women," said Zahra Mkome, director, TB/HIV projects at PATH in Tanzania. "[It] improved team work, commitment, motivation of healthcare workers, awareness and involvement of communities in TB control activities." An evaluation comparing six months of TB case notification before and after the project showed a 54 percent increase in detection of TB in all forms in Meru, while in Arusha it increased by 117 percent. The standard operating procedure “rules” were used to provide clear and simple instructions to the health workers on how to improve TB case detection at different units and sections within health facilities, both outpatient and inpatient departments. Each area was provided with a plan and goals to implement their strategy, plus additional equipment to aid diagnosis such as paediatric score charts. Each area appointed a task force for TB treatment and these groups were encouraged to hold regular feedback meetings. Little data exists on the scale of the TB epidemic in Tanzania, and experts believe the records created by this system could prove a crucial tool in combating its spread and establishing where it is already most prevalent. One doctor based in a rural practice was particularly encouraged by the increased reporting of paediatric cases. He said some children suffering severe respiratory distress had been saved, "who in normal circumstances would have died". A number of the clinicians involved attributed an increase in notification of cases in the under-16 age group specifically to the wider use of paediatric diagnostic score charts. However, several challenges were flagged during the pilot: healthcare workers at Arusha's Selian Hospital said there was an urgent need to strengthen laboratory services to help confirm diagnoses; a lack of microscopes in labs and delays in issuing results were also highlighted. Challenges to scale-up Rolling out the rules on a national scale could also prove challenging as the majority of Tanzanians live in very rural areas and a poor road network means access to healthcare is limited. Mobile diagnosis and training centres that offer new methods of testing - for example, with the use of fluorescence microscopes [ http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001057 ] - could make diagnosis much faster and more accurate. "Patients in Tanzania often have to travel very long distances as most live in rural areas, which costs them money to travel every day and some are essentially too week to go on their own as a very large number are already suffering from the weakness that comes with HIV," said Alex Schulzer of the Novartis Foundation for Sustainable Development, which runs patient-centred TB programmes with the government. A shortage of medical professionals could also hinder the expansion of the programme; Schulzer recommended the use of lower cadre health workers and the community itself to fill gaps. The Novartis programme gives patients the choice to either take the daily treatment at a health facility under the supervision of a medical professional, or at home, supported by a family or community member. In the case of home-based treatment, the patient and treatment supporter are required to visit the health facility once a week during the two-month intensive phase to refill prescriptions and see a medical professional. Schulzer said the programme had created a system that gave patients "the freedom not to have to walk miles to the clinic every day. "We also needed to relieve some of the healthcare providers who cannot cope with such large patient numbers on a daily basis," he added. ah/kr/mw Fri, 27 Jan 2012 01:01:01 GMT ]]>NAROK, 27 January 2012 (PLUSNEWS) - Voluntary counselling and testing centres around Kenya are turning people away due to a shortage of HIV testing kits after the recall in December of more than one million faulty HIV tests. http://www.plusnews.org/report.aspx?ReportID=94741 http://www.plusnews.org/report.aspx?ReportID=94741 NAROK, 27 January 2012 (PLUSNEWS) - Voluntary counselling and testing centres around Kenya are turning people away due to a shortage of HIV testing kits after the recall in December of more than one million faulty HIV tests.]]> NAROK, 27 January 2012 (PLUSNEWS) - Voluntary counselling and testing centres around Kenya are turning people away due to a shortage of HIV testing kits after the recall in December of more than one million faulty HIV tests. "We have had a shortage of the test kits for the past month and we have had to turn away patients. There are serious gaps with the supply chain and this has led to constant shortages of these crucial commodities," said John Sankok, director of the Christian Missionaries Fellowship, which runs several health clinics in the Rift Valley Province's Narok South District. "We have had to prioritize and use the kits available for testing expectant mothers, because this is very crucial," he added. In November, the UN World Health Organization removed the Standard Diagnostics Bioline® HIV 1/2 3.0 Rapid HIV Test Kit from its list of approved rapid test kits with immediate effect; the alert was issued after Bioline failed quality assurance tests. The Kenyan government has since withdrawn it; an estimated one million kits were in circulation at the time of the recall, about one-tenth of all those available in the country; Tanzania has also banned the tests. Bioline was used as a confirmatory test, the second conducted during standard HIV testing, which uses three tests - an initial screening test, a confirmatory test and if there is a discrepancy, a third, tie-breaker test. As a result of the recall, Unigold, the brand used in Kenya as a tie-breaker, now replaces Bioline as the confirmatory test, and the enzyme-linked immunosorbent assay (ELISA) test - which requires a blood sample be sent to a laboratory and takes significantly longer than the rapid tests - becomes the tie-breaker. A brand known as Determine retains its place as the official screening test. Senior government officials blamed the shortage on congestion at the Mombasa port. "There have been problems with the port due to slow clearance of cargo occasioned by congestion and this has led to delays in distributing Unigold," said Nicholas Muraguri, head of the National AIDS and Sexually transmitted infections Control Programme. "We, however, expect things to normalize by the end of this month." Sankok said until the Unigold kits arrive, his clinics and other were stuck. "The HIV testing procedure is such that you cannot do a test if you are missing any of the kits. So until the Unigold gets to the facilities, nothing will happen in terms of HIV testing," he said. People seeking HIV testing have also expressed frustration with the delays. "It is very discouraging when you go to the facility when you really want to get tested, then you are turned way and when you return after some time you are turned away again," said Judith*, a VCT client in Narok. *Not her real name ko/kr/mw Mon, 23 Jan 2012 01:01:01 GMT ]]>MBABANE, 23 January 2012 (PLUSNEWS) - Swaziland is still short of lab reagents needed for CD4 count testing, which is used to initiate and monitor patients on antiretroviral treatment, and HIV-positive people are growing increasingly frustrated as the country enters its fourth month without a way to establish the strength of their immune system. http://www.plusnews.org/report.aspx?ReportID=94707 http://www.plusnews.org/report.aspx?ReportID=94707 MBABANE, 23 January 2012 (PLUSNEWS) - Swaziland is still short of lab reagents needed for CD4 count testing, which is used to initiate and monitor patients on antiretroviral treatment, and HIV-positive people are growing increasingly frustrated as the country enters its fourth month without a way to establish the strength of their immune system.]]> MBABANE, 23 January 2012 (PLUSNEWS) - Swaziland is still short of lab reagents needed for CD4 count testing, which is used to initiate and monitor patients on antiretroviral treatment, and HIV-positive people are growing increasingly frustrated as the country enters its fourth month without a way to establish the strength of their immune system. “This is setting us back years in the way we treat people living with HIV and AIDS. Government says it has no money to buy the chemicals needed to determine CD4 counts,” Thembi Nkambule, director of the Swaziland Network of People Living with HIV and AIDS (SWANEPHA), an umbrella organization for the country’s HIV and AIDS support groups, told IRIN/Plus News. Deciding on when to start a patient on ARV drugs is usually based on a combination of CD4 cell count test results and HIV disease progression, which the World Health Organization (WHO) has defined according to four clinical stages, with stage four being AIDS. In addition, guidelines for managing patients on ARV therapy also use CD4 count testing to measure the impact of the medication on the patient's health. The government’s ongoing financial crisis again hit the health sector in October 2011 when supplies of lab reagents - the chemicals needed to operate the CD4 count apparatus - began drying up. Since December, CD4 count testing has virtually ground to a halt in Swaziland, which has the world's highest HIV prevalence. Shortages of HIV programme supplies in Swaziland were first reported in mid-2011. Although the stock-outs have been largely blamed on reduced revenues from the Southern African Customs Union (SACU), the country also opted not to apply for funding in Round 10 from the Global Fund to Fight AIDS, TB and Malaria. Instead, it chose to assume financial responsibility for HIV treatment itself, at a time when SACU revenues were already expected to decline. Health Minister Themba Xaba said in a statement, “We need R7 million [US$875,000] to purchase the CD4 machine reagents, which is a lot of money. This, however, does not mean that patients are not getting any treatment. There are clinical stages and guidelines that are used.” In the absence of a CD4 count test, guidelines suggest that patients at stage three or four, determined by observable symptoms defined by the WHO, should be started on ARVs. “Doctors can only go by how a patient tells them he or she is feeling, or if there are symptoms. The problem is that many people with HIV do not get sick or have physical symptoms while their CD4 counts are dropping to the level where they must take ARVs,” said Nkambule. “Not having accurate information on CD4 counts puts the doctor in the same position as performing surgery blindfolded." According to Nkambule, equipment for monitoring liver and kidney function is also out of order. “When government ran out of money we were promised by government that the health sector would not be compromised," he added. The health ministry is looking to the Ministry of Finance to come up with the necessary funding. Xaba has advised HIV-positive people to have their CD4 tests conducted at private labs. However, the test costs R150 ($19), which is unaffordable in a country where 70 percent of the population live below the poverty line. “For many of us coming up with bus fare to the clinic is a big challenge. Taking CD4 tests is not a one-off thing. Many tests are required. I would say few people are going to private doctors for these tests,” said Mandla Tsela, an AIDS testing and counselling officer in Manzini. AIDS groups have criticized the constant uncertainty: in 2011, the country also experienced ARV stock-outs and had to be bailed out by the US President's Emergency Plan for AIDS Relief (PEPFAR), which gave the country $7 million in emergency funding in August. Swaziland now has a buffer stock of first-line ARVs that should last until April 2012. “Why does there have to be a crisis or something has to break down before any action is taken? First the people living with HIV and AIDS were put at risk because of the supply of ARVs, and now we don’t know really who should be on treatment because they don’t have their CD4 counts,” Nkambule said. jh/kn/mw Mon, 23 Jan 2012 01:01:01 GMT ]]>NAIROBI, 23 January 2012 (PLUSNEWS) - A small Kenyan study has found that more women than men feel HIV is a less serious threat after their male partners are circumcised; the study also made local news for finding that female partners of recently circumcised men found sex more enjoyable. http://www.plusnews.org/report.aspx?ReportID=94703 http://www.plusnews.org/report.aspx?ReportID=94703 NAIROBI, 23 January 2012 (PLUSNEWS) - A small Kenyan study has found that more women than men feel HIV is a less serious threat after their male partners are circumcised; the study also made local news for finding that female partners of recently circumcised men found sex more enjoyable.]]