<?xml version="1.0" encoding="UTF-8"?><rss xmlns:content="http://purl.org/rss/1.0/modules/content/" version="2.0"><channel><title>IRIN - HIV/AIDS (PlusNews)</title><link>http://www.irinnews.org/irin-fp.aspx</link><description>Updated everyday</description><language>en-gb</language><lastBuildDate>Mon, 21 May 2012 09:30:34 GMT</lastBuildDate><item><title>MADAGASCAR: Low HIV prevalence has its own challenges </title><pubDate>Mon, 21 May 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2011/201106131237540870t.jpg" />]]>ANTANANARIVO 21 May 2012 (IRIN) - Madagascar has a low level of HIV prevalence, and managing its AIDS programme should present no major difficulties. But the apparent advantage of a low infection rate, combined with the ongoing political crisis, has brought its own challenges. 
</description><body><![CDATA[ANTANANARIVO 21 May 2012 (IRIN) - Madagascar has a low level of HIV prevalence, and managing its AIDS programme should present no major difficulties. But the apparent advantage of a low infection rate, combined with the ongoing political crisis, has brought its own challenges. 

Madagascar, and the neighbouring islands states of Comoros, Mauritius and Seychelles, are anomalies in the context of HIV/AIDS in Africa. Prevalence is very low - around 0.37 percent, or 24,000 confirmed cases - and restricted to a few sections of the population. 

Recent research has revealed that the groups most infected are men having sex with men (14 percent), intravenous drug users (7 percent) and prison populations. HIV prevalence among female commercial sex workers is relatively low. 

The UNAIDS Inter-Country Coordinator, Dr Mamoudou Diallo, says the low prevalence makes it a challenge to carry out a concerted national programme. "In the Indian Ocean islands, HIV and AIDS is a condition very few people have seen. It's not like the African mainland, where everyone knows someone who has it. As a result, many people here are not convinced of the danger of AIDS. This includes the leaders." 

Getting antiretroviral (ARV) drugs to the 472 patients who need them is not easy, and recent stock-outs have sometimes left patients without treatment for months, exposing them to the risk of developing drug-resistance. 

The Malagasy Ministry of Health and its private sector distributor, Salama, have problems placing orders because suppliers are not interested in providing small quantities, making it difficult to keep adequate supplies of ARVs in stock. "We try to use a supply station in Denmark and place the order through UNICEF [UN Children’s Fund]," Diallo told IRIN/PlusNews. The expensive drugs can't be given to patients for months in advance and must be held in stock. 

One possibility being explored is putting in place a central purchasing mechanism for the four Indian Ocean countries. This facility would fall under the oversight of the High Level Partnership Forum, which is expected to be set up after discussions with the Indian Ocean Commission, an inter-governmental cooperation group. 

The forum would include Ministers of Foreign Affairs, Ministers of Health; Networks of people living with HIV, support groups, and various financial partners. 

Donors warn that although the spread of HIV/AIDS in Madagascar has been limited until now, the potential for an epidemic still exists. The country’s growing industries, mining, and tourism are all potential sources of rising HIV infection, while its young people are among the groups most vulnerable to HIV infection. 

Madagascar's 2008/09 Demographic and Health Survey (DHS), notes that more than half of the young men and women 15 to 24 years of age had their first sexual encounter before the age of 18. Nearly one out of five young men had more than one sexual partner in the past year, but only 8.8 percent used a condom. In the adult population the percentage of condom use was even lower: 7.4 percent for men and 7.6 percent for women. 

Diallo sees a real but hidden threat of escalating HIV/AIDS infection in this behaviour. "Since men having sex with men is not accepted in Malagasy society, a third of these men are also married, potentially passing the virus on to wives and the wider society," he said. 

Low condom usage has already caused one of the highest rates of sexually transmitted infections (STIs) in the world: syphilis prevalence is as high as 4.4 percent among pregnant women and 12.1 percent among female sex workers, according to government figures. "We need a system of vigilance, and to carry out a prevention plan to help fight HIV at every level and with everyone involved," Diallo said. 

But AIDS prevention work has been complicated by the political instability of the last three years. Madagascar last carried out a national AIDS prevention plan during the administration of President Marc Ravalomanana. 

In early 2009, Andry Rajoelina, the opposition leader and mayor of Antananarivo, the capital, ousted Ravalomanana but the move was widely condemned and donors halted all but the most basic humanitarian funding. Promised elections have yet to be called and although funding has improved, the levels remain low. 

The National AIDS Control Committee (Conseil National de Lutte contre le SIDA - CNLS) is attached to the President's Office and facilitated by international donors. Work is now mostly done by the Forum of Partners, which operates under the CNLS with participation by the UN, international donors, civil society and the private sector. 

"[Around] 90 to 95 percent of all AIDS-related work is financed from abroad, while this should be about 60 percent. However, the ministers here don't have AIDS on their agenda," said Diallo, who is looking for funding to improve and expand HIV/AIDS data collection. 

"It's hard, because other countries have millions of patients, and here there are 826 monitored people living with HIV, of whom 472 are treated. But on the other hand, studies on the low prevalence reasons here can help everybody." 

ar/kn/he 
]]></body><pubDate>Mon, 21 May 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95487</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2011/201106131237540870t.jpg"/></td><td valign="top">ANTANANARIVO 21 May 2012 (IRIN) - Madagascar has a low level of HIV prevalence, and managing its AIDS programme should present no major difficulties. But the apparent advantage of a low infection rate, combined with the ongoing political crisis, has brought its own challenges. 
</td></tr></table>]]></content:encoded></item><item><title>NEPAL: HIV widows on the edge</title><pubDate>Tue, 15 May 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201205150830370312t.jpg" />]]>RAKAM 15 May 2012 (IRIN) - Widows living with HIV in Nepal’s remote hill districts in some of the country’s poorest and vulnerable communities face a particularly bleak future.</description><body><![CDATA[RAKAM 15 May 2012 (IRIN) - Widows living with HIV in Nepal’s remote hill districts in some of the country’s poorest and vulnerable communities face a particularly bleak future. 

“My husband died four years ago. We had to sell our cattle and farm to pay his medical bills,” 32-year-old Sumi Karki* told IRIN in the tiny village of Rakam in Dailekh District, about 700km northwest of the capital, Kathmandu. 

Infected by her husband, a former labour migrant to India, she has no idea how she will care for her three children in the future, much less pay for their schooling. 

Most of Rakam’s more than 2,000 impoverished residents depend on subsistence agriculture and remittances from relatives working abroad as migrant labourers to get by. 

Now, struggling to put food on the table, Karki cannot even afford the travel costs to Surkhet, the nearest town, to check her CD4 count (a measure of immune system strength). 

Concentrated epidemic 

According to the National Centre for AIDS and STD [sexually transmitted disease] Control in the Ministry of Health and Population (NCASC), [ http://www.ncasc.gov.np/ ] there are more than 50,000 adults and children living with HIV, and an estimated overall prevalence of 0.30 percent in the adult population (15-49 years old). 

Most new infections occurred among adult males (58 percent), followed by women of reproductive age (28 percent), while 8 percent of infections occurred among children under 15 years old. 

With an estimated 29.4 percent of all HIV infections occurring amongst labour migrants - although many believe the real number to be higher - the significance of this group, and the affected women, cannot be ignored. 

Each year, tens of thousands of men leave home in search of work abroad, mostly in neighbouring India. Estimates suggest that more than 1 million Nepalese men live in India alone. However, it’s not just money they bring back with them. 

Many of these men frequent commercial sex workers and practice unsafe sex while they are away, and then infect their wives with HIV when they return home. 

A 2010 Integrated Biological and Behavioural Surveillance Survey [ http://nepal.usaid.gov/downloads/all-downloads/category/10-business-opportunities.html?download=206:wives-of-migrnats-factsheet ] of 600 women in Nepal’s Far-Western region found that HIV prevalence among the wives of migrant labourers was 0.8 percent, and 22.5 percent amongst widows. 

But despite these figures, assistance and support for these women is low. “The women remain so vulnerable because they never use, or even dare to ask to use, condoms when their husbands return home,” said Deepa Bohara, coordinator of Parivartan Ko Lagi Pahuch (Access for Change), the only NGO supporting the women in Rakam village. 

The group distributes antiretroviral (ARV) drugs once every two months. In Dailekh District alone there are 185 cases, and more than half of them are widows, hospital officials say. Like Karki, most of these widows are desperately poor after spending what little money they had on medical care for their husbands before they died. 

Government indifference 

“There is no humanitarian aid or HIV/AIDS care for these poor widows, who are living in total despair because of government indifference,” said Nani Devi, coordinator of HIV-positive single women’s support group, Nava Prabhat Ekal Mahila Samuha. 

Government agencies in the capital and the district were too busy blaming each other for their own ineffectiveness while these women continued to suffer, Devi claimed. 

“We are tired and frustrated asking in Kathmandu for the government’s help while we watch these poor women suffer,” said Dil Bahadur Shahi, chief development officer of the Dailekh District Development Committee, the top local governmental body in the district. 

The NCASC reportedly provides just over US$2,200 per year to support all 185 people living with HIV and AIDS in Dailekh. 

“We have requested aid for these poor women for many years, but have not received any concrete response,” said Khagendra Jung Shah, chief of the district health office. 

The NCASC coordinates most of the funding for HIVAIDS at the national level, but has neglected this district, local government officials and NGO workers claim. 

Meanwhile, the Joint United Nations Programme on HIV/AIDS (UNAIDS) [ http://www.unaids.org/en/regionscountries/countries/nepal/ ] has expressed concern over the plight of these women and has pledged to follow up with the authorities. 

“We will address this issue strongly with the government officials so that these poor women will get all the support they can,” said Maria Elena Filio-Borromeo, the UNAIDS country representative. 

Hemant Chandra Ojha, a senior medical officer at NCASC agreed, saying, “We have to start a very serious discussion and decide how we should proceed with help for these single women.” 

*Not her real name 

nn/ds/he 
]]></body><pubDate>Tue, 15 May 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95457</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201205150830370312t.jpg"/></td><td valign="top">RAKAM 15 May 2012 (IRIN) - Widows living with HIV in Nepal’s remote hill districts in some of the country’s poorest and vulnerable communities face a particularly bleak future.</td></tr></table>]]></content:encoded></item><item><title>HIV/AIDS: Global Fund will have US$1.6 billion more</title><pubDate>Thu, 10 May 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2010/201011291150590936t.jpg" />]]>JOHANNESBURG 10 May 2012 (IRIN) - The Global Fund to fight AIDS, Tuberculosis and Malaria has announced that it will have US$1.6 billion more to invest in life-saving programmes between 2012 and 2014.</description><body><![CDATA[JOHANNESBURG 10 May 2012 (IRIN) - The Global Fund to fight AIDS, Tuberculosis (TB) and Malaria has announced that it will have US$1.6 billion more to invest in life-saving programmes between 2012 and 2014.

The new funds are a result of "strategic decisions made by the Board, freeing up funds that can be invested in countries where there is the most pressing demand", a statement by the Fund said. [ http://www.theglobalfund.org/en/mediacenter/pressreleases/2012-05-09_Global_Fund_Forecasts_USD_1_6_billion_in_Available_Funds_for_2012_2014_Major_Shift_Reflects_Strategic_Choices_by_Board_Renewed_Confidence/] Organizational changes have brought "improved financial supervision and overall efficiency"; for instance, the Fund has cut its staff by 7.4 percent. In addition, it has received new donations recently, including $750 from the Bill and Melinda Gates Foundation and $340 million from Japan.

Poor funding in 2011 forced the Fund to make an unprecedented decision to cancel its 11th round of funding, [http://www.plusnews.org/Report/94293/HIV-AIDS-Global-Fund-cancels-funding ] raising fears that gains made in the fight HIV would be lost. Some $616 million in grant requests is now being considered by the Technical Review Panel.

UNAIDS said the money would allow countries and communities to take the lead in determining their priorities to meet the targets of the 2011 UN Political Declaration on AIDS [ http://www.plusnews.org/Report/92940/HIV-AIDS-UN-High-Level-Meeting-on-AIDS-where-to-from-here ].

"This ushers in a new era for the Global Fund and I am pleased to see that it is opening the door to new partnerships," Michel Sidibé, executive director of UNAIDS, said in a statement. [http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2012/may/20120509psglobalfund/ ] "The Global Fund must keep firmly focused on country successes, and continue to leverage resources to ensure that countries can reach their goals and that more lives are saved."

The international NGO, Médecins Sans Frontières (MSF), welcomed the new money but cautioned that the Fund must stick to country-driven, needs-driven and demand-driven programming. Sharonann Lynch, HIV policy advisor to MSF International, urged the Global Fund, which will have its 26th board meeting in Geneva, Switzerland, on 10 and 11 May, to adhere to its founding principle of saving lives.

"The Global Fund will deliberate on whether it can afford to open a new funding window this year [2012]. MSF demands that it does so as quickly as possible - we can't afford to waste more time and squander the opportunity to save lives and prevent new infections," Lynch told IRIN/PlusNews.

"The funding window must be made available to all poor countries affected - the fear is that rushed reform within the Global Fund could lead to new strategies where it cherry-picks countries and interventions under the guise of poor funding.”

The Global Fund is one of the largest contributors to the fight against HIV, TB and malaria, and by 2010 was disbursing $3.5 billion annually. It has supported 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 the world’s malaria prevention and treatment, and three-quarters of all tuberculosis efforts, now depend on it.

"Countries that implement our grants are saving more and more people, but demand for services is still enormous,” said Gabriel Jaramillo, who became General Manager of the Global Fund in February 2012. “With more money, we can save more lives."

kr/he 
	
]]></body><pubDate>Thu, 10 May 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95434</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2010/201011291150590936t.jpg"/></td><td valign="top">JOHANNESBURG 10 May 2012 (IRIN) - The Global Fund to fight AIDS, Tuberculosis and Malaria has announced that it will have US$1.6 billion more to invest in life-saving programmes between 2012 and 2014.</td></tr></table>]]></content:encoded></item><item><title>RWANDA: Substantial HIV funding has not hurt other patient care</title><pubDate>Wed, 09 May 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2009/200902209t.jpg" />]]>NAIROBI 09 May 2012 (IRIN) - The large amount of donor funding that has gone into Rwanda&apos;s fight against HIV has not affected efforts to prevent and treat unrelated diseases, such as malaria and measles, and may in fact have improved overall healthcare, a six-year study has found.</description><body><![CDATA[NAIROBI 09 May 2012 (IRIN) - The large amount of donor funding that has gone into Rwanda's fight against HIV has not affected efforts to prevent and treat unrelated diseases, such as malaria and measles, and may in fact have improved overall healthcare, a six-year study has found. 

