<?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/</link><description>Updated everyday</description><language>en-gb</language><lastBuildDate>Mon, 13 May 2013 11:30:48 GMT</lastBuildDate><item><title>Circumcision plans go awry in Swaziland </title><pubDate>Mon, 13 May 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2011/201110270744480110t.jpg" />]]>MBABANE 13 May 2013 (IRIN) - It was an ambitious plan to circumcising the majority of men in Swaziland, an effort to reduce the risk of HIV transmission in a country with the world&apos;s highest HIV prevalence. How could it have gone wrong? </description><body><![CDATA[MBABANE 13 May 2013 (IRIN) - It was an ambitious plan to circumcising the majority of men in Swaziland, an effort to reduce the risk of HIV transmission in a country with the world's highest HIV prevalence. How could it have gone wrong? 

“First they told me that circumcision will not really protect me against HIV. Then they tell me that I cannot have sex for some weeks or months after circumcision. I told them ‘fusaki’ [get out]!” Eric Dlamini, a 22-year-old law student, told IRIN. 

These views are at the heart of the failure of the Accelerated Saturation Initiative (ASI) to achieve more than a fraction of its targeted goal, the circumcision of 80 percent of Swazi males between ages 15 and 49 within a year. 

The programme, a partnership between the Ministry of Health and Social Welfare and the US-based Futures Group, was launched in 2010, and extended to 30 March 2012 when initial efforts showed a failure to achieve targeted results. But only about 20 percent - or 32,000 - of the targeted demographic were circumcised through the programme. 

US$15.5 million was spent on the programme, or $484 per circumcised male. 

“We do not believe [ASI] was a failure but an additional prevention measure that is contributing to the overall combination efforts to end the HIV/AIDS pandemic in the country,” US Embassy in Swaziland spokesperson Molly Sanchez Crowe told the local press. 

Imposed from outside?

Male circumcision has been scientifically proven to reduce a man's risk of contracting HIV through vaginal intercourse by as much as 60 percent. Follow-up studies have found that the effectiveness of male circumcision in HIV prevention is maintained for several years. 

Government health officials, like Minister of Health Benedict Xaba and Khanya Mabuza, the acting director of the National Emergency Council on HIV and AIDS (NERCHA), have noted that ASI taught the country important lessons and left behind several clinics and other health infrastructure. 

But a year after the programme ended, Swazi health officials are still trying to figure out what went wrong. Health workers, who spoke to IRIN on the condition of anonymity, pointed out that the programme was hastily implemented. They wondered why the short implementation time was not extended. Ending the programme, they fear, may suggest to international donors that the country is a hopeless cause. 

“We have been struggling with HIV for 20 years, and we see programmes come and go. Some are fads... and some are not well thought out. The Swaziland programme came from the outside. The health ministry was willing to go along because there was money there. But it was imposed,” said Thandi Mduli, an HIV testing officer in Manzini. 

Officials with health-oriented NGOs admitted to IRIN they are “terrified” of criticizing an initiative funded by the “mighty” US President’s Emergency Plan for AIDS Relief (PEPFAR) and involving the global population control NGO Population Services International (PSI). 

The ASI programme was an attempt to duplicate in Swaziland the circumcision successes seen in Kenya and other countries, without apparently doing the pre-campaign ground work. Kenya has carried out an estimated 477,000 circumcisions since its programme started in 2008, according to the government. [ http://www.irinnews.org/Report/96717/KENYA-Push-to-meet-2013-male-circumcision-targets ] 

In 2011, UNAIDS and PEPFAR launched a five-year plan to have more than 20 million men in 14 eastern and southern African countries undergo medical male circumcision by 2015. 

Reasons for failure 

“There were a lot of issues involving male circumcision that were not properly explained to Swazi men, so they rejected it and they talked to their friends, and word of mouth was negative instead of positive. This is the opposite of what a campaign like this needs to work,” said NERCHA's Mabuza. 

Other issues included unfamiliarity of the procedure. “When I heard I would still have to wear a condom, I said, ‘What is the point?’” said Samkelo Mduli, a university student. 

A survey commissioned by the Futures Group in 2011 found that although there was a 91 percent awareness of circumcision, nationally, the largest barrier to circumcision was fear of pain. Other barriers included fear of something going wrong, and a general lack of understanding of the procedure. [ https://www.k4health.org/toolkits/male-circumcision-swaziland ] 

Another reason for the rejection of circumcision was not anticipated by ASI promoters: belief in witchcraft, which is widespread in Swaziland. Criminals are known to seek “strengthening” potions made with human body parts. Killings associated with “ritual murder” routinely correspond with national elections. Victims, usually children or older people, are found with body parts missing. One attack made headlines in the Swazi press recently. 

“That’s also what I wanted to know, and they wouldn’t tell me - what happens to my foreskin once it is cut off?” said Mduli. 

Health Minister Xaba alluded to this when he told the Times of Swaziland, “Some men feared that the foreskin could end up in wrong hands, being used by some unscrupulous people for their ulterior motives.” 

“This is embarrassing and nobody wants to talk about it,” said the programme director of a faith-based HIV/AIDS initiative in Manzini. “The circumcision initiative failed because of this arrogance on the part of its promoters. It would have been easy to be honest and explain to the Swazi men that their foreskins would be incinerated like all surgical refuse. But the promoters said, ‘Oh, no, we can’t talk about witchcraft. What will the donors say?’” 

jh/kn/rz 

]]></body><pubDate>Mon, 13 May 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/98023/Circumcision-plans-go-awry-in-Swaziland</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2011/201110270744480110t.jpg"/></td><td valign="top">MBABANE 13 May 2013 (IRIN) - It was an ambitious plan to circumcising the majority of men in Swaziland, an effort to reduce the risk of HIV transmission in a country with the world&apos;s highest HIV prevalence. How could it have gone wrong? </td></tr></table>]]></content:encoded></item><item><title>Europe’s undocumented migrants struggle to access healthcare</title><pubDate>Thu, 25 Apr 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/20058301t.jpg" />]]>NAIROBI 25 April 2013 (IRIN) - Europe&apos;s financial crisis and rising xenophobia are complicating access to medical treatment for undocumented migrants, according to a new report by the international NGO Médecins du Monde (MdM).</description><body><![CDATA[NAIROBI 25 April 2013 (IRIN) - Europe's financial crisis and rising xenophobia are complicating access to medical treatment for undocumented migrants, according to a new report [ http://www.mdm-international.org/IMG/pdf/MdM_Report_access_healthcare_in_times_of_crisis_and_rising_xenophobia.pdf ] by the international NGO Médecins du Monde (MdM). 

"Soaring unemployment rates, rising child poverty, people losing their homes because of insolvency every month… The social systems in Europe are quaking under the strain," the authors say. "The crisis has generated austerity measures that have had a deep impact on all social safety nets, including healthcare provision."

"The economic crisis, rising unemployment and lower levels of social protection all too often lead to the finger being pointed at groups that were already facing social exclusion before the crisis, eg, sex workers, migrants and Roma [a marginalized ethnic community," they added.

Because migrants from countries with high HIV prevalence represent a significant number of diagnosed HIV cases in the European Union (EU), analysts fear that their exclusion from healthcare could lead to public health problems. In 2010, the European Centre for Disease Prevention and Control (ECDC) reported [ http://ecdc.europa.eu/en/publications/publications/hiv-migration-meeting-report.pdf ] that approximately 35 percent of new heterosexual infections in the EU were diagnosed in migrants from sub-Saharan Africa; around 60 percent of these cases were reported in Belgium, Sweden and the UK.

Poor access to care

"Undocumented migrants with HIV/AIDS are one of the most vulnerable groups in Europe today. Undocumented migrants have very limited access to healthcare services, receiving only emergency care in many EU member states," Elisabeth Schmidt-Hieber, communications officer for the NGO Platform for International Cooperation on Undocumented Migrants [ http://picum.org/ ], told IRIN. "Those with HIV/ AIDS often face insurmountable barriers to accessing prevention, diagnosis and treatment, both of the virus and of other illnesses arising from their health condition."

Language barriers, integration problems and poor socioeconomic status make migrants even more prone to exclusion from healthcare.

Although a few countries, such as Italy, make a clear commitment to providing life-prolonging antiretroviral drugs (ARVs) to undocumented HIV-positive migrants who need them, most countries do not. A 2012 ECDC report notes that antiretroviral therapy (ART) is not available to undocumented migrants in 16 EU and European Economic Area countries. According to the MdM report, in 2012, the Spanish government reduced public health expenditure from 10.6 percent of the national budget in 2009 to 6 percent in 2012. Spain has since excluded adult undocumented migrants from public healthcare. The country no longer provides HIV/AIDS, cancer, renal failure or hepatitis treatment for undocumented migrants.

In Sweden, HIV and AIDS testing and treatment is only available to undocumented migrants after the full cost has been paid. There is also no access to hepatitis testing or treatment. However, after many complaints from human rights groups, the Swedish government decided to review its healthcare regulations for undocumented migrants and asylum seekers.

There are a few exceptions. In Portugal, antiretroviral drugs are considered so important that they are immediately available to everyone, including undocumented migrants. By contrast, healthcare in general is available only after three months of residence. In 2012, the UK changed its policy on the provision of ARVs to include all people [ http://www.plusnews.org/Report/96483/HIV-AIDS-Free-ARVs-for-all-in-England ] living in the UK, regardless of immigration status.

According to the MdM report, healthcare is being used by some countries to regulate migration flows. In Germany, although access to HIV treatment is provided, civil servants are required to report undocumented migrants seeking health services to the immigration department. Because of this, many avoid any treatment for themselves or their children, even though they are entitled to it. MdM reported that between 22 and 36 percent of vulnerable patients - including undocumented migrants, sex workers and drug users - had quit looking for medical care.

The European AIDS Treatment Group (EATG), an organization focusing on drug development, treatment literacy and treatment advocacy, told IRIN that there are signs in some countries that migrants - even those living with HIV - are being deported more actively [ http://www.irinnews.org/report/97815/Europe-s-forced-returnees-claim-abuse ] than before. Through a joint project called REVA, the Swedish police have joined hands with the Migration Board and the Prison and Probation Service to increase the number of deportations. Random identity checks have made many migrants afraid to leave their homes - further limiting their access to care.

Anti-immigrant sentiment, policies

"There is a more active policy of sending back. This [is] clearly to avoid paying [for] HIV drugs… especially if the country of origin has access to certain drugs," Koen Block, the executive director of EATG, told IRIN. 

Rising unemployment due to the economic crisis has also led to an increase in anti-immigrant attitudes. In 2012, the Racist Violence Recording Network reported 87 incidents of racist violence against refugees and migrants in Greece, for example [ http://www.unhcr.gr/fileadmin/Greece/News/2012/pr/ConclusionsOctober2012EN.pdf ].

In February, the Belgian Public Centre for Social Welfare in Antwerp, headed by a member of the right-wing N-VA party, decided that it would no longer automatically reimburse [ http://www.designersagainstaids.com/press/item/not_all_seropositive_people_are_equal_anymore_in_antwerp ] undocumented migrants living in the city for ARVs, unless they promised to return to their country of origin as soon as possible. Civil society groups who oppose the plan say it is against the law.

Analysts say that these measures, aimed at cost-saving, are counterproductive. "Indirect costs are rising as illnesses become aggravated and chronic as the result of delayed treatment, overcrowding of emergency services and inefficient public health policy," Frank Vanbiervliet, MdM's European project coordinator, told IRIN.

According to the EU Agency for Fundamental Human Rights, in 2012, irregular migrants were entitled to emergency healthcare in 20 out of 27 EU member states. (Portugal and Greece consider HIV an emergency.) In nine out of the 20 countries - Cyprus, Estonia, Lithuania, Luxembourg, Malta, Romania, Slovakia, Spain and Slovenia - irregular migrants are provided with access to emergency healthcare free of charge. In Austria, Bulgaria, the Czech Republic, Denmark, Finland, Greece, Hungary, Ireland, Latvia, Poland and Sweden, undocumented migrants are entitled to emergency healthcare, but have to pay for it.

In Greece [ http://www.irinnews.org/report/96518/MIGRATION-Fear-and-loathing-on-the-streets-of-Athens ], undocumented migrants have no access at all to healthcare except for emergency care, and only until the condition has been stabilized. Although HIV is considered an emergency, it is unclear what "stabilization" means, says the MdM report. 

However, critics say that the term “emergency” is too vague and is already causing confusion. "Do you merely define it as a life-threatening condition that needs attention within the hour to prevent death? What about the woman that is six months pregnant and comes to the hospital with heavy cramps - she also mentions that she has already lost a child before. What about someone with type II diabetes and high blood pressure who risks a serious cardiovascular complication within the next months?" Vanbiervliet asked.

"Merely allowing access to 'emergency care' puts us in an impossible position as health professionals. We ask for all EU member states to implement the opinions of the EU Fundamental Rights Agency, which means changing restrictive legal frameworks so that everyone can access all forms of essential preventive and curative healthcare," he added. 

lam/kr/rz

]]></body><pubDate>Thu, 25 Apr 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97922/Europe-s-undocumented-migrants-struggle-to-access-healthcare</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/20058301t.jpg"/></td><td valign="top">NAIROBI 25 April 2013 (IRIN) - Europe&apos;s financial crisis and rising xenophobia are complicating access to medical treatment for undocumented migrants, according to a new report by the international NGO Médecins du Monde (MdM).</td></tr></table>]]></content:encoded></item><item><title>Shortages of new one-a-day ARV pills in South Africa</title><pubDate>Fri, 19 Apr 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2007/2007062614t.jpg" />]]>JOHANNESBURG 19 April 2013 (IRIN) - Just days into the rollout of fixed-dose combination (FDC) antiretrovirals (ARVs) by South Africa’s HIV treatment programme - the world&apos;s largest - activists are raising fears of drug shortages.</description><body><![CDATA[JOHANNESBURG 19 April 2013 (IRIN) - Just days into the rollout of fixed-dose combination (FDC) antiretrovirals (ARVs) by South Africa’s HIV treatment programme - the world's largest - activists are raising fears of drug shortages. 