> NAIROBI, 23 January 2012 (PLUSNEWS) - A small Kenyan study has found that more women than men feel HIV is a less serious threat after their male partners are circumcised; the study also made local news for finding that female partners of recently circumcised men found sex more enjoyable. The University of Illinois' Chicago School of Public Health study [ http://www.irinnews.org/pdf/okeyo_ICASA_FP_abstract.pdf ] of 51 young women - presented in December 2011 in Addis Ababa, Ethiopia, at the 16th International Conference on AIDS and Sexually transmitted infections in Africa - found that most women were happy with the appearance of their partner's penis and enjoyed sex more after circumcision. However, the study also revealed that more women than men were likely to perceive HIV as a less serious threat - 51 percent of men compared with 76 percent of female participants, and to feel that condoms were less necessary following circumcision - 4 percent of men compared with 51 percent of female participants. A greater number of women than men said after circumcision, they were more likely to have more than one sexual partner - 22 percent compared with 2 percent of men, and to have sex without a condom - 28 percent against 2 percent of men. The study was conducted in Nyanza Province, home to the Luo, Kenya's largest non-circumcising ethnic community and the focus of the country's male circumcision programme. Since 2008, more than 350,000 men have been circumcised in Nyanza alone; the government aims to circumcise 1.1 million men by 2013. The study's authors say the findings highlight the need to involve female partners in the male circumcision process, which has a strong counselling component, impressing upon men the partial nature of the procedure's protection against HIV. "If women do not have a good understanding of the partial protection afforded by male circumcision against HIV, they may view circumcised men as 'safe' or even HIV-negative, just because they are circumcised," said Nelli Westercamp of the University of Illinois School of Public Health, one of the study's authors. "It is crucial to involve women in the male circumcision decision-making, whether through counselling or public health education specifically targeting women. Couples’ counselling before the procedure would perhaps be the most beneficial for women whose partners want to go for the cut," she added. "It will not only clarify the concept of partial protection, but also could make a difference in the men's healing process and time of resumption of sex after the procedure, if the woman is involved and supports the man through the process." According to Ronnie Asino, the district project coordinator for the Nyanza Reproductive Health Society, community outreach programmes target both men and women on all aspects of male circumcision. "We have community outreach programmes where we hold sensitization forums to educate people, including women, on the various aspects of male circumcision," he said. Asino noted that married men were usually accompanied by their spouses and were therefore more likely to benefit from couples’ counselling before the procedure. "Unmarried men will show up alone and it is them whose partners are more likely to miss out on the counselling provided," he added. ko/kr/mw Thu, 19 Jan 2012 01:01:01 GMT ]]>NAIROBI/JOHANNESBURG, 19 January 2012 (PLUSNEWS) - Uganda's National Drug Authority recently arrested sales representatives of a company selling a drug that purports to cure HIV; the firm's owners are not licensed to sell medicine and are being sought by the police. http://www.plusnews.org/report.aspx?ReportID=94679 http://www.plusnews.org/report.aspx?ReportID=94679 NAIROBI/JOHANNESBURG, 19 January 2012 (PLUSNEWS) - Uganda's National Drug Authority recently arrested sales representatives of a company selling a drug that purports to cure HIV; the firm's owners are not licensed to sell medicine and are being sought by the police.]]> NAIROBI/JOHANNESBURG, 19 January 2012 (PLUSNEWS) - Uganda's National Drug Authority recently arrested sales representatives of a company selling a drug that purports to cure HIV; the firm's owners are not licensed to sell medicine and are being sought by the police. The drug, known as Virol ZAPPER, was being sold in 37ml liquid doses, each costing about US$210; patients were advised to take 10 drops daily. It was being advertised on local radio and TV stations as a miracle cure for HIV. The sale of such "cures" is a profitable racket for charlatans willing to take advantage of desperate HIV-positive people; here is a collection of some dodgy treatments that have made the news in Africa over the years: Tanzania - In 2011, tens of thousands of people from all over East Africa flocked to the tiny village of Loliondo [ http://plusnews.org/report.aspx?ReportID=92360 ] in Tanzania seeking a cure for several diseases, including diabetes, tuberculosis and HIV. Ambilikile Mwasapile, a former Lutheran pastor, was charging 500 Tanzanian shillings - about $0.33 - for a cup for his concoction. Several sick people died in the queues, which at their peak numbered 15,000 people. Studies are being conducted to determine the properties of Mwasapile's treatment. South Africa - A 2008 Cape High Court judgment ruled that clinical trials of multivitamins in the treatment of HIV/AIDS by controversial vitamin salesman Matthias Rath [ http://plusnews.org/report.aspx?ReportID=78739 ] were unlawful, and stopped them. The court also prohibited Rath from publishing any more advertisements claiming that his product, VitaCell, cured AIDS, pending further review by the Medicines Control Council. Rath, who had been operating in South Africa since about 2004, claimed his multivitamins treated AIDS, heart disease, cancer, diabetes, bird flu and numerous other illnesses. Rath ran numerous advertisements aimed at convincing HIV-positive people to take his high-dose multivitamins rather than ARVs, available free-of-charge through the public health system, which he claimed were "toxic". Kenya - In 2008, the government warned HIV-positive people in the country's eastern Coast Province [ http://www.plusnews.org/Report.aspx?ReportId=79915 ] to reject herbal "cures" peddled by fake herbalists who claimed their concoctions contained unique ingredients that could boost the immune system and even cure HIV. An estimated 80 percent of Kenyans use traditional healers either exclusively or in conjunction with western medicine; the government is drafting regulations to stop fraudulent herbalists from practising. Gambia - In 2007, President Yahya Jammeh was roundly denounced by AIDS activists when he said he had found a cure for HIV/AIDS and began treating citizens. Shortly after his announcement, Jammeh expelled [ http://www.plusnews.org/report.aspx?ReportID=70123 ] the most senior UN official in the country for questioning his "cure". The programme is still running, but more Gambians are choosing ARVs over Jammeh's treatment. Ethiopia - In 2007, thousands of HIV-positive patients flocked to Entoto, an ancient mountain north of the capital, Addis Ababa, seeking a "holy water" [ http://plusnews.org/report.aspx?ReportID=72375 ] cure for AIDS after local priests said they could cure HIV. The Archbishop of the Ethiopian Orthodox Church, Abune Paulos, later advised patients to continue with their ARVs even as they sought healing at Entoto. São Tome and Principe - In 2007, questions were raised about Dorviro-Sida, [ http://plusnews.org/report.aspx?ReportID=74543 ] or "Put AIDS to sleep" in Portuguese, an anti-AIDS herbal remedy produced by Amancio Valentim, president of the Association of Traditional Medicine of São Tome and Principe. Valentim claimed three tablespoons of the brownish syrup, taken every day before meals, could reduce the viral load and make patients feel better; he said four patients who had taken the drug for four years had tested negative for HIV. AIDS activists were concerned the drug could make HIV-positive people complacent about taking their ARVs, and the health ministry said it did not support Valentim's treatment. South Africa - In 2006, a clinic in South Africa's east coast city of Durban began to sell "ubhejane" [ http://plusnews.org/report.aspx?ReportID=39547 ] - a herbal mixture believed to treat HIV/AIDS. The controversial traditional medicine received vast media coverage, mainly due to the backing it received from influential political figures such as the former health minister, Dr Manto Tshabalala-Msimang, and provincial health officials. Ubhejane, a dark brown liquid sold in old plastic milk bottles, had not undergone any clinical trials to test its efficacy. All that the tests confirmed was that it was not toxic. But HIV-positive patients were far more willing to accept the traditional medicine as an effective remedy, flocking to the clinic to buy a full course of the herbal remedy that retailed at R374 ($40). Uganda - In 2006, the Ugandan government banned the use of a popular anti-AIDS herb remedy known as "Khomeini" [ http://plusnews.org/report.aspx?ReportID=39532 ], after tests found it provided no cure. Iranian Sheikh Allagholi Elahi claimed the drug - which contained olive oil and honey and cost $1,650 per dose - could cure HIV/AIDS and TB in three weeks. Studies by experts in Uganda and Kenya found that while patients had gained weight due to the nutritional content of the drug, it was incapable of curing HIV. kr/kn/mw Wed, 18 Jan 2012 01:01:01 GMT ]]>JOHANNESBURG, 18 January 2012 (PLUSNEWS) - Botswana has marked many "firsts" in Africa's fight against the HI virus. IRIN/PlusNews details the most important events in its battle: http://www.plusnews.org/report.aspx?ReportID=94671 http://www.plusnews.org/report.aspx?ReportID=94671 JOHANNESBURG, 18 January 2012 (PLUSNEWS) - Botswana has marked many "firsts" in Africa's fight against the HI virus. IRIN/PlusNews details the most important events in its battle:]]> JOHANNESBURG, 18 January 2012 (PLUSNEWS) - Botswana has marked many "firsts" in Africa's fight against the HI virus. IRIN/PlusNews details the most important events in its battle: 1984 - Botswana diagnoses its first patient with HIV; 1987 - The country develops the first of many national plans to tackle HIV and AIDS; 1995 - As HIV cases mount, it introduces a national community home-based care programme to complement the over-stretched health system and medical staff shortage compounded by the lack of a national medical school; 1999 - The country establishes the National AIDS Coordinating Agency (NACA). It also introduces prevention of mother-to-child HIV transmission (PMTCT), a first in Africa, with initial pilot sites in the capital, Gaborone, and Francistown. In a little less than a decade, about 90 percent of Botswana's HIV-positive pregnant women and their babies will benefit from PMTCT services; 2000 - The World Health Organization estimates that 85 percent of 15-year-olds in Botswana will eventually die of AIDS-related illnesses. 2001 - The Debswana mining company, a joint venture between mining conglomerate De Beers and the Botswana government, becomes the first business in the world to provide free ARV treatment to its employees, spouses and their children younger than 21. As of November, all health facilities are reportedly providing PMTCT services; 2002 - After making bulk purchases of the three drug combinations needed to treat HIV, the government launches the Masa, or "A New Dawn" in the local Setswana, HIV treatment programme. Training of nurses and what are largely foreign contract doctors in HIV diagnosis and treatment begins. The country also becomes the first in southern Africa, a region hard-hit by HIV, to provide free treatment to its citizens; 2003 - First national strategic plan on HIV, as recommended by UNAIDS. The plan runs until 2009. About 7 percent of adults and children needing HIV treatment are estimated to be on ARVs; 2004 - Voluntary counselling and HIV rapid testing (VCT) is introduced, a major boost to PMTCT efforts in which VCT for expecting mothers is task-shifted away from nurses and midwives to lay counsellors. By 2007, the country has also introduced the dried blood spot HIV testing needed to diagnose babies born to HIV-positive mothers; 2005 - With universal HIV education in schools, about 40 percent of young men and women know how to prevent HIV infection. Meanwhile, about a third of all pregnant women are found to be HIV-positive, according to government surveys; 2006 - Ministry of Finance announces that condoms will be added to the list of tax-exempt items, cutting their cost; 2009 - NACA launches a programme to address multiple concurrent partnerships, thought to be a HIV risk factor, while the Ministry of Health begins rolling out medical male circumcision. After years of lobbying by the UN Refugee Agency (UNHCR) and local AIDS and human rights groups, the government agrees in April to relax a policy that explicitly bars non-citizens from accessing HIV treatment;[ http://www.plusnews.org/report.aspx?reportid=89765 ] 2010 - At a cost of almost US$350 million, Botswana achieves universal access targets with more than 80 percent of HIV-positive adults and children on ARVs. The second national strategic plan is launched, to run until 2016. The government also passes an amendment to its Employment Act ending workplace dismissal based on an individual's sexual orientation or HIV status;[ http://www.plusnews.org/report.aspx?reportid=90437 ] 2011 - The country attracts criticism after government refuses to provide HIV-positive foreign nationals in its prisons with HIV treatment. llg/mw Wed, 18 Jan 2012 01:01:01 GMT ]]>JOHANNESBURG, 18 January 2012 (PLUSNEWS) - One part novella and two parts textbook, Saturday is for Funerals* pairs the recollections of Unity Dow, five-times author and Botswana's first female high-court judge, with the analysis of Harvard health sciences professor, virologist and chair of the Botswana-Harvard AIDS Institute, Max Essex. http://www.plusnews.org/report.aspx?ReportID=94670 http://www.plusnews.org/report.aspx?ReportID=94670 JOHANNESBURG, 18 January 2012 (PLUSNEWS) - One part novella and two parts textbook, Saturday is for Funerals* pairs the recollections of Unity Dow, five-times author and Botswana's first female high-court judge, with the analysis of Harvard health sciences professor, virologist and chair of the Botswana-Harvard AIDS Institute, Max Essex.]]