Researchers at Brandeis University in the US compared the performance of health clinics providing HIV services with those that did not by collecting data on the number of vaccines administered, visits to register child growth, and non-HIV/AIDS hospitalizations to monitor the attention given to non-HIV health issues. 

"We wanted to examine how AIDS funding interacts with the rest of the health sector in Rwanda," Dr Donald Shepard, a professor at the Schneider Institute for Health Policy at Brandeis and the study's lead author, told IRIN/PlusNews. "There are conflicting views - some thought AIDS funding impacted the wider health system favourably, while others thought it worked the other way." 

The fight against HIV has been the one of the best-funded health issues in recent times. A study in 2009 by the UN World Health Organization (WHO) [ http://www.who.int/bulletin/volumes/87/12/08-058677/en/index.html ] found that funding for HIV/AIDS accounted for almost one-third of total health overseas development assistance between 2002 and 2006. 

There has been a backlash [ http://www.plusnews.org/Report/79325/GLOBAL-Is-AIDS-still-an-emergency ] against the large amount spent on AIDS, with critics suggesting that funding for HIV is disproportionate to the global disease burden and is using vital resources that could be spent on other diseases. 

The proponents of AIDS funding argue that the devastating impact of HIV justifies the high funding to fight the disease, and that the money has been used to strengthen health systems through improvements in infrastructure and functioning. The authors felt that Rwanda was a good case study because it has received strong HIV funding and has been used to support arguments on both sides. 

"What we found in Rwanda was that large amounts of AIDS funding had not had an adverse impact, as some feared - there is no evidence that it detracted from the rest of the health system," Shepard said. “On the contrary, the evidence suggests that the benefits have spun off into the rest of the health system. In health centres providing HIV services, for example, BCG [Bacillus Calmette-Guérin, a vaccine against tuberculosis] vaccinations increased at a higher rate than at those health centres that didn't provide HIV services." 

The authors found that while there were neither "prominent diversions nor enhancement effects" after introducing HIV services to health centres, there was evidence that the health centres offering HIV services provided better preventive care than those that did not, including better immunization programmes. 

According to Shepard, the fact that AIDS funding had been able to work well within the wider health system was no accident, but the result of a deliberate policy by the Rwandan government. "Rwanda made a thoughtful effort to integrate AIDS services into the general health system - staff who treated HIV patients also treated other patients, and systems set up using HIV funds supported other health issues in a systematic way," he said. 

Rwanda's community-based health insurance, known as Mutuelle, [ http://www.moh.gov.rw/index.php?option=com_content&view=article&id=294:more-than-80-percent-pay-up-for-mutuelle-de-sante&catid=1:latest-news&Itemid=2 ] and its performance-based financing for health centres, contributed significantly to the overall smooth and efficient running of the health system. 

Shepard noted that the findings, while specific to Rwanda, meant that donors should continue their funding for HIV. 

He suggested that "Other countries should look at Rwanda and adapt its systems to their own settings, using funding for HIV to broadly support the health system and strengthen the response to other diseases." 

kr/he 

]]></body><pubDate>Wed, 09 May 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95428</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2009/200902209t.jpg"/></td><td valign="top">NAIROBI 09 May 2012 (IRIN) - The large amount of donor funding that has gone into Rwanda&apos;s fight against HIV has not affected efforts to prevent and treat unrelated diseases, such as malaria and measles, and may in fact have improved overall healthcare, a six-year study has found.</td></tr></table>]]></content:encoded></item><item><title>DRC: Reducing the HIV risk of girls living on the street</title><pubDate>Tue, 08 May 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2011/201111140904110390t.jpg" />]]>KINSHASA 08 May 2012 (IRIN) - Sarah, 16, started sleeping on the streets of Kinshasa, capital of the Democratic republic of Congo (DRC), when she was only eight years old. She doesn&apos;t remember how she came to live on the streets, but thinks it was soon after her mother died.</description><body><![CDATA[KINSHASA 08 May 2012 (IRIN) - Sarah, 16, started sleeping on the streets of Kinshasa, capital of the Democratic republic of Congo (DRC), when she was only eight years old. She doesn't remember how she came to live on the streets, but thinks it was soon after her mother died. 

Sarah is one of an estimated 20,000 children living rough on Kinshasa's streets, many from homes too poor to feed them, some after being thrown out of their homes because they were accused of sorcery, while others end up on the streets as a result of the divorce and remarriage of a parent whose new partner won't accept them. According to NGOs, about one-third of these children are girls, and around 80 percent of girls on the street make a living from sex. 

"Some men take you by force, and if you scream for help they beat you," Sarah told IRIN/PlusNews. "Younger girls can be taken advantage of and get only about US$1 for sex, but if you negotiate, you can get $10 for one whole night... sometimes you go to a hotel, sometimes you just find a dark place to do it." 

Sarah's face and arms are marked by scars from a fight with a group of girls who cut her with a razor. "When it's night you have to find somewhere to sleep. If it rains, your usual place may be flooded, and we're always running from the police," she said. "If you have no money and have to borrow some to eat, you will pay forever, because a debt on the street is never finished." 

Girls regularly experience violence, but help for street children, particularly girls, is very limited. An international NGO, Doctors of the World (Medecins du Monde), and their local partners, including the NGO, Aide à l'Enfance Défavorisée (AED) - Help for Disadvantaged Children - run a programme that seeks to protect girls up to the age of 21 living on the street from sexual and gender-based violence, unwanted pregnancy and sexually transmitted infections (STIs), including HIV. 

"Our partners have ambulances that go out on the streets and provide basic primary healthcare and referral for street children, and sexual and reproductive health services for girls, including contraceptives and condoms," said Pascale Barnich-Mungwa, country coordinator for MDM in DRC. 

With Doctors of the World reporting HIV prevalence among girls they have tested at 12-15 percent, the provision of healthcare is crucial. "We teach them and help them with their drugs - ARV coverage is already difficult in the DRC, but now you have minors living on the street and at risk of theft of their drugs, which makes adherence tough," she said. 

AED also runs a drop-in centre where girls can access healthcare and take time to rest, as well as learn tailoring and other skills, and even music. 

"Activities like music help to build self-esteem. Many of these girls are raped as often as twice a week, so rape becomes the norm, and they survive by building a wall between themselves and their bodies. Activities like dance help them to take charge of their bodies again, somehow," said Barnich-Mungwa. Rape is one of the rituals girls go through when being initiated into sex work on the street, usually supervised by an older girl known as a 'yaya', or older sister, she said. 

Doctors of the World's main aim is risk-reduction, rather than reintegration of the girls into their families. Many girls run away from abusive homes, and families often want no more to do with children they sent away. "If we have girls below 12, reintegration may be possible if they've been on the streets for short periods, but once they have been raped and are already involved in sex work, it becomes much more difficult,” Barnich-Mungwa said. 

“So at first, with our partners, we work to reduce the risks linked to their situation through education, user groups, etc. Once we've increased the risk awareness towards sexual behaviour and/or violence, we work at reducing it through contraception, condom use, and so on," she said. 

One organization that does aim at reintegrating girls with their families is War Child, which runs a similar programme in a different part of the city. "Our ambulances accept anyone on the street for first aid, provision of condoms and advice, but we specifically target girls aged 17 and under,” said Michel Gratton, the War Child country director in DRC. 

“We invite them into the ambulance, where they talk to a counsellor one-on-one to see if they have any desire to return home. We try to convince them to come to our transit centre, where they have access to literacy classes, life skills and psychosocial services. If the girls are keen to return home, we start to look for their families and begin a process of medication, with regular follow-up of the girls who do go back home.” 

Reintegration into families is rarely easy. "It's more difficult if the girls are pregnant, because not only has the girl's bride price value gone down, but the families have to pay for expensive healthcare, especially if they have to have a caesarean section [because they are very young]." 

There are a number of girls in the AED drop-in centre compound, known as Bomoyi Bwa Sika, meaning ‘New Life’ in the local Lingala language. Some look as young as 10, several are pregnant or carrying babies. The centre has a primary healthcare centre as well as a sexual and reproductive health centre where pregnant girls come for antenatal care. 

"We receive about 50 girls every day - today it's not even midday and we have received 53, and 14 slept here last night," said Mama Francoise Nzeza, the director of the centre. "When the police are patrolling and picking up girls, we can get up to 80 per day." 

Nzeza says she would love to see the girls off the street and out of sex work, but they do not have the funds to offer them alternative accommodation and income-generating activities, and reintegration is often impossible. "We can't tell them to stop sex work because we can't give them an alternative - what we can do is give them condoms and contraception to prevent disease and unwanted pregnancy, but we can't judge or moralize about their situation." 

One of the drop-in centre's key challenges is changing social behaviour. "Many of the girls on the street are violent - the streets make them hard and aggressive. We try to socialise them, so that if they get the chance they can live in mainstream society," Nzeza said. 

Reducing the number of children who end up on Kinshasa's streets must be a society-wide effort. "It must involve a reduction in poverty and joblessness, so that parents can look after their children. It must involve conversations with churches, many of which are involved in these accusations of sorcery. It must involve sensitizing parents about their responsibility to their children, even after divorce," she said. "In addition, we must insist that the laws to protect children are implemented." 

kr/he ]]></body><pubDate>Tue, 08 May 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95427</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2011/201111140904110390t.jpg"/></td><td valign="top">KINSHASA 08 May 2012 (IRIN) - Sarah, 16, started sleeping on the streets of Kinshasa, capital of the Democratic republic of Congo (DRC), when she was only eight years old. She doesn&apos;t remember how she came to live on the streets, but thinks it was soon after her mother died.</td></tr></table>]]></content:encoded></item><item><title>DRC: HIV effort needs government, donor commitment to succeed</title><pubDate>Fri, 04 May 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2010/201011291150590936t.jpg" />]]>KINSHASA 04 May 2012 (IRIN) - Many national hospitals in the Democratic Republic of Congo (DRC) are not accepting new HIV-positive patients for antiretroviral (ARV) treatment. The only way to get onto a treatment list is to wait until a space opens up due to a death or drop-out, or seek the limited treatment options available outside the government&apos;s programmes, but few people can afford the drugs.</description><body><![CDATA[KINSHASA 04 May 2012 (IRIN) - Many national hospitals in the Democratic Republic of Congo (DRC) are not accepting new HIV-positive patients for antiretroviral (ARV) treatment. The only way to get onto a treatment list is to wait until a space opens up due to a death or drop-out, or seek the limited treatment options available outside the government's programmes, but few people can afford the drugs. 

"At least in the big cities like Kinshasa [the capital] and Lubumbashi there is some coverage, but in rural areas there is a big problem," said Erick Ngoie, head of advocacy for Union Congolaise des Organisations des personnes vivant avec le VIH (UCOP-Plus), an umbrella network of organizations of people living with HIV in DRC. 

Chief among the problems in the DRC's fight against HIV is a severe funding deficit. [ http://www.plusnews.org/Report/88718/DRC-Funding-crunch-threatens-ARV-rollout ]. A major World Bank project recently closed after six years, while UNITAID, an international health financing mechanism that provides funding for paediatric and second-line ARVs, will end 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 likely to worsen the situation. 

"ARV coverage in Kinshasa is about 30 percent, and much lower in the rest of the country - close to half of the health zones are not covered by any HIV treatment programme," said Anja De Weggheleire, medical coordinator for Médecins Sans Frontières in the DRC. "Many health zones may offer HIV services at only one site, and even then it may not be the whole package." 

Only 12.3 percent of people who need life-prolonging ARV treatment have access to it, according to government statistics. Poor information and low testing coverage - just 9 percent of adults know their HIV status - means people are often diagnosed in very advanced stages of illness, when treatment options are limited. 

"There is an urgent need for more centres because people need access to testing earlier. Many patients come here very late, with multiple pathologies... some arrive here and only survive a few days, while others die on the way to the hospital," said Dr Laura Rinchey, the manager of the MSF-run Centre Hospitalier de Kabinda (CHK) in Kinshasa. 

MSF started 2012 with a campaign to highlight the huge funding gap in the DRC's HIV treatment programme, and urged people to seek testing and treatment. Since then, demand for services at CHK has gone up significantly, straining the centre's resources. "We are now treating about 3,200 patients, which is about 20 percent of people on ARVs in Kinshasa," Rinchey said. 

At Réseau National d'Organisations Assises Communautaire (RNOAC), a national network of community-based organizations, patients who are well enough to live at home come to collect drugs provided by MSF and receive support from other people living with HIV. 

"We help them deal with stigma, teach them how to live a healthy life, with a balanced diet, and give them treatment education," said Jean Lukela, coordinator of RNOAC. Stigma remains high, Lukela said, with many people being ostracized by their families after they test positive for HIV, and others turning to churches for 'healing', rather than seeking medical help. 

Clarrise Kambele, 30, frail and recovering from an HIV-related illness that nearly killed her, shelters at the RNOAC centre. Diagnosed with HIV in 2009, she didn't start taking ARVs until she fell very ill in 2012. Her husband abandoned her and took their child to his parents' home, leaving her to fend for herself. Too sick to work, Kambele was soon living on the streets, where an RNOAC volunteer found her and brought her to the NGO. 

"I was very weak and my feet had swollen so much I couldn't walk. Now I'm still weak but much better, but I don't know what will happen to me when I leave here. My husband won't take me back - he won't even let me see our child - and my own family is dead," she told IRIN/PlusNews. 

"We need the government to take HIV as a priority, and take the lead in HIV information so people can know that someone living with HIV is just like anyone else - they should not be shunned," Lukela said. "All support for HIV programmes comes from outside - we need the government to put its hands in its own pockets to pay for HIV treatment and care." 

UCOP-Plus's Ngoie noted that unless donors and the government commit more resources to fighting HIV, the country's programmes will probably fail. "Because of poor funding, NGOs have disappeared, community-based agencies have closed. Some of the centres that remain have no people trained to handle HIV," he said. 