Patients on the triple-therapy regimen will be able to take just one pill daily to control the virus. This has the advantages of improving adherence, simplifying regimens so that prescribing errors are reduced, and enabling the introduction of community models of care. 

Motsoaledi launched the phased rollout of FDCs on 8 April at a small community health centre north of the country's capital, Pretoria. New patients and HIV-positive women who are pregnant or breastfeeding will be the first to receive the new medication. They will initially receive a one-month supply of FDCs, while stable patients will be given a three-month supply. 

"The central procurement unit in the national department of health has worked tirelessly with suppliers, provincial medical depots as well as facilities, to ensure that depots placed orders with suppliers, and health facilities placed orders with depots," Health Minister Dr Aaron Motsoaledi said. "We are confident that we have sufficient supplies of ARVs for all patients who are eligible for the FDCs." 

But stock shortages have already been reported in Western Cape Province and more are thought to be occurring in other provinces, according to activists. In March, the Western Cape Department of Health told AIDS lobby group the Treatment Action Campaign (TAC) and Médecins Sans Frontières (MSF) / Doctors Without Borders that it had received significantly smaller stocks of the FDCs than had been ordered from suppliers. 

Dr Lynne Wilkinson, the MSF project coordinator in Khayelitsha, a township on the outskirts of Cape Town, said this meant the depot could not maintain the usual two- or three-month buffer stock. 

The ARV tender, worth about US$672 million, was awarded in November 2012 [ http://www.plusnews.org/Report/96930/SOUTH-AFRICA-New-ARV-tender-drops-prices-changes-treatment ]. It logged the country's second consecutive drop in drug prices and also introduced a 3-in-1 pill combining tenofovir, emtricitabine and efevarinz. 

Researcher Simonia Mashangoane said TAC continues to receive reports from health facilities in Mpumalanga and Gauteng provinces, with some saying they have received insufficient supplies of the FDCs. Recent shortages of the ARV, lamivudine, have also been reported. In a joint statement with the National Association of People Living with HIV and AIDS (NAPWA), TAC criticised the health department’s communications and called for clear timelines regarding the introduction of FDC drugs. 

"Public announcements created the expectation that the pills will be widely available from 1 April, but non-priority groups might have to wait many more months before being switched to the FDCs," TAC and NAPWA said in their statement. "Patients have not been given any indication as to when the various phases will be initiated, and how long they will have to wait." 

Wilkinson said there are also concerns that because new ARV patients have been prioritized to receive the FDC, they could be especially vulnerable if FDC stockouts force clinicians to switch them to the old regimen of three separate ARVs. 

"Newly initiated patients are counselled about the treatment that they are about to receive," Wilkinson told IRIN. "The problem is if they are counselled on how to take one pill a day, and in a few months that stock runs out and they have to be put on three separate pills, the clinic has to re-counsel them. If that doesn't happen, then there's a chance patients won't take the treatment properly." 

According to Western Cape Department of Health spokesperson Hélène Rossouw, the problem lies with the National Department of Health. “The problem is that the national government procures the medicines, so it’s all centralized at the national level in accordance with treasury regulations,” Rossouw told IRIN. “The awarding of the tenders… the signing of contracts… takes time.” 

"What’s happening in the Western Cape is a domino effect of [those delays],” she added. “The Western Cape Minister of Health Theuns Botha is looking at the possibility of procuring our own stocks separately because we have had too many problems with national government delays, and our patients go without.” 

Supply and demand 

The inability of pharmaceutical companies to ramp up production to meet demand after winning a tender has at times been seen as contriuting to the threat of drug shortages. 

Stavros Nicolaou, Senior Executive at Aspen Pharmacare, one of three companies to be given the FDC tender, said the latest award had sought to avoid stockouts at dispensing level by introducing a grace period for suppliers. Aspen is the largest supplier of generic medicines to the public and private health sectors in South Africa, he said, and is also the only local company producing the FDCs. 

"Historically, what happened was that a tender was awarded on 15 December, and on 1 January… you'd be expected to supply," Nicolaou told IRIN. "If it was the first time you were going to supply, you had to have anticipated winning the tender to be ready to go out with product on the first of January." 

Drug companies need about three months of lead-time to order, ship, receive and assure the quality of the active pharmaceutical ingredients needed for manufacturing drugs. In the case of FDCs, Aspen had also had to make structural alterations to its manufacturing facilities to accommodate the special technology required to manufacture a pill that combines three drugs. 

Nicolaou said he did not believe that any possible FDC shortage was attributable to the inability of drug companies to supply. He noted that Aspen and other drug companies had met with the Department of Health in June 2012, before the tender was opened, to devise feasible timelines for ramped up production of the FDCs, develop plans for a phased rollout, and discuss the requirements of the tender, which hinged largely on projections of how many patients would make the switch to FDCs. 

Stopping stockouts 

An estimated 70 to 80 percent of patients on the triple regimen are expected to make the switch by the end of the year. To combat stockouts, data is being collected on a weekly basis from provincial depots to identify weaknesses in the supply chain, and the department has also instituted monthly meetings with suppliers, at which three-month forecasts are presented. 

Recent stockouts of regularly prescribed ARVs in Gauteng Province have been attributed to financial management problems, including corruption, in the provincial department of health, rather than to supply-chain issues. The Gauteng provincial treasury intervened in December 2012. 

"We've been told that some of the drug shortages in Gauteng are due to poor budgeting and financial management," said TAC provincial coordinator Stephen Ngcobo. "We did our own research and found that... the budget was not covering the need, and that the [ARV] budget had been cut in half over the past two or three years, and this was having an effect… [now]." 

Activists have begun a civil disobedience campaign in the province to draw attention to ARV and other drug stockouts, and civil society organizations will soon be launching a project to monitor supply problems. 

llg/kn/he 

]]></body><pubDate>Fri, 19 Apr 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97880/Shortages-of-new-one-a-day-ARV-pills-in-South-Africa</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2007/2007062614t.jpg"/></td><td valign="top">JOHANNESBURG 19 April 2013 (IRIN) - Just days into the rollout of fixed-dose combination (FDC) antiretrovirals (ARVs) by South Africa’s HIV treatment programme - the world&apos;s largest - activists are raising fears of drug shortages.</td></tr></table>]]></content:encoded></item><item><title>Unwelcome side effects of mining in Mozambique</title><pubDate>Thu, 11 Apr 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2011/201107261238340824t.jpg" />]]>TETE 11 April 2013 (IRIN) - It is 15.45 in the afternoon and two young women are already sitting outside the Night Clinic in Moatize, a small town in Mozambique&apos;s northern Tete Province, near one of the largest coal mines in the southern hemisphere, owned by Brazilian mining giant, Vale. The national 123 road cuts through the town, and the clinic lies just off it, intentionally located to bring its services as close as possible to its target patients: miners, truck drivers and sex workers.</description><body><![CDATA[TETE 11 April 2013 (IRIN) - It is 15.45 and two young women are already sitting outside the Night Clinic in Moatize, a small town in Mozambique's northern Tete Province, near one of the largest coal mines in the southern hemisphere, owned by Brazilian mining giant, Vale. The national 123 road cuts through the town, and the clinic lies just off it, intentionally located to bring its services as close as possible to its target patients: miners, truck drivers and sex workers. 

"When the big mining companies were established here, people started moving in from neighbouring countries: Zimbabwe, Malawi and Zambia. Tete became a window of hope, but when people don’t find the jobs they hoped to find, many of them end up involved in prostitution or criminality," said Oswaldo Inacio Jossiteala, a programme officer at the International Centre for Reproductive Health (ICRH). 

Every mining boom brings the fear of a rising HIV infection rate, particularly in a country like Mozambique, where the estimated prevalence is already 11.3 percent. 

Although the incidence of infection in Tete has been stable at 7 percent, officials are concerned that this could be changing. In an interview with Radio Mozambique, Domingos Viola, the coordinator of the provincial working group for the fight against HIV/AIDS, noted that in 2012, 35,000 cases of sexually transmitted infections (STIs) were registered in the area, 10,000 of them in Moatize, at the centre of the coal boom, which has just 40,000 residents. 

The recently opened Night Clinic is part of a project called the Improved Sexual and Reproductive Health and Rights Services for Most at Risk Populations (MARP) in Tete, set up with the goal of reducing STIs and HIV in Tete and Moatize. 

Most of the patients are between 16 and 35 years old, and 30 to 35 receive medical attention every evening. According to Jossiteala, "The target group are often stigmatized when they go to ordinary clinics - we believe they find it easier to come here, and that the new clinic will attract more patients." 

The project is a collaboration between Mozambican health authorities, the International Centre for Reproductive Health, USAID, and the Flemish International Cooperation Agency (FICA) [ http://www.icrh.org/projects/improved-sexual-and-reproductive-health-and-rights-services-for-most-at-risk-populations-in ]. Vale has contributed $200,000 for the infrastructure, while the local health authority is paying for staff and medicines. 

The Night Clinic has activists working in local communities, at trucks stops and guesthouses, trying to convince target groups to visit and make use of the services. They also lobby for the rights of sex workers in the province. 

"If a sex worker is beaten by a customer, or if a customer doesn’t pay, the women have the right to take the case to court. But since most of them are here illegally, that is very difficult. The women are afraid that the authorities will turn against them, but now we see small changes in the attitudes." 

The Mozambican media last year reported cases of policemen abusing foreign sex workers in Tete and soliciting bribes from them, but Jossiteala noted that since clinic staff began educating sex workers about their rights, this is slowly changing. 

As mining companies flourish in the province, residents are growing increasingly unhappy with the inadequate contribution of the firms to the wellbeing of surrounding communities. Most of the people working in the mines are men under 40 years old, many of them living alone. Américo Conceicão, acting Permanent Secretary of Tete Province, has urged the mining companies to do more. 

"They have internal HIV-programmes, but how their employees act affects the whole community, not just the mining company. They need to work together with the health authorities concerning these issues," he said. 

Carla Mosse, the provincial director of health in Tete, hopes that with the worrying rise in the incidence of STIs and HIV, mining companies will step up and play a bigger role. 

"We are too disorganized. We need to elaborate a provincial plan for social responsibility where we, together with the companies, have decided what they will contribute each year. Now, if we need something we send a letter asking for help, and the answer is always, ‘No, no, no’." 

awn/kn/he 

]]></body><pubDate>Thu, 11 Apr 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97822/Unwelcome-side-effects-of-mining-in-Mozambique</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2011/201107261238340824t.jpg"/></td><td valign="top">TETE 11 April 2013 (IRIN) - It is 15.45 in the afternoon and two young women are already sitting outside the Night Clinic in Moatize, a small town in Mozambique&apos;s northern Tete Province, near one of the largest coal mines in the southern hemisphere, owned by Brazilian mining giant, Vale. The national 123 road cuts through the town, and the clinic lies just off it, intentionally located to bring its services as close as possible to its target patients: miners, truck drivers and sex workers.</td></tr></table>]]></content:encoded></item><item><title>Boost for healthcare in DRC</title><pubDate>Sun, 31 Mar 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201304020549030977t.jpg" />]]>NAIROBI 31 March 2013 (IRIN) - The British government has announced a major new programme aimed at providing essential healthcare to six million people in the Democratic Republic of Congo (DRC). The five-year, US$270.7 million project will focus on rebuilding health facilities, training health workers, and supplying drugs and equipment.</description><body><![CDATA[NAIROBI 31 March 2013 (IRIN) - The British government has announced a major new programme [ https://www.gov.uk/government/news/new-british-boost-for-healthcare-in-drc ] aimed at providing essential healthcare to six million people in the Democratic Republic of Congo (DRC). The five-year, US$270.7 million project will focus on rebuilding health facilities, training health workers, and supplying drugs and equipment.

Civil war has destroyed much of the country’s health infrastructure, as well as the road networks and vital services such as electricity, meaning patients often have to travel long distances to health centres that may not be equipped to handle their complications.

IRIN has put together a list of five health issues in DRC that require urgent attention:

Maternal and Child Health - DRC’s maternal mortality ratio [ http://www.unfpa.org/sowmy/resources/docs/country_info/profile/en_DRC_SoWMy_Profile.pdf ] is 670 deaths per 100,000 live births, with an estimated 19,000 maternal deaths annually. The country has a severe shortage of health workers - less than one health professional is available per 1,000 people.

With 170 out of every 1,000 children dying before they reach the age of five and 10 percent of infants underweight, DRC has one of the worst child health indicators [ http://www.unicef.org/sowc2012/pdfs/SOWC%202012-Main%20Report_EN_13Mar2012.pdf ] in the world. It is one of five countries in the world in which about half of under-five deaths occur. Some of the biggest killers of children are diarrhoea, malaria, malnutrition and pneumonia.

Sexual violence - Several studies report high levels of sexual violence perpetrated against women, children and men in DRC, both by armed groups and within the home; one study [ http://jama.jamanetwork.com/article.aspx?articleid=186342 ], conducted in the North and South Kivu and Ituri in 2010, found that 40 percent of women and 24 percent of men had experienced sexual violence.

Between the stigma of rape and the dearth of decent health services in DRC, sexual violence often leaves survivors injured, infected with sexually transmitted illnesses and severely traumatized. Some of the main requirements are first aid and trauma services, counselling, diagnosis and treatment of sexually transmitted infections, HIV post-exposure prophylaxis and access to contraception.