> JOHANNESBURG, 18 January 2012 (PLUSNEWS) - One part novella and two parts textbook, Saturday is for Funerals* [ http://www.hup.harvard.edu/catalog.php?isbn=9780674050778 ] pairs the recollections of Unity Dow, five-times author and Botswana's first female high-court judge, with the analysis of Harvard health sciences professor, virologist and chair of the Botswana-Harvard AIDS Institute, Max Essex. As Essex notes, Botswana is typically held up as one of the first African countries to boast early successes in tackling HIV. Although HIV prevalence remains high, with about one in four adults living with HIV, it has been particularly hailed for the early political will shown by leaders, such as former President Festus Mogae, in addressing HIV. Under Mogae, Botswana introduced prevention of mother-to-child HIV transmission (PMTCT) services in 1999 and almost six years later was able to boast that these services reached as many as 90 percent of all HIV-positive pregnant women. [ http://www.plusnews.org/report.aspx?reportid=74389 ] He also introduced antiretroviral (ARV) treatment by 2002, at a time when former South African president, Thabo Mbeki [ http://www.plusnews.org/report.aspx?reportid=93411 ], was still questioning the link between HIV and AIDS, and his health minister, Manto Tshabalala-Msimang, was describing ARVs as "poisons". Botswana's national PMTCT programme had been under way for four years when South Africa finally launched its PMTCT programme in 2003, after a protracted legal battle with the Treatment Action Campaign, a lobby group. Changing times, changing lives Rising HIV prevalence rates in the 1990s meant big changes in Botswana. By 2000, writes Essex, the World Health Organization had issued dire warnings: 85 percent of 15-year-olds in the country would die from AIDS-related illnesses; life expectancy would drop by 44 years. But Dow recounts the more insidious and poignant changes, the ones that crept into people's daily lives and culture as deaths mounted before ARVs were available. "If you have not seen someone for a while and you meet their mother, you are afraid to ask after them. Perhaps they have died and you have not heard," writes Dow, recounting the words of her mother. "It was never like this before. You must remember people's children and be sure to ask how they are. How can you ask about people who may be dead?" The title of the book itself points to the way rising AIDS-related deaths meant funerals became a weekend fixture. So much so that the cultural practice of midnight grave-digging had to change to meet growing demand. Young men could now be seen digging graves in the afternoons as well, Essex notes. Dow recounts how, as an advocate for women and children, she became an HIV resource for friends, family, strangers and, as a high court judge, those in her courthouse. When most still will not name the virus, her directness in approaching the subject is appreciated, she writes. In each chapter, Dow's prose is followed by Essex's medical review of the issues encapsulated in Dow's vignettes. Untrained experts will likely benefit from Essex's scientific explanations, particularly of ARV resistance and side-effects. However, there are gaps. He fails to distinguish between traditional and medical male circumcision: some forms of traditional circumcision may not remove enough of the foreskin to offer protection from HIV infection. In clinical trials, medical male circumcision has been shown to reduce a man's likelihood of contracting HIV through vaginal intercourse by up to 60 percent. [ http://www.plusnews.org/report.aspx?reportid=94604 ] His explanation of clinical trial procedures is a welcome addition, especially when read against the backdrop of mass media reports that in southern Africa continue to portray participants as "guinea pigs". However, some would challenge his assertion that it is important to encourage HIV vaccine trial participants to avoid pregnancy not only because potential vaccines have not been tested for safety in pregnant women but because "additionally it seems important to strongly discourage pregnancy for HIV-positive women, whether in trials or not, to prevent the risk that more HIV-positive infants will be born". Such arguments have resulted in alleged forced sterilizations of HIV-positive women in Namibia and South Africa, despite the fact that PMTCT services are available. [ http://www.plusnews.org/report.aspx?reportid=85012 ] Essex's wording around migration is also likely to spark some discontent: "Refugees and immigrants from all over southern Africa see Botswana as the place to be. This obviously increases tension, as well as demand on programmes with limited resources." Despite the fact that migration has been a facet of southern Africa for centuries, contributing to the region's high burdens of HIV and tuberculosis, migrants continue to face challenges in securing cross-border healthcare. While the Southern African Development Community has reviewed the idea of health passports to address this, there has been little progress. As recently as August 2011, the Botswana government was reportedly refusing to treat HIV-positive foreign nationals in its prisons. [ http://www.mmegi.bw/index.php?sid=6&aid=935&dir=2011/August/Friday12 ] In addition, the number of migrants remains difficult to estimate and research from South Africa and other countries shows that it is often migrants who wait until it is too late to access care. [ http://bit.ly/wpWgrh ] Many foreign nationals in Botswana are likely to have come from countries such as Zimbabwe and Zambia, which have lower HIV prevalence rates. Despite such shortcomings, Saturday is for Funerals manages to provide a window into how HIV changed one country that largely seemed to "get it right" when confronting HIV and AIDS while providing readers with the scientific background to understand how and why many of the issues faced by Botswana continue to challenge that country and many others. If nothing else, it is an addition to the ever-evolving story of HIV in which, as its authors note, "understanding how people live and love is the key to understanding how and whether the science breakthroughs will work, and how to redesign them so they will work better". *Released as a paperback in 2011 llg/kn/mw Wed, 18 Jan 2012 01:01:01 GMT ]]>DAR ES SALAAM, 18 January 2012 (PLUSNEWS) - The demand for medical male circumcision is growing among Tanzania's non-circumcising communities, and officials say the country is on track to surpass its goal of reaching 2.8 million men by 2015. http://www.plusnews.org/report.aspx?ReportID=94667 http://www.plusnews.org/report.aspx?ReportID=94667 DAR ES SALAAM, 18 January 2012 (PLUSNEWS) - The demand for medical male circumcision is growing among Tanzania's non-circumcising communities, and officials say the country is on track to surpass its goal of reaching 2.8 million men by 2015.]]> DAR ES SALAAM, 18 January 2012 (PLUSNEWS) - The demand for medical male circumcision is growing among Tanzania's non-circumcising communities, and officials say the country is on track to surpass its goal of reaching 2.8 million men by 2015. "The response is good and encouraging. Government and health officials are very cooperative," said Charles Wanga, a communications officer with Jhpiego [ http://www.jhpiego.org ], an NGO affiliated with Johns Hopkins University that is working with the government to roll out the programme in Iringa, a region in the southern Tanzanian highlands. An estimated 67 percent of Tanzanian men are circumcised, but prevalence varies from region to region; in some parts of western Tanzania, circumcision levels are as low as 20 percent. The programme - launched [ http://www.irinnews.org/report.aspx?reportid=91849 ] in 2011 - aims to circumcise 2.8 million males aged between 10 and 34 within five years. It focuses on seven regions in western Tanzania where levels of male circumcision are particularly low: Iringa, Kagera, Mar, Mwanza, Rukwa, Shinyanga and Tabora. Wanga told PlusNews that the project aimed to circumcise 260,000 men and boys in Iringa by 2015; the first phase, which ended in December 2011, was expected to cover 20,000. "Up to September [2011], 30,000 men and boys were circumcised under the programme, which reflects success of 150 percent," he said. According to Jhpiego, most of those volunteering for male circumcision in Iringa are adolescent boys and unmarried men; older, married men have been more reluctant to come forward. Just 38 percent of Iringa men are circumcised; the region has an HIV prevalence rate of 15.7 percent - about three times the national average. In the northwestern region of Kagera, more than 13,000 men and boys underwent circumcision between 2010 and 2011, according to Songoro Biki, an official with the NGO, International Centre for AIDS Prevention, which is supporting male circumcision in the area. "The response to the campaign is quite promising as more people were showing up voluntarily for the 'cut'; we expect to reach over 300,000 by 2015," he said. He said the service was being provided at the Bukoba Regional hospital and Rubya hospital, in Muleba district, adding that plans were under way to provide the service at Maruku and Izimbya Wards, in Bukoba Rural district. The programme - supported by the Tanzanian government, the US government and the Global Fund to fight AIDS, Tuberculosis and Malaria - provides the service free of charge; male circumcision usually costs US$10-17. Tanzania has also trained nurses to perform the procedure, as the country has a shortage of doctors. Three randomized controlled trials in Kenya, South Africa and Uganda provided evidence [ http://www.plusnews.org/report.aspx?reportid=62729 ] that male circumcision can reduce a man's risk of becoming infected with HIV through heterosexual intercourse by as much as 60 percent. According to the UN World Health Organization [ http://whqlibdoc.who.int/publications/2011/9789241502511_eng.pdf ], Tanzania needs to circumcise some 1,373,271 men in order to achieve 80 percent prevalence, which would potentially avert 200,000 new HIV infections within five years. jk/kr/mw Mon, 16 Jan 2012 01:01:01 GMT ]]>KISUMU, 16 January 2012 (PLUSNEWS) - Involving men is increasingly being promoted as a key element in the prevention of mother-to-child transmission of HIV, and while its benefits are well-documented - in one Kenyan study it reduced the risks of vertical transmission and infant mortality by more than 40 percent compared with no involvement - it can occasionally lead to domestic discord and even violence. http://www.plusnews.org/report.aspx?ReportID=94652 http://www.plusnews.org/report.aspx?ReportID=94652 KISUMU, 16 January 2012 (PLUSNEWS) - Involving men is increasingly being promoted as a key element in the prevention of mother-to-child transmission of HIV, and while its benefits are well-documented - in one Kenyan study it reduced the risks of vertical transmission and infant mortality by more than 40 percent compared with no involvement - it can occasionally lead to domestic discord and even violence.]]> KISUMU, 16 January 2012 (PLUSNEWS) - Involving men is increasingly being promoted as a key element in the prevention of mother-to-child transmission of HIV, and while its benefits are well-documented - in one study [ http://www.ncbi.nlm.nih.gov/pubmed/21084999 ] it reduced the risks of vertical transmission and infant mortality by more than 40 percent compared with no involvement - it can occasionally lead to domestic discord and even violence. Silvia*, a 33-year-old mother of six, now living at her mother's home in western Kenya, says her 14-year marriage was doomed the minute she followed her healthcare worker's advice to bring her husband for an antenatal visit after she tested HIV-positive. "I was tested and I was told I was positive; I asked if I could go ahead and just carry the pregnancy and the nurse assured me it was fine," she said. "She, however, asked me to bring my husband when coming for the next visit and I agreed." She convinced her husband to accompany her on her next visit, but when he tested HIV-negative, he accused her of cheating on him. "He left me at the hospital... When I got home, he beat me up and said the child I was carrying wasn't his and he chased me away," she added. "The nurse thought she was helping us but it turned out to be a curse for me." There is limited research into the area of gender-based violence following HIV-testing, but a presentation by the NGO, the Sonke Gender Justice Network, [ http://www.slideshare.net/evonleer/3-ias-men-and-pmtct-peacockvienna-2010 ] at the 2010 International AIDS Society conference in Vienna, Austria, reported that women's experiences upon disclosing their status to their male partners were often "complex and positive": some studies reported violence levels of up to 14 percent, while others stated that about half of HIV-positive women said their partners reacted supportively to the disclosure. According to Beatrice Misoga, PMTCT programme officer with the AIDS Population Health Integrated Assistance (APHIA Plus), gender-based violence is more common in discordant relationships where the man is HIV-negative. "Male involvement has helped realize success with PMTCT programmes where it has been applied because prevention of mother to child transmission is a family issue, but yes, there have been challenges in certain aspects like the possibility of gender-based violence targeting women and more so in a situation where the male partner is not willing to be part of it." Tensions In 2009, Human Rights Watch cautioned [ http://www.plusnews.org/report.aspx?reportid=87598 ] the Kenyan government to ensure that human rights were protected during a large-scale home-based counselling and testing programme; HRW noted that HIV-positive mothers - among them girls under the age of 18 - sometimes suffered violence, mistreatment, disinheritance, and discrimination from their husbands, in-laws, or their own families. Some women, too fearful of the repercussions of revealing their HIV status to their husbands, opt out of PMTCT programmes altogether. "A woman comes to the facility but the moment you mention her man, she disappears and might resurface to give birth - some go to traditional birth attendants," said Julie Miseda, a nurse at Nyanza Province's Siaya District Hospital. "Some will tell you they are not married but the day they give birth, a man appears and claims he is the father. "At times, involving both of them creates tension between them and they tend to keep very crucial information, for example, a history of a sexually transmitted infection, to themselves," she added. Supporting men According to APHIA Plus's Misoga, to preserve the benefits of male involvement in PMTCT, health clinics had to become more aware of the counselling needs of men. "Despite the disadvantages, the benefits of male involvement are immense and what needs to be done is to make these antenatal clinics male friendly. It is also important to give constant information and messages targeting men on the need to be part of prevention of mother to child transmission programmes," she said. Christopher Mukabi, a local peer educator, says male support groups have proved useful in improving the way couples deal with an HIV diagnosis. "Bringing men together in male support groups and then using these groups to convince them to get into PMTCT programmes can help deal with some of the challenges, but stigma and alcoholism are still problems in getting men involved." ko/kr/mw *Not her real name Mon, 9 Jan 2012 01:01:01 GMT ]]>KIGALI, 9 January 2012 (PLUSNEWS) - This will be a busy year for Rwanda's health centres as the country attempts to reach its goal of medically circumcising 50 percent of men by June 2013 as part of HIV prevention efforts. http://www.plusnews.org/report.aspx?ReportID=94604 http://www.plusnews.org/report.aspx?ReportID=94604 KIGALI, 9 January 2012 (PLUSNEWS) - This will be a busy year for Rwanda's health centres as the country attempts to reach its goal of medically circumcising 50 percent of men by June 2013 as part of HIV prevention efforts.]]