"In this situation, we cannot achieve 'zero new infections, zero deaths and zero stigma',” Ngoie stressed. “We don't want this to be just a slogan, we want it to be real." 

kr/he 

]]></body><pubDate>Fri, 04 May 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95412</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2010/201011291150590936t.jpg"/></td><td valign="top">KINSHASA 04 May 2012 (IRIN) - Many national hospitals in the Democratic Republic of Congo (DRC) are not accepting new HIV-positive patients for antiretroviral (ARV) treatment. The only way to get onto a treatment list is to wait until a space opens up due to a death or drop-out, or seek the limited treatment options available outside the government&apos;s programmes, but few people can afford the drugs.</td></tr></table>]]></content:encoded></item><item><title>UGANDA: Combining safe riding on a motorcycle taxi with safe sex</title><pubDate>Thu, 03 May 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2009/200904290906280617t.jpg" />]]>KAMPALA 03 May 2012 (IRIN) - It&apos;s Saturday night and Jaffari Musoke*, who rides a &apos;boda boda&apos; - motorcycle taxi - arrives at his regular stage, or departure point, near several hotels in Kampala, the Ugandan capital. He has an easy camaraderie with the sex workers who hang around the hotels, taking many of them home after a night&apos;s work. Sometimes he mixes business with pleasure.</description><body><![CDATA[KAMPALA 03 May 2012 (IRIN) - It's Saturday night and Jaffari Musoke*, who rides a 'boda boda' - motorcycle taxi - arrives at his regular stage, or departure point, near several hotels in Kampala, the Ugandan capital. He has an easy camaraderie with the sex workers who hang around the hotels, taking many of them home after a night's work. Sometimes he mixes business with pleasure. 

"Man, this is the nature of our work. We have a lot of temptations and risks involved in this job, especially at night," he told IRIN/PlusNews, as a girl climbed on his bike so he could take her to meet a client. 

An estimated 100,000 Ugandan men earn a living as boda boda riders, and around 73,800 motorcycles were imported over the last 5 years, according to the Registrar of Motor Vehicles. 

The riders tend to be young men, weaving in and out of the traffic on Kampala's potholed roads, often without safety gear and little regard for traffic regulations. A survey report released in 2011 [ http://www.uhspa.org/wp-content/uploads/downloads/2011/06/Crane-Survey-Report-Round-1-Dec10.pdf ] compared their sexual behaviour to groups classified as 'most at risk' by the Uganda AIDS Commission, which include sex workers, uniformed services, prison populations and fishing communities. 

The survey - by the Ministry of Health, the US Centres for Disease Control and Prevention, and Makerere University's School of Public Health - covered 694 riders in Kampala between July 2008 and March 2009, and found an HIV prevalence rate of 7.5 percent. The national rate is 6.7 percent. 

More than 25 percent of the riders reported having multiple sex partners and were engaging in anal sex with both women and men, 12 percent identified themselves as bi-sexual and four percent as gay, and 25 percent believed it was less important to use condoms for anal sex than for vaginal sex. 

Approximately half the riders said they were “not as careful about HIV and sex because there is better treatment for AIDS”, while 21 percent reported having sold sex to at least two women, and 78 percent had bought sex from at least two women. 

The Uganda Health Marketing Group (UHMG), a local NGO, is running a year-long campaign named, “Get Protected. Get Ready to Roll with Protector” (a brand of condom), which aims to encourage safer sex practices among boda boda riders. UHMG is running the campaign in six selected districts across the country, targeting 5,000 riders as direct beneficiaries, and their clients as secondary beneficiaries. 

Condoms and helmets 

UHMG is using two products in its campaign - condoms to prevent HIV infection, and branded helmets to improve safety on the road. 

"[This programme] provides HIV prevention education among boda boda riders, while at the same time improving their safety, as well as that of their customers,” said Julian Atim, HIV/AIDS programme manager at UHMG. "It utilizes peer educators, who are boda boda cyclists themselves, working in close collaboration with health workers from Good Life Clinics, which are privately owned health facilities supported by UHMG." 

The programme offers riders a comprehensive package of HIV prevention services, including HIV counselling and testing, assessment and treatment of sexually transmitted infections, and referral for safe male circumcision. 

Through Good Life clinics and community outreaches, some 1,500,000 condoms have been sold to boda boda riders at a subsidized cost, and100,000 more have been distributed for free in the districts implementing the programme. The campaign also uses riders to sell condoms, and they have sold more than 100,000 in the six participating districts since the campaign started in August 2011. 

"Providing socially marketed condoms to the peer educators at the boda boda stages has been a very successful strategy, as indicated by the increased demand of condoms among… cyclists," said Atim." UHMG also works with kiosk and shop owners near the stages to stock condoms, and the peer educators carry out condom demonstrations." 

Buazi Openj Mungu, a boda boda and peer educator in northwestern Uganda's Nebbi District, told IRIN/PlusNews by telephone that the campaign had boosted the riders' knowledge about HIV prevention and treatment. "The boda boda riders used to engage in reckless behaviour like having unprotected sex, exposing their lives to HIV," he said. "As a result of the campaign, we have taught them about HIV/AIDS and many of them are now using condoms." 

Safi Alema Tiyo, general secretary of the Boda Boda Association in the northwestern district of Arua, said he had noticed an increase in the number of riders seeking male circumcision for HIV prevention. 

UHMG's Atim said the programme may be renewed if funds are available. 

so/kr/he 

]]></body><pubDate>Thu, 03 May 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95406</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2009/200904290906280617t.jpg"/></td><td valign="top">KAMPALA 03 May 2012 (IRIN) - It&apos;s Saturday night and Jaffari Musoke*, who rides a &apos;boda boda&apos; - motorcycle taxi - arrives at his regular stage, or departure point, near several hotels in Kampala, the Ugandan capital. He has an easy camaraderie with the sex workers who hang around the hotels, taking many of them home after a night&apos;s work. Sometimes he mixes business with pleasure.</td></tr></table>]]></content:encoded></item><item><title>HIV/AIDS: New book tracks the epidemic to its origins</title><pubDate>Wed, 02 May 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2010/201007230839380887t.jpg" />]]>MBABANE 02 May 2012 (IRIN) - We&apos;ve all heard the myths and hypotheses about the origins of the epidemic caused by the HI virus, but a new book, “Tinderbox: How the West Sparked the AIDS Epidemic and How the World Can Finally Overcome It”, sheds more light on where it all began. It is a fascinating account of the medical detective work that traced the disease to Cameroon a century ago.</description><body><![CDATA[MBABANE 02 May 2012 (IRIN) - We've all heard the myths and hypotheses about the origins of the epidemic caused by the HI virus, but a new book, “Tinderbox: How the West Sparked the AIDS Epidemic and How the World Can Finally Overcome It”, sheds more light on where it all began. It is a fascinating account of the medical detective work that traced the disease to Cameroon a century ago. 

“AIDS is not a new disease. With ‘Tinderbox’ we wanted to write a defining AIDS book for this generation that will get people excited to talk about AIDS again. We were able to apply new discoveries on the origin of AIDS,” said Daniel Halperin, who co-wrote the book with American journalist Craig Timberg. 

Scientists have long known that a blood sample preserved in a hospital in Kinshasa, capital of the Democratic Republic of Congo, dating from 1959, indicated that HIV had been around decades before it was recognized in the 1980s. In 2008, Michael Worobey of the University of Arizona reported on a second sample of the virus, from a lymph node biopsy taken in Kinshasa in 1960, which helped establish the virus’ evolutionary timeline. 

"By comparing these two historic pieces of virus and mapping out the differences in their genetic structures in his lab at the University of Arizona, Worobey determined that HIV-1 group M was much older than anyone had thought. Both samples of the virus appeared to have descended from a single ancestor at some time between 1884 and 1924. The most likely date was 1908," the book recounted. 

Meanwhile, a research team led by microbiologist Beatrice Hahn of the University of Alabama pinpointed the geographic location of the virus. An SIV (simian immunodeficiency virus) infecting chimpanzees in Cameroon proved to be an identical match to HIV-1 group M. 

“This SIV was likely around for centuries and may very well have been passed on to a hunter or someone handling the carcass of an infected chimp. The chimp’s blood could have infected the person through an open wound," said Halperin. 

The authors add a dimension that has received little attention: colonialism and how it helped spread the HIV epidemic. “Once the virus made the jump from chimp to human, a single infected person could have carried HIV down the Sangha [River], on to the Congo River and into Kinshasa. The Belgians had founded the city in 1881; by the early 20th century, Kinshasa, then called Leopoldville, was the biggest city in central Africa, fuelled by the dizzying growth of trade with the outside world.” 

The epidemic was born between 1881 and 1924. A few decades later, the virus had migrated far from its point of origin, mutating into new but equally deadly subtypes. 

“Scientists studying HIV-1 group M already had found many related varieties - what scientists call subtypes - each with slightly different genetic structures and paths through the world. One, scientists discovered, had travelled east from Kinshasa toward Lake Victoria. One went south to Zambia, Botswana and South Africa. One hopped all the way across the ocean to Haiti, then to the United States and Europe,” Halperin and Timberg wrote. 

They are not complimentary about efforts to combat the spread of HIV. “On the prevention side, the United States and other donors have fallen short. Part of the problem has been the polarized nature of AIDS politics, with its battles over condoms versus abstinence. Few outsiders - not the US government, the United Nations, religiously based charities, or even the Bill & Melinda Gates Foundation - have made impressive gains in preventing the spread of HIV among adults, despite massive investments of money and political will," Timberg told IRIN/PlusNews. 

The book notes that the steepest drop in HIV infection rates in the past 15 years occurred in Zimbabwe, a country that received less foreign aid than its neighbours during this period. 

“When debating how to prevent HIV, liberals like to talk about condoms, while conservatives often talk about abstinence. Yet the track record for both ideas has been disappointing,” said Timberg. 

Halperin, an epidemiologist who has worked on AIDS policies for several southern African countries in the past decade while Timberg was covering AIDS in the region for the Washington Post, told IRIN/PlusNews that engaging in sex with multiple partners was also a root cause of the epidemic’s origin more than a century ago. 

One goal of “Tinderbox” is to change public perceptions about AIDS. No longer a great mystery, HIV has been identified as a mutable virus with a documented history. The second popular perception the book addresses is that AIDS prevention and treatment can be “one size fits all”. 

The authors believe that the key ingredient in bringing the epidemic under control - the “behaviour change” that has eluded so many AIDS prevention initiatives - can best be achieved through internal rather than external actors. 

“The evidence is abundant that if you have more than one partner, the chance of HIV infection is increased. It is sometimes difficult for Africans to talk about sexual things in a one-on-one setting. What we found effective is when people talk collectively. If you take a look at the places where HIV went down dramatically, it was where members of society talked to one another: Zimbabwe, Uganda and elsewhere… We saw musicians, leaders, politicians leading the discussions. It is harder if this information comes from foreigners, or anyone outside the community or social group or even family,” said Timberg. 

jh/kn/he

]]></body><pubDate>Wed, 02 May 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95399</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2010/201007230839380887t.jpg"/></td><td valign="top">MBABANE 02 May 2012 (IRIN) - We&apos;ve all heard the myths and hypotheses about the origins of the epidemic caused by the HI virus, but a new book, “Tinderbox: How the West Sparked the AIDS Epidemic and How the World Can Finally Overcome It”, sheds more light on where it all began. It is a fascinating account of the medical detective work that traced the disease to Cameroon a century ago.</td></tr></table>]]></content:encoded></item><item><title>UGANDA: Inadequate healthcare and rising HIV prevalence in Karamoja</title><pubDate>Mon, 30 Apr 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201204301022560882t.jpg" />]]>MOROTO 30 April 2012 (IRIN) - The nomadic Karimojong ethnic group, once regarded as a low-risk HIV population because regional instability in northeastern Uganda and strong adherence to their culture kept them relatively isolated, have not been a priority on the country&apos;s HIV agenda, but recent statistics show prevalence among this community is now 5.8 percent, up from 3.5 percent five years ago.</description><body><![CDATA[MOROTO 30 April 2012 (IRIN) - The nomadic Karimojong ethnic group, once regarded as a low-risk HIV population because regional instability in northeastern Uganda and strong adherence to their culture kept them relatively isolated, have not been a priority on the country's HIV agenda, but recent statistics show prevalence among this community is now 5.8 percent, up from 3.5 percent five years ago. 

Over the past decade large numbers of Karimojong have settled in urban centres, where business is flourishing and many NGOs have set up shop; there has also been heavy military deployment in the area as part of a disarmament exercise. These and other changes in a strongly traditionalist society have combined to push prevalence closer to the national average of 6.7 percent. 

"The drivers of the pandemic that exist elsewhere are now occurring here. There is also a lot of alcoholism and [domestic] abuse here, which is one of the drivers of HIV/AIDS infection," Dr Michael Omeke, health officer for the Karamoja region's Moroto District, told IRIN/PlusNews. 

Limited health services

Just five hospitals serve seven districts and a population of 1.2 million scattered over some 28,000 square kilometres. "In general, HIV treatment and care services are still low in the region," said David Wakoko, Karamoja area manager for the Mulago-Mbarara Teaching Hospitals' Joint AIDS Programme (MJAP). 

Most health centres in the region do not have clinical officers trained to provide life-prolonging antiretroviral (ARV) drugs or offer HIV care and treatment. Kaabong District for example, has five health facilities, but only the district hospital has a medical officer authorised to treat HIV-positive patients, and the hospital does not have a CD4 machine to test blood samples and measure immune strength. 

Few health workers are keen to live in the remote and underdeveloped region. "Human resources are a big challenge. You need someone who is qualified to help these people, but we are not attracting… personnel," said Dr John Anguzu, District Health Officer in Nakapiripirit. "Even the local people we try to train here to help, they leave." 

The region has also not been spared the drug shortages that have occurred in other parts of the country. "We do experience ARVs stock-outs... We are trying to work with the Ministry of Health and National Medical Stores to see that these stock-outs are reduced," said Omeke. 

A lack of food in the arid region and the long distances to health centres are major problems for people living with HIV. "These are weak people and can't move long distances to go for treatment and drugs. The health centres are too far," said Gabriel Lokubal, who lives in Moroto. "ARVs are very strong drugs, which require a lot of eating. However, most of us don't have food, so some people have stopped going for drugs." 

Knowledge about HIV is also very low. A recently released preliminary report on the AIDS Indicator Survey shows that just 30 percent of women and 45 percent of men in the northeast are well-informed about HIV/AIDS. 

A complex region

Spreading the word about HIV is not easy in Karamoja, where open discussions about sex are extremely unusual and the population is largely uneducated. According to MJAP statistics only 35 percent of Karimojong men have accessed HIV/AIDS services, compared to 65 percent of women. 

"Because of the nature of the society and tradition, the men remain in the kraals [communal cattle pens] and are on the move in search of pasture and water for their cattle. They have little interest in seeking HIV services," said MJAP's Wakoko. "Most of those who access HIV/AIDS services are women, especially the pregnant ones, who visit health facilities for ante-natal services." 

"The HIV patients also tie HIV services to food. If you don’t have food, people don’t come," Anguzu said in Nakapiripirit. 

Stigma is highly problematic for health services trying to reach people living with HIV. "When you test a person and… [the result] is HIV-positive, he or she will never come back again for further… [treatment]," said a nurse at the ARV clinic at Moroto Regional Referral Hospital. "We are trying to sensitize the community to accept their status and learn to live positively." 