During a recent visit to eastern DRC, UK Foreign Secretary William Hague announced $312,110 in new funding [ http://physiciansforhumanrights.org/press/news/uk-announces-funds-to-help-survivors-of-rape-democratic-republic-of-congo.html ] to support the NGO Physicians for Human Rights, which works at Panzi Hospital in South Kivu Province, “to help efforts to develop local and national capacity to document and collect evidence of sexual violence”.

Diarrhoeal diseases - The consumption of unsafe water is one of the main causes of the diarrhoeal diseases - such as cholera - that infect and kill children and adults in DRC. A cholera epidemic that started in June 2011 has infected tens of thousands and killed more than 200 people. In the capital, Kinshasa [ http://www.irinnews.org/report/95384/DRC-Poor-sanitation-systems-hinder-fight-against-cholera ], which has been hit by the epidemic, less than 40 percent of people have no access to piped water. According to the UN Children’s Fund, UNICEF [ http://www.unicef.org/media/media_68359.html ], 36 million people in DRC live without improved drinking water, and 50 million without improved sanitation.

Some of the measures to boost access to safe water and sanitation include hygiene awareness campaigns, rehabilitation of water supply and of sanitation facilities, disinfection of contaminated environments, chlorination of water, and distribution of soap.

Immunization - Despite the existence of an effective vaccine for measles at a cost of roughly $1 per vaccine, the disease is one of the leading killers of children in DRC. According to the Global Alliance for Vaccines [ http://www.gavialliance.org/library/news/gavi-features/2012/seth-berkley-visits-dr-congo-to-view-progress-on-immunisation/ ], 20-30 percent of children in DRC do not have access to immunization. Some challenges to universal vaccine coverage include the poor road network, the size of the country (DRC is Africa’s second largest country), unreliable electricity for vaccines that require refrigeration, and low awareness within the population.

HIV - More than one million people in DRC are living with HIV; 350,000 of these qualify for life-prolonging antiretroviral drugs, but only 44,000 - or 15 percent - are actually on treatment. Just 9 percent of the population knows of their HIV status, largely because of low awareness, but also because of a shortage of facilities - for instance, only one laboratory in the country is equipped to carry out polymerase chain reaction tests for early infant diagnosis.

Just 5.6 percent of HIV-positive pregnant Congolese women receive ARVs to prevent transmission of HIV to their babies; according to government figures, the mother-to-child transmission [ http://www.plusnews.org/Report/95346/DRC-End-of-mother-to-child-HIV-transmission-still-a-long-way-off ] rate is about 37 percent.

Humanitarian agencies have called on the government and donors to urgently boost funding [ http://www.plusnews.org/Report/95412/DRC-HIV-effort-needs-government-donor-commitment-to-succeed ] for HIV prevention, treatment and care.

kr/rz

]]></body><pubDate>Sun, 31 Mar 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97761/Boost-for-healthcare-in-DRC</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201304020549030977t.jpg"/></td><td valign="top">NAIROBI 31 March 2013 (IRIN) - The British government has announced a major new programme aimed at providing essential healthcare to six million people in the Democratic Republic of Congo (DRC). The five-year, US$270.7 million project will focus on rebuilding health facilities, training health workers, and supplying drugs and equipment.</td></tr></table>]]></content:encoded></item><item><title>Activists fear less focus on HIV after 2015</title><pubDate>Thu, 28 Mar 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201303290329450154t.jpg" />]]>BANGKOK 28 March 2013 (IRIN) - As a UN high-level panel completes worldwide consultations to pick development goals for 2015 and beyond, PlusNews consulted experts to see how HIV/AIDS might fit into this new agenda.</description><body><![CDATA[BANGKOK 28 March 2013 (IRIN) - As a UN high-level panel completes worldwide consultations [ http://www.post2015hlp.org/ ] to pick development goals for 2015 and beyond, PlusNews consulted experts to see how HIV/AIDS might fit into this new agenda. 

The UN Secretary General’s Special Envoy for AIDS in Asia and the Pacific, Prasada Rao, told IRIN countries have generally done well on Millennium Development Goal (MDG) 6, which seeks to stop new HIV infections by 2015. Twenty-two of the 33 countries that have seen a drop in HIV incidences from 2001-2010 are in sub-Saharan Africa, the hardest-hit region. New HIV infections have been halved from their levels a decade ago, but the goal needs to be carried forward, said Rao. “We can’t just drop it here. We need to go the full length.”

When the MDG goals were presented in 2000 - along with a 2015 deadline to meet them - the idea of an AIDS-free world invited incredulity, said the envoy. But prevention and treatment gains in recent years changed perceptions, he added. “It is no longer [just] an aspiration, but an achievable [goal]… The time has come when we really need to look at this concept of ending AIDS and how to position it in the post-2015 agenda.”

Since August 2012, the UN has held 83 national consultations on creating goals for 2015-2030 [ http://issuu.com/undevelopmentgroup/docs/global-conversation-begins-web ]. For health-related goals, a draft report [ http://www.irinnews.org/pdf/health_agenda_post_2015.pdf ] has been prepared for the 27-member high-level panel. The draft is based on months of moderated debates, web-based consultations, e-surveys, e-discussions and face-to-face meetings with civil society groups, governments, researchers as well as more than 100 position papers [ http://www.worldwewant2015.org/health ]. 

Focus moving away from HIV?

The 28 February draft includes calls for HIV to be included in the new goals, but also suggestions to move beyond disease-specific goals (an “overly narrow, target-driven approach” according to the UK NGO Health Poverty Action) to address health equity, non-communicable disease [ http://www.irinnews.org/report/97048/HEALTH-How-we-live-and-die ] and weak health systems. 

During the consultations, there were already signs that HIV might lose attention, the International Council of AIDS Service Organizations (ICASO) wrote in a December 2012 release [ http://www.icaso.org/announcements/aids-epidemic-the-end-is-here-not-quite ]: “There are rumblings that the post-2015 health agenda will focus on cancer, diabetes, heart disease and other less politicized afflictions. HIV is no longer seen as a crisis; ironically the AIDS response is being dealt a blow by its own success.”

ICASO, along with Stop AIDS Alliance and International Civil Society Support, hosted an online survey, webinars and a January meeting in Amsterdam [ http://www.worldwewant2015.org/
file/311569/download/338668 ] for HIV, tuberculosis and malaria advocates. 

The health draft report currently reads: “Pulling back from these goals now would waste the profitable investments made to date. Ending preventable child and maternal deaths, and ending the epidemics of HIV, tuberculosis and malaria should be reaffirmed as global priorities.”

The Bill & Melinda Gates Foundation has cautioned against “an overarching health goal that covers such a long list of issues that is it impossible to set any priority” while Stop AIDS Alliance called for “approaches that place human rights and equity at the centre [and] move away from the top-down thinking that characterized the MDGs”. 

Clarity needed

At a meeting on health [ http://www.worldwewant2015.org/node/332068 ] in the post-2015 agenda, held in Botswana earlier this month, participants lauded gains facilitated by MDGs - increased funding and attention to global health, for one - but also noted how these goals led to “fragmented approaches to development”. 

For Asia’s AIDS envoy, Rao, goals have to be demystified to attract supporters, including parliamentarians, to fight HIV. “Otherwise, it looks very exotic. What do you mean by an AIDS-free generation? One of the [slogans] we used at UNAIDS was ‘End AIDS’, but what do you mean by ‘End AIDS’? You need to translate that into clearly actionable strategies and programmes. What needs to be done in the next 10 years to end AIDS?”

For him, those steps are: reduce new HIV infections to negligible levels, with elimination targets; provide antiretroviral (ARV) treatment to at least 80 percent of those who need it; and change laws, or their enforcement, that have blocked access to HIV prevention and treatment services [ http://www.plusnews.org/Report/94817/ASIA-Breaking-down-legal-barriers-to-HIV-information-access ].

One target of MDG 6 is to provide ARVs to all in need by 2010; this target is still unmet. According to the 2012 MDG Progress Report [ http://www.un.org/millenniumgoals/pdf/MDG%20Report%202012.pdf ], from 2008-2010, about 1.3 million new people were enrolled and retained on ARVs. At this rate, less than 14 million people will be receiving treatment at the end of 2015, over one million short of the 15 million target, the report calculated. 

The post-2015 panel is expected to present its recommendations to the UN Secretary-General this June. 

pt/rz

]]></body><pubDate>Thu, 28 Mar 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97750/Activists-fear-less-focus-on-HIV-after-2015</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201303290329450154t.jpg"/></td><td valign="top">BANGKOK 28 March 2013 (IRIN) - As a UN high-level panel completes worldwide consultations to pick development goals for 2015 and beyond, PlusNews consulted experts to see how HIV/AIDS might fit into this new agenda.</td></tr></table>]]></content:encoded></item><item><title>Indonesia to override patents for live-saving medicines</title><pubDate>Mon, 25 Mar 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201303251314210920t.jpg" />]]>JAKARTA 25 March 2013 (IRIN) - The Indonesian government hopes to implement one of the largest ever examples of “compulsory licensing”, which will enable the generic manufacture of drugs still under patent.</description><body><![CDATA[JAKARTA 25 March 2013 (IRIN) - The Indonesian government hopes to implement one of the largest ever examples of “compulsory licensing”, which will enable the generic manufacture of drugs still under patent. 

Advocates of the move say the reduced drug costs achieved through compulsory licensing have been instrumental in reducing HIV mortality rates in Indonesia. 

“One of the major reasons for decreased HIV mortality rates is the provision of anti-retroviral [ARV] treatment, and if [Indonesia] can’t afford the anti-retroviral treatment, the mortality rate will return” to the higher levels of previous years, Samsuridjal Djauzi, chairman of the Association of Indonesian Physicians Concerned about HIV/AIDS, told IRIN. 

The latest use of compulsory licensing - Indonesia’s third to date - will allow the government to expand its access to the second-line ARVs, he said, including tenofovir, emtricitabine, and lopinavir/ritonavir. 

Under the World Trade Organization's Trade Related Aspects of Intellectual Property Rights (TRIPS), countries can override patents for public health purposes by issuing compulsory licenses that enable the generic manufacture of drugs still under patent. 

“Urgent need” 

In this latest move, a September 2012 [ http://www.ihs.com/products/global-insight/industry-economic-report.aspx?id=1065972339 ] presidential decree announced the government would procure generic equivalents of the international patents for seven HIV/AIDS and hepatitis B medicines, citing the “urgent need” to control these diseases. 

“The implementation of the third compulsory licensing depends on the capability/readiness of the manufacturer [Kimia Farma]. I estimate efavirenz [another HIV medication on the list] [ http://www.ihs.com/products/global-insight/industry-economic-report.aspx?id=1065972339 ] will be available in the next three to six months. For other drugs, [we] will need more time,” Djauzi said. 

According to UNAIDS [ http://www.unaids.org/en/regionscountries/countries/indonesia/ ], an estimated 380,000 people are living with HIV/AIDS in Indonesia. The number may not appear alarming considering that Indonesia is a developing country with nearly 250 million people, but the prevalence rate is now 25 percent higher than it was a decade ago. 

The spread of HIV is attributed to low condom use and epidemic-level infection rates - 36.4 percent - among injecting drug users, experts say. 

The cost of normal treatment is around US$90 per person per month, Usep Solehudin, who coordinates free distribution of ARVs for some 120 patients at a clinic in Jakarta called Yayasan Pelita Ilmu (YPI), told IRIN. This is beyond the means of most of his patients, whose incomes are generally $100 to $200 per month. 

“The patients would not otherwise be able to buy it [the ARVs] because they cannot afford it,” he said. “They would just ignore their health.” 

Jakarta first used compulsory licensing in 2004, ushering in increased medication access. 

The number of Indonesians receiving ARVs has quadrupled since 2008, to 30,000 today, and the government is looking to maintain this rate of expansion, said Cho Kah Sin, country director of UNAIDS in Indonesia. 

The latest government license focuses on second-line ARVs, which are prescribed to patients who have developed resistance to first-line treatment. Resistance in a population tends to develop within several years of a drug’s introduction. The government is therefore expecting that increasing numbers of Indonesians with HIV will require second-line treatment, said Cho Kah Sin. 

Innovation at risk? 

Critics of compulsory licensing say its usage undermines medical innovation. 

“Systematic issuance of compulsory licenses sets a negative precedent and can reduce the incentive to invest in the research and development of new medicines that address unmet medical needs,” said Andrew Jenner, director of innovation, intellectual property and trade at the Switzerland-based International Federation of Pharmaceutical Manufacturers and Associations, in a written statement to IRIN. 

“We believe that negotiated approaches, such as tiered pricing and voluntary licensing, are generally more effective and sustainable, both medically and economically,” said Jenner, whose organization represents four pharmaceutical companies whose medicines are to be generically replicated by Indonesia. Tiered pricing is the practice of setting different prices for different markets. 

Others studies [ http://pubs.aeaweb.org/doi/pdfplus/10.1257/jep.27.1.3 ], however, argue there is no empirical evidence that patents increase innovation and productivity. 

Peter Maybarduk, who directs the Global Access to Medicines Programme for Public Citizen, a US-based NGO, advocates wider use of “compulsory licensing” by developing countries. “We don’t think compulsory licensing should only be used in the most dire scenarios,” he said. 

Switzerland-based Michelle Childs, who heads the Campaign for Access to Essential Medicine for Médecins Sans Frontières, agrees: “If there is a clash between access to [essential] medicines and patent rights... the primacy of access should be promoted,” she said. 