> KIGALI, 9 January 2012 (PLUSNEWS) - This will be a busy year for Rwanda's health centres as the country attempts to reach its goal of medically circumcising 50 percent of men by June 2013 as part of HIV prevention efforts. "We plan to extend free male circumcision services to all men in Rwanda - we are targeting two million circumcisions by 2013," said Simoni Kanyaruhango, head of the national male circumcision programme at the Rwanda Bio-Medical Centre. "The programme has, under the sponsorship of the Global Fund [to fight AIDS, Tuberculosis and Malaria], extended the necessary kits ... to all district hospitals, which will in turn offer the service free of charge to the public." The free male circumcision programme began in October 2011, and officials at the Ministry of Health say demand is growing. "Here we carry out circumcisions every weekend but we are looking at including the working days as the demand is increasing by the day," said Christian Ntizimira, director of Kibagabaga Hospital in the capital, Kigali. A large randomized controlled trial in Kenya, South Africa and Uganda found that medical male circumcision can reduce a man's risk of contracting HIV through vaginal intercourse by almost 60 percent. In order to reach 80 percent coverage - a target set by UNAIDS and the World Health Organization (WHO) under a new plan [ http://www.plusnews.org/report.aspx?reportid=94404 ] to accelerate medical male circumcision in eastern and southern Africa - Rwanda would need to circumcise 1,746,052 men; at present, some 15 percent are circumcised. However, with a severe shortage of highly trained medical staff - according to WHO, [ http://www.who.int/whosis/whostat/EN_WHS2011_Full.pdf ] Rwanda has just two doctors per 100,000 population - the goal is unlikely to be met unless lower cadre health workers are involved in the campaign. Simpler techniques At present, the programme is using circumcision surgery, the only WHO-approved method. The government is hoping for WHO approval of a device known as the "PrePex system", which delivers "bloodless" male circumcision [ http://www.plusnews.org/report.aspx?reportid=91919 ] and would reduce the need for a sterile environment, anaesthetic and highly trained medical personnel. The PrePex system works through a special elastic mechanism that fits closely around an inner ring, trapping the foreskin, which dries up and is removed after a week. "This device has been clinically studied and found effective. We are only awaiting approval from the World Health Organization Technical Advisory Group on technical innovations in male circumcision," said Vincent Mutabazi, lead investigator in the PrePex Clinical study. "With WHO approval of the device, we could perform male circumcisions anywhere, any time or even run mobile clinics out to remote communities rather than have men travel long distances for the circumcisions," said Agnes Binagwaho, the Rwandan Minister of Health. Education gaps Messages on male circumcision have been widely broadcast using print and electronic media, and health centres are also being used to promote the programme. However, many in the target population remain unaware or afraid of the procedure. "I know about it of course and I appreciate its importance, but what would happen if I don't heal properly or even heal at all?" asked James Nkuusi, a restaurant owner in Remera, a Kigali suburb. "Besides, my wives are used to me the way I am now - my size, you know. If I got circumcised it would be difficult for me to satisfy them I guess, and I would never let that happen." Experts say male circumcision does not affect [ http://www.malecircumcision.org/publications/documents/Low_cost_leaflet.pdf ] penis size. Rwanda Bio-Medical Centre's Kanyaruhango said the government had made significant progress in demystifying the procedure. It is also being careful to emphasize that male circumcision must work in conjunction with other HIV prevention methods to be successful. "Male circumcision should only be one element of a comprehensive HIV prevention package, which should include the promotion of condom use, the provision of HIV counselling and testing services and treatment of sexually transmitted infections. And this is what we emphasize," said Kanyaruhango. rkm/kr/mw Fri, 6 Jan 2012 01:01:01 GMT ]]>DAR ES SALAAM, 6 January 2012 (PLUSNEWS) - Tanzanian health authorities have announced the withdrawal of a South Korean HIV test kit from circulation following warnings about its poor quality. http://www.plusnews.org/report.aspx?ReportID=94592 http://www.plusnews.org/report.aspx?ReportID=94592 DAR ES SALAAM, 6 January 2012 (PLUSNEWS) - Tanzanian health authorities have announced the withdrawal of a South Korean HIV test kit from circulation following warnings about its poor quality.]]> DAR ES SALAAM, 6 January 2012 (PLUSNEWS) - Tanzanian health authorities have announced the withdrawal of a South Korean HIV test kit from circulation following warnings about its poor quality. In November, the UN World Health Organization removed the Standard Diagnostics Bioline® HIV 1/2 3.0 Rapid HIV Test Kit from its list of approved rapid test kits with immediate effect; the alert was issued after Bioline failed quality assurance tests. The Tanzanian government has followed neighbouring Kenya [ http://www.plusnews.org/report.aspx?reportid=94586 ] in issuing an immediate recall of all Bioline testing kits in the country. "What we know so far is that 1,178 test kits have been used in the field, but we have yet to substantiate exactly how many of them were defective," Hadji Mponda, Tanzania's Health Minister, said at a news conference on 5 January. jk/kr Thu, 5 Jan 2012 01:01:01 GMT ]]>NAIROBI, 5 January 2012 (PLUSNEWS) - The Kenyan government has changed its HIV testing algorithm following the withdrawal of a widely used brand of HIV test on warnings from UN World Health Organization. http://www.plusnews.org/report.aspx?ReportID=94586 http://www.plusnews.org/report.aspx?ReportID=94586 NAIROBI, 5 January 2012 (PLUSNEWS) - The Kenyan government has changed its HIV testing algorithm following the withdrawal of a widely used brand of HIV test on warnings from UN World Health Organization.]]> NAIROBI, 5 January 2012 (PLUSNEWS) - The Kenyan government has changed its HIV testing algorithm following the withdrawal of a widely used brand of HIV test on warnings from UN World Health Organization (WHO). In November, WHO removed [ http://nascop.or.ke/library/HTC/bioline.pdf ] the Standard Diagnostics Bioline® HIV 1/2 3.0 Rapid HIV Test Kit from its list of approved rapid test kits with immediate effect; the alert was issued after Bioline failed quality assurance tests. The Kenyan government estimates one million kits were in circulation at the time of the recall, about one-tenth of all the HIV kits available in the country. "We followed the World Health Organization alert and have in turn ordered all health facilities and voluntary counselling and testing centres to stop using the kit," said Shahnaz Sharif, Kenya's director of public health at the Ministry of Public Health and Sanitation. New guidelines Bioline, which is manufactured in South Korea, was in use as a confirmatory test, the second conducted during standard HIV testing, which uses three tests - an initial screening test, a confirmatory test and if there is a discrepancy, a third, tie-breaker test. As a result of the recall, Unigold, the brand used in Kenya as a tie-breaker, now replaces Bioline as the confirmatory test, and the enzyme-linked immunosorbent assay (ELISA) test - which requires a blood sample be sent to a laboratory and takes significantly longer than the rapid tests - becomes the tie-breaker. A brand known as Determine retains its place as the official screening test. "We have already engaged the services of a supply chain management organization to help with collecting the Bioline kit from facilities countrywide and at the same time, replace it with Unigold; it [the supply chain management firm] has the database of all the health facilities that received the faulty Bioline kit," said Peter Cherutich, deputy director of the National AIDS and Sexually transmitted infections Control Programme. "Health facilities will commence working with the various partners to help trace people who might have been tested with the faulty kit so that they can come for repeat tests," said Jackson Kioko, director of public health and sanitation in Kenya's Nyanza Province, which has the country's highest HIV prevalence levels - 14.8 percent compared with a national average of 7.4 percent. Concern However, health workers are concerned that the use of the ELISA test will discourage nervous testers. "Except in the cases of infants, HIV tests results have always been instant and that has been the beauty of it; the process of having to wait for your result in case of discrepancies might be very agonizing for many people," said Julie Nasirembe, a nurse at a health facility in Nairobi. There is also concern about the impact the recall will have on public confidence in HIV testing, especially as the country pushes for universal access to HIV counselling and testing. "We don't know how widely this Bioline kit might have been used but it definitely eroded your confidence, not only in the health facilities but even in yourself, because if you test negative you are not sure if you are accurately negative," said Dan Mutisya, a resident of Kenya's capital Nairobi. ko/kr/mw Wed, 4 Jan 2012 01:01:01 GMT ]]>ADDIS ABABA, 4 January 2012 (PLUSNEWS) - Ethiopia's new plan to eliminate mother-to-child HIV transmission by 2015 cannot be attained unless men are more meaningfully involved in reproductive health, experts say. http://www.plusnews.org/report.aspx?ReportID=94579 http://www.plusnews.org/report.aspx?ReportID=94579 ADDIS ABABA, 4 January 2012 (PLUSNEWS) - Ethiopia's new plan to eliminate mother-to-child HIV transmission by 2015 cannot be attained unless men are more meaningfully involved in reproductive health, experts say.]]> ADDIS ABABA, 4 January 2012 (PLUSNEWS) - Ethiopia's new plan to eliminate mother-to-child HIV transmission by 2015 cannot be attained unless men are more meaningfully involved in reproductive health, experts say. "Among the pregnant women who come to our hospital, less than 10 percent of them come with their partners," said Etalem Gebrehiwot, head nurse at the prevention of mother-to-child transmission (PMTCT) wing of Gandhi Memorial Hospital. "Those who find out that they are living with the virus usually face a problem while taking medicines, given that most prefer to take it without the knowledge of their partners." Studies [ http://www.search4dev.nl/document/185326 ] show that low male partner involvement is one of the challenges to the success of the country's PMTCT programme. According to experts, men's involvement in PMTCT can have a positive impact on PMTCT by encouraging their partners to visit antenatal clinics and have skilled health workers attend the birth of their children. In a 2010 Kenyan study [ http://www.ncbi.nlm.nih.gov/pubmed/21084999 ], male partner involvement in PMTCT reduced the risks of vertical transmission and infant mortality by more than 40 percent compared to no involvement. "The biggest challenge we are currently facing is to convince mothers to get tested in order to determine that they are eligible for PMTCT services... the major reason for their resistance is lack of consent from their husbands or partners, who are more influential in family matters including this," said Aster Shewa, who supervises Zewditu Hospital antiretroviral service centre in Addis Ababa. "Besides, after they know their status, most HIV-positive mothers refrain from disclosing it, which usually impacts the way they use PMTCT services and their effectiveness," she added. Many men do not see the advantages of an HIV test; one father, whose wife gave birth to a daughter in November 2011, told IRIN/PlusNews: "We are married - what is there to test about?" "At the moment, hospitals with PMTCT services are increasing, and we have to work hard in convincing pregnant women, along with their partners, to use health facilities with the service in order to reach zero new infections," said Aster. New national plan The national accelerated emergency PMTCT plan - launched in December 2011 - has three objectives: reaching 90 