In an effort to bring the services closer to the people, Uganda's Ministry of Health and MJAP are running a home-based HIV counselling and testing programme, but low staffing and occasional insecurity in the region are affecting the door-to-door campaign. 

"The security situation remains fluid, as it changes any time despite general improvement in the sub-region, thereby affecting the implementation of programme in most of the catchment areas," said MJAP's Wakoko. 

Health workers in the region say the nature of the causes and effects of HIV mean it cannot be tackled in isolation, and a holistic approach should be used. 

"The interventions need to be shared among sectors - health is concept which is determined by social, economic and cultural aspects," said Samuel Enginyu, a health educator with the Ministry of Health. "We are working on an integrated and collaborative approach with the Minister of Gender and Culture and other stakeholders." 

so/kr/he

]]></body><pubDate>Mon, 30 Apr 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95383</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201204301022560882t.jpg"/></td><td valign="top">MOROTO 30 April 2012 (IRIN) - The nomadic Karimojong ethnic group, once regarded as a low-risk HIV population because regional instability in northeastern Uganda and strong adherence to their culture kept them relatively isolated, have not been a priority on the country&apos;s HIV agenda, but recent statistics show prevalence among this community is now 5.8 percent, up from 3.5 percent five years ago.</td></tr></table>]]></content:encoded></item><item><title>EAST AFRICA: Regional HIV Bill passed without criminalization clause</title><pubDate>Fri, 27 Apr 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2007/2007070910t.jpg" />]]>NAIROBI 27 April 2012 (IRIN) - East Africa&apos;s Legislative Assembly has passed a regional HIV/AIDS Bill that seeks to protect the rights of people living with HIV and harmonize regional legislation and policy on the prevention and treatment of HIV.</description><body><![CDATA[NAIROBI 27 April 2012 (IRIN) - East Africa's Legislative Assembly has passed a regional HIV/AIDS Bill that seeks to protect the rights of people living with HIV and harmonize regional legislation and policy on the prevention and treatment of HIV. 

Activists have welcomed the passing of the Bill, [ http://www.irinnews.org/Report/88635/EAST-AFRICA-One-region-one-HIV-law ] which, unlike some of the laws in the region's individual member states, does not criminalize the deliberate transmission of HIV. 

"Criminalization impedes rather than promotes the fight against HIV, because it violates the rights of people living with HIV on many fronts," Nelson Otuoma, the coordinator of the Network of People Living with HIV and AIDS in Kenya (NEPHAK), told IRIN/PlusNews. 

Member countries whose HIV legislation has criminalization clauses will be pressed to amend the laws to reflect the spirit of the regional Bill. Three of the East Africa Community's five member states - Burundi, Kenya and Tanzania - have passed HIV laws with clauses that criminalize wilful transmission, while Rwanda and Uganda have not yet passed legislation. 

"This [regional] Bill has a human rights approach to HIV as a major component, and criminalization was never its intention. We expect countries to use this Bill as a template for their legislation and we will lobby towards that end,” said Joyce Abalo, a programme officer at the East Africa National Networks of AIDS Service Organizations (EANNASO). 

"This Bill is an important first step towards strengthening HIV response in the region, because HIV issues must also be at the core of regional cooperation, which countries are quickly embracing," Abalo said. The proposed legislation also outlaws discrimination, guarantees rights to privacy and ensures the provision of health care, regardless of HIV status. 

NEPHAK's Otuoma said the Bill would improve access to HIV services in the regional bloc. "You can't move freely to another country if you are not sure you will get your [HIV] treatment there. Now, should this bill become law, one knows that even he is Kenyan, he can get his treatment in Uganda." 

The East Africa Community HIV and AIDS Prevention and Management Bill (2012) was passed by the East Africa Legislative Assembly on 23 April at its fifth session, held in the Kenyan capital, Nairobi. The heads of state of the member countries are expected to assent to it before it becomes law. 

ko/kr/he

]]></body><pubDate>Fri, 27 Apr 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95371</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2007/2007070910t.jpg"/></td><td valign="top">NAIROBI 27 April 2012 (IRIN) - East Africa&apos;s Legislative Assembly has passed a regional HIV/AIDS Bill that seeks to protect the rights of people living with HIV and harmonize regional legislation and policy on the prevention and treatment of HIV.</td></tr></table>]]></content:encoded></item><item><title>SWAZILAND: Nurses demand protection from TB infection</title><pubDate>Thu, 26 Apr 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2008/200810288t.jpg" />]]>MBABANE 26 April 2012 (IRIN) - Hospitals are not protecting their workers from tuberculosis (TB) infection, say nurses in Swaziland, who recently staged a rare public demonstration to draw attention to how vulnerable they are to this highly infectious disease. </description><body><![CDATA[MBABANE 26 April 2012 (IRIN) - Hospitals are not protecting their workers from tuberculosis (TB) infection, say nurses in Swaziland, who recently staged a rare public demonstration to draw attention to how vulnerable they are to this highly infectious disease. 

Nurses attached to the National TB Hospital in Swaziland's commercial hub, Manzini, are blaming inadequate infection measures at the hospital for the risk they face. TB is one of the primary killers and the main opportunistic disease in people living with HIV and AIDS. In a country with the world's highest HIV prevalence, 80 percent of HIV-positive people are co-infected with TB. 

A study conducted in neighbouring South Africa's KwaZulu-Natal (KZN) Province has found that the incidence of extensively drug-resistant (XDR-TB) and multidrug-resistant (MDR) TB is six to seven times higher among health care workers than among non-health care worker patients. There are no official figures for health care workers infected with TB in Swaziland. 

Health personnel warn that government's inaction could make things worse. "Government is killing us with its negligence. We just buried one of our sisters [another nurse] who died of TB. She contracted TB at the hospital where she worked," Abigale Dube, a nurse and member of the Swaziland Democratic Nurses Union (SDNU), told IRIN/PlusNews. 

There are no national guidelines on TB infection control measures in the country's health care facilities, and nurses say this makes matters worse. 

"What we gathered is that in the other hospitals, nurses have contracted multidrug-resistant TB because they are exposed to the disease on a daily basis. This can only mean their working environment is unsafe," said Nurses' Union General Secretary Nathi Kunene. 

A nationwide strike attended by all nurses would ensue if issues like poor ventilation, unhygienic conditions and a lack of protective gear were not addressed, Kunene said. 

Swaziland has the world's highest TB infection level, and a 2010 survey found that 7.7 percent of all TB cases involved multidrug-resistant TB, putting it among the countries with the highest rates of this variant of the disease. 

According to a recent report [ http://wwwnc.cdc.gov/eid/article/18/1/11-0850_article.htm ] on MDR-TB in Swaziland, "the high prevalence of drug resistance in a country already facing a huge epidemic of TB and HIV shows an urgent need for major interventions in terms of detection, treatment, and infection control". 

Health services are being overwhelmed by the number of patients. "There is a shortage of nurses in Swaziland. The country does not pay well compared to other countries, and we have nurses trained here who are doing quite well in Europe, where they are in demand,” said Nurse Dube 

“The reason they don't stay here is the same reason that the remaining nurses are in danger - no money to make the hospitals safe places to work, so there will be fewer nurses as they grow sick and die." 

The Ministry of Health has responded to rising TB rates by "decentralizing" TB care from Mbabane, the capital, and Manzini to some regional health facilities, so that patients do not have to take long bus trips to receive treatment. 

Even with 15 clinics nationwide now offering free TB testing, the number is still inadequate, and transport costs and user fees at health facilities are still a major hurdle for patients. 

The National TB Programme announced this week that Swaziland's TB response has received a US$19.4 million boost from the Global Fund to fight Tuberculosis AIDS and Malaria. One of the areas that will be strengthened is infection control measures at healthcare facilities. 

"Following the declaration of TB as an emergency, the country has already geared to working in an emergency mode in the fight against the epidemic,” it said in a statement. “The funding will go a long way in addressing TB challenges." 

jh/kn/he 
]]></body><pubDate>Thu, 26 Apr 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95364</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2008/200810288t.jpg"/></td><td valign="top">MBABANE 26 April 2012 (IRIN) - Hospitals are not protecting their workers from tuberculosis (TB) infection, say nurses in Swaziland, who recently staged a rare public demonstration to draw attention to how vulnerable they are to this highly infectious disease. </td></tr></table>]]></content:encoded></item><item><title>KENYA: High court ruling on anti-counterfeit law &quot;upholds right to health&quot;</title><pubDate>Wed, 25 Apr 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201203221135570456t.jpg" />]]>NAIROBI 25 April 2012 (IRIN) - Kenyan HIV activists say a ruling by the High Court that the definition of &quot;anti-counterfeit&quot; in the 2008 Anti-Counterfeit Act is too broad will save millions of lives and protect the right to life of citizens.</description><body><![CDATA[NAIROBI 25 April 2012 (IRIN) - Kenyan HIV activists say a ruling by the High Court that the definition of "anti-counterfeit" in the 2008 Anti-Counterfeit Act is too broad will save millions of lives and protect the right to life of citizens. 

The case filed by three people living with HIV in July 2009 argued that sections 2, 32 and 34 of the Act [ http://www.aca.or.ke/wp-content/uploads/2010/11/The-Anti-Counterfeit-Act-2008.pdf ] contained ambiguities, which, if misinterpreted or abused, would be detrimental to Kenyans' access to essential generic medicines. 

High Court Judge Mumbi Ngugi found that the Act failed to clearly distinguish between counterfeit and generic medicines. She called on parliament to review these ambiguities that could result in the arbitrary seizure of generic medicines under the pretext of fighting counterfeit drugs. 

Like many low- and middle-income countries, more than 80 percent of the drugs used by Kenyans are generic and largely manufactured in India. The judgement also ensures that government agencies cannot interfere with the importation and distribution of generic medicines. 

"The right to life, dignity and health of people like the petitioners, who are infected with the HIV virus, cannot be secured by a vague proviso in a situation where those charged with the responsibility of enforcement of the law may not have a clear understanding of the difference between generic and counterfeit medicine," she said in her judgement [ http://www.aidslawproject.org/wp-content/uploads/2012/04/Judgment-Petition-No-409-of-2009-Anti-counterfeit-case.pdf ]. 

"As an interested party, this judgement was a victory for us because the judge specified that protecting intellectual property rights cannot override the interests and rights of the individual - it's a powerful message," Jacinta Nyachae, executive director of local NGO, the AIDS Law Project (ALP), told IRIN/PlusNews. [ http://www.aidslawproject.org/2012/04/24/press-statement-health-activists-welcome-high-court-judgment-on-anti-counterfeit-law ] "She [Judge Ngugi] found that the wording of the Act was unconstitutional and a threat to the right to life, dignity and health." 

With advice of the Attorney General, the minister concerned will be expected to amend the Act to reflect the judgment. 

UNAIDS executive director Michel Sidibé welcomed the decision. "A vast majority of people in Kenya rely on quality generic drugs for their daily survival. Through this important ruling, the High Court of Kenya has upheld a fundamental element of the right to health," he said. "This decision will set an important precedent for ensuring access to life-saving drugs around the world." 

Kenya has not had a case where patients were denied access to generic drugs as a result of the Act, but ALP's Nyachae noted that generic drugs bound for Africa had been held in Europe in the past, which formed the basis for the case. In 2009 a shipment [ http://www.plusnews.org/Report/83459/NIGERIA-Seizure-of-drug-shipment-threatens-ARV-access ] of drugs headed to Nigeria was held at The Netherlands' Schipol Airport on the grounds that they violated patent rights. 

Uganda and Tanzania currently have draft anti-counterfeit bills. "We are working to ensure that the text of the law is not as vague as that of the Kenyan Act," Nyachae noted. 

James Kamau, coordinator of the Kenya Treatment Access Movement, said the judgement is historic and protects not just Kenya, but the entire eastern African region. 

"Uganda, Rwanda, Burundi, and so on - all the countries that depend on Kenyan ports to import their drugs - have now been shielded from the threat of being denied access to vital generics as a result of the ruling," he told IRIN/PlusNews. "We hope to see a ripple effect, where countries will pick up on this ruling and adapt it to protect their own citizens." 

"Even in Kenya this judgement is not just important for people living with HIV, but to all 42 million Kenyans, who depend on generics to treat all kinds of illnesses,” Kamau said. “It extends well beyond ARVs [antiretrovirals] and to drugs for opportunistic infections and all other diseases." 

kr/he

]]></body><pubDate>Wed, 25 Apr 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95352</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201203221135570456t.jpg"/></td><td valign="top">NAIROBI 25 April 2012 (IRIN) - Kenyan HIV activists say a ruling by the High Court that the definition of &quot;anti-counterfeit&quot; in the 2008 Anti-Counterfeit Act is too broad will save millions of lives and protect the right to life of citizens.</td></tr></table>]]></content:encoded></item><item><title>KENYA: Protest over $500 million in unspent PEPFAR funds</title><pubDate>Wed, 25 Apr 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/20058301t.jpg" />]]>NAIROBI/KISUMU 25 April 2012 (IRIN) - More than 400 Kenyan AIDS activists have demonstrated in the capital, Nairobi, demanding that the US President&apos;s Emergency Plan for AIDS Relief release some US$500 million for HIV programmes in Kenya that is stuck in the pipeline.</description><body><![CDATA[NAIROBI/KISUMU 25 April 2012 (IRIN) - More than 400 Kenyan AIDS activists have demonstrated in the capital, Nairobi, demanding that the US President's Emergency Plan for AIDS Relief release some US$500 million for HIV programmes in Kenya that is stuck in the pipeline. 

The US government recently revealed that close to $1.5 billion has been in the global PEPFAR pipeline for more than 18 months. The allocation to Kenya is the largest. 

"We are protesting the US government's withholding of crucial funding for HIV programmes in the country. Last year, [special programmes minister] Esther Murugi pledged that the government would put one million Kenyans on HIV treatment by 2015 - without this funding, that goal cannot be achieved," said Rose Kaberia, director of the International Treatment Preparedness Coalition (ITPC) in Eastern Africa. [ http://www.itpcglobal.org/ ] 

The protestors presented a memorandum listing their demands to US Ambassador to Kenya Scott Gration, head of PEPFAR-Kenya Katherine Perry, Kenya's Director of Public Health, Shahnaz Sharif, and other senior Ministry of Health Officials. 

The unspent money has led US President Barack Obama's government to request a $550 million cut in PEPFAR's global funding under the 2013 budget. Activists have expressed concern that a slow-down in global HIV funding could put lives at risk. [ http://www.plusnews.org/Report/95137/HIV-AIDS-Activists-call-for-emergency-Global-Fund-donor-meeting ] 

Kenya expected a 44 percent cut in PEPFAR funding for national programmes, so the PEPFAR country operational plan for 2013 keeps enrolment on HIV treatment at the 2011 figure of 100,000 new initiations annually. 