Maura Linda Sitanggang, director-general of the pharmaceutical department at Indonesia’s Ministry of Health, did not respond to requests for an interview. 

bb/ds/rz 

]]></body><pubDate>Mon, 25 Mar 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97728/Indonesia-to-override-patents-for-live-saving-medicines</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201303251314210920t.jpg"/></td><td valign="top">JAKARTA 25 March 2013 (IRIN) - The Indonesian government hopes to implement one of the largest ever examples of “compulsory licensing”, which will enable the generic manufacture of drugs still under patent.</td></tr></table>]]></content:encoded></item><item><title>Tackling poverty and disease with innovative health financing</title><pubDate>Tue, 19 Mar 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201303190721300614t.jpg" />]]>MAPUTO 19 March 2013 (IRIN) - Mozambique has become the latest African country to implement a financial transaction tax (FTT) and airplane levy to fund health services in developing countries, part of the UNITAID initiative. Philippe Douste-Blazy, board chairman of the international financing mechanism, spoke to IRIN about the state of play in innovative health financing.</description><body><![CDATA[MAPUTO 19 March 2013 (IRIN) - Mozambique has become the latest African country to implement a financial transaction tax (FTT) and airplane levy to fund health services in developing countries, part of the UNITAID initiative. Philippe Douste-Blazy, board chairman of the international financing mechanism, spoke to IRIN about the state of play in innovative health financing. 

Q: We’ve heard a lot about innovative financing since HIV funding began to flat-line in 2009. What’s happened since? 

A: We began with a levy on plane tickets in 2006 in France and 13 countries. In the last two months, we’ve added Morocco. This week, we have been told Mozambique will also join. We’ve also added Chad, and I hope that discussions with Japan are going to continue. 

It’s very important to understand why we do innovative financing… We are living through one of the biggest economic crises in history. You cannot ask members of parliament in Europe or the United States for money. We should continue to try, but it is impossible. We have to ask Brazil, India, China, South Africa, Russia to give more - but they don’t do that. So we have to create innovative financing mechanisms. 

The idea is very simple: to take a micro, painless, tiny solidarity contribution from activities that benefit from globalization - that’s mobile, internet, and financial transactions, plane tickets, etc. We proved that innovative financing can help achieve the Millennium Development Goals. In five years, we’ve raised US$2 billion from the small levy or tax on plane tickets. We’ve treated eight out of 10 children with HIV, 322 million people with malaria and one million people with tuberculosis. UNITAID is the first laboratory of innovative financing in the world. 

Q: Does innovative financing look different in developed countries such as France than it does in resource-poor countries like Mozambique? 

A: No. The strength of the concept is that we are all part of a global community. When a person buys a plane ticket, it is the same price in Paris, Bamako or Maputo. If you can buy a plane ticket, you can pay one dollar more; you have no difference between [the contributions of] developed and developing countries. The strength of this concept is [it fosters not only] North-South solidarity but also South-South solidarity. 

Q: Why haven’t more countries joined UNITAID? 

A: Each time I speak to a head of state, he says, “This is fantastic. We are going to do this.” After that, he speaks to his minister of finance, and his minister of finance says it’s not possible. 

In the case of FTTs, ministers of finance are afraid their stock exchanges will be bypassed. It’s false argument. In 1984, British Prime Minister Margaret Thatcher [imposed] a 0.5 percent levy per share [transacted]. This FTT didn’t change anything. Nicholas Sarkozy did it in March 2011… Now, I believe that I have convinced President Dilma Vana Rousseff of Brazil to do that as well. 

So often head of states forget 1.5 billion people are living in the South… If you are a head of state, you should have a vision for your country, of course, but also about your country in the world. That vision cannot continue to be selfish. 

Q: You are hoping the US government will join UNITAID. Explain the US government’s reluctance. 

A: The American people are the most generous people in the world. There is a culture of giving in that country… but when it is obligatory - and this is cultural - the answer is no. The word “tax” is very difficult for Americans. We have to explain to them that this is an absolutely painless, micro contribution and that it is managed by the public and private sector and civil society - not only by some big United Nations agency with the American government at the table. 

I think it is possible to get an agreement. We are a long way from convincing, them but some members of Congress are becoming convinced. 

Q: What is your top priority at the moment? 

A: When we see this gap between rich and poor grow, you can do two things: Revolution - although in history, revolution is not always success. It’s often a failure, with a lot of civil wars. The other thing to do is... use the momentum of capitalism to take innovative financing further. Say that the more traders who are going to do financial transactions, the more I am going to take 0.0001 percent of that transaction for the poor. 

The answer is to create a UNITAID movement, to take micro solidarity contribution from globalized activities. We live in a global village. It’s as true for Apple and Google as it is for the rich and the poor. 

llg/kn/rz 

]]></body><pubDate>Tue, 19 Mar 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97675/Tackling-poverty-and-disease-with-innovative-health-financing</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201303190721300614t.jpg"/></td><td valign="top">MAPUTO 19 March 2013 (IRIN) - Mozambique has become the latest African country to implement a financial transaction tax (FTT) and airplane levy to fund health services in developing countries, part of the UNITAID initiative. Philippe Douste-Blazy, board chairman of the international financing mechanism, spoke to IRIN about the state of play in innovative health financing.</td></tr></table>]]></content:encoded></item><item><title>Mozambique’s first HIV vaccine trial heralds new era in local research</title><pubDate>Fri, 15 Mar 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201207241016190211t.jpg" />]]>MAPUTO 15 March 2013 (IRIN) - Mozambique has completed its first HIV vaccine trial and is set to embark on a second, a demonstration of the country’s increased HIV research capacity.</description><body><![CDATA[MAPUTO 15 March 2013 (IRIN) - Mozambique has completed its first HIV vaccine trial and is set to embark on a second, a demonstration of the country’s increased HIV research capacity. 

This week, researchers at Mozambique’s Polana Cancio Centre for Research and Public Health completed a trial evaluating the safety of an HIV vaccine candidate. The study was conducted through the UK HIV Vaccine Consortium’s Tanzania and Mozambique HIV Vaccine Programme (TaMoVac) [ http://www1.imperial.ac.uk/medicine/research/researchthemes/infection/infectious_diseases/hiv_trials/vaccines/ukhvc/ ]. Preliminary results from the Phase I trial indicated the vaccine was safe, but researchers say it will be months before they know if the vaccine produced an immune response in participants. 

The country also launched its second HIV vaccine trial, this one of a Phase II HIV vaccine candidate, also through TaMoVac, this week. As part of this multi-site study, which is taking place in both Mozambique and Tanzania, Mozambique will recruit 20 percent of the 200-patient sample. 

According to Ilesh Jani, director general of Mozambique’s National Institute of Health, the studies, while small, mark important first steps towards bolstering clinical trial and research capacity for diseases such as HIV and malaria. These diseases, along with malnutrition, continue to drive death rates in the country [ http://www.plusnews.org/Report/90868/MOZAMBIQUE-Technology-revolution-hits-HIV-testing-and-treatment ].

“We should be in the driver's seat, not sitting in the back of the car waiting for someone to find the answer,” Jani told IRIN/PlusNews. “We need to get involved and take leadership to find the solutions.” 

“Maybe we don’t yet have the capacity to develop these products in the lab, but we have the capacity to test them and accelerate discovery,” he added. 

Larger HIV vaccines trials in the pipeline 

The centre - which is located on the outskirts of the capital city, Maputo - aims to help the National Institute of Health understand the health concerns of the country’s increasingly peri-urban population. 

“Maybe half of Mozambique will be living in peri-urban areas in the next 10 years,” Jani said. “It’s a setting where we don’t completely understand the determinants of health.” 

Understanding these determinants will require household mapping and an HIV prevalence study. Researchers at the centre expect that this study will show an HIV prevalence rate of at least three percent in the local community. 

If this is true, Polana Cancio could become a clinical research site for larger, more advanced HIV vaccine trials. Nationally, Mozambique has an HIV prevalence rate of about 11 percent, according to UNAIDS. 

The centre will also be conducting a study into common causes of fever. 

Jani added that, while it might not be possible for the all the products tested by the centre to enter the market patent-free, he hopes that products tested at the centre - and found to be effective - will be affordable for use in countries like Mozambique. 

llg/kn/rz 

]]></body><pubDate>Fri, 15 Mar 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97657/Mozambique-s-first-HIV-vaccine-trial-heralds-new-era-in-local-research</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201207241016190211t.jpg"/></td><td valign="top">MAPUTO 15 March 2013 (IRIN) - Mozambique has completed its first HIV vaccine trial and is set to embark on a second, a demonstration of the country’s increased HIV research capacity.</td></tr></table>]]></content:encoded></item><item><title>In Brief: Condoms needed in PNG prisons</title><pubDate>Thu, 14 Mar 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2010/201012021344220326t.jpg" />]]>BANGKOK 14 March 2013 (IRIN) - A Papua New Guinea (PNG) study released today calls for condoms to be made more widely available in prisons.</description><body><![CDATA[BANGKOK 14 March 2013 (IRIN) - A Papua New Guinea (PNG) study released today calls for condoms to be made more widely available in prisons.

“All prisoners must have condoms,” Angela Kelly, one of the authors of the study [ http://www.pngimr.org.pg/research%20publications/Kelly%20et%20al%202012%20%20Emerging%20HIV%20Risk%20in%20PNG.pdf ] by the PNG Institute of Medical Research, told IRIN, noting that they could help prevent the spread of HIV/AIDS.

Although condoms are one of the government’s key HIV prevention tools, there is no official policy in place regarding prisons, with many viewing their distribution as supporting male-to-male sex which is illegal in PNG.

The study found that unsafe, forced and consensual male-to-male sex was taking place in four of the country’s 19 overcrowded prisons visited; some sexual relations were long-term, some sex was for goods or as a punishment, and some involved more than one partner.

Only one of the four prisons provided condoms to inmates; most prison staff believed condoms encouraged sex, the study found. While there is no figure for HIV prevalence in PNG prisons, it is widely believed to exceed the national average of 0.8 percent.

ds/cb

]]></body><pubDate>Thu, 14 Mar 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97646/In-Brief-Condoms-needed-in-PNG-prisons</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2010/201012021344220326t.jpg"/></td><td valign="top">BANGKOK 14 March 2013 (IRIN) - A Papua New Guinea (PNG) study released today calls for condoms to be made more widely available in prisons.</td></tr></table>]]></content:encoded></item><item><title>Uganda government under pressure to boost ARV funding</title><pubDate>Thu, 14 Mar 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201210031338410066t.jpg" />]]>KAMPALA 14 March 2013 (IRIN) - The Ugandan government&apos;s draft 2013/2014 budget allocates US$38.5 million to enrol a further 100,000 people living with HIV on life-prolonging antiretroviral (ARV) drugs. But activists say the money, while welcome in a country still largely dependent on donor funds for its HIV programmes, is not sufficient to meet treatment needs.</description><body><![CDATA[KAMPALA 14 March 2013 (IRIN) - The Ugandan government's draft 2013/2014 budget allocates US$38.5 million to enrol a further 100,000 people living with HIV on life-prolonging antiretroviral (ARV) drugs. But activists say the money, while welcome in a country still largely dependent on donor funds for its HIV programmes, is not sufficient to meet treatment needs.

"With the current allocation and funding, we still have a long way to go," said Raymond Byaruhanga, the executive director of the AIDS Information Centre (AIC). "We need the government‘s commitment to increase the number of people on ARVs and decrease the number of those getting HIV if we are to achieve universal access."

The country enrolled an estimated 65,493 new HIV patients on ARVs in 2012, bringing to 356,056 the number of those on ARV therapy (ART), according to Uganda AIDS Commission statistics. However, this figure represents less than 70 percent of those in need of treatment. The government has set a target of reaching 80 percent of HIV-positive people with ARVs by 2015.

"The government efforts to contribute more funding for adding more patients on ART is commendable. However, we still need additional resources for scaling up on evidence [-based] interventions in order to be in position to halve the new infections," Monica Dea, senior programme advisor for the US Centres for Disease Control in Uganda, told IRIN.

Playing catch up

Uganda has seen its HIV prevalence rise from 6.4 to 7.3 percent over the past five years. Experts say the rising prevalence [ http://www.plusnews.org/Report/95116/UGANDA-Higher-HIV-rate-cause-for-concern ] means the government must work doubly hard to ensure even more people are placed on treatment, especially given recent research showing ARVs have a role in preventing HIV transmission [ http://www.plusnews.org/Report/93251/HIV-AIDS-Treatment-as-prevention-the-tough-road-ahead ].

But limited funding, frequent drug stocks outs, too few CD4 count machines - which measure patients’ immune strength - and understaffing in the public health sector continue to hamper plans to achieve universal ART access.

According to Alex Ario, programme manager at the health ministry’s AIDS control programme, the financial gap in the public sector for 2013/2014 is about $29 million.

"WHO [the UN World Health Organization] is changing its treatment guidelines in the coming months in order to act on exciting new science that shows that treatment saves lives and is one of the most powerful HIV-prevention tools available. This means that in 2013, the number of people in Uganda clinically eligible for treatment will expand beyond just those whose CD4 is less than 350," Asia Russell, director of international policy at the Health Global Access Project (Health GAP), told IRIN. "Despite this, the draft Budget Framework Paper for the health sector proposes no increase in investment for HIV treatment."

"Ugandan civil society is calling on the government to substantially increase its investment in ART for financial year 2013/14 in order to save lives, slash rates of new infections, and begin to end the AIDS epidemic," she added.

Corruption

Activists have also expressed disappointment in a local pharmaceutical plant [ http://www.plusnews.org/Report/74715/UGANDA-Factory-to-boost-ARV-rollout ] - started in 2007 and jointly owned by a local company, Quality Chemicals Industries Limited (QCIL), and Indian generics giant Cipla Limited - that was expected to improve treatment access by providing cheaper ARVs locally. However, the factory's drugs have remained overpriced, and the plant is currently embroiled in a $17.8 million corruption scandal.

In a 20 December 2011 report to Uganda's President Yoweri Museveni, then acting government anti-graft boss Raphael Baku noted that between December 2009 and October 2010, the government’s National Medical Stores (NMS) paid $17.8 million more than it should have to QCIL, in violation of its Memorandum of Understanding (MoU) with the government. The funds allocated for ARV procurement in the budget are intended for purchasing drugs manufactured by QCIL.