percent of pregnant women with access to antenatal care services; ensuring universal access by pregnant women to a skilled attendant during delivery; and providing ARVs to at least 80 percent of HIV-positive pregnant women. An estimated 1.2 million Ethiopians are living with HIV, including about 90,000 pregnant women; just 9.3 percent of pregnant women who are eligible for HIV services are currently receiving them. The number of Ethiopian women who visit antenatal clinics is growing - from 616,763 in 2008-2009 to 796,099 in 2009-2010 - and the number of mothers receiving HIV testing as part of PMTCT services has grown to over 70 percent, but just 6 percent of births are attended by a skilled health worker, according to the UN World Health Organization [ http://www.who.int/whosis/whostat/EN_WHS10_Full.pdf ]. "The new plan will focus on increasing the quality of services that expectant mothers get in the health services and also retain those who are using it. We intend to work on both in the demand and supply side of the service," said Tadesse Ketema, a maternal health adviser at the Ministry of Health. "Through the health extension programme, the country manages to create easy access for family planning services for many families and that has worked so far. We are now planning to copy that in the PMTCT programme to reach out [to] each pregnant woman and give the service at their convenience," he added. Ethiopia's "health extension programme" [ http://www.irinnews.org/report.aspx?reportid=72371 ] employs more than 30,000 lower cadre health workers to provide basic health care at village level. The government also intends to use "health development armies" - community groups mobilized to further government health programmes - to create demand and convince the community, including male partners, to benefit from nearby PMTCT services. bt/kr/cb Thu, 29 Dec 2011 12:12:12 GMT ]]>NAIROBI/JOHANNESBURG, 29 December 2011 (PLUSNEWS) - It's been a roller coaster of a year in HIV and AIDS. AIDS turned 30 in 2011, and with new evidence of the effectiveness of HIV treatment as prevention, experts are increasingly talking about "the end of AIDS". At the same time, however, funding for HIV has become ever more uncertain, jeopardizing efforts to put new, life-saving science into action. http://www.plusnews.org/report.aspx?ReportID=94562 http://www.plusnews.org/report.aspx?ReportID=94562 NAIROBI/JOHANNESBURG, 29 December 2011 (PLUSNEWS) - It's been a roller coaster of a year in HIV and AIDS. AIDS turned 30 in 2011, and with new evidence of the effectiveness of HIV treatment as prevention, experts are increasingly talking about "the end of AIDS". At the same time, however, funding for HIV has become ever more uncertain, jeopardizing efforts to put new, life-saving science into action.]]> NAIROBI/JOHANNESBURG, 29 December 2011 (PLUSNEWS) - It's been a roller coaster of a year in HIV and AIDS. AIDS turned 30 in 2011, and with new evidence of the effectiveness of HIV treatment as prevention, experts are increasingly talking about "the end of AIDS". At the same time, however, funding for HIV has become ever more uncertain, jeopardizing efforts to put new, life-saving science into action. IRIN/PlusNews brings you 10 HIV-related stories that made headlines in 2011: AIDS turns 30 - The first case of HIV was reported in 1981, and 2011 was a year of reflection [ http://www.irinnews.org/report.aspx?reportid=92883 ] on the growth of the epidemic and progress made in the fight against it. In 30 years, an estimated 30 million people have died, another 34 million are living with the virus and an estimated 7,000 new infections occur every day. An estimated 6.6 million people were on treatment globally by December 2010, but some nine million people who qualified for antiretrovirals (ARVs) did not receive them. ARVs as Prevention - The little pills that turned HIV from a death sentence into a chronic condition could now help us prevent new HIV infections. In May, the HPTN 052 study, [ http://www.plusnews.org/report.aspx?reportid=92710 ] a large, randomized controlled trial, found that earlier initiation of HIV treatment led to a 96 percent reduction in HIV transmission to the HIV-uninfected partner. Activists have called on the UN World Health Organization (WHO) to rapidly develop guidelines on the use of ARVs as prevention. AIDS funding - In November, poor funding forced a board meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria in Accra, Ghana, to cancel [ http://www.plusnews.org/report.aspx?reportid=94293 ] its 11th round of funding, which was to fund programmes from 2011 to 2013. The international financing mechanism is responsible for about 70 percent of HIV treatment in developing countries. Earlier in the year, the Kaiser Family Foundation and UNAIDS released a report [ http://www.kff.org/hivaids/upload/7347-07.pdf ] showing that funding fell from US$7.6 billion in 2009 to $6.9 billion in 2010 - the first time funding has dropped [ http://www.plusnews.org/report.aspx?reportid=93521 ] in more than a decade of tracking HIV/AIDS spending. Between 2002 and 2008, spending rose more than six-fold before levelling off in 2009. Disappointing prevention trials - In April, a three-country study, known as FEM-PrEP, [ http://www.plusnews.org/report.aspx?reportid=92514 ] was halted after daily doses of the ARV Truvada, used as a pre-exposure prophylaxis (PrEP), failed to prevent HIV infection in the women participating. In September, the independent Data and Safety Monitoring Board (DSMB) for the Vaginal and Oral Interventions to Control the Epidemic (VOICE) study - which aimed to test the safety, effectiveness and acceptability of the daily use of one of two different ARV tablets or of a vaginal gel - recommended [ http://www.irinnews.org/report.aspx?reportid=93847 ] that women assigned to the tenofovir tablet should discontinue use because the study would be unable to show a difference in effectiveness between the drug and a placebo. In November, on the recommendation of the DSMP, the trial discontinued [ http://www.mtnstopshiv.org/node/3909 ] the use of the tenofovir-containing gel - and a control placebo gel - on the grounds that it was not effective in preventing HIV in the women participating in the trial. Gaffe-prone politicians - In November, South African media reported that Helen Zille, premier of the Western Cape and leader of the Democratic Alliance, while addressing a wellness summit hosted by the Western Cape Health department, called for people who knowingly infected people with HIV to be charged with attempted murder. She also questioned why government should foot the bill for people who contracted HIV through "irresponsible behaviour" and urged the government to shift its focus from the treatment to the prevention of diseases. HIV activists in South Africa were angered by Zille's remarks; rights organization Treatment Action Campaign [ http://www.tac.org.za/community/node/3203 ] called them "misleading and unscientific". Uganda's recently appointed health minister, Christine Ondoa, was in August berated by AIDS activists for comments she allegedly made in an interview with a local newspaper on 1 August. According to Uganda's Observer newspaper, Ondoa claimed to know three people who had been cured of HIV through prayer. The two join a long list of blunders [ http://www.plusnews.org/report.aspx?reportid=93411 ] by African leaders on the subject of HIV. Anti-gay legislation in Africa - As a new session of parliament began in May, MPs backing a tougher anti-gay bill [ http://www.plusnews.org/report.aspx?reportid=92739 ] - which includes a death penalty clause for repeat offenders - said they would persevere with it, despite President Yoweri Museveni's calls [ http://www.plusnews.org/report.aspx?reportid=87728 ] for them to drop it. In November, Nigeria's Senate voted to criminalize gay marriage, gay advocacy groups and same-sex public displays of affection. The bill must be passed by the House of Representatives and signed by President Goodluck Jonathan before becoming law, but AIDS activists have said it can only serve to drive gay Nigerians further underground and away from HIV prevention and care services. Western countries have responded to the growth of anti-gay legislation; British Prime Minister David Cameron has threatened to withhold aid to countries violating the rights of their gay citizens, while US Secretary of State Hillary Clinton said in December that the Obama administration would Use its foreign policy to combat efforts abroad to criminalize homosexual conduct. Following Clinton's speech, Malawi - which in 2011 arrested gay rights activist Gift Trapence - has said it will review its anti-homosexuality legislation. Threats to generic ARVs - According to activists, the European Union (EU) in 2011 continued to push for tougher intellectual property rules in its negotiations with India over the terms of a free trade agreement. India - known as the 'pharmacy of the developing world' - produces the vast majority of the ARVs used in developing countries. Swiss pharmaceutical giant Novartis is also back in the Indian courts, challenging patent laws aimed at preventing the extension of drug patents for minor changes in existing products, a practice known as "evergreening". If Novartis is successful, India will be forced to grant more patents on drugs than they currently do, which will keep newer drugs out of reach of those who need them the most. In March, UNAIDS released a policy brief [ http://www.plusnews.org/report.aspx?reportid=92222 ] to help countries make intellectual property rights work for them, amid growing concerns over access to Indian generics. Contraception and HIV risk - Helping women avoid unwanted pregnancies is an important part of prevention of mother-to-child HIV transmission, so when a study [ http://www.plusnews.org/report.aspx?reportid=93908 ] conducted in seven African countries found that women who relied on hormonal shots - many African women use the contraceptive Depo-provera - to prevent pregnancy doubled their HIV risk, HIV programmers were left confused and disappointed. Published in The Lancet in October, the study also found that in women who were HIV-positive, using "the shot" doubled the chances that they transmitted HIV to their partners. According to Jared Baeten, one of the study's authors, previous studies have suggested that perhaps contraception can lead to microscopic thinning of the vaginal mucous membrane and changes to the genital tract, making it easier for HIV to establish itself. UNAIDS has called for more research and analysis ahead of a January 2012 meeting when WHO will review various studies as it prepares to revise recommendations on HIV and contraception use. Medicines Patent Pool - In July, Gilead Sciences became the first pharmaceutical company to sign [ http://www.plusnews.org/report.aspx?reportid=93213 ] a licensing agreement with the Medicines Patent Pool. The patent pool was established in 2010 by the international health financing mechanism, UNITAID, and aims to stimulate innovation and improve access to HIV medicines through the negotiation of voluntary licences on medicine patents that enable generic competition and facilitate the development of new formulations. The agreement allows for the production of several of Gilead's HIV medicines, including tenofovir and emtricitabine, as well as two integrase inhibitors, which block retroviral replication, cobicistat and elvitegravir (both still in development), and combinations that include these medicines. The US National Institutes of Health was the first [ http://www.plusnews.org/report.aspx?reportid=90643 ] patent holder to join the pool when it licensed the life-prolonging antiretroviral (ARV), darunavir, in October 2010. New HIV targets - "Zero new infections, zero stigma and zero AIDS-related deaths" was the bold new goal [ http://www.plusnews.org/report.aspx?reportid=92962 ] set during the UN High-Level Meeting on AIDS in June. The meeting concluded with the adoption of a declaration that seeks, by 2015, to double the number of people on ARVs to 15 million, end mother-to-child transmission of HIV, halve tuberculosis-related deaths in people living with HIV, and increase preventive measures for the "most vulnerable populations". The goal appeared within reach when in December US President Barack Obama [ http://www.plusnews.org/report.aspx?reportid=94371 ] pledged to provide HIV treatment to some six million people globally by 2013, an increase of two million on the previous target. kr/llg/cb Tue, 27 Dec 2011 12:12:12 GMT ]]>NAIROBI, 27 December 2011 (PLUSNEWS) - From scientific breakthroughs to herbal "cures", HIV was never far from the headlines in 2011. http://www.plusnews.org/report.aspx?ReportID=94548 http://www.plusnews.org/report.aspx?ReportID=94548 NAIROBI, 27 December 2011 (PLUSNEWS) - From scientific breakthroughs to herbal "cures", HIV was never far from the headlines in 2011.]]