In the past year, several NGOs have raised the alarm over dwindling funds for HIV programmes around the country, with some having to shut down clinics and offices providing HIV treatment. 

"We have ARV [antiretroviral] shortages... the worst part is that it disrupts people's HIV treatment regimens, yet treatment for HIV is only effective when it is consistent," a nurse at Kisumu District Hospital in western Kenya told IRIN/PlusNews. 

"The Kenyan government needs to ask for these funds, and the US government needs to say, ‘Yes’," said Paul Davis, director of global campaigns for US advocacy group Health Global Access Project. [ http://www.healthgap.org/ ] 

Peter Cherutich, acting head of the National AIDS and STI (sexually transmitted infections) Control Programme (NASCOP), told IRIN/PlusNews that the Kenyan government had not been aware of the unspent money until recently. 

"This news came as a surprise to us. The way PEPFAR's country operational plans work, the disbursements tend to be delayed - that is likely to be the cause of the money stuck at the US treasury," he told IRIN/PlusNews. "We will be meeting the US government to negotiate the urgent release of the funds, which are crucial to our HIV treatment and prevention activities - we are starting a dialogue." 

US Global AIDS coordinator Eric Goosby noted in an interview with the health blog, Global Post, [ http://www.globalpost.com/dispatches/globalpost-blogs/global-pulse/qa-us-global-aids-coordinator-eric-goosby ] that one of the reasons for such a large amount of unspent money for Kenya was the country’s two health ministries - one for medical services and the other for public health - which "definitely slowed things down". 

"The need in programmes that deliver life-sustaining or life-saving services is that you want to have a redundancy in the flow of money, so if the money isn't there, or if the appropriation is delayed - as you've seen over and over - by months, the service doesn't stop," the blog quoted Goosby as saying. "We had built in, as a policy, a 12-to-18-month period, which means you can keep a 12-to-18-month pipeline. I feel comfortable with that, it's responsible. Any more than that, it's not; any less than that, I'm worried that you are vulnerable." 

ITPC's Kaberia noted that the money was all the more necessary since the UN World Health Organization had recently issued new guidelines on treatment options for the prevention of mother-to-child transmission and discordant couples, in which one partner is HIV positive and the other is not. 

"As we now know, treatment is prevention, and more people on treatment means fewer HIV infections; we will need money to implement these new treatment and prevention programmes," she said. 

Modelling by the US Centres for Disease Control indicates that accelerating the enrolment of patients to meet Kenya's target of having one million persons who need it on treatment by 2015 would cut new HIV infections by over 31 percent in the same period. 

kr/ko/he

]]></body><pubDate>Wed, 25 Apr 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95357</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/20058301t.jpg"/></td><td valign="top">NAIROBI/KISUMU 25 April 2012 (IRIN) - More than 400 Kenyan AIDS activists have demonstrated in the capital, Nairobi, demanding that the US President&apos;s Emergency Plan for AIDS Relief release some US$500 million for HIV programmes in Kenya that is stuck in the pipeline.</td></tr></table>]]></content:encoded></item><item><title>DRC: End of mother-to-child HIV transmission still a long way off</title><pubDate>Tue, 24 Apr 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2007/200702263t.jpg" />]]>KINSHASA 24 April 2012 (IRIN) - Poorly integrated maternal health services, a lack of human resources and a serious shortage of money for treatment mean the Democratic Republic of Congo is unlikely to meet the global plan of eliminating mother-to-child transmission by 2015.</description><body><![CDATA[KINSHASA 24 April 2012 (IRIN) - Poorly integrated maternal health services, a lack of human resources and a serious shortage of money for treatment mean the Democratic Republic of Congo (DRC) is unlikely to meet the global plan of eliminating [ http://www.plusnews.org/Report/91250/HIV-AIDS-Looking-forward-to-an-AIDS-free-generation ] mother-to-child transmission by 2015. 

"It is a catastrophe. An HIV test during antenatal visits is not automatic - the information may be given but the tests may not be available, or the treatment may not be available," said Thérèse Kabale Omari, the director for Kinshasa Province of Femme Plus, an organization that works with women living with HIV in seven provinces of the DRC. 

Only one laboratory in the country is equipped to carry out polymerase chain reaction tests for early infant diagnosis. "When an HIV-positive mother has a baby in [the southern province of] Kasai-Occidental, the centre must send the sample to Kinshasa, the capital of DRC. Getting results back can take weeks, and these women often don't live near the health centre," Omari said. 

According to 2011 government statistics, just 5.6 percent of HIV-positive pregnant Congolese women receive ARVs to prevent transmission of HIV to their babies, but the official estimate puts the mother-to-child transmission rate at 36.8 percent. 

Major problems 

A nationwide shortage [ http://www.plusnews.org/Report/94781/DRC-Alarm-bells-over-poor-funding-for-HIV-treatment ] of life-prolonging antiretroviral (ARV) drugs after the closure of some HIV projects and reduced funding for others means Omari is often forced to negotiate with doctors for HIV-positive women to be accepted in local treatment programmes. "I have to plead with them to prioritize pregnant women when someone dies or drops out off treatment," she said. 

"If you help someone to find out their HIV status, then you should have a way to treat them if they test HIV-positive, but today we can't give women that assurance," Omari noted. Dr John Ditekemena, country director of the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), says while the DRC has strong policies and strategies for fighting HIV, and for the prevention of mother-to-child transmission (PMTCT), a severe lack of resources means they cannot be fully implemented. 

"A main problem is coverage - many pregnant women who are tested will not return to the same facility for delivery. The DRC is a huge country with very limited resources - human resources, logistics, problems with the supply chain coordination - and the disastrous situation of the health infrastructure mean we won't be able to reach the goal of eliminating mother-to-child transmission by 2015," he said. 

Femme Plus's Omari noted that 'free' treatment was rarely completely free. "For example, the HIV test may be free, but you have to pay for the patient card, for the syringe they use if you need some treatment, for transport - the costs add up and few women can afford them," she said. 

Mariam, in her 20s, was diagnosed with HIV while she was pregnant a year ago, but has not started on ARVs because she cannot afford the US$15 it costs to get a CD4 test, which measures immune strength. She has since had her baby but the child has not been tested for HIV. 

Mariam's husband travelled to the southeastern city of Lubumbashi shortly before she was diagnosed and has not returned. She suspects he has left her and their children for good. To make ends meet, she sells plastic bags of drinking water on the streets of Kinshasa, the capital, but the money she makes is barely enough to feed her family, let alone pay for health care. 

"I have not been tested and I think I am getting sick because I have noticed an itchy rash all over my arms recently," she told IRIN/PlusNews. "I have two other children who are healthy but the baby gets sick often - I am worried." 

Ramping up PMTCT 

EGPAF and its partners, under a project known as Projet Intégré de VIH/SIDA au Congo - Integrated HIV/AIDS Project (ProVIC) - supported by the US President's Emergency Plan for AIDS Relief (PEPFAR), are assisting 24 maternal health facilities in five provinces of the DRC. Separately but also funded by PEPFAR, EGPAF is supporting 53 sites in Kinshasa and 17 in Lubumbashi as part of the "Malamu" project - meaning 'good' in the local Lingala language - to accelerate the pace of PMTCT in the DRC. 

"The idea is to have a network of sites where women can receive the full package of PMTCT services, which will help improve coverage," said Ditekemena, adding that the project was working to build up other areas of PMTCT such as male involvement and counselling on infant feeding. 

"If you invite 100 women to the antenatal clinic with their husbands, only 10 or 12 will show up - we are extending the hours of service to allow men to come in after work or at the weekend," he added. "Mother and infant follow-up is difficult if she is not counselled properly, especially if she does not have a support system around her - spouse, family, community." 

The ProVIC project aims to see 50,000 pregnant women tested for HIV and get their results in 2012, while the Malamu project aims to test 30,000 women. 

"Slowly, step by step, we can increase coverage and improve the quality of care,” said EGPAF's Ditekemena. “Perhaps by 2019 we will have eliminated mother-to-child HIV transmission in the DRC."

kr/he

]]></body><pubDate>Tue, 24 Apr 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95346</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2007/200702263t.jpg"/></td><td valign="top">KINSHASA 24 April 2012 (IRIN) - Poorly integrated maternal health services, a lack of human resources and a serious shortage of money for treatment mean the Democratic Republic of Congo is unlikely to meet the global plan of eliminating mother-to-child transmission by 2015.</td></tr></table>]]></content:encoded></item><item><title>HIV/AIDS: A Rogues&apos; Gallery</title><pubDate>Wed, 18 Apr 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2009/200909291220100610t.jpg" />]]>JOHANNESBURG 18 April 2012 (IRIN) - Grantees of the Global Fund to Fight AIDS, Tuberculosis and Malaria who allegedly committed fraud or misused funds unwittingly did a lot of damage to the Fund – and, many say, global health - as donors withdrew and the beleaguered organization faced a &quot;crisis of confidence&quot; in recent years. But the Fund has responded and is undergoing an extensive restructuring process. IRIN/PlusNews takes a look at some of the alleged fraudsters and the progress of the investigations.</description><body><![CDATA[JOHANNESBURG 18 April 2012 (IRIN) - Grantees of the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria who allegedly committed fraud or misused funds unwittingly did a lot of damage to the Fund – and, many say, global health - as donors withdrew and the beleaguered organization faced a "crisis of confidence" in recent years. But the Fund has responded and is undergoing an extensive restructuring process. IRIN/PlusNews takes a look at some of the alleged fraudsters and the progress of the investigations.

2009 Mali [ http://www.scribd.com/doc/83403550 ] 

Alleged culprits: Malian Ministry of Health, National Control Programme against TB, National Council for the Fight Against AIDS, and the National Programme for the Fight Against Malaria. 

Allegations: In December 2010 the Global Fund announced that it had suspended two malaria grants with immediate effect, and had terminated a third TB grant after it found evidence of misappropriation and unjustified expenditure. 

The Fund found that at least US$5.2 million in disbursements related to HIV, TB and malaria had been misappropriated and little money was dedicated to purchasing medicines. Organizations pilfered funds using fraudulent invoices, per diem payments and training events. The Fund’s investigation revealed that organizations often colluded with the Ministry of Health and national TB and malaria control programmes to falsify invoices, signatures, bank statements and official stamps, which were discovered buried in someone's garden. 

By December 2010, the Malian authorities had arrested 15 people in connection with the allegations and the Ministry of Health had repaid $304,000. Due to possible threats against Global Fund staff, the US government provided them with protection. 

The investigation into the mismanagement of HIV funds was still ongoing in July 2011. 

2009 Mauritania [ http://www.scribd.com/doc/83397462 ] 

Culprits: The national AIDS committee, the national TB programme, two NGO networks, ROMATUB and RNLPV, the National Institute for Public Health. 

Allegations: In July 2009 the Global Fund suspended funding to the executive secretariat of the national AIDS committee after finding evidence of fraudulent and unjustified expenditures. The Fund demanded the reimbursement of $1.7 million within three months, and immediate removal of the people identified as being responsible. 

Fake receipts, invoices and companies had been used to defraud the Fund since 2004. According to audits by the Fund's Office of the Inspector General (OIG), various local oversight bodies had failed to bring this to the Global Fund's attention. 

Officials of the national AIDS committee also instituted a kickback scheme that required payments of up to 50 percent of a grant from the NGO sub-recipient as a pre-condition for participation in Global Fund programmes. Sub-recipients were also forced to issue invoices for bogus training or expenses and then return this money to the national AIDS committee. Witnesses said this was a long-running practice at the national body and pre-dated Global Fund support. 

The NGO network, ROMATUB, was an implementing partner in Global Fund tuberculosis programmes. The Fund found that the network charged for work never completed. It submitted photographs of the same people in the same locations as proof of nationwide community outreach work supposedly carried out in different villages. 

The Mauritanian government cooperated in the investigations, refunding $1.7 million and arresting four national AIDS committee officials. The executive director of the national AIDS committee and all employees working on Global Fund grants were removed. 

As of March 2012, the Fund did not know whether those arrested had been brought to trial, as prosecutions had not yet commenced by July 2011. According to the OIG, national law enforcement agents had not communicated with the Fund since 2009. 

The OIG has recommended that any further disbursements to Mauritania be conditional upon the completion of all related criminal inquiries, and those convicted serving sentences. 

Mauritania, Cote d'Ivoire, Djibouti, Mali and Papua New Guinea have been placed on an "Additional Safeguards Policy" list. Countries on this list are subjected to closer scrutiny and restrictions on financial transactions relating to grants. [ http://www.theglobalfund.org/es/mediacenter/pressreleases/Global_Fund_suspends_two_malaria_grants,_terminates_TB_grant_to_Mali/ ] 

2009 Zambia [ http://www.plusnews.org/Report/92191/ZAMBIA-Corruption-scandal-rocks-ARV-programme ]

Alleged culprits: Zambian Ministry of Health and Ministry of Finance, Zambian National AIDS Network (ZNAN). 

Allegations: After reports by a whistle-blower of fraud in Zambia's Ministry of Health (MoH) in 2009, the Global Fund - with help from Zambia's Office of the Auditor General - found that the ministry had misspent $6.7 million. The Ministry of Finance and National Planning had similarly misspent about $3 million and one of its accountants had defrauded the Global Fund of about $104,000. 

The Fund also allegedly uncovered fraud and misuse in the Zambian National AIDS Network, then headed by former UN Special Envoy for AIDS in Africa Elizabeth Mataka. The Global Fund audit of ZNAN highlighted financial mismanagement that included the purchase of cars for personal use by ZNAN management, exorbitant salaries that were sometimes more than double the local sector standard, and the disbursement of funds to sub-recipients who could not provide auditors with financial records, as in the case of disbursements to the Maureen Mwanawasa Community Initiative, headed by Zambia's former First Lady. 

The Global Fund subsequently suspended grants to all these organizations and stripped the MoH of its Principal Recipient status, transferring this responsibility to the Zambia country office of the UNDP. The change in Principle Recipient led to major delays in the distribution of funds and stock-outs of antiretroviral (ARV) and TB drugs for treating this common co-infection. 

In August 2011 Zambian HIV activists delivered a petition to the national AIDS council, demanding that government seize some of ZNAN's assets in order to repay the money, and that government move to pay back some of the money on the organization's behalf - as it had done for the Ministry of Health. 

2010 Nigeria [ http://www.scribd.com/doc/83398634 ] 

Alleged culprits: Yakubu Gowon Centre for National Unity and International Cooperation, Christian Health Association of Nigeria. 