QCIL and NMS are accused of manipulating the MoU in order to achieve a 15 percent mark-up on imported drugs; the mark-up had actually been intended only for locally produced drugs. QCIL is also accused of continuing to sell imported drugs manufactured by Cipla to the government at inflated prices even after it started producing its own drugs.

QCIL denies the allegations.

The inspector general of government, anti-corruption activists and HIV activists have demanded the government recover the funds and prosecute those involved. 

"Our government is good at creating institutions, but when it comes to implementing their recommendations, it fails," said Cissy Kagaba, the executive director the Anti-Corruption Coalition Uganda (ACCU). "We demand for an immediate action on the reports of the oversight government organs to specifically recovery all the monies lost. This is the taxpayers’ money."

Asuman Lukwago, the permanent secretary at the Ministry of Health, told IRIN that action would be taken on the reports.

"[ARVs] should be readily available to all who need them because they are life-saving drugs. I think it is treacherous for someone to overprice the drugs because this makes them inaccessible to the most vulnerable, who will most likely end up dying," said Stephen Watiti, a senior medical officer at Mildmay Uganda, an HIV treatment centre close to the capital, Kampala.

New ways to fund HIV programmes

According to Ario, the government is seeking alternative ways to fund ARVs. "Strategies are being explored to increase domestic HIV funding, such as establishing the HIV Trust Fund," he said.

The Ugandan government recently developed a draft working paper on establishing this $1 billion fund [ http://www.plusnews.org/Report/96443/UGANDA-HIV-trust-fund-in-the-works ] for its HIV/AIDS programmes.

"I support the establishment of a trust fund by adding a levy on such items like beer, cigarettes, airtime or introducing an AIDS tax to make sure all money needed to sustain ART is available instead of depending on donors [for] 80-90 percent, as is the case at the moment," said Watiti.

so/kr/rz

]]></body><pubDate>Thu, 14 Mar 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97651/Uganda-government-under-pressure-to-boost-ARV-funding</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201210031338410066t.jpg"/></td><td valign="top">KAMPALA 14 March 2013 (IRIN) - The Ugandan government&apos;s draft 2013/2014 budget allocates US$38.5 million to enrol a further 100,000 people living with HIV on life-prolonging antiretroviral (ARV) drugs. But activists say the money, while welcome in a country still largely dependent on donor funds for its HIV programmes, is not sufficient to meet treatment needs.</td></tr></table>]]></content:encoded></item><item><title>Third-line ARVs could widen treatment gap in Zimbabwe</title><pubDate>Tue, 12 Mar 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2007/2007062614t.jpg" />]]>HARARE 12 March 2013 (IRIN) - HIV/AIDS activists in Zimbabwe have welcomed the government’s move to address the problem of HIV drug resistance by introducing third-line antiretroviral drug (ARVs). But it remains unclear how the cash-strapped government will finance this, as procuring the drugs will invariably be expensive and could divert resources away from other HIV treatment efforts.</description><body><![CDATA[HARARE 12 March 2013 (IRIN) - HIV/AIDS activists in Zimbabwe have welcomed the government’s move to address the problem of HIV drug resistance by introducing third-line antiretroviral drug (ARVs). But it remains unclear how the cash-strapped government will finance this, as procuring the drugs will invariably be expensive and could divert resources away from other HIV treatment efforts.

As ARV access improves, an increasing number of patients will eventually need third-line medicines, which are used when patients stop responding to first- and second-line treatment regimens. Research by PharmAccess, a Dutch foundation providing HIV treatment services to the private sector in sub-Saharan Africa, has shown that in 11 countries, transmitted drug resistance increased by 38 percent for each year the country scaled-up ARV treatment.

Yet third-line drugs are either unaffordable or unavailable in many developing countries.

Zimbabwe, which introduced ARV therapy in 2004, is reaching an estimated 347,000 people with treatment, but 600,000 are estimated to be in need of the drugs. Currently, those who have failed to respond to second-line treatment are being referred to research organizations.

Poorly resourced

Owen Mugurungi, the national coordinator of the HIV/AIDS and tuberculosis unit in Zimbabwe’s health ministry, says the government is considering introducing third-line ARVs to respond to treatment failures on the first- and second-line regimens. Mugurungi attributed treatment failures to lack of drug adherence and drug resistance [ http://www.plusnews.org/Report/91866/AFRICA-Need-for-systematic-HIV-drug-resistance-testing ].

HIV drug resistance can be acquired, in which resistance develops following a patient’s poor adherence to treatment, or transmitted, in which a person becomes infected with a drug-resistant strain of the virus [ http://www.who.int/hiv/facts/drug_resistance/en/index.html ].

Mugurungi told IRIN/PlusNews that the government was working with the University of Zimbabwe to determine the number of people who had developed resistance to treatment. Levels of drugs resistance in sub-Saharan Africa are under 5 percent, but a few surveillance studies in East and Southern Africa have reported increasing levels of transmitted drug resistance [ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3537300/ ].

HIV/AIDS activists fear that drug resistance and treatment failure could be linked to the government’s poor management of the national HIV/AIDS treatment programme.

Tinashe Mundawarara, the Zimbabwe Lawyers for Human Rights project manager for HIV, human rights and law, said cases of resistance should not be surprising given the country’s poorly resourced health care system. Frequent drug stock-outs may have contributed to treatment interruptions, for example. 

“Drug resistance must be addressed quickly because delay may result in the resistance spreading to other related drugs, thus limiting future treatment options. It is good that the government has noticed the problem and seeks to address it,” said Mundawarara.  “We applaud that.”

Widening treatment gap

But Itai Rusike, director of the Community Working Group on Health, has raised concerns that introducing a third-line drug regimen could further widen the treatment gap.

“In a way, it is a welcome move. But the reality on the ground is that there are people on the ground that have not even enjoyed the first-line treatment,” said Rusike. “Only 40 percent of people in need of ARVs are on treatment. And then for us to move to the next stage, which is even more expensive, is condemning those in need of treatment to death because they may never access treatment after this.”

Rusike, whose organization works to ensure the equitable distribution of health resources in the country, said the majority of people in need of treatment still lack access to it.

“With this development, many of them may never graduate to the first-line treatment. So what we are saying is let us attend to the basics first. We have people who have been on the waiting list for years,” said Rusike. 

For HIV/AIDS activist Stanley Takaona, third-line treatment options will require greater management of the national ARV programme to prevent drug stock-outs. He said this is critical because after third-line treatment, there are no other options [ http://www.plusnews.org/Report/95991/ZIMBABWE-Activists-slam-poor-management-of-ARV-supply ].

“Once the drugs have been introduced, the government needs to invest a lot in the care and management of patients on third-line to promote rigorous drug adherence, regular C4D count and full blood count tests to monitor how patients are responding to treatment.”

He added, “But meanwhile, there are still many people whose lives still depend on accessing the first-line.”

Zimbabwe has about 1.2 million people living with HIV. The number of people needing treatment increased when Zimbabwe adopted the World Health Organization treatment guidelines recommending patients begin treatment at a CD4 count of 350, compared to the 200 count in earlier treatment guidelines. Pregnant women and infants living with HIV are being initiated on treatment regardless of their CD4 count [ http://www.plusnews.org/Report/87263/GLOBAL-WHO-sets-new-HIV-treatment-guidelines ].

st/kn/rz

]]></body><pubDate>Tue, 12 Mar 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97627/Third-line-ARVs-could-widen-treatment-gap-in-Zimbabwe</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2007/2007062614t.jpg"/></td><td valign="top">HARARE 12 March 2013 (IRIN) - HIV/AIDS activists in Zimbabwe have welcomed the government’s move to address the problem of HIV drug resistance by introducing third-line antiretroviral drug (ARVs). But it remains unclear how the cash-strapped government will finance this, as procuring the drugs will invariably be expensive and could divert resources away from other HIV treatment efforts.</td></tr></table>]]></content:encoded></item><item><title>Has HIV funding revived lagging health systems?</title><pubDate>Wed, 06 Mar 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201210181651140537t.jpg" />]]>JOHANNESBURG 06 March 2013 (IRIN) - The HIV/AIDS epidemic arrived in sub-Saharan Africa after decades of neglect had left healthcare systems dangerously weak, barely able to cope with the onslaught of patients. Then the money started pouring in - funding for HIV programmes rose from 5.5 percent of health aid in 1998 to nearly half of it almost 10 years later.</description><body><![CDATA[JOHANNESBURG 06 March 2013 (IRIN) - The HIV/AIDS epidemic arrived in sub-Saharan Africa after decades of neglect had left healthcare systems dangerously weak, barely able to cope with the onslaught of patients. Then the money started pouring in - funding for HIV programmes rose from 5.5 percent of health aid in 1998 to nearly half of it almost 10 years later. 

But the jury is still out on whether the large sums of AIDS funding have made healthcare systems more resilient, whether " the capacity gains conferred over the past decade will be durable as donors pull out [and whether] previous, pre-aid boom fragilities in service delivery and volatility in public spending would be reduced in the post-donor period," noted Amanda Glassman, director of global health policy and research at the Washington-based Center for Global Development [ http://WWW.CGDEV.ORG ]. 

Some have argued [ http://www.irinnews.org/Report/86754/GLOBAL-AIDS-funding-debate-heats-up ] that the AIDS epidemic has helped generate an overall increase in health funding and mobilized an international push for more equitable healthcare access. But others maintain that the billions of donor dollars spent fighting HIV/AIDS in the last decade have done little to strengthen fragile national health systems. 

In the initial, emergency phase of the epidemic, donors bypassed [ http://www.plusnews.org/Report/81331/HAITI-Donors-single-out-AIDS ] weak areas of national health systems to set up structures that would yield faster results. On the ground, this meant modern HIV/AIDS clinics, fully staffed and equipped, offering free services in one corner of a public hospital, while the rest of the hospital limped along with inadequate infrastructure, high user fees and staff shortages. 

"It was appropriate and inevitable at the time. We had to react the way we did. Now, we need to be responsive to the current situation and what we learned," said Alan Whiteside, executive director of the Health Economics and HIV/AIDS Research Division (HEARD) at the University of KwaZulu-Natal. 

Lessons learned

It is difficult to assess whether donor funding has increased resilience [ http://www.irinnews.org/Report/97584/Understanding-resilience ], but gains in health status and HIV/AIDS service coverage - such as the number of eligible people receiving antiretrovirals (ARV) and the number of pregnant women receiving services to prevent mother-to-child transmission of the virus - suggest that health-system capacity has been strengthened, Glassman told IRIN. 

Even with its health sector crippled by tuberculosis (TB) and HIV epidemics, South Africa's antiretroviral programme [ http://www.irinnews.org/Report/96935/SOUTH-AFRICA-Treatment-programme-by-numbers ] is now the biggest in the world - over 1.7 million HIV-positive people are treated by the government. And in this year's budget speech, Finance Minister Pravin Gordhan announced plans to put an additional 500,000 people on treatment each year. 

"The [treatment programme] has added staff and resources to the base of the health system, brought in a whole lot of technical assistance from the outside, and, in an intangible way, it has raised hope amongst [healthcare] providers," said Helen Schneider of the School of the Public Health at the University of the Western Cape. 

HIV treatment programmes have created new regiments [ http://www.irinnews.org/Report/87694/AFRICA-Task-shifting-new-technology-crucial-to-ending-mother-to-child-transmission ] of healthcare workers, including lay counsellors and patients with good ARV adherence who assist with adherence counselling through clinics and community outreach. The community outreach approach has been extended to home-based care for patients with extensively drug-resistant TB. In addition, to deal with the scarcity of doctors, nurses have been certified to initiate HIV treatment and to expand access to HIV treatment. 

Community health has been positively affected. A recent study [ http://www.africacentre.ac.za/Default.aspx?tabid=595 ] conducted in South Africa's KwaZulu-Natal Province - one of the regions hardest hit by the HIV epidemic - found that increased access to ARV therapy has raised adult life expectancy by more than 11 years since 2004. The observed increase in life expectancy was one of the most rapid in the history of public health, noted the authors of the study, released in the February edition of the journal Science. 

But major challenges remain - particularly for countries that are over-reliant on international funding and that still don't spend enough of their domestic budgets on health. 

The real test 

As AIDS becomes a chronic and manageable condition, donors are turning their attention to strengthening health systems. The Global Fund to Fight AIDS, TB and Malaria has acknowledged that weak health systems have limited the performance potential of its projects. The US President's Emergency Plan for AIDS Relief [ http://www.iom.edu/Reports/2013/Evaluation-of-PEPFAR.aspx ] (PEPFAR) is looking at a "deeper integration of HIV services into existing national programs and systems".  

And the real test to measure the resilience of health systems is yet to come. "We won't really know if that strengthening can be sustained until donors phase out," Glassman told IRIN. 

Savvy recipient countries that have used donor funds earmarked for specific diseases to build their health systems will fare better. Rwanda [ http://www.irinnews.org/Report/95428/RWANDA-Substantial-HIV-funding-has-not-hurt-other-patient-care ], for example, used its Global Fund and PEPFAR monies to fund insurance coverage for the poor, including benefits related to HIV, TB and malaria. 