> NAIROBI, 27 December 2011 (PLUSNEWS) - From scientific breakthroughs to herbal "cures", HIV was never far from the headlines in 2011. IRIN/PlusNews brings you some of the people behind this year's headlines: Mandisa Dlamini - Mandisa, daughter of murdered HIV activist Gugu Dlamini, took centre stage [ http://www.irinnews.org/report.aspx?reportid=92929 ] at the South African AIDS Conference in the country's port city of Durban. Thirteen years after she was killed because of her HIV status, Gugu's murder continues to be a potent symbol of the dangers of stigmatization. Mandisa's story was an emotive reminder of the darker side of HIV aid and activism; she said following her mother's death, which has been used to draw international attention to HIV stigma, friends were few and far between. Her story of growing up alone and becoming a teenage mother following Gugu's death before being taken in by a social worker she now calls mother, was not only a window into the lives of so many children, but also a commentary on how the HIV response often fails the most vulnerable ones left behind. Myron Cohen - A professor of medicine, microbiology and immunology and public health at the US University of North Carolina at Chapel Hill, Myron Cohen was the principal investigator in HPTN 052, [ http://www.plusnews.org/report.aspx?reportid=92710 ] the landmark randomized controlled trial which provided definitive proof that antiretroviral treatment reduces HIV transmission. Hailed as one of the major scientific breakthroughs of 2011, "treatment as prevention" presents an opportunity for high burden countries to make real progress in significantly reducing the number of new HIV infections. Ambilikile Mwasapile - The Tanzanian herbalist, a retired Lutheran pastor, made news with a concoction of herbs he claimed could cure [ http://www.plusnews.org/report.aspx?reportid=92360 ] several ailments, including diabetes, tuberculosis and HIV infection. At his busiest, Mwasapile was reported to be seeing up to 2,000 people a day from all over the East African region; news outlets reported that people died from various illnesses while waiting to see him. HIV activists criticized the Tanzanian government for failing to reign in Mwasapile and properly advise people living with HIV that they must continue with their HIV medication, even after taking his drink. David Kato - One of Uganda's leading gay rights activists, David Kato [ http://www.plusnews.org/report.aspx?reportid=91744 ] was murdered on 26 January, leaving the country's gay community afraid and angry. Kato was vehemently opposed to an anti-homosexuality bill [ http://www.plusnews.org/report.aspx?reportid=92739 ] - still before parliament - which would impose the death penalty on people found guilty of "aggravated homosexuality". The continued stigmatization of men who have sex with men, in Ugandan society and under Ugandan law, has been pinpointed as one of the main reasons they have failed to access HIV services, despite being categorized as a "most at-risk" population. In October 2010, Kato - a schoolteacher by profession - had his name and photograph and name published by a local tabloid, The Rolling Stone, under the headline, "Hang Them". He and others named in the publication sued, and a judge ruled that the paper had violated their constitutional rights to privacy and ordered compensation. In November 2011, a court sentenced a man to 30 years in prison for the murder of Kato. However, activists continue to claim there was a cover-up of the events surrounding his death. Barack Obama – The US is already a global leader in the fight against HIV – close to half the 6.6 million people who accessed ARVs in 2011 did so through the US President's Emergency Plan for AIDS Relief (PEPFAR) – and in December, President Barack Obama reaffirmed his government’s commitment to ending the pandemic when he pledged [ http://www.irinnews.org/report.aspx?reportid=94371 ] to provide treatment to six million people globally by 2013, an increase of two million on PEPFAR's previous target. He also pledged that the US would provide ARVs to prevent mother-to-child HIV transmission to 1.5 million women, support 4.7 million male circumcisions in eastern and southern Africa, and fund the distribution of at least one billion male condoms. kr/llg/cb Thu, 22 Dec 2011 12:12:12 GMT ]]>NAIROBI, 22 December 2011 (PLUSNEWS) - While antiretroviral drugs have significantly improved the life expectancy of people living with HIV, the virus - and often the ARVs themselves - can make people more susceptible to non-communicable diseases than the rest of the population. http://www.plusnews.org/report.aspx?ReportID=94522 http://www.plusnews.org/report.aspx?ReportID=94522 NAIROBI, 22 December 2011 (PLUSNEWS) - While antiretroviral drugs have significantly improved the life expectancy of people living with HIV, the virus - and often the ARVs themselves - can make people more susceptible to non-communicable diseases than the rest of the population.]]> NAIROBI, 22 December 2011 (PLUSNEWS) - While antiretroviral drugs have significantly improved the life expectancy [ http://www.plusnews.org/report.aspx?reportid=93269 ] of people living with HIV, the virus - and often the ARVs themselves - can make people more susceptible to non-communicable diseases than the rest of the population. Here are six non-communicable diseases that are more likely to affect people living with HIV: Heart disease - Several studies have made the link between coronary disease and HIV infection: one [ http://www.retroconference.org/2011/PDFs/809.pdf ] presented at the 18th Conference on Retroviruses and Opportunistic Infections (CROI) in March 2011 found that HIV-infected participants had an increased risk of "acute myocardial infarction" - heart attack - compared with demographically and behaviourally similar HIV-negative study participants. Another 2011 study [ http://archinte.ama-assn.org/cgi/content/short/171/8/737 ] found that HIV infection was a risk factor for heart failure, with ongoing viral replication associated with a higher risk of developing heart failure. The link between ARVs and heart disease is less clear; one study [ http://www.retroconference.org/2011/Abstracts/40434.htm ], also presented at CROI, found that HIV infection increased the risk of coronary heart disease, but ARVs and higher CD4 counts – a measure of immune strength - significantly reduced this risk. However, a 2011 Canadian study [ http://www.ncbi.nlm.nih.gov/pubmed/21499115 ] found that several ARVs - abacavir, efavirenz, lopinavir, and ritonavir - were all associated with an increased risk of heart attack. Cervical cancer - After breast cancer, it [ http://www.medscape.com/viewarticle/714655 ] is the second most common cancer among women worldwide; more than 80 percent of new cases and deaths from the disease occur in developing countries. Studies have found that HIV-positive women are at higher risk of human papillomavirus (HPV), a precursor to cervical cancer; women with low CD4 counts seem to be particularly vulnerable. HPV can be prevented with a vaccine recommended for pre-adolescent girls before they reach their sexual debut but the vaccine is too expensive for most women in developing countries. In addition, cervical cancer screening levels remain very low in many poor countries; for instance, just 3.2 percent of Kenyan [ http://www.plusnews.org/report.aspx?reportid=93209 ] women aged 18-69 are tested every three years, compared with 70 percent of women in the developed world. Other cancers - People living with HIV are more susceptible to several cancers, including Kaposi sarcoma, Hodgkin's and non-Hodgkin's lymphoma, anal cancer, skin cancer and liver cancer - than HIV-negative people, a new study has found. Published in Cancer Epidemiology, Biomarkers and Prevention, the study [ http://cebp.aacrjournals.org/content/early/2011/11/18/1055-9965.EPI-11-0777.abstract?sid=5134a395-412a-4cdf-b8b1-bf5d5beee14f ] found that immunodeficiency was positively associated with all cancers examined except prostate cancer. The authors recommended starting antiretroviral therapy earlier to maintain high CD4 levels. Mental illness - Studies show that the prevalence of mental illness among HIV-positive in-patients and out-patients in the US ranges between 5 and 23 percent compared with 0.3-0.4 percent in the general population. According to the World Health Organization (WHO) [ http://apps.who.int/gb/ebwha/pdf_files/EB124/B124_6-en.pdf ], apart from the psychological impact of HIV, the virus has direct effects on the central nervous system, leading to neuropsychiatric complications, including HIV encephalopathy, depression, mania, cognitive disorders, and dementia. Studies also show that depression can lead to high-risk behaviour [ http://www.ncbi.nlm.nih.gov/pubmed/21078150 ], including transactional sex, partner abuse and low condom use. However, depression is frequently overlooked [ http://www.plusnews.org/report.aspx?reportid=94410 ] by healthcare providers; a severe shortage of mental health professionals in developing countries means patients often suffer in silence. Kidney disease - Known as HIV-associated nephropathy [ http://www.nephrologyrounds.org/crus/nephus_0809_07.pdf ], kidney disease is relatively common in people living with HIV. The virus interferes with the kidneys' ability to function correctly, particularly in people with advanced HIV who have a low CD4 count and a high viral load, as well as older people. Poorly functioning kidneys can cause other health conditions, including cardiovascular disease, nerve damage, bone disease, and anaemia. Certain ARVs, tenofovir in particular, have also been associated [ http://journals.lww.com/jaids/Fulltext/2010/01010/Impact_of_Tenofovir_on_Renal_Function_in.10.aspx ] with a decline in renal function. Liver disease - A leading cause of morbidity and death among HIV-positive individuals [ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62001-6/fulltext#bib3 ], it is mainly caused by co-infection with hepatitis B or hepatitis C, alcohol abuse, insulin resistance or side-effects of medicines. Experts say early identification and proper management of liver disease in HIV-infected people are crucial to improve long-term outcomes. kr/mw Wed, 21 Dec 2011 12:12:12 GMT ]]>NAIROBI, 21 December 2011 (PLUSNEWS) - Would-be participants in HIV research often refuse to volunteer out of fear of being labelled as HIV-positive and subsequently stigmatized by their communities, according to a recent study conducted in Kenya. http://www.plusnews.org/report.aspx?ReportID=94513 http://www.plusnews.org/report.aspx?ReportID=94513 NAIROBI, 21 December 2011 (PLUSNEWS) - Would-be participants in HIV research often refuse to volunteer out of fear of being labelled as HIV-positive and subsequently stigmatized by their communities, according to a recent study conducted in Kenya.]]> NAIROBI, 21 December 2011 (PLUSNEWS) - Would-be participants in HIV research often refuse to volunteer out of fear of being labelled as HIV-positive and subsequently stigmatized by their communities, according to a recent study conducted in Kenya. Conducted by the USA's Research Triangle Institute International and published by the US National Library of Medicine [ http://www.ncbi.nlm.nih.gov/pubmed/21964057 ] in November, the study involved over 130 participants - including current and former study participants, community leaders and study staff - at two research centres in Nairobi.  "Volunteers are often assumed by family and community members to be HIV positive because of their participation in vaccine research... HIV-related stigma is perceived as pervasive and damaging in the communities where volunteers live, thus they fear consequent stigma if people believe them to be HIV positive," the authors say in the study abstract. "Potential volunteers fear being tested for HIV, a prerequisite for participation, because of possible disclosure of HIV status in communities with high perceived HIV-related stigma." According to Walter Jaoko, lead researcher at the Kenya AIDS Vaccine Initiative, misinformation about HIV clinical research is one of the biggest impediments to people's participation in research, which is a crucial part of finding ways to combat the virus. "People will tell you they will get infected with HIV if they participate in the study or some other people will tell them the same," he told IRIN/PlusNews. "This is mainly misinformation and it is a big problem getting people to willingly participate in clinical studies - not just for HIV but for many other diseases." Protus Momanyi, a 33-year-old Nairobi resident, said the main impediment to his participation in HIV research was the requirement for an HIV test. "I have never been tested for HIV and I fear going for it for my own reasons," he said. The study authors concluded that there was a need for "integration of stigma-reduction programming into education and outreach activities for volunteers and the communities in which they live". ko/kr/cb Mon, 19 Dec 2011 12:12:12 GMT ]]>KISUMU, 19 December 2011 (PLUSNEWS) - For the past five years, Achieng*, a 35-year-old widow and mother of six, has sold fish on the Kenyan shores of Lake Victoria; like many women in the fish trade, Achieng often has to have sex with fishermen in order to get the best catch of the day, a system known in the local Luo language as 'jaboya'. http://www.plusnews.org/report.aspx?ReportID=94497 http://www.plusnews.org/report.aspx?ReportID=94497 KISUMU, 19 December 2011 (PLUSNEWS) - For the past five years, Achieng*, a 35-year-old widow and mother of six, has sold fish on the Kenyan shores of Lake Victoria; like many women in the fish trade, Achieng often has to have sex with fishermen in order to get the best catch of the day, a system known in the local Luo language as 'jaboya'.]]> KISUMU, 19 December 2011 (PLUSNEWS) - For the past five years, Achieng*, a 35-year-old widow and mother of six, has sold fish on the Kenyan shores of Lake Victoria; like many women in the fish trade, Achieng often has to have sex with fishermen in order to get the best catch of the day, a system known in the local Luo language as 'jaboya'. "When you are a woman and you want to get into the business of selling fish, you must be ready to lose your pride and use your body for bargaining," she told IRIN/PlusNews. "Being ready to give sex as and when it is needed by the fishermen... it guarantees your survival here on the beach." 