Allegations: The Global Fund alleges that the Yakubu Gowon Centre misappropriated funds and exchanged $22 million of Global Fund money for Naira, the Nigerian currency, on the black market. At least one party involved in the transactions allegedly had previous links to money laundering, fraud and conflict diamonds. The Christian Health Association of Nigeria also engaged in black market currency trading. 

As a result of the Yakubu Gowon Centre's transactions between 2005 and 2009, about $825,000 in Global Fund money for malaria programming was lost, according to a Global Fund OIG investigation report, which recommended that the Fund immediately terminate the Centre as a Principle Recipient for its grants and bar it from any future participation in Global Fund programmes. 

When asked, the Yakubu Gowon Centre could not account for missing funds. In a written response to the Global Fund's investigation report, the Centre said the allegedly missing funds had gone to operational expenses, management fees, maintenance and salaries. Despite documentation demonstrating the contrary, the centre denied allegations that it had used the black market to exchange currency. 

In June 2011 the Yakubu Gowon Centre was replaced as a Principle Recipient. Accounting firm KMPG, which was supposed to provide in-country financial oversight, was also relieved of its position with the Global Fund. 

llg/kn/he

]]></body><pubDate>Wed, 18 Apr 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95294</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2009/200909291220100610t.jpg"/></td><td valign="top">JOHANNESBURG 18 April 2012 (IRIN) - Grantees of the Global Fund to Fight AIDS, Tuberculosis and Malaria who allegedly committed fraud or misused funds unwittingly did a lot of damage to the Fund – and, many say, global health - as donors withdrew and the beleaguered organization faced a &quot;crisis of confidence&quot; in recent years. But the Fund has responded and is undergoing an extensive restructuring process. IRIN/PlusNews takes a look at some of the alleged fraudsters and the progress of the investigations.</td></tr></table>]]></content:encoded></item><item><title>PAPUA NEW GUINEA: Violence and belief in magic raise risk of HIV for women</title><pubDate>Wed, 18 Apr 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2010/201003251007110759t.jpg" />]]>PORT MORESBY 18 April 2012 (IRIN) - High levels of sexual violence and a cultural belief in witchcraft are putting an increasing number of women at risk of HIV in Papua New Guinea (PNG), health experts say.</description><body><![CDATA[PORT MORESBY 18 April 2012 (IRIN) - High levels of sexual violence and a cultural belief in witchcraft are putting an increasing number of women at risk of HIV in Papua New Guinea (PNG), health experts say.
 
According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), PNG accounts for most of the 30,000 reported cases of people living with HIV in the Pacific region, around 59 percent of which are women.
 
“This might be due to most HIV surveillance data coming from antenatal clinics where pregnant women are tested, a [genuine] high incidence among women, or both,” Stuart Watson, UNAIDS country director told IRIN.
 
PNG’s HIV prevalence of 0.9 percent [ http://www.unaids.org/en/media/unaids/contentassets/documents/factsheet/2010/20101123_FS_oceania_em_en.pdf ] is the highest among Pacific region countries.
 
Violence contributing to HIV
 
However, gender inequality is proving a major driver in the spread of HIV. “The low status of women in the community makes them prone to violence - sexual and otherwise,” Watson said.
 
Gender-based violence [ http://www.irinnews.org/Report/95030/PAPUA-NEW-GUINEA-Gender-based-violence-left-untreated ] is widespread among the country’s 6.5 million ethnically divided inhabitants.
 
The PNG Law Reform Commission reported that 70 percent of women had been physically abused by their husbands, and in some parts of the country the number reaches 100 percent.
 
Human Rights Watch (HRW) [ http://www.hrw.org/news/2009/01/27/where-violence-against-women-rampant ] estimated that 50 percent of women in PNG have experienced forced sex in their lifetime.
 
Abused girls at higher risk of HIV
 
A UNAIDS study found strong links between gender-based violence and HIV infection, and noted that the first sexual encounter of many girls was forced. “These circumstances make it extremely difficult to negotiate condom use. The trauma of experiencing abuse usually sets off a pattern of unsafe sexual practices,” Watson said.
 
The report also found that women who had been sexually abused as children, [ http://www.unaids.org.fj/index.php?option=com_content&view=article&id=573:abused-girls-more-at-risk-of-hiv&catid=23:hiv-in-the-pacific&Itemid=68 ] or experienced sexual abuse by an intimate partner, were twice as likely to test positive for HIV than those who had not.
 
Adding to the HIV risk that women are exposed to, it is common practice for men to have multiple sexual partners and wives. “Polygamy is an accepted practice,” said Ume Wainetti, head of the Family Sexual Violence Centre (FSVC) in PNG.
 
“Older men take on a younger bride because they think she is “clean” [free of HIV infection]. “Some girls also become victims of gang rapes, known as ‘line-ups’,” Wainetti said.
 
Witchcraft and other cultural practices
 
Human rights watchdog Amnesty International reported that [ http://www2.ohchr.org/english/bodies/cedaw/docs/ngos/AmnestyInternational_PapuaNewGuinea46.pdf ] “puri-puri” or “sanguma”, a traditional belief in witchcraft and magic, is widely practised in remote communities and highland provinces, and is often “a pretext for brutal acts of violence against women who are accused of being a witch and spreading HIV.”
 
“Sorcery is still practiced,” said John [not his real name], an office employee in the capital, Port Moresby. “People buy spells to avenge transgressions, or if someone gets sick and they don’t know how to explain it, they say it is due to sorcery - it’s a much easier explanation for many. Sometimes you need someone to blame [for a death].”
 
The Amnesty report also noted that women are six times more likely to be accused of witchcraft than men. Under the 1971 Sorcery Act of PNG, it is a criminal act punishable by up to two years in prison.
 
The UN Special Rapporteur on Violence against Women, Rashida Manjoo, ended her week-long visit to the country in March by calling for the government to repeal the act.
 
“I was shocked to witness the brutality of the assaults perpetrated against suspected sorcerers, which in many cases include torture, rape, mutilations and murder. Any misfortune or death within the community can be used as an excuse to accuse such person of being a sorcerer,” Manjoo said.
 
Watson pointed out that “The belief in sorcery makes for little health-seeking behaviour, and this makes matters worse, especially for women.”
 
According to Australian Agency for International Development (AusAID), HIV is one of the biggest developmental challenges facing this mineral-rich nation.
 
If HIV continues to spread at its current rate, AusAID estimates that [ http://www.ausaid.gov.au/publications/pdf/png_hiv_strategy.pdf ] over half a million Papua New Guineans will be living with HIV by 2025.
 
as/ds/he

]]></body><pubDate>Wed, 18 Apr 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95312</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2010/201003251007110759t.jpg"/></td><td valign="top">PORT MORESBY 18 April 2012 (IRIN) - High levels of sexual violence and a cultural belief in witchcraft are putting an increasing number of women at risk of HIV in Papua New Guinea (PNG), health experts say.</td></tr></table>]]></content:encoded></item><item><title>NEPAL: Treatment illiteracy puts HIV benchmarks in peril</title><pubDate>Tue, 17 Apr 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201204170945020672t.jpg" />]]>KATHMANDU 17 April 2012 (IRIN) - Poor understanding of antiretroviral therapy (ART) amongst health officials, clinicians and patients in Nepal could undermine gains in the country’s HIV/AIDS prevention efforts and threaten future progress in lowering the number of new infections.</description><body><![CDATA[KATHMANDU 17 April 2012 (IRIN) - Poor understanding of antiretroviral therapy (ART) amongst health officials, clinicians and patients in Nepal could undermine gains in the country’s HIV/AIDS prevention efforts and threaten future progress in lowering the number of new infections. 
 
“Treatment illiteracy is occurring at all levels, from patients who have to keep up with their own treatment, to clinicians who administer treatment, to government officials crafting policies,” said Gokaran Bhatt, coordinator of Nepal’s Country Coordinating Mechanism, the independent body tasked with coordinating all money granted to Nepal by the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria. [ http://www.theglobalfund.org/en/ccm/ ] 
 
Government figures for 2012 put HIV prevalence in the adult population at below 0.3 percent, down from 0.45 percent in 2005. 
 
According to Nepal’s first National AIDS Response Progress report, [ http://www.unaids.org/en/dataanalysis/monitoringcountryprogress/progressreports/2012countries/ce_NP_Narrative_Report.pdf ] an estimated 50,000 people are living with HIV, and four out of every five new infections are attributed to sexual transmission. ART was introduced in Nepal in 2004 and 6,483 people are currently receiving antiretroviral (ARV) drugs. 
 
“Given the poverty and geographical challenges in Nepal, we are doing extremely well here,” Sashi Sharma, head of the Internal Medicine Unit at the Teaching Hospital in the capital, Kathmandu, told IRIN. 
 
But many now argue those gains could evaporate if proper adherence to treatment policies and regimens is not exercised. 
 
Patient adherence
 
It is extremely important that patients always follow their ART regimen. “In a resource-poor country like Nepal, adherence is our only option to survive, and the baseline of adherence is treatment literacy,” said Rajhiv Khafle, founder of the National Association of People Living with HIV Nepal (NAP+N). [ http://www.napn.org.np/ ] 
 
Health workers stress that patients need a combination of counselling and monitoring to help them understand that they must always take their medicines at the same time each day, and that a dose should never be skipped. “Before ART can start, patients have to go through a full two-day counselling session,” noted Madhab Raj Pant, an HIV technical officer who worked in rural Doti District for two years. 
 
To ensure that patients will visit the distribution centre, get tested, and receive ongoing counselling, ART medicines are dispensed on a monthly basis. Nepal currently reports a “lost cases” rate of 9 percent - patients who start on ART and then do not return for three consecutive months. 
 
A variety of reasons can cause patients not to adhere to their regimen. In some areas, difficult terrain makes travelling to the nearest ART distribution centre costly and time-consuming. Bishnu Pokhrel*, who lives in a village in the Doti area, has to walk for a whole day to reach the nearest ART distribution centre. Public transportation is too expensive, and can also be unreliable due to landslides and strikes, he said.
 
When travel is impossible, some patients turn to HIV-positive friends to borrow doses of drugs. “Borrowing is not good practice. It encourages irregular taking of medication and patients aren’t medical professionals, so they might take the incorrect dose or incorrect pills,” Pant explained.
 
Breaking away from ART can harm the positive health effects of following a regular regimen. “We sometimes see a drop-off or a gap in adherence after the first six or seven months,” said Pant. “When patients feel better, they sometimes think they are cured.” 
 
Clinician adherence
 
ARV treatment illiteracy on the part of clinicians can also cause problems. Dilip Gurung, the executive director of a community support group in the city of Pokhara, reports that he has sometimes seen clinicians change ART regimens several times to try to get the patient to feel better. 
 
“Changing ART regimens can lead to fear among patients, confusion about how to properly administer the new drugs, and drug resistance,” Gurung said.
 
Public health officials agree. “It scares us if people are administering combinations that are not part of the national guidelines. If the patients on these drugs have problems or build resistance, we can’t help them - the national system can only help people within its guidelines,” said Hemant Ojha of the National Centre for AIDS and STD (sexually transmitted diseases) Control (NCASC) [ http://www.ncasc.gov.np/ ] 
 
Some outreach workers say drugs alone are not enough. “Clinicians sometimes act as if ART is a solution alone,” said Ekta Mahat, a programme officer at NAP+N. “It’s not - you need nutrition, a realistic access plan based on the patient’s life, education about possible side effects, and discipline to take the medication at the right time.” 
 
Policy adherence 
 
According to the NCASC, Nepal has approximately 196 HIV testing and counselling centres [ http://www.unaids.org/en/dataanalysis/monitoringcountryprogress/progressreports/2012countries/ce_BD_Narrative_Report[1].pdf ], as well as 35 ART distribution centres and sub-centres located throughout the country. [ http://www.ncasc.gov.np/uploaded/SDP/ART_Sites_in_Nepal_2010.pdf ] All ART drugs are distributed free of charge. 
 
But “availability is not necessarily accessibility”, Mahat said. Policies that neglect the comprehensive nutritional, financial, educational, and pharmaceutical needs of people living with HIV/AIDS amount to treatment illiteracy at the policy level. 
 
Moreover, government guidelines and the strategies of some HIV NGOs do not always take the same approach. “When we get a call from a patient whose ART isn’t working, we mobilize to get that person help,” said Khafle of NAP+N. “It’s not a public health approach, it’s a humanitarian approach.” 
 
Observers fear the positive results from national HIV efforts could be diluted if tensions over the administration of HIV programmes continue, and adherence issues hamper implementation. 
 
“Nepal has done extremely well in the last decade,” said Marlyn Elena Filio-Borromeo, UNAIDS country coordinator, “but these gains are fragile.” 
 
*not his real name
 
kk/ds/he

]]></body><pubDate>Tue, 17 Apr 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95303</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201204170945020672t.jpg"/></td><td valign="top">KATHMANDU 17 April 2012 (IRIN) - Poor understanding of antiretroviral therapy (ART) amongst health officials, clinicians and patients in Nepal could undermine gains in the country’s HIV/AIDS prevention efforts and threaten future progress in lowering the number of new infections.</td></tr></table>]]></content:encoded></item><item><title>AFRICA: Co-trimoxazole discontinuation linked to increased malaria</title><pubDate>Wed, 11 Apr 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201204111252450923t.jpg" />]]>NAIROBI 11 April 2012 (IRIN) - Abruptly discontinuing co-trimoxazole - an antibiotic used to prevent opportunistic infections in HIV-positive people - can lead to a higher incidence of malaria and diarrhoea compared with patients who keep on taking the drug, a new study has found.</description><body><![CDATA[NAIROBI 11 April 2012 (IRIN) - Abruptly discontinuing co-trimoxazole - an antibiotic used to prevent opportunistic infections in HIV-positive people - can lead to a higher incidence of malaria and diarrhoea compared with patients who keep on taking the drug, a new study has found. [ http://cid.oxfordjournals.org/content/54/8/1204.full ] 

The research was conducted by the US Centres for Disease Control (CDC) in eastern Uganda, where malaria is endemic, and published in March 2012 by the Oxford Journal of Clinical Infectious Diseases. 

The researchers found that 72 percent of the 315 cases of fever reported by study participants occurred among those who had stopped taking co-trimoxazole prophylaxis, and they were also nearly twice more likely to report diarrhoea. 

"The findings most likely mean that HIV-infected persons, while on co-trimoxazole, have a lower rate of these infectious diseases, and stopping the drug increases the rate," James Campbell, lead researcher of the study and director of science at CDC Uganda, told IRIN/PlusNews. 