"Governments that allowed all the donor spending off-budget on AIDS will have a major problem building resilience, and the transition arrangements [for when donors pull out] in those settings are still vague," Glassman warned. 

kn/rz 

-----------------------------------------------------------------------------------------------------------
Building resilience

A series of articles exploring what resilience means for vulnerable communities, and its impact on the architecture of aid
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]]></body><pubDate>Wed, 06 Mar 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97601/Has-HIV-funding-revived-lagging-health-systems</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201210181651140537t.jpg"/></td><td valign="top">JOHANNESBURG 06 March 2013 (IRIN) - The HIV/AIDS epidemic arrived in sub-Saharan Africa after decades of neglect had left healthcare systems dangerously weak, barely able to cope with the onslaught of patients. Then the money started pouring in - funding for HIV programmes rose from 5.5 percent of health aid in 1998 to nearly half of it almost 10 years later.</td></tr></table>]]></content:encoded></item><item><title>HIV/AIDS: Disappointment in HIV prevention trial</title><pubDate>Tue, 05 Mar 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2008/2008052210t.jpg" />]]>JOHANNESBURG 05 March 2013 (IRIN) - A three-year clinical trial involving over 5,000 women in East and Southern Africa has found that pre-exposure prophylaxis (PrEP) - whether a vaginal gel or an oral tablet - is not effective at preventing HIV infection in young, unmarried women.</description><body><![CDATA[JOHANNESBURG 05 March 2013 (IRIN) - A three-year clinical trial involving over 5,000 women in East and Southern Africa has found that pre-exposure prophylaxis (PrEP) - whether a vaginal gel or an oral tablet - is not effective at preventing HIV infection in young, unmarried women.

The Vaginal and Oral Interventions to Control the Epidemic (VOICE) study - involving HIV-negative women in South Africa, Uganda and Zimbabwe - aimed to test the safety, effectiveness and acceptability of three HIV-prevention methods: daily use of a vaginal gel containing the antiretroviral (ARV) drug tenofovir; daily use of oral tablets containing tenofovir, and daily use of oral Truvada, a combination of tenofovir and another ARV, emtricitabine. In 2011, VOICE stopped testing oral tenofovir and tenofovir gel after reviews found that it was not effective, leaving only the Truvada arm of the trial to continue. 

But ultimately none of the products worked among the women enrolled in the trial, as most participants did not use them daily as recommended, researchers found. 

Of the 5,029 women enrolled in VOICE, 312 acquired HIV during the trial - an overall HIV incidence of 5.7 percent - nearly twice the rate that researchers had expected when designing the study. 

PrEP 

"Although there may be other explanations for why these products don't always work to prevent HIV, it's hard to ignore the fact that so few women in our study used them. Clearly an approach of daily product use is not going to work for the population of women who participated in VOICE," said Jeanne Marrazzo, one of the trial's investigators. 

"We can't determine whether the products were effective with very, very low rates of product use," Marrazzo noted. 

Adherence makes all the difference in PrEP, which involves giving anti-HIV drugs to HIV-negative people to prevent infection in case of exposure. According to Mike Chirenje, another trial investigator, in other trials where the products had been used consistently, Truvada had been found to be effective in preventing HIV transmission. 

In July 2011, scientists announced that the Partners PrEP trial [ http://www.irinnews.org/Report/93226/HIV-AIDS-More-proof-that-PrEP-works ] had ended a year early after finding overwhelming evidence of the effectiveness of oral tenofovir and Truvada in preventing HIV infection among sero-discordant couples; earlier in the year, a major randomized clinical trial, HPTN 052, found that treating an HIV-infected individual reduced the risk of sexual transmission of HIV to an uninfected partner by as much as 96 percent. 

In 2010, the Centre for the AIDS Programme of Research in South Africa (CAPRISA) found that a vaginal gel containing tenofovir used before and after sex prevented four out of ten HIV infections. 

But in April 2011, the FEM-PrEP study found that giving HIV-negative women Truvada to prevent them from getting HIV was ineffective [ http://www.irinnews.org/Report/93847/HIV-AIDS-Setback-for-PrEP-as-branch-of-trial-is-halted ]: there was no difference in HIV incidence between women taking Truvada and women taking placebo. Adherence levels in this study were also low, Chirenje told journalists during a telephone briefing. 

Adherence 

Researchers analysed blood samples from 773 VOICE study participants and found adherence to the medication was low across all groups: the drug was detected in 29 percent of blood samples from women in the Truvada group, 28 percent in the oral tenofovir group and 23 percent among those in the tenofovir gel arm. To make matters worse, young, single women were the least likely to use PrEP, despite their higher risk of becoming HIV-positive. In the Truvada arm of the trial, the ARV was detected in the blood of only 21 percent of younger, single women, compared to 54 percent of those married and over age 25. 

An adherence rate of 80 percent would "give you a really good signal of what's working," Chirenje told IRIN/PlusNews. 

Adherence was calculated to be 90 percent, however, based on what the trial participants told researchers and on monthly counts of unused gel applicators and leftover pills. Trial investigators are currently analysing the results to determine why the women did not use the products. 

“Biomedical tools do not work in a vacuum but rather in the complex realities of women’s and girls’ lives. The women of VOICE and other prevention trials have much to tell us. Now we need to listen to what they are saying and design prevention options based on a better understanding of their reproductive and sexual health needs and desires, their perceptions of personal risk for HIV infection, and their interest in and ability to use the products offered in those trials,” Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition (AVAC), said in a statement. 

kn/rz 

]]></body><pubDate>Tue, 05 Mar 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97593/HIV-AIDS-Disappointment-in-HIV-prevention-trial</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2008/2008052210t.jpg"/></td><td valign="top">JOHANNESBURG 05 March 2013 (IRIN) - A three-year clinical trial involving over 5,000 women in East and Southern Africa has found that pre-exposure prophylaxis (PrEP) - whether a vaginal gel or an oral tablet - is not effective at preventing HIV infection in young, unmarried women.</td></tr></table>]]></content:encoded></item><item><title>Analysis: Condoms continue to confound Uganda</title><pubDate>Fri, 01 Mar 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2009/200907170659220562t.jpg" />]]>KAMPALA 01 March 2013 (IRIN) - The condom has played a central role in Uganda’s official HIV prevention strategy for over two decades, but the country has yet to get it right, with condom use declining and the government unable to meet what demand does exist.</description><body><![CDATA[KAMPALA 01 March 2013 (IRIN) - The condom has played a central role in Uganda’s official HIV prevention strategy for over two decades, but the country has yet to get it right, with condom use declining and the government unable to meet what demand does exist.

The country's ‘ABC’ strategy for HIV prevention - Abstinence, Being faithful and Condom use - had early success in lowering HIV prevalence, but the government later faced accusations [ http://www.americanprogress.org/wp-content/uploads/issues/2010/01/pdf/pepfar.pdf ] of bowing to US pressure to emphasize abstinence over condom use, which experts say has hurt prevention efforts.

Now experts say that if the country is to roll back rising HIV prevalence [ http://www.irinnews.org/Report/95116/UGANDA-Higher-HIV-rate-cause-for-concern ], the condom must reclaim its place as one of the main components of Uganda's HIV prevention strategy. 

"The fact that there is a recorded increase in new HIV infections is a proxy indicator that the tool that is known to prevent HIV has been used in a relaxed manner. Condoms have been long established as one of the most effective technologies for the prevention of not only HIV but also STIs [sexually transmitted infections] and unwanted pregnancies," said Milly Katana, a long-time HIV activist and one of the inaugural board members of the Global Fund to fight HIV, Tuberculosis and Malaria.

"In order to have consistent condom use among sexually active populations that are at risk of HIV infection, the country needs to go back to basics - people who have scientific evidence of the efficacy of condoms [should] work with communities in providing accurate information that is not based on moral judgments and biases."

"This is a crisis"

Research shows that while high-risk sex is common, condom use is not. According to the 2011 AIDS Indicator Survey [ http://health.go.ug/docs/UAIS_2011_REPORT.pdf ], "among respondents age[d] 15-49 who were sexually active in the preceding 12 months, 17 percent of women and 34 percent of men engaged in sex with a non-marital, non-cohabiting partner. Of them, 29 percent of women and 38 percent of men reported using condoms at the most recent high-risk sex."

This represents a sharp decline from the 47 percent of men and women in this age group who used condoms during high-risk sex in 2005.

"This is a crisis government must not ignore. The government must support all efforts to increase access to and use of condoms through aggressive condom promotion, fixing chronic procurement delays and reforming the outmoded post-shipment batch testing requirement," Alice Kayongo Mutebi, HIV/AIDS policy adviser for the Community Health Alliance Uganda, told IRIN.

The post-shipment testing requirement was introduced following a scandal in 2004 in which government-subsidized ‘Engabu’ (meaning “shield”) condoms failed a "free from holes" and "smell" test [ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)71861-4/fulltext ]; the requirement has, in the past, lead to delays in condoms reaching the public, sometimes resulting in condom shortages [ http://www.plusnews.org/Report/38009/UGANDA-New-import-measures-lead-to-condom-shortage ].

According to Vastha Kibirige, the Ministry of Health’s condom programme coordinator, although Uganda requires some 240 million condoms annually, the public sector procures just half that, and some years, as few as 80 million.

"Condom use is erratic in Uganda, partly because they are not always available to users," Kibirige told IRIN. "Condoms are not on the essential drugs list and therefore, for the public sector, condoms are [supplied] as per available resources from UNFPA [the UN Population Fund] and USAID [the US Agency for International Development] or the Global Fund... This support is given when the resources are available rather than when the country needs condoms."

But critics say the government must reduce its reliance on donors and increase domestic spending on vital HIV services such as the purchase of condoms.

Kibirige said the government was currently working to launch a new brand of condoms - the first since the Engabu fiasco - within three months.

"We are still doing research, design and branding in order to produce attractive and more appealing condoms for the public," she added. "We need to step-up social mobilization... condom promotion and education for the key populations, as well as programmes targeting the vulnerable populations, including married people." 

Denis Kibira, medicines adviser at the Coalition for Health Promotion and Social Development Uganda, cast doubt on the efficiency of the government's condoms delivery channels.

"Condoms are also mainly distributed through the public health facilities, and it is questionable that if one wants a condom, they will endure and queue up at a health facility," he told IRIN. "In contrast, you will not find condoms in places where they should be... such as public entertainment places like bars and restaurants. We need to make use of dispensing facilities for condoms in the restrooms of all public places."

Leadership

But, Kibira adds, placing condoms in the right venues without a clear message on their use would be counterproductive. "The condom campaigns are hurt by the lack of support and mixed messages sent out by, especially, the political leadership," he said. 

"Our HIV prevention strategy lists ABC, but political leadership - and, in particular, the president - comes up to frequently emphasize A and B, and has openly spoken against safe medical male circumcision," he added. "This confuses the public."

President Yoweri Museveni has criticized [ http://www.youtube.com/watch?v=T5j9dLnu25w ] the emphasis placed on condom use in Uganda's HIV strategy, saying that rather than having three equal prongs, the ABC strategy should focus on abstinence first, faithfulness second and condoms third.

And in a country where the vast majority of people are strongly religious [ http://features.pewforum.org/africa/country.php?c=228 ], religious institutions' objection to condom use plays a part in the public's perception and use of them.

"For the Catholic faith, condoms are absolutely out. The church will not advocate for the use of condoms," Vincent Karatunga, secretary for inter-religious dialogue and ecumenism at the Roman Catholic secretariat, told IRIN. "Sex is a gift from God and [should take place] strictly in marriage. It's abstinence for the unmarried and faithfulness for those who are married."

Many leaders of the increasingly popular Pentecostal churches are also vehemently anti-condom; popular preachers like Martin Ssempa [ http://www.irinnews.org/Report/39474/UGANDA-Abstinence-the-safest-or-most-dangerous-HIV-strategy ] - who has set fire to condoms during his sermons - are not only against condom use, but are also heavily critical of high-risk populations they consider immoral, including men who have sex with men (MSM) and sex workers.

High-risk populations

The Crane Survey [ http://www.uhspa.org/wp-content/uploads/downloads/2011/06/Crane-Survey-Report-Round-1-Dec10.pdf ], a 2009 study of high-risk groups in Uganda, reported that the HIV prevalence among MSM respondents was 13.7 percent, more than twice the national prevalence of about 6.4 percent. A 2011 study [ http://journals.lww.com/stdjournal/Abstract/2011/04000/HIV_and_Other_Sexually_Transmitted_Infections_in_a.13.aspx ] published in the Journal of the American Sexually Transmitted Diseases Association found that 37 percent of 1,027 female sex workers surveyed in Kampala's red-light districts were HIV-positive, compared to that year’s average national prevalence of 7.3 percent.

Widespread discrimination against MSM [ http://www.plusnews.org/Report/93586/UGANDA-Calls-for-inclusion-of-MSM-in-new-HIV-strategy ] and sex workers [ http://www.plusnews.org/Report/89771/UGANDA-Sex-workers-demand-rights-not-rescue ], including by health workers, keeps them from accessing vital HIV prevention services, including condoms and safe personal lubricant [ http://www.irinnews.org/Report/97517/Lack-of-lube-hurts-HIV-prevention ].

The national HIV strategy does not make any provisions for HIV prevention among sex workers and MSM; activists say including them would present legal challenges given that same-sex activity and sex work are both illegal.

"These communities have very patchy coverage of effective, high-impact prevention programmes. This is a massive missed opportunity," said an activist who preferred anonymity. "There is need to protect these key populations by scaling up condoms. The higher-than-average HIV prevalence among these populations means it is particularly crucial for the government to make sure condoms are not just available, but are being used."

According to UNAIDS [ http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/JC2434_WorldAIDSday_results_en.pdf ], “popular opinion in countries with generalized epidemics is that HIV infection is found evenly across the adult population”; however, the evidence points to large numbers of new infections driven by high-risk groups such as sex workers and MSM.

Experts also say there is a need to divorce morality from public health policy if results are to be achieved. "These new figures showing rising HIV incidence and declining condom [use] require a robust, evidence-based response," Allen Kuteesa, the executive director of the Health Rights Action Group, told IRIN. "We cannot bury our heads in the sand with ineffective, moralistic approaches." 