'Jaboya' has long been associated with the high levels of HIV infection in Kenya's western Nyanza Province, where HIV prevalence is over 14.9 percent, double the national average of 7.4 percent. It is even higher among fishing communities. The Kenya HIV Prevention Response and Modes of Transmission Analysis 2009 [ http://siteresources.worldbank.org/INTHIVAIDS/Resources/375798-1103037153392/KenyaMOT22March09Final.pdf ] reported that HIV prevalence among fishing communities stands at 30 percent, while an estimated 25 percent of all new infections in Nyanza are attributed to this group. An estimated 27,000 women are involved in the fish trade in Nyanza either directly or indirectly, according to the Ministry of Fisheries. Achieng says she is aware of the risks, but the immediate needs of her family override any concern she may have about contracting HIV. "You know you can get HIV... but then you remember you have a family that needs to be provided for, and you say, let me die providing for them," she said. According to Charles Okal, the provincial AIDS and sexually transmitted infections coordinator for Nyanza, while efforts to reach out to fishing communities with HIV prevention messages have begun to show results, the continued poverty of women means they remain vulnerable to 'jaboya'. "Fish trade that goes along with sex-for-fish continues to be one of the greatest challenges in the prevention of HIV in Nyanza... There are still challenges which involve the economic and social vulnerabilities of the women involved in the trade," he said. Economic empowerment A recent donation of six boats to women's groups in Nyanza by the US Peace Corps shows some of the ways 'jaboya' can be addressed; the women are able to fish for themselves, eliminating dependence on fishermen. "When you have nothing, those who have something must tell you to bend over backwards for them. Now we have boats and we will no longer be at anybody's mercy," Millicent Onyango, one of the beneficiaries of the US Peace Corps' "No Sex for Fish" project. According to Okeyo Owuor, director of the Victoria Institute for Research on Environment and Development, which is part of the initiative, empowering women economically is key to ending the dangerous fish-for-sex trade. "These women need fish but they don't own any boat. This means they have to play along with whoever has the boat and these are men who will demand for sex before giving any fish. But when you empower them to own the boat, then they have the ultimate power to say no to sexual demands," he said. "Six boats might look small but many such initiatives can make an impact in ending the sex-for-fish trade if replicated over time. It is important to start from somewhere," he added. Many of the women trading in fish across Lake Victoria's landing sites have formed groups to help them save money to buy their own fishing equipment. "We want to help ourselves by putting some of our savings aside so that when we have enough, we can buy our own boats and nets and help each other. So we will have nearly all women who are at the beaches own a boat either individually, or as a group," said Lillian Rajula, the leader of one such group. According to Nyanza AIDS coordinator Okal, economic programmes must go hand in hand with other HIV prevention methods like the promotion of voluntary medical male circumcision, condom use and behaviour change communication. "Apart from the need to empower the women, behaviour change communication targeting men is important so that they look at the women as business partners and not sex partners; these kind of efforts are ongoing and are being embraced, albeit slowly," he said. *Not her real name ko/kr/cb Thu, 15 Dec 2011 12:12:12 GMT ]]>BANGKOK, 15 December 2011 (PLUSNEWS) - The number of reported HIV cases has tripled in Indonesia in recent years, curtailing productivity and trapping affected girls and women, especially, in poverty, according to a recent UN Development Programme (UNDP) report. http://www.plusnews.org/report.aspx?ReportID=94480 http://www.plusnews.org/report.aspx?ReportID=94480 BANGKOK, 15 December 2011 (PLUSNEWS) - The number of reported HIV cases has tripled in Indonesia in recent years, curtailing productivity and trapping affected girls and women, especially, in poverty, according to a recent UN Development Programme (UNDP) report.]]> BANGKOK, 15 December 2011 (PLUSNEWS) - The number of reported HIV cases has tripled in Indonesia in recent years, curtailing productivity and trapping affected girls and women, especially, in poverty, according to a recent UN Development Programme (UNDP) report [ http://www.beta.undp.org/undp/en/home/librarypage/hiv-aids/the_socio-economicimpactofhivatthehouseholdlevelinasiaaregionala.html ]. Women, representing a quarter of all people living with HIV in Indonesia, shoulder family finances when their partners can no longer work, or when they face education and employment discrimination, said the report. "Discrimination against people with AIDS is still very strong in Indonesia, especially for women. Many HIV-positive women are being called 'bad women' or 'bad girls', but at the same time, many of them have to work more after their husbands were diagnosed with HIV," said Chya Wibisono, an HIV-positive officer at the local NGO, Indonesia Women's Positive Network. [ http://www.ippi.or.id/ ]. Women in HIV-affected households put in longer hours but were less likely to own their homes, livestock and vehicles. They were also more likely to be widowed and denied inheritance rights - the case for 71 percent of all HIV-affected widows. Across all countries covered by the study (Cambodia, China, India, Indonesia and Vietnam), HIV-affected households experienced significant drops in incomes, savings, assets, and ability to buy protein-rich food. Compared with non-HIV-affected families, affected families in Indonesia were 38 percent more likely to live below the international poverty line of US$1.25 per person per day - the second highest of all the countries surveyed - with more than a quarter of these households reporting having to sell assets to pay medical costs, the report says. While antiretroviral therapy (ART) for HIV is provided free, the medication has reached about half of patients in need, compared with 94 percent in Cambodia, where free ART coverage has proven to be effective in reducing households' financial burden, according to the UNDP report. "Real [progress] has been made to improve ART coverage in Indonesia. The percentage of coverage has increased significantly from 25 to 50 percent over the last three years, but this is still far from enough," said Nancy Fee, country coordinator of UNAIDS in Indonesia. As of December 2009, some 18,000 people had reported HIV at an advanced stage, of whom 6,653 were receiving ART, according to the government. [ http://aidsdatahub.org/dmdocuments/indonesia_2010_country_progress_report_en.pdf ]. People were going without medication mostly because they had not tested for HIV and did not know their status; in addition, continuity and availability of ART stock as well as availability of certified health workers to administer the drugs were challenges, according to the government. Different for girls Daughters in HIV-affected families were also more likely to be pulled out of school than sons to take care of their sick family members. "It is most often [girls] who are removed first. This is both to save resources spent on schooling, as well as to utilize the girl child for labour," said Clifton Cortez, health and development practice leader at the Bangkok-based UNDP Asia-Pacific Regional Centre. The UNDP report suggested conditional cash transfers - paying children based on their school enrolment and attendance - to encourage parents to keep children in school. According to the World Bank [ http://www.unesco.org/new/fileadmin/MULTIMEDIA/HQ/BSP/GENDER/Images/Women%20Girls%20HIV%20Education%20and%20Workplace_Joint%20paper_FINAL.pdf ], the risk of HIV infection is more than halved for young people, particularly girls, who stay in school and complete a basic education. In Indonesia, 28 percent of women surveyed between the ages of 15-24 had not heard of HIV and had little knowledge of condom usage, said the UNDP report. "No discrimination" However, Nafsiah Mboi, secretary of the government's National AIDS Commission, dismissed concerns that women and children bore the economic brunt of HIV. "There is no specific scheme for HIV-affected families or women, but everyone who is poor can ask for assistance. There is no discrimination," she said. While a National Social Security System (SJSN) has been in place since 2004 - a basic framework for reforming the country's social security programme covering health insurance, employment injury, pensions and death benefits - the International Labour Organization estimated 54 percent of the country's population (mostly workers in the informal economy, employees without contracts and their families) were still excluded in 2011 from the national social health protection scheme. Instead of small government-funded isolated projects, Fee from UNAIDS said the country needed a "universal social protection floor" - a minimum level of essential social services and income security for all in times of economic and financial crisis - to ensure everybody, including those affected by HIV, had equal access to healthcare and other social services. Parliament approved legislation on 28 October that aims to implement SJSN and provide universal health insurance coverage by 2014. sh/pt/mw Thu, 15 Dec 2011 12:12:12 GMT ]]>KAMPALA, 15 December 2011 (PLUSNEWS) - A plan to virtually eradicate mother-to-child transmission of HIV in Uganda by 2015 by adopting a more cost-effective treatment regimen, beefing up health infrastructure and increasing women's access to family planning, comes with high expectations and significant challenges. http://www.plusnews.org/report.aspx?ReportID=94478 http://www.plusnews.org/report.aspx?ReportID=94478 KAMPALA, 15 December 2011 (PLUSNEWS) - A plan to virtually eradicate mother-to-child transmission of HIV in Uganda by 2015 by adopting a more cost-effective treatment regimen, beefing up health infrastructure and increasing women's access to family planning, comes with high expectations and significant challenges.]]> KAMPALA, 15 December 2011 (PLUSNEWS) - A plan to virtually eradicate mother-to-child transmission of HIV in Uganda by 2015 by adopting a more cost-effective treatment regimen, beefing up health infrastructure and increasing women's access to family planning, comes with high expectations and significant challenges. After heterosexual transmission, vertical transmission is Uganda's second leading cause of new infections – the country registers at least 20,000 new infections through childbirth each year. In the absence of any interventions, transmission rates range from 15 to 45 percent, but with effective PMTCT interventions this can be lowered to below 5 percent. "We have not made a lot of headway on PMTCT; the interventions we have work [but] we have to make a new commitment," Jane Ruth Aceng, director-general of Uganda's health services, said during a recent meeting to evaluate the elimination plan. Uganda started offering PMTCT in 2000, with the initial programme calling for a single dose of the antiretroviral (ARV), Nevirapine, during delivery. The programme was revised in 2006 to introduce combination ARV regimens, but the delivery of those drugs has not been consistent, something the new plan aims to change. According to Godfrey Esiru, the Ministry of Health's national PMTCT coordinator, there are at least 1,590 facilities offering PMTCT. However, success will require more than just a rapid scale-up to virtually eliminate vertical transmission by 2015 - a target in line with global HIV prevention goals; Uganda will need to overcome the structural bottlenecks and communication gaps that have plagued its PMTCT programme. A struggling programme Comprehensive PMTCT services - which include counselling and testing, the use of combination ARVs, safe delivery and proper infant feeding practices - are often limited to larger national and regional referral hospitals, but the smaller health centres that are often the closest options for rural women can only offer limited facilities. And access to the health system does not guarantee access to PMTCT services; although more than 90 percent of women seek antenatal care at least once during their pregnancy, just 42 percent go on to give birth with the assistance of skilled health professionals. According to Leonard Okello, country director for the International HIV/AIDS Alliance, the country's myriad problems begin with an ongoing shortage of trained health workers and basic equipment in the community health facilities that pregnant women access most frequently. "When the nurses know [a mother] is HIV-positive and they have only one pair of gloves, even the nurses... would find it difficult to help, because they're not sure they won't get infected themselves," he said. The government has faced criticism for a perceived lack of political commitment to PMTCT, but with the launch of the new programme, activists are hopeful that the country will now give the intervention due attention. A cornerstone of the new plan is a shift to the World Health Organization’s latest guidelines on PMTCT [ http://whqlibdoc.who.int/publications/2010/9789241599818_eng.pdf ]. Starting in January 2012, Uganda will begin the shift from its current regimen - which involves single-dose ARVs from 14 weeks, during delivery and for seven days after delivery for women with a CD4 count, a measure of immune strength, of 350 or below - to Option B, which involves putting eligible women on triple-therapy ARVs from the 14th week of pregnancy until one week after breastfeeding has ended, which can be up to one year. Some activists argue, however, that Uganda should join Malawi and leapfrog both choices to Option B-plus, whereby all HIV-positive pregnant women begin combination ARVs, irrespective of their CD4 count. "We are wasting money in debates, seminars, meetings, conferences on whether we should do it or not," said Okello. "Just do it [Option B-plus]. Let's get moving." Due to a cash crunch [ http://www.plusnews.org/report.aspx?reportid=92043 ], the shift to Option B has been delayed, and the country opted first to transition all facilities to Option A, for which it had the drugs in stock. Starting with the launch in January, Option B will be rolled out in phases, first to national and regional referral hospitals, and then to health centres throughout the country. By February 2013, Esiru said the ministry hoped to roll out Option B to all facilities that offer PMTCT. It also hopes to introduce PMTCT into an additional 20 percent of the country's sub-county health centres; just 10 percent offer PMTCT services. Wider improvements ahead Under the plan, the ministry's reproductive health division will work to improve the uptake of contraceptives to at least halve the number of unintended pregnancies, especially among HIV-positive women. The unmet need for family planning in Uganda is estimated at 41 percent, and the country's population growth rate of 3.3 percent is one of the world's highest. Village health teams will also become more aggressive in reaching out to the community with rapid HIV tests, specifically to identify HIV-positive pregnant women who have not yet entered the health system. After birth, women need to remain connected to health services, to family planning specialists and to resources for testing their child's HIV status. The Ministry of Health is in the process of consolidating all infant HIV testing to one lab in Kampala that has an automated system – which many regional testing locations lack. Through a network of hubs, government drivers gather blood samples from health centres around the country and deliver them to the central Kampala lab within days. "Something that was two weeks is now something like two days," said Charles Kiyaga, national coordinator for early infant diagnosis, adding that the system made it easier to track down HIV-positive children and get them started on treatment quickly. Health workers will have to undergo training to make the transition from Option A to Option B, while new health workers will have to be placed in regional facilities and quickly trained. In addition, the supply of drugs and basic supplies will need to be consistent. The ministry has not yet finalized the cost of the plan, though it is certain to be high. There is money available, though, both from the Ugandan government and donors. Funding from the US President's Emergency Plan for AIDS Relief will almost certainly make up the majority; in 2010 alone, it gave Uganda more than US$14.8 million for PMTCT, according to ministry documents. Officials hope that if the programme shows initial success, more donors will sign on to support it. ag/kr/mw Tue, 13 Dec 2011 12:12:12 GMT ]]>MBABANE, 13 December 2011 (PLUSNEWS) - A new wave of HIV activism is rising in Swaziland as people living with HIV take to the streets in protest, many for the first time in their lives, over continued shortages of antiretroviral (ARV) treatment. http://www.plusnews.org/report.aspx?ReportID=94456 http://www.plusnews.org/report.aspx?ReportID=94456 MBABANE, 13 December 2011 (PLUSNEWS) - A new wave of HIV activism is rising in Swaziland as people living with HIV take to the streets in protest, many for the first time in their lives, over continued shortages of antiretroviral (ARV) treatment.]]> MBABANE, 13 December 2011 (PLUSNEWS) - A new wave of HIV activism is rising in Swaziland as people living with HIV take to the streets in protest, many for the first time in their lives, over continued shortages of antiretroviral (ARV) treatment. Swaziland 's deepening financial crisis is taking a toll on service delivery, and the country is experiencing an unprecedented number of protests over issues such as school closures and a lack of HIV treatment. While Africa's last absolute monarchy does not allow formal political opposition to operate, a new brand of HIV activism may be taking hold as anger mounts over a lack of ARVs. [ http://www.irinnews.org/report.aspx?reportid=92722 ] “People living with HIV and AIDS are more politically active," said Thandi Nkambule, director of the Swaziland Network for People with HIV and AIDS (SWANEPHA), an umbrella body. He noted that there are similarities between Swaziland's newfound HIV activism and established movements in neighbouring South Africa. [ http://www.plusnews.org/report.aspx?reportid=93877 ] “The leaders of the HIV support groups are joining the marches because they know that [government] leadership lacks the political will to meet the needs of people living with HIV and AIDS.” About a quarter of all adult Swazis are living with HIV and about 47,000 patients nationally were on ARVs at the end of 2009, according to UNAIDS. [ http://www.irinnews.org/report.aspx?reportid=92526 ] Shortages of HIV programme supplies in Swaziland began making headlines in mid-2011. Media reports have largely attributed stock-outs to reduced revenues from the Southern Africa Customs Union (SACU), but the country also opted not to apply for funding in Round 10 from the Global Fund to Fight AIDS, TB and Malaria. Instead, it chose to assume financial responsibility for HIV treatment itself, at a time when SACU revenues were already projected to decline. Domestic funding has proved insufficient to back this decision. [ http://www.irinnews.org/report.aspx?reportid=94209 ] Rising voices on the ground Thandi Khumalo has been on ARVs for a year. Earlier in 2011 she took part in her first trade union protest as part of a “Week of Global Action” to press for political reform in Swaziland. “The clinic where I go has never run out of ARVs, like some other places that have been hit by the government financial crisis, but I know people in our support group who have experienced interruptions," she said during a demonstration. [ http://www.irinnews.org/report.aspx?reportid=92722 ] "I have never been involved in politics... [but] we all live in fear that this will happen to us - that is why I am doing this political march. Something has to change in the way this country is run, or we will die,” Khumalo told IRIN/PlusNews. “This is survival for me." The Ministry of Health has disputed allegations that Swaziland is experiencing sporadic shortages of ARVs, and Health Minister Themba Xaba recently said anyone experiencing stock outs should contact him personally. The minister also alleged that pro-democracy groups have used allegations of ARV stock-outs for political gain, but activists disagree. “The shortages of medicines and basic supplies in hospitals are real - that is why the nurses staged a protest action this year," said SWANEPHA member Solomon Thwala, who added that SWANEPHA members have been verifying and reporting stock-outs that the government continues to deny. In August the US President's Emergency Plan for AIDS Relief (PEPFAR) gave the country US$7 million in emergency funding, but this was only for first-line ARVs. Swaziland now has a buffer stock of first-line ARVs that should last until April 2012. [ http://www.irinnews.org/report.aspx?reportid=94209 ] Prudence Simelane, a garment worker, also joined demonstrations to protest shortages of the drugs that she says have given Swazis hope, but which she feels can no longer be entrusted to government. “Swazis never cared about AIDS - they were told they would die if they got HIV and there was nothing they could do - but now we can live with HIV." She surprised herself by joining in recent demonstrations. "We have hope because of the ARVs - people are thinking about their lives, and about the future,” Simelane said. “That is why we are so frightened - because we can’t trust government to keep us supplied with drugs." jh/llg/he Fri, 9 Dec 2011 12:12:12 GMT ]]>ADDIS ABABA, 9 December 2011 (PLUSNEWS) - Unless African governments increase their funding for and engagement in HIV research, the continent cannot hope to attain equal status in determining its research agenda and priorities, speakers said at the 16th International Conference on AIDS and Sexually Transmitted Infections (STIs) in Africa. http://www.plusnews.org/report.aspx?ReportID=94433 http://www.plusnews.org/report.aspx?ReportID=94433 ADDIS ABABA, 9 December 2011 (PLUSNEWS) - Unless African governments increase their funding for and engagement in HIV research, the continent cannot hope to attain equal status in determining its research agenda and priorities, speakers said at the 16th International Conference on AIDS and Sexually Transmitted Infections (STIs) in Africa.]]> ADDIS ABABA, 9 December 2011 (PLUSNEWS) - Unless African governments increase their funding for and engagement in HIV research, the continent cannot hope to attain equal status in determining its research agenda and priorities, speakers said at the 16th International Conference on AIDS and Sexually Transmitted Infections (STIs) in Africa. "In most low-income or poor countries, health research is donor-driven, with insignificant local budgets compared to the 2 percent annual budget recommended by WHO [World Health Organization]," said Dr Beyene Petros, chair of the Ethiopian Bioethics Initiative. Donor-driven funding often means that research starts and ends on the say-so of funders, rather than being based on a country's needs. Beyene noted a Dutch grant of approximately US$13 million to the Ethiopian government to investigate capacity development in HIV/AIDS research for eight years. When the grant ended in 2002, the Ethiopian government applied for a renewal. It was denied, leaving scientists, who had been hoping to launch a local vaccine initiative, at a loss. The Dutch government instead decided to fund family planning and HIV prevention activities in the country. The field of HIV research - largely donor-driven - is vibrant in eastern and southern Africa. But "West Africa, in particular, is characterized by an absence in of clinical trials of potential HIV vaccines, and or microbicides, and a lack of data on drug-resistant tuberculosis," said Dr Souleymane Mboup, of Senegal’s Cheikh Anta Diop University. Prof Nelson Sewankambo, principal of the College of Health Sciences at Uganda's Makerere University, said heavy donor involvement in local research can actually harm existing national institutions, which may lose strategic direction and become retarded by the loss of key staff to research projects and distortion of institutional structures and governance. "Inequities in collaboration can lead to lack of transparency in the decision-making process, as well as disputes over publication rights, ownership of data, specimens and equipment," Sewankambo said. Speakers also noted that inadequate community engagement was common when partnerships were skewed in favour of the donor priorities. "There ought to be distributive justice and fair partnerships between sponsors, investigators, subjects, communities and countries," said Cameroonian writer Prof Godfrey Tangwa, of the University of Yaounde. Sewankambo noted that in the past, weak local institutions had allowed ethical violations in research projects, such as the use of placebos in studies on mother-to-child HIV transmission [ http://www.columbia.edu/itc/hs/pubhealth/p9408/readings/lurie-wolfe_1997.pdf ]. "Even when these issues were pointed out, the debate began in the North. Where were we Africans when these wrongs were going on? It is not enough for us to blame countries in the North for the state of health research - we need to look at what we in the South are not doing right in government funding of research and in negotiation of research partnerships," he said. Sewankambo noted that there was a need to build new, more equitable partnership models and expand local capacity to sustain research activities once donor-funded projects ended. The involvement of policy-makers is key to ensuring that research is turned into evidence-based policy, said Anne Cockroft, of Canada's Global Health Research Initiative (GHRI). She pointed out that there was often a gap in "knowledge translation" between researchers and policy-makers, leading to poor decisions being taken. "[HIV] prevention research results have to be translated into policies and action, and research users and decision-makers need skills to evaluate findings and prioritise for action," she said, adding that outside interests and funding often led to externally driven policy decisions, while poor understanding of research led to policies based partly on evidence, or based on poor evidence. GHRI has been working with parliamentarians in Botswana to expand their ability to make decisions based on evidence after many said they experienced difficulties in interpreting scientific evidence. There has been some progress in the past few decades. Wen Kilama, managing trustee of the African Malaria Network Trust, said partnerships have largely moved on from "colonial style" research, in which Africans had little or no say in research conducted in their countries, and African scientists are now more involved in priority-setting and actual research. "The Ugandan government has created an enabling environment for research and recently came up with a law which led to the creation of the Uganda National Health Research Organization, which, if managed properly, has the potential to greatly improve the way research is conducted in the country," Sewankambo said. Kenya and Tanzania have similar bodies, and African scientists have created several networks to strengthen research capacity, but regulation has lagged behind the development of research capability. The East Africa Consortium for Clinical Research has been established, but it has yet to develop a regional policy to guide the regulation of health research and clinical trials, and remains largely donor-dependent in the development of health research policy. Ethiopia's Beyene pointed out that "Unless we strengthen our own research capacity, dependence on donors will be perpetuated." kr/he