Many countries recommend that people who start antiretroviral therapy (ART) should discontinue co-trimoxazole when their CD4 cell count - a measure of immune strength - goes above 200, but this practice has not been evaluated in sub-Saharan Africa. 

The UN World Health Organization (WHO) estimates that 90 percent of the annual global total of 655,000 malaria deaths occur in Africa. The disease is also associated with a more rapid decline in CD4 cell count [ http://journals.lww.com/jaids/fulltext/2006/01010/association_between_malaria_and_cd4_cell_count.23.aspx ] and a higher viral load [ http://www.ncbi.nlm.nih.gov/pubmed/15331818 ] among HIV-positive pregnant women. 

Co-trimoxazole is relatively cheap, but the researchers note that lifetime prophylaxis using the drug may have cost and toxicity implications. The study was halted on the recommendation of the Data Safety Monitoring Board - an independent group of experts that advises the study investigators - after just four months, leaving unanswered questions about whether discontinuing cotrimoxazole is warranted. 

Campbell said, "Important questions include the effect of more frequent malaria and diarrhoea episodes on the longer-term outcomes of HIV infection, the longer-term risks of inducing or selecting for resistant micro-organisms, and comparing antimicrobial prophylaxis to other means of reducing the risk of malaria and diarrhoea in this population." 

kr/ko/he

]]></body><pubDate>Wed, 11 Apr 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95268</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201204111252450923t.jpg"/></td><td valign="top">NAIROBI 11 April 2012 (IRIN) - Abruptly discontinuing co-trimoxazole - an antibiotic used to prevent opportunistic infections in HIV-positive people - can lead to a higher incidence of malaria and diarrhoea compared with patients who keep on taking the drug, a new study has found.</td></tr></table>]]></content:encoded></item><item><title>KENYA: Better training needed for counsellors of HIV-discordant couples</title><pubDate>Thu, 05 Apr 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2009/200907271222000139t.jpg" />]]>NAKURU/NAIROBI 05 April 2012 (IRIN) - The Kenyan government has issued guidelines on counselling for HIV-discordant couples, but many counsellors in smaller, rural health centres remain untrained.</description><body><![CDATA[NAKURU/NAIROBI 05 April 2012 (IRIN) - The Kenyan government has issued guidelines on counselling for HIV-discordant couples, but many counsellors in smaller, rural health centres remain untrained.

"HIV infection among discordant couples will increase without adequate counselling because... it is only through counselling that they learn to live with each other, and use preventive measures such as condoms consistently," said Churchill Alumasa, the coordinator at the local NGO, Discordant Couples of Kenya (DISCOK). 

According to the government, six out of every 10 HIV-positive couples are discordant, amounting to an estimated 350,000 couples. 

When Rose Njeri, 31, a mother of one, tested HIV-positive two years ago during a routine antenatal visit, she was advised to bring her husband along for her next visit. When he tested negative, he became hostile towards her. 

"Trouble started immediately. He insulted me as we headed home, saying I knew my status and wanted to infect him intentionally," Njeri told IRIN/PlusNews. 

Couples counselling 

The couple was given a counselling session on safe sex, but Njeri said her husband sometimes insists on unprotected sex when he comes home drunk. 

"It is also important to note that couples counselling cannot be done once. It needs to be continuous, especially if there is a case of discordance," said Vivian Mwenesi, a counsellor at a health facility in the capital, Nairobi. 

Studies show that couple counselling and testing not only lowers risky behaviour, [ http://www.rzhrg.org/publications_files/IAS06posters.pdf ] but can also significantly decrease the risk of HIV infection. 

"Challenges associated with discordance can be reduced if counsellors test couples together and they benefit from knowing each other's status at the same time, and in the presence of a counsellor,” said DISCOK's Alumasa. 

“[Counsellors] should also dedicate more time to these couples because their cases are normally different," he said, and mistrust and engaging in risky sexual behaviour can be diminished by ensuring that couples are tested together, rather than separately. 

Yet Mwenesi noted that many couples preferred to test individually rather than together, thereby missing out on the opportunity for couples counselling. "If you insist on testing them together, some disappear forever," she said. 

Children 

The unmet reproductive health needs of HIV-discordant couples are a key issue and needs to be addressed. "Discordant couples who are not counselled together are likely to engage in unprotected sex in search of a child, and [if] one partner doesn't know the status of the other, they find it hard to discuss condom use," Mwenesi said. "For discordant couples, condoms remain the most effective contraceptive, but their use can only improve in a situation where there is vibrant couples counselling." 

A number of reproductive options exist for HIV-discordant couples, including artificial insemination after 'sperm washing', and the infected partner starting antiretroviral therapy (ART) to decrease the chances of transmission to the HIV-negative partner. However, counsellors are often not equipped to provide couples with this information. 

Health workers are awaiting guidelines on HIV-discordant couples from the UN World Health Organization. These were due to be released in 2011 but were delayed by findings [ http://www.plusnews.org/Report/92710/HIV-AIDS-ARVs-as-prevention-must-move-quickly-from-science-to-action ] on the impact of early treatment on reducing HIV infection within stable sexual relationships. 

Experts say home-based counselling and testing and psychosocial support groups are also helpful tools in reaching out to discordant couples. 

Nicholas Muraguri, head of Kenya's National AIDS and Sexually transmitted infections Control Programme, noted that "Involvement of partners in prevention programmes, such as medical male circumcision and prevention of mother-to-child transmission programmes, provides for a greater opportunity to provide couple counselling." 

rk/ko/kr/he 

]]></body><pubDate>Thu, 05 Apr 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95238</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2009/200907271222000139t.jpg"/></td><td valign="top">NAKURU/NAIROBI 05 April 2012 (IRIN) - The Kenyan government has issued guidelines on counselling for HIV-discordant couples, but many counsellors in smaller, rural health centres remain untrained.</td></tr></table>]]></content:encoded></item><item><title>NEPAL: HIV-positive children, orphans neglected</title><pubDate>Tue, 03 Apr 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2011/201103021645360958t.jpg" />]]>RAKAM 03 April 2012 (IRIN) - In the village of Rakam in Dailekh District, about 700km northwest of the Nepalese capital, Kathmandu, 12-year-old Ravi* is living with HIV and has no idea if he will finish his education.</description><body><![CDATA[RAKAM 03 April 2012 (IRIN) - In the village of Rakam in Dailekh District, about 700km northwest of the Nepalese capital, Kathmandu, 12-year-old Ravi* is living with HIV and has no idea if he will finish his education.

"I feel weak all the time. My uncle is tired of hearing my complaints," he told IRIN. Barely six when he lost his parents to AIDS-related illnesses, he now lives with his father's brother and family, who are struggling to support him.

It is proving a challenge. They can't even afford the bumpy eight-hour bus journey to the nearest city of Surkhet for his CD4 count test, which measures immune strength.

According to the National Centre for AIDS and sexually transmitted disease (STD) Control (NCASC), [ http://www.ncasc.gov.np/old/ ] there are close to 5,000 children under 14 years of age living with HIV in Nepal today, but local NGOs and health workers estimate the real number to be much higher. 

"There could be many more orphans and children living with HIV, but the government of Nepal has failed to pay any attention to their plight. Supplying medicines is not enough," said AIDS activist Deepa Bohara, the coordinator for NGO Parivartan ko Lagi Pahuch (Access for Change). 

There are as many as 15 HIV-positive orphans and children in Dailekh alone, the group reported. "We are extremely worried about the welfare of these children. We hope to get enough government support to help them," said Khagendra Jung Shah, chief of the Dailekh District Hospital. 

His office can only provide life-prolonging antiretroviral drugs - there is no separate budget to give these children any social support. Moreover, there are no programmes to sponsor their education, pay for medical expenses or offer psychosocial counselling. 

Dailekh is one of the poorest districts in the country, with most people living on less than US$1 per day, according to government figures. 

Stigma remains high in Nepal, and HIV-positive orphans sometimes face neglect from relatives after their parents die. In one extreme case six months ago, a five-year-old orphaned HIV-positive child (name withheld upon request) died of exposure after his relatives forced him to sleep in the barn out of fear that he would infect the other children. 

"I don't fear dying from AIDS, but constantly worry about the day when my mother dies and I will be alone in this world," said Ashim *, 10, who lives with his HIV-positive mother. 

"We are extremely worried, not only about the orphans, but also those whose HIV-positive parents are alive. What happens after their parents die?" said another health worker, Sushil Bikram Thapa from Nepal STD and AIDS Research Centre, a local NGO. 

According to the National Centre for AIDS and STD Control in the Ministry of Health and Population [ http://www.mohp.gov.np/english/home/index.php ], there are more than 50,000 adults and children living with HIV, and an estimated overall prevalence of 0.30 percent in the adult population (15-49 years old). 

*Not his real name 

nn/ds/kr/he

]]></body><pubDate>Tue, 03 Apr 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95228</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2011/201103021645360958t.jpg"/></td><td valign="top">RAKAM 03 April 2012 (IRIN) - In the village of Rakam in Dailekh District, about 700km northwest of the Nepalese capital, Kathmandu, 12-year-old Ravi* is living with HIV and has no idea if he will finish his education.</td></tr></table>]]></content:encoded></item><item><title>DRC: Kinshasa fashion highlights lack of ARVs</title><pubDate>Tue, 03 Apr 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201204020942470685t.jpg" />]]>KINSHASA 03 April 2012 (IRIN) - Twelve HIV-positive women held a fashion show in Kinshasa, capital of the Democratic Republic of Congo, on 30 March to highlight the plight of tens of thousands of people with HIV/AIDS, and challenge donors and the authorities to provide adequate treatment.</description><body><![CDATA[KINSHASA 03 April 2012 (IRIN) - Twelve HIV-positive women held a fashion show in Kinshasa, capital of the Democratic Republic of Congo (DRC), on 30 March to highlight the plight of tens of thousands of people with HIV/AIDS, and challenge donors and the authorities to provide adequate treatment.
 
"Last year we said, 'Let's have a generation without AIDS'," said Emilie, 37, a married social worker with three children, who participated. "Today, here in Kinshasa, we have a drugs stock-out. We've been given expired drugs, and now lenders are leaving us. How are we going to have an AIDS-free generation here in Congo if we do not have the medicines?"
 
Rachel, 38, who learned she was HIV-positive in December; said, "We must campaign until we get the medicines." Her four-year-old son died from an AIDS-related illness about a week before the fashion show.
 
"With ARVs [life-prolonging antiretrovirals] I am healthy. The fight against HIV is not over. I’m not keeping quiet any more," shouted the women. 
 
Médecins Sans Frontières ( MSF), an international NGO which helped sponsor the event, says more than a million of DRC's nearly 70 million people are HIV-positive, though many are unaware of their status. Some 350,000 people should be taking ARVs, but only 50,000 - fewer than 15 percent - are receiving treatment, "one of the lowest rates in the world".
 
Prevention of mother-to-child transmission (PMTCT) is almost non-existent. "Only an estimated 1 percent of HIV-positive pregnant women have access to PMTCT treatment. Without treatment, about one-third of their children will be born with HIV," said MSF.
 
The NGO provides ARVs to over 5,000 patients in six of DRC's 11 provinces, and said it "deplores the lack of investment by the Congolese government", which disburses less than half of the 7 percent of its health budget earmarked for fighting HIV/AIDS.
 
MSF also regrets that some donors "are pulling back or reducing their subsidies, like the Global Fund [to Fight AIDS, Tuberculosis and Malaria]”, which is the "largest provider of ARVs in DRC".
 
"We have just negotiated to put 700 patients on ARVs in the next three months - a big step - but there is absolutely no funding for this. We have just the drugs," said Pascale Barnich-Mungwa, who works in DRC for Médecins du Monde, a humanitarian NGO.
 
She believes the fashion show will have a strong impact. "It is our responsibility to engage professionally with this struggle… It's important to have events like these because it gives them [HIV-positive people] a voice and helps legitimize their cause," said Barnich-Mungwa.
 
According to MSF, about 15,000 people are registered on a waiting list and need ARVs "urgently, otherwise they will die within three years".
 
hb/cb/he

]]></body><pubDate>Tue, 03 Apr 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95232</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201204020942470685t.jpg"/></td><td valign="top">KINSHASA 03 April 2012 (IRIN) - Twelve HIV-positive women held a fashion show in Kinshasa, capital of the Democratic Republic of Congo, on 30 March to highlight the plight of tens of thousands of people with HIV/AIDS, and challenge donors and the authorities to provide adequate treatment.</td></tr></table>]]></content:encoded></item><item><title>UGANDA: Deaf demand inclusion in HIV programmes</title><pubDate>Mon, 02 Apr 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201204021133550829t.jpg" />]]>KAMPALA 02 April 2012 (IRIN) - Leaders of the deaf community in Uganda say the government&apos;s HIV programmes have failed them because their special needs are not taken into consideration.</description><body><![CDATA[KAMPALA 02 April 2012 (IRIN) - Leaders of the deaf community in Uganda say the government's HIV programmes have failed them because their special needs are not taken into consideration. 

"I am disappointed with the way the government has acted... they are not sensitive to deaf persons. There are no specialized health facilities where the deaf can access HIV services," Alex Ndezi, a deaf Ugandan legislator for persons with disabilities, told IRIN/PlusNews. 

"The government has failed to train health workers in sign language. Whenever they [deaf people] go to health centres they need interpreters, who require payment… [few] can afford to pay… [them]." 

According to UNAIDS, [ http://www.unaids.org/en/resources/presscentre/featurestories/2011/june/20110609disabilityreport ] people with disabilities may be at risk of HIV infection for a number of reasons, including "insufficient access to appropriate HIV prevention and support services, and their higher risk of experiencing sexual assault or abuse… They may also be turned away from HIV education forums or not be invited by outreach workers because of assumptions that they are not sexually active, or do not engage in other risk behaviours such as injecting drugs." 

Alex Lawoko, chairperson of northern Uganda's Gulu Association, told IRIN/PlusNews that deaf girls and women were particularly vulnerable to sexual exploitation and often became sex workers due to poverty. 

"We need to include livelihood projects in fighting against HIV/AIDS in the deaf community... deaf females we interviewed in regard to their reasons for sexual trade said they are looking for income, as they lack money to support their life," he said. 

Deaf people miss out on radio programmes and adverts aimed at educating people about HIV, while television broadcasts on the topic are rarely accompanied by sign language interpretation. 

Christine Ondoa, Uganda's Health Minister, told IRIN/PlusNews that her ministry had finalized a document on HIV/AIDS strategic plans, programmes, services, and "all the HIV and related issues among people with disabilities; all [the points] they have raised are addressed in the document". 

Survey 

The Ministry of Health, the US Centres for Disease Control (CDC) and the School of Public Health at Makerere University in the capital, Kampala, will soon begin the first ever HIV-related survey among deaf people in the greater Kampala area. There are no statistics on HIV levels among the deaf. 

Using a video-based sign language questionnaire, the research will investigate respondents' general health status, alcohol, tobacco, and drug use, as well as access to health care, HIV testing, treatment and care, and HIV-related risk behaviours. It will also offer participants the option to test for HIV and syphilis. Treatment for syphilis will be provided while HIV-infected respondents will be referred to care and treatment providers. 

The survey, funded by the US President's Emergency Plan for AIDS Relief (PEPFAR), aims to interview a sample size of 1,000 deaf adults residing in Kampala, Mukono, Wakiso and Mpigi districts. It is expected to start by June 2012 and run for six months. 

"Surveillance is a core public health function. It informs both policy-making and programme planning. Surveys are also used for public health advocacy and general community awareness," said Wolfgang Hladik, an epidemiologist at CDC-Uganda. 

The survey is the first step towards an opportunity to create well-informed, effective HIV prevention, treatment and care strategies for deaf people. "It's a welcome move. We are going to support and ensure it succeeds," said Ndezi. "There has been no information and data on HIV among the deaf persons." 

so/kr/he

]]></body><pubDate>Mon, 02 Apr 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95218</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201204021133550829t.jpg"/></td><td valign="top">KAMPALA 02 April 2012 (IRIN) - Leaders of the deaf community in Uganda say the government&apos;s HIV programmes have failed them because their special needs are not taken into consideration.</td></tr></table>]]></content:encoded></item><item><title>UGANDA: HIV services in western refugee camps overwhelmed</title><pubDate>Thu, 29 Mar 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2012/201203281225390764t.jpg" />]]>ISINGIRO 29 March 2012 (IRIN) - Health workers manning five health centres in two refugee camps in the southwestern Ugandan district of Isingiro say they are overwhelmed by the high number of refugees and local residents in need of HIV services.</description><body><![CDATA[ISINGIRO 29 March 2012 (IRIN) - Health workers manning five health centres in two refugee camps in the southwestern Ugandan district of Isingiro say they are overwhelmed by the high number of refugees and local residents in need of HIV services. 

Severe personnel shortages in Nakivale and Oruchinga refugee settlements have led to long queues at the clinics and placed a heavy burden on the few health workers available, many of whom often have to take double shifts to meet demand. 

"It's the same staff to do ward work and carry out sensitization and awareness campaigns to increase the refugees' understanding of HIV/AIDS, and how to prevent transmitting the disease," said Dr Chris Omara, health coordinator for Medical Teams International (MTI) [ http://www.medicalteams.org/sf/where_we_work/africa/uganda.aspx ], a medical NGO that works in humanitarian emergencies. 

MTI runs two clinics of its own and supports three government health centres in the settlements. Some 180 health workers, only three of whom are doctors, are responsible for a population of over 139,000 people - 63,749 refugees and more than 76,000 local residents - in the area, which has an HIV prevalence of 6 percent. 

The UN Refugee Agency [ http://www.unhcr.org/pages/49e483c06.html ], which provides MTI with US$2 per refugee per year for medication, says it difficult to recruit and retain health personnel to work among Uganda's refugee populations. 

Dr Isaac Odongo, MTI's regional programme manager for southwestern Uganda, noted that the need for information on HIV and sexually transmitted infections (STIs) was crucial for refugees, many of whom came from conflict-prone areas of the Democratic republic of Congo (DRC) where such information was hard to come by. 

"The HIV infection rates are generally low among the refugees when they just come [but] with time, they get into reckless activities [unprotected sex] with locals and they get infected," he said. 

Uganda suffers from a chronic shortage of health workers [ http://www.irinnews.org/Report/94083/UGANDA-Mothers-to-be-most-at-risk-from-inadequate-health-budget ] - less than half of the vacant health positions are filled - but the recent influx of refugees [ http://www.irinnews.org/Report/94966/UGANDA-DRC-refugee-influx-stretching-camp-facilities ] fleeing violence in neighbouring DRC has put even more pressure on Isingiro's health services. 

MTI replaced the German NGO, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) [German Agency for international Cooperation] in the area three months ago, and one MTI official, who spoke on condition of anonymity, said the transition had also affected the smooth provision of HIV services to patients. 

"We have just been in the field for three months. It's not easy to have all the patients on board. There are also issues to do with procurement and requisition of ARVs [antiretrovirals] and TB drugs," said the official. 

At one of the health centres in Nakivale refugee settlement there are 69 HIV-exposed infants who need close monitoring and supervision. However, the health centre has only one general doctor, Dr Gideon Ndaula, who has to see HIV-positive people as well as other patients, and the same scenario is repeated in health centres across the settlement. 

On the day IRIN/PlusNews visited the facility, Ndaula was performing male circumcisions and was unable to attend to other patients. Uganda's Ministry of Health has embarked on a large-scale voluntary medical male circumcision programme as part of HIV prevention efforts. 

Follow-up is another major problem. The fear of stigmatization causes many local people and refugees to limit their attendance at the health centre to the bare minimum. 

"We have a challenge in following and monitoring some cases, especially among the nationals. They come once and don't return. When the disease worsens, it's not easy for us to follow," said Ndaula. 

Health workers are often too busy to provide counselling on infant feeding for HIV-positive mothers, many of whom could infect their babies through incorrect feeding methods [ http://www.plusnews.org/Report/85939/GLOBAL-Breast-really-is-best ]. 

Florence Ajonye, the HIV/AIDS focal person at the heal facility in Nakivale settlement, told IRIN/PlusNews that patients often had to wait to be enrolled on life-prolonging ARV drugs, even when they qualified. 

"There are so many patients here to see. The doctor sees between 30 and 50 [every day] - far too many to ensure adequate attention. Sometimes people wait for hours to be attended to. As a result... we start with those who are critically ill," she said. 

"The supplies are not enough. There are times we run short of ARVs and Septrin [an antibiotic used to prevent opportunistic infections] for our patients. We have to either request from the other facilities or have to buy the drugs to… [ensure] continuity of the services." 

"At times we have come here [the health centre] and found no drugs," said one patient. "As for me, I can't manage to buy ARVs and TB drugs in Isingiro or Mbarara [another western Ugandan town]." 

so/kr/he

]]></body><pubDate>Thu, 29 Mar 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95187</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2012/201203281225390764t.jpg"/></td><td valign="top">ISINGIRO 29 March 2012 (IRIN) - Health workers manning five health centres in two refugee camps in the southwestern Ugandan district of Isingiro say they are overwhelmed by the high number of refugees and local residents in need of HIV services.</td></tr></table>]]></content:encoded></item><item><title>KENYA: Many sex workers are married, new report reveals</title><pubDate>Tue, 27 Mar 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2011/201107261234070199t.jpg" />]]>NAIROBI 27 March 2012 (IRIN) - A new survey of commercial sex work in Kenya, the first to include male sex workers, has revealed that 40 percent of female and male commercial sex workers are in marriages or stable unions.</description><body><![CDATA[NAIROBI 27 March 2012 (IRIN) - A new survey of commercial sex work in Kenya, the first to include male sex workers, has revealed that 40 percent of female and male commercial sex workers are in marriages or stable unions. 

According to the survey by the National AIDS and Sexually transmitted infections Control Programme (NASCOP), the World Bank, Kenya Prisons and Canada's University of Manitoba, there are an estimated 200,000 commercial sex workers in Kenya, 15,000 of whom are men. 

The study, which covered all the country’s urban areas with the exception of North Eastern Province, found that Rift Valley and Nairobi provinces had the biggest number of sex workers. 

"[A] majority of the male commercial sex workers have sex with men, and this puts them at greater risk because anal sex, as is already known, is a catalyst for the spread of HIV, and because of the stigma involved, many do not seek services like HIV testing," said Nicholas Muraguri, head of NASCOP. 

Muraguri said the high number of married commercial sex workers could accelerate the spread of HIV within marriage - statistics show that people in stable sexual partnerships account for 44 percent of new HIV infections. 

"Their spouses or girlfriends or boyfriends do not know they are engaged in commercial sex work, which puts marriages and stable unions at even greater risk of HIV," he pointed out. 

The survey did not assess the level of condom use between sex workers and their clients, but Muraguri told IRIN/PlusNews initial studies had shown that "The level of condom use between them [sex workers] and their clients is just slightly above 50 percent, which is worrying. Sex workers tend not to use condoms with their regular clients." 

According to the Kenya HIV Prevention Response and Modes of Transmission Analysis, 2009, commercial sex workers and their clients together contribute 14 percent of all new HIV infections, while men who have sex with men and prisoners account for 15.2 percent. 

The Kenya National AIDS Strategic Plan 2009-13 identifies the most at-risk populations as key drivers of new HIV infections, making up one-third of all new cases. 

Muraguri said the government has recognized the need to create safe access to HIV services for often marginalized high-risk groups. 

"These are groups that continue to operate secretively because there are no safe conditions for them," he said. "We must provide this [access] either within the law or through change in societal mentality to ensure they receive services to save them and the general population." 

ko/kr/he

]]></body><pubDate>Tue, 27 Mar 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95173</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2011/201107261234070199t.jpg"/></td><td valign="top">NAIROBI 27 March 2012 (IRIN) - A new survey of commercial sex work in Kenya, the first to include male sex workers, has revealed that 40 percent of female and male commercial sex workers are in marriages or stable unions.</td></tr></table>]]></content:encoded></item><item><title>ETHIOPIA: New HIV policy focuses on HIV in the workplace</title><pubDate>Mon, 26 Mar 2012 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://irinnews.org/images/2009/200910020817110641t.jpg" />]]>ADDIS ABABA 26 March 2012 (IRIN) - The government has teamed up with Ethiopia&apos;s main employees&apos; and employers&apos; associations to launch a new HIV/AIDS workplace policy that is to be implemented across the nation.</description><body><![CDATA[ADDIS ABABA 26 March 2012 (IRIN) - The government has teamed up with Ethiopia’s main employees' and employers' associations to launch a new HIV/AIDS workplace policy that is to be implemented across the nation. 

The new policy came into force in January 2012 and will be applied across the board in state and private organizations. It is expected to protect job seekers from mandatory HIV tests, while facilitating voluntary counselling and testing and defending the right of employees living with HIV to medical leave or job re-allocation. It also provides guidelines for the establishment of an AIDS fund to help employees cope with living with the virus. 

The new policy is in line with the country's goal of halving new HIV infections by 2015. "Where HIV/AIDS hurts the country most is in workplaces, where the productive part of the society -alongside their employers, family and the rest of their community - suffer finically, economically and socially in aftershocks of every new HIV infection," said Solomon Demissie, director of the Harmonious Industrial Relation Directorate at the Ministry of Labour and Social Affairs. 

"This is why combating HIV in workplaces holds a big stake in our fight. The sector needs a combined and revitalized effort from all concerned actors." 

According to a 2009 study, "Managing HIV and AIDS in the workplace" by the NGO, Stop AIDS Now, [ http://www.stopaidsnow.org/our_work_article/workplace_ethiopia ] most NGOs admitted that they did not have the skills to develop an HIV/AIDS workplace policy. 

"NGOs do not have concrete knowledge of the costs of developing and implementing a workplace policy, and most respondents worry that all activities for responding to HIV in the workplace have financial implications by increasing overhead costs. Furthermore, they are not sure of the sustainability of such undertakings," the report noted. 

Solomon said the ministry had met with all stakeholders to ensure they were on the same page. "Since this a set of new commitments that will demand considerable efforts, including financial obligations from everybody, we had to make sure all are comfortable with it. After a series of discussions, the policy document was endorsed by all actors unanimously." 

The new policy brings an agreement with the Ethiopian Employers Federation and The Confederation of Ethiopian Trade Unions, and is also endorsed by the Ethiopian Privatization and Public Enterprises Supervising Agency, which oversees 53 state organizations. 

It stipulates that employers will make the necessary investments to ensure universal precautions in workplaces to protect employees from HIV infection, and are also expected to put in place a post-exposure prophylaxis system for their workforce. 

Employers committed to making available personnel and funds to implement the policy in their businesses, and to facilitate employees' access to condoms and treatment for sexually transmitted infections. 

"We have been actively working to fight HIV for more than a decade now. At times we were resisted by organizations, including state-run firms that were concerned by the financial ramifications of such commitments," said Tadele Yimer, president of the Ethiopian Employers Federation. 

"We made significant progress convincing both investors and government employers to prioritize the HIV agenda and undertake a number of initiatives including... schemes to support marriages and people living with HIV," he added. 

"What we hope it [the new policy] will do is bring about an agreed consent and uniform approach among employers to fight HIV/AIDS nationally." 
The federation brings to the agreement a commitment by around 700 organizations across a broad range of sectors like transport, construction, hotels, airlines, banks, insurance and others, many with their own trade union. 

Officials at the Confederation of Ethiopian Trade Unions - who developed their own workplace HIV policy in 2001 - expressed relief that employers are now on board. "Employees' deaths were on the rise. There was stigma and discrimination at times, forcing employees to leave their jobs... [putting] their families in difficult positions," said Fissehatsion Biyadgelinge, head of the confederation's social affairs department. 

"Since the 2001 guideline, which was developed from the national policy with the support of international donors, including Pathfinder International, we have tried to reverse the trend by raising awareness through continued campaigns, and led various efforts to fight HIV/AIDS by encouraging voluntary counselling and testing and fighting for more rights for employees living with HIV/AIDS." 

The umbrella organization of over 400 employees' unions and an estimated 400,000 members, says some of its anti-HIV/AIDS campaigns have been failing short because of funding constraints. 

"With the new policy of establishing an AIDS fund, employees can contribute a small portion of money and from it we can finance HIV campaigns and cater for employees and families that are affected by HIV," Fissehatsion said. 

The AIDS fund will raise a monthly contribution from employees and will also be run with assistance from the organizations' credit and saving associations. Money from the fund will be used for treatment, care and support programmes such as medical checkups and balanced diets, and other social assistance programmes for employees and their families. 

"We cannot forever rely on donors," Fissehatsion said. "The ownership has to be ours - the employees." 

kt/kr/he

]]></body><pubDate>Mon, 26 Mar 2012 00:00:00 GMT</pubDate><link>http://www.irinnews.org/report.aspx?ReportId=95165</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://irinnews.org/images/2009/200910020817110641t.jpg"/></td><td valign="top">ADDIS ABABA 26 March 2012 (IRIN) - The government has teamed up with Ethiopia&apos;s main employees&apos; and employers&apos; associations to launch a new HIV/AIDS workplace policy that is to be implemented across the nation.</td></tr></table>]]></content:encoded></item></channel></rss>