"However much we want them to work, such [moralistic] approaches only provide false protection," Kuteesa added. "Our communities need bold scale-up of all effective prevention tools, including women-controlled methods such as the female condom, alongside biomedical approaches such as male circumcision and HIV treatment as prevention." 

so/kr/rz

]]></body><pubDate>Fri, 01 Mar 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97573/Analysis-Condoms-continue-to-confound-Uganda</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2009/200907170659220562t.jpg"/></td><td valign="top">KAMPALA 01 March 2013 (IRIN) - The condom has played a central role in Uganda’s official HIV prevention strategy for over two decades, but the country has yet to get it right, with condom use declining and the government unable to meet what demand does exist.</td></tr></table>]]></content:encoded></item><item><title>Global Fund announces first new grants under new model</title><pubDate>Thu, 28 Feb 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2012/201202280750190440t.jpg" />]]>JOHANNESBURG 28 February 2013 (IRIN) - After spending more than a year reviewing and reforming its grant process, the Global Fund to Fight AIDS, Tuberculosis and Malaria is back in business, announcing the first handful of countries slated to receive up to US$1.9 billion in available funding over the next two years.</description><body><![CDATA[JOHANNESBURG 28 February 2013 (IRIN) - After spending more than a year [ http://www.irinnews.org/Report/96405/HEALTH-A-timeline-of-Global-Fund-reforms ] reviewing and reforming its grant process [ http://www.irinnews.org/Report/96405/HEALTH-A-timeline-of-Global-Fund-reforms ], the Global Fund to Fight AIDS, Tuberculosis and Malaria is back in business, announcing the first handful of countries slated to receive up to US$1.9 billion in available funding over the next two years. 

The Democratic Republic of Congo, Myanmar and Zimbabwe are among the six countries set to receive funding under the Global Fund’s new model, the Fund announced on 28 February. 

With up to nearly two billion dollars available between now and 2014, El Salvador, Kazakhstan and the Philippines, as well as three regional programmes, will also receive new funding, including access to an incentive funding pool aimed at fostering ambitious, high-impact and co-funded interventions. 

According the Fund, countries were selected for financing this year based, in part, on whether they would face an interruption of services without new funding and whether they were currently being underfunded based on levels set by the new model. 

The new model, part of the many reforms, has introduced a system in which countries are grouped into bands based on a calculation of financial need and disease burden [ http://www.plusnews.org/Report/96385/HEALTH-The-Global-Fund-adopts-new-funding-model ].

Test driving the new model 

In awarding the new funding, the Global Fund board also chose geographically diverse countries as well as non-traditional applicants. It is looking to use these new grants as a learning opportunity, according to the new executive director, Mark Dybul [ http://www.plusnews.org/Report/96829/HEALTH-New-Global-Fund-executive-director-on-the-Fund-s-future ].

“The new funding model gives us a special chance to learn and adapt,” he said in a statement. “During this year, we will monitor various aspects of the new funding model process so that we can adapt in real time. We are a learning institution, and we will gain insight and knowledge as we work together.” 

Historically, the Fund has only accepted applications from country coordinating mechanisms (CCMs), or the bodies in charge of national Global Fund processes. The Fund has now chosen to fund civil society proposals as well, including those by the Eurasian Harm Reduction Network, a group that deals with the underserved needs of injecting drug users. 

According to Global Fund board documents, the Fund will be paying particular attention to how the new model improves services for underserved, most-at-risk populations like injecting drug users [ http://www.scribd.com/doc/127758639/Global-Fund-Board-Document-on-first-countries-to-receive-funding-under-new-model ].

An additional 50 countries, including Malawi, Swaziland and Zambia, will receive money via renewals and the extension of existing grants, or grant reprogramming, to free up already committed funding [ http://www.scribd.com/doc/127758639/Global-Fund-Board-Document-on-first-countries-to-receive-funding-under-new-model ]. 

llg/kn/rz 

]]></body><pubDate>Thu, 28 Feb 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97567/Global-Fund-announces-first-new-grants-under-new-model</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2012/201202280750190440t.jpg"/></td><td valign="top">JOHANNESBURG 28 February 2013 (IRIN) - After spending more than a year reviewing and reforming its grant process, the Global Fund to Fight AIDS, Tuberculosis and Malaria is back in business, announcing the first handful of countries slated to receive up to US$1.9 billion in available funding over the next two years.</td></tr></table>]]></content:encoded></item><item><title>Kenya’s HIV programmes steel themselves for elections</title><pubDate>Tue, 26 Feb 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2008/200804282t.jpg" />]]>NAIROBI 26 February 2013 (IRIN) - When violence broke out following the announcement of Kenya’s poll results in 2007, Henry Mwiterere and his family fled to safety shortly before their house, in the Rift Valley town of Burnt Forest, was burned to the ground.</description><body><![CDATA[NAIROBI 26 February 2013 (IRIN) - When violence broke out following the announcement of Kenya’s poll results in 2007, Henry Mwiterere [ http://www.irinnews.org/Report/77950/KENYA-Henry-Mwitirere-Kenya-I-m-displaced-but-at-least-I-can-help-other-HIV-positive-people ] and his family fled to safety shortly before their house, in the Rift Valley town of Burnt Forest, was burned to the ground.

Mwiterere, who has lived with HIV for over a decade, escaped with his life-prolonging antiretroviral drugs (ARVs), but many people were not so lucky. They were forced to abandon their ARVs in the frenzy, missing several days' doses and risking drug-resistance [ http://www.irinnews.org/Report/76288/KENYA-Drug-resistance-risk-as-displaced-HIV-patients-skip-ARV-doses ] in the process.

This time around, Mwiterere - who is a support worker with the Academic Model Providing Access to Healthcare (AMPATH) [ http://www.ampathkenya.org ], an organization that treats more than 140,000 HIV-positive people in western Kenya - says patients are much more aware. With the 2013 general election just around the corner, many are coming to collect their drugs early to ensure that, should the worst happen, they will be prepared.

"We now give patients drugs every three months, and we've seen patients coming early to collect them. Although we've seen movement - people from Kisumu, for instance, are leaving Nakuru to go home where they feel safer - people are getting their drugs and taking them with them."

Health service providers are doing their best to make sure their patients are not left stranded. Médecins Sans Frontières (MSF), which is caring for 10,500 HIV-positive people in Nyanza Province's Homa Bay and 2,400 in the Nairobi slum of Mathare, as well as hundreds of tuberculosis (TB) patients at both sites, will be operating with a full staff and with extra staff on stand-by throughout the election period. The organization has also made preparations to provide additional first aid and trauma care should it be required.

Stocking up

"In anticipation of possible election-related violence, we started to modify our patient appointments. Since September 2012, we've been adjusting their schedules to ensure that we have minimum consultations in the two weeks around the election and patients have the required medications during this period," Hajir Elyas, deputy medical coordinator for MSF, told IRIN.

"We have ordered extra supplies and medications that are provided by MSF to cover for a couple of months, but we have also liaised with the Ministry of Health, which supplies our ARVs, to create a buffer stock of medication during this period," she added.

In early 2008, MSF was able to organize mobile teams to supply health centres with additional medication; these will also be available this year, as will a 24-hour hotline for patients who find themselves without medication or the means to reach a health centre.

Joseph Sitienei, from the National AIDS and Sexually Transmitted Infections Control Programme (NASCOP), told IRIN that the government had provided additional stocks of HIV and TB medication to its health facilities ahead of the polls.
 
"Emergencies seriously disrupt people's treatment process, and with diseases like TB or HIV, where adherence is critical, the consequences of such disruptions are even more severe. We realize that," he told IRIN. "We have greatly decentralized [stocks of] both TB and HIV medicine so that they can be easily accessible during this period. The government has issued a circular to all health facilities to ensure that they all have medicines that can last for one more month over the three months of stocks they normally receive."

He said health centres had also advised patients to carry their patient cards - issued by their primary health facility and containing their history and treatment regimens - at all times so that they would be able to access their medication from the closest government-run health facility in the event of an emergency.

Sexual violence

Another major problem following the last election was the high level of sexual violence [ http://www.irinnews.org/Report/76068/KENYA-Rape-on-the-rise-in-post-election-violence ]. Women, men and children experienced rape and sexual assault, with many contracting sexually transmitted infections and suffering post-traumatic stress. Few of these cases were prosecuted; on 21 February, eight survivors of sexual violence committed during that period took the government to court [ http://www.irinnews.org/Report/97516/Post-election-rape-survivors-sue-Kenyan-government ] over its failure to protect them or investigate the crimes committed against them.

"Political violence highly increases women and even men's... risk of sexual violence and of sexual transmitted infections such as HIV," said Saida Ali, the executive director of the Coalition on Violence Against Women (COVAW).

She said the Peace Initiative Kenya, a coalition of civil society groups, were distributing dignity kits - containing reusable sanitary towels, cotton wool, a kanga (sarong), reusable baby nappies, underwear, petroleum jelly and soap - to hospitals in Nairobi to support women who may suffer sexual violence. They have also donated post-exposure prophylaxis (PEP) - a course of ARVs given to people recently exposed to HIV to reduce their likelihood of contracting the virus - to a hospital in the capital and to one in the Rift Valley.

She stressed, however, that the onus was on the government to ensure that survivors of sexual violence were able to access emergency medical treatment.

"Things that women need in an event that they report rape, like PEP, must be available at facilities," she said. "For marginalized areas like North Eastern [Province], the government should ensure that emergency centres exist, because in such places available health facilities are far apart and not easily accessible to many and particularly in emergencies."

kr/ko/rz

]]></body><pubDate>Tue, 26 Feb 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97545/Kenya-s-HIV-programmes-steel-themselves-for-elections</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2008/200804282t.jpg"/></td><td valign="top">NAIROBI 26 February 2013 (IRIN) - When violence broke out following the announcement of Kenya’s poll results in 2007, Henry Mwiterere and his family fled to safety shortly before their house, in the Rift Valley town of Burnt Forest, was burned to the ground.</td></tr></table>]]></content:encoded></item><item><title>Activists pressure Kenya&apos;s presidential candidates to act on HIV</title><pubDate>Mon, 25 Feb 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201302251208480834t.jpg" />]]>BOMET 25 February 2013 (IRIN) - A small team of HIV/AIDS activists is trailing Kenyan presidential candidates as they crisscross the country, pressing them to increase their commitment to the care and treatment of people living with HIV.</description><body><![CDATA[BOMET 25 February 2013 (IRIN) - A small team of HIV/AIDS activists is trailing Kenyan presidential candidates as they crisscross the country, pressing them to increase their commitment to the care and treatment of people living with HIV.

With just days until what is likely to be a close election, the activists are saying they can help deliver votes from many of the more than one million Kenyans living with HIV to the candidates most willing to address their concerns.

The 17 activists, who come from a range of civil society organizations, are calling on each of the eight presidential candidates to sign a manifesto guaranteeing a scale-up of HIV-testing, the elimination of mother-to-child transmission, and accelerated rollout of antiretroviral therapy (ART). After publishing their demands, the activists hit the campaign trail; they are prepared to dog candidates and disrupt rallies to secure those commitments.

Forgotten

"Many leaders, they do forget about us," said Loise Wanjiku, an HIV-positive woman from southwestern Kenya, where she says drug shortages are inhibiting the treatment of opportunistic infections associated with HIV.

Wanjiku was one of 17 activists who showed up at a recent rally by Prime Minister Raila Odinga - one of the frontrunners in the presidential race - in Bomet, Rift Valley Province, an hour and a half from her home.

"They've been attending campaign rallies from all the candidates to raise their voices, to hold up signs, to chant… and to try to urge the candidates to do more and say more about HIV, based on the demands in the manifesto," said Paul Davis, the director of global campaigns for Health Global Access Project (Health GAP) [ http://healthgap.org/ ], a US-based activist group.

Kenya faces a funding gap [ http://www.irinnews.org/Report/92750/KENYA-Protest-as-government-grapples-with-HIV-funding-shortages ] for its HIV programmes estimated at $1.67 billion. And although the country has steadily increased the number of people on ART, more than 100,000 [ http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_KE_Narrative_Report.pdf ] HIV-positive Kenyans who need the drugs have no access to them.

Yet the presidential candidates have largely been silent on the issue.

In the country's first-ever presidential debate, hosted in early February, HIV/AIDS was not mentioned until the last question, when candidates addressed it as part of the broader need for improvements in health care. In the two leading candidates’ coalition manifestos, the proposed response to HIV is even less detailed: Deputy Prime Minister Uhuru Kenyatta's Jubilee Coalition mentions HIV/AIDS patients as part of the plan for universal healthcare. Prime Minister Raila Odinga's Coalition for Reforms and Democracy does not mention HIV at all.

Promises

The rally in Bomet was the first major success of the AIDS activists' campaign. Positioning themselves around the speaker's platform with a range of hand-drawn posters, the organizers threatened to interrupt Odinga if he did not mention HIV within the first half of his speech. He responded by promising free ART to all HIV-positive Kenyans and pledging to increase the health budget to 15 percent, as African leaders promised in the Abuja Declaration in 2001 [ http://www.who.int/healthsystems/publications/abuja_declaration/en/index.html ].

HIV-positive people are "part of our society", Odinga told the massive crowd, adding that "we all deserve to be healthy". Odinga's team said he did not feel pressured by the activists, but welcomed the opportunity to interact with them.

The activists staged a similar demonstration at a Kenyatta campaign two days later in Kisii, but the candidate failed to address them. They are hopeful, however, that he will eventually respond to their demands based on his record - when Kenyatta was finance minister in 2009, he signed an agreement to increase overall health funding by 40 percent by 2013.

A Kenyatta campaign spokesperson said the team is putting together a detailed HIV/AIDS response plan, which they will release before the election.

At a rally earlier this month, Deputy Prime Minister Musalia Mudavadi, another presidential candidate, promised more funding for the health sector, saying the "nation needs healthy people to run it".

Health GAP's Davis said Odinga's promise has potential implications for the campaign. "Now the ball is in the court of the Jubilee candidates… to see if they're going to step up or run the risk of losing [the votes of] 1.6 million people with HIV, their families, their friends, their loved ones, their co-workers."

He said HIV patients were prepared to transcend the ethnic affiliations that often determine voting patterns in Kenya and vote instead for the candidate most likely to respond to their needs. In Wanjiku's case, Odinga's rally helped her make up her mind. Because he was the first candidate to commit to meeting the activists’ demands, he won her vote.

"They want somebody who will care for them," she said. "Not a tribe, but a person who is caring."

ag/kr/rz

]]></body><pubDate>Mon, 25 Feb 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97539/Activists-pressure-Kenya-apos-s-presidential-candidates-to-act-on-HIV</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201302251208480834t.jpg"/></td><td valign="top">BOMET 25 February 2013 (IRIN) - A small team of HIV/AIDS activists is trailing Kenyan presidential candidates as they crisscross the country, pressing them to increase their commitment to the care and treatment of people living with HIV.</td></tr></table>]]></content:encoded></item><item><title>Lack of “lube” hurts HIV prevention</title><pubDate>Thu, 21 Feb 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2010/201011050533290644t.jpg" />]]>KATHMANDU 21 February 2013 (IRIN) - Safer-sex messaging on condoms is universal but the generally poor availability of lubricants, and awareness of them, is hindering HIV prevention, health activists warn.</description><body><![CDATA[KATHMANDU 21 February 2013 (IRIN) - Safer-sex messaging on condoms is universal; but the generally poor availability and awareness around lubricants is hindering HIV prevention, health activists warn. 

Some personal lubricant - or “lube”- has been shown to lower the risk of HIV transmission by decreasing the risk of condoms breaking. 

Despite preliminary proof of lube’s efficacy, far less of the product is procured and distributed than condoms, leading people to use alternative, sometimes harmful, substances during intercourse such as butter or petroleum jelly; oil-based lubricants weaken latex, making the condom more likely to break. 

Activists say, however, that a blind spot [ https://www.surveymonkey.com/s/CalltoActionLubeSafety ] in research on lubricants as a part of HIV prevention programmes means not enough is known about their impact on HIV risk. 

Availability 

A 2012 survey [ http://www.msmgf.org/files/msmgf//documents/GMHR_2012.pdf ] by The Global Forum on MSM & HIV (MSMGF), a US-based coalition focused on men who have sex with men (MSM), found that barely a quarter of the 5,000 people from 165 countries surveyed reported easy access to free lubricant. A full 25 percent said free lubricant was completely unavailable. Less than 10 percent of people living in low-income countries reported easy access. 

While condoms have been part of family planning and HIV prevention work for decades, safe personal lubricant has only recently emerged as a donor priority. For example, the US government began distributing condoms in the 1970s through its aid and diplomatic missions, but its aid arm, the US Agency for International Development, only began distributing lubricant in 2008. 

“Where health systems are less developed, it is critical to help establish and maintain supply chains and distribution systems, as well as support efforts to build and accurately forecast demand [for lube],” explained a representative from the US President’s Emergency Plan for AIDS Relief (PEPFAR): 

Acknowledging the importance of using personal lubricants with condoms, especially during anal sex, the UN Population Fund (UNFPA) decided in 2012 to include water-based lubricants in the procurement list of commodities available to governmental and non-governmental clients in low and middle-income countries [ http://www.unfpa.org/public/home/procurement/AccessRH ].

However, outside of community-care settings, the real demand for lubricant remains largely misunderstood. 

Research in Burundi found that health care providers sometimes do not provide lube to patients because they consider it to be “promoting homosexual behaviour”, highly-stigmatized there [ http://www.rectalmicrobicides.org/docs/GLAM_Tookit_Version1.0_FINAL.pdf ]. With lube requests stymied in formal health care settings, NGOs can become the sole method of access. 

“Key populations - such as MSM and sex workers - who need the lubricant the most, often get their health-related services from local NGOs, which are not often included in [HIV/AIDS] policies or broader [health] programmes,” explained Bidia Deperthes, a senior HIV adviser with UNFPA’s Comprehensive Condom Programming division in New York. 

With these NGOs frequently absent from meetings with donors, lube demand can appear falsely low. 

UNFPA, a global leader in the purchase and distribution of contraceptives, spent more than 18 percent of its 2011 budget [ http://www.unfpa.org/webdav/site/global/shared/procurement/02_about/01_statistics/procurement-statistics2011.pdf ] on male condoms, but less than 0.5 percent on personal lubricants, citing donors’ and decision-makers’ lack of understanding of the true demand for the latter as one reason. 

Alternatives 

“Before there was lube from the outreach workers, I would use butter,” said Lucky, a transgender sex worker in Kathmandu, Nepal, who said she still uses non-lube products as lubricants when NGOs run out of money to fund free lubricant. 

“The condoms would break sometimes, but at least it didn’t hurt as much,” she said. 

Silicon and water-based lubricants are “condom compatible” and do not corrode latex. Other types of lubricant, including commercially-produced petroleum-based products like Vaseline, can destroy condoms and put users at risk of HIV and other sexually transmitted diseases. 

The World Health Organization (WHO) has published a list [ http://apps.who.int/iris/bitstream/10665/76580/1/WHO_RHR_12.33_eng.pdf ] of substances commonly used as alternatives to condom-compatible lubricant that may boost the risk of condom failure. 

According to an International Rectal Microbicide Advocates (IRMA) 2009 study [ http://www.rectalmicrobicides.org/docs/Chris%20Beyrer%20MSM%20Africa%20microbicides.pdf ], most MSM throughout Africa are not using condom-compatible lubricant, a trend also seen in other regions facing a high burden of HIV. 

A microbicide is a cream, gel, douche or an enema that may help reduce a person’s risk of HIV infection vaginally or rectally. Medical studies [ http://www.plusnews.org/Report/92067/HIV-AIDS-Microbicide-gel-could-stop-spread-of-HIV-during-anal-sex ] have shown rectal microbicides can offer protection in the absence of condoms and back-up protection if a condom breaks or slips off during anal intercourse. 

Distribution and access 

The American Foundation for AIDS Research and the US-based Johns Hopkins School of Public Health have identified availability of water-based lubricant and its cost as significant barriers [ http://www.amfar.org/uploadedFiles/_amfar.org/In_The_Community/Publications/MSM-GlobalRept2012.pdf ] to lubricant access in several countries including Guyana, Ukraine and China. 

Lubricant is commercially categorized differently across countries - ranging from a medical device to a cosmetic product - meaning its manufacture, import and export can encounter legal and bureaucratic cross-border delays [ http://www.rectalmicrobicides.org/docs/Lube%20safety%20Q&A%20FINAL%20Oct%2013.pdf ] before reaching users. 

Studies have found that even assuming high costs for lubricant production and distribution, “condom-compatible” lube prevention packages [ http://www.ncbi.nlm.nih.gov/pubmed/22819663 ] that include a condom plus a safe lubricant would only amount to about 1 percent of the global HIV/AIDS budget for 2011 (US$134 million). 

Call for more research 

Scientists have noted that even in places where lubricant is readily available and widely used, little comprehensive research has been conducted on its safety [ http://www.msmgf.org/index.cfm/id/11/aid/6282/lang/en ].

A 2007 global survey [ http://www.rectalmicrobicides.org/docs/IRMAColorFinalWeb.pdf ] revealed more than 100 different types of lubricants [ http://irma-rectalmicrobicides.blogspot.com/2012/12/chemical-engineering-news-studies-raise.html ] are used worldwide during intercourse. WHO has outlined [
http://apps.who.int/iris/bitstream/10665/76580/1/WHO_RHR_12.33_eng.pdf ] how vaginal and anal intercourse may require different types of lubricant. 

“Most importantly, we need to determine the safety of sexual lubricants that are on the market already,” said Jim Pickett, chair of IRMA. 

Experts see the lack of research as a disappointment 30 years into the AIDS epidemic, and as a mandate for more studies [ http://irma-rectalmicrobicides.blogspot.ca/2013/02/irma-issues-global-call-to-action-we.html ] on lubricant. 

kk/pt/cb 

]]></body><pubDate>Thu, 21 Feb 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97517/Lack-of-lube-hurts-HIV-prevention</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2010/201011050533290644t.jpg"/></td><td valign="top">KATHMANDU 21 February 2013 (IRIN) - Safer-sex messaging on condoms is universal but the generally poor availability of lubricants, and awareness of them, is hindering HIV prevention, health activists warn.</td></tr></table>]]></content:encoded></item><item><title>Cervical cancer a major threat to HIV-positive women</title><pubDate>Fri, 08 Feb 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2010/201010061008180671t.jpg" />]]>HARARE 08 February 2013 (IRIN) - HIV-positive women are living longer, but are now dying of cervical cancer. In Zimbabwe, cervical cancer is now the most common cancer among women, particularly those living with HIV. Activists are urging the government to step up efforts to prevent deaths related to the disease, accusing it of paying lip service to the problem.</description><body><![CDATA[HARARE 08 February 2013 (IRIN) - HIV-positive women are living longer, but are now dying of cervical cancer. In Zimbabwe, cervical cancer is now the most common cancer among women, particularly those living with HIV. Activists are urging the government to step up efforts to prevent deaths related to the disease, accusing it of paying lip service to the problem. 

According to the Zimbabwe National Cancer Registry, cervical cancer affects about 30 percent of women in the country. Cervical cancer is caused by the sexually transmitted human papilloma virus (HPV). Although condoms are said to lower the risk of getting HPV [ http://www.nbcnews.com/id/13461194/ ], they do not prevent the risk of acquiring this virus completely. About 1,900 women are diagnosed with the disease every year in Zimbabwe and 1,300 die, according to the UN World Health Organization [ http://www.afro.who.int/en/clusters-a-programmes/dpc/non-communicable-diseases-managementndm/programme-components/cancer/cervical-cancer/2810-cervical-cancer.html ].

Efforts poorly resourced 

In October last year, the government registered a cervical cancer vaccine for the prevention of HPV and reported that by early this year the new vaccine would be available for women in the country. However, those plans have been scuppered by financial constraints. 

A number of public health institutions in Zimbabwe, including Parirenyatwa Hospital, the country's largest referral hospital, were supported by the UN Population Fund (UNFPA) to run free cervical cancer tests known as visual inspection with ascetic acid and cervicography. While this method is faster and cheaper than the traditional pap smears, the machines at Parirenyatwa Hospital are not enough to service the large number of women coming from around the country for the service. Women have been forced to wait for up to a month to get screened. 

In addition, some women who had been screened and found to have cervical cancer have been waiting for up to three months for treatment. One woman at the hospital, who asked not to be identified, told IRIN/PlusNews that after waiting for three months to begin her treatment, she was told the radio therapy machines had broken down and had to wait again until the machines were repaired. 

AIDS activist Promise Mthembu noted that research indicated that more women in sub-Saharan Africa are dying of cervical cancer than of maternal mortality-related deaths. She urged the Zimbabwean government to do more to address this growing crisis. 

“Before HIV/AIDS, cervical cancer was a disease of older women, affecting women beyond reproductive age, and it was marginalized because of this. But now it is affecting younger women,” said Mthembu. 

“It is important that we have a comprehensive package for women that addresses cervical cancer. What we have seen in HIV/AIDS policy is that policy has been promoting pap smears or screening for cervical cancer. While a pap smear is a means to an end, why should the government screen cervical cancer if it doesn’t have means to treat cervical cancer?” 

Awareness needed 

Oncologist and cancer-prevention activist Anna Nyakabau says it is unacceptable that a large number of women continue to die as a result of cervical cancer given the slow progression of cervical cancer in a person’s body. 

According to Nyakabau, many women are dying in Zimbabwe because they present themselves to health facilities when it is too late to save their lives. She says the disease is evasive because symptoms only show when the disease is already at an advanced stage. She says it is important for the government and its partners to increase knowledge among the population about the dangers of cervical cancer and the importance of regular screening for the disease. 

Minister of Health and Child Welfare Henry Madzorera admitted that lack of funds had stymied the roll-out a cervical cancer vaccine early this year, but said the government would be mobilizing funds from donors to launch the vaccine in 2014. Meanwhile, he said, the government would focus on other strategies to reduce cervical cancer deaths in the country, such as screening and testing and treatment for those infected. 

st/kn/rz 

]]></body><pubDate>Fri, 08 Feb 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97429/Cervical-cancer-a-major-threat-to-HIV-positive-women</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2010/201010061008180671t.jpg"/></td><td valign="top">HARARE 08 February 2013 (IRIN) - HIV-positive women are living longer, but are now dying of cervical cancer. In Zimbabwe, cervical cancer is now the most common cancer among women, particularly those living with HIV. Activists are urging the government to step up efforts to prevent deaths related to the disease, accusing it of paying lip service to the problem.</td></tr></table>]]></content:encoded></item><item><title>Ugandan authorities concerned as HIV self-test kits hit the market</title><pubDate>Wed, 06 Feb 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2011/201101050941290039t.jpg" />]]>KAMPALA 06 February 2013 (IRIN) - The sale of HIV test kits to the public by private chemists in Uganda is causing concern among health officials, who feel that HIV testing should remain in the hands of professionals and be accompanied by counselling.</description><body><![CDATA[KAMPALA 06 February 2013 (IRIN) - The sale of HIV test kits to the public by private chemists in Uganda is causing concern among health officials, who feel that HIV testing should remain in the hands of professionals and be accompanied by counselling.

A number of pharmacies in the capital, Kampala, are stocking HIV test kits imported from China, India and several European countries; they retail for as little as 3,000 Uganda shillings (US$1.12).

"There is high demand for the HIV test kits. People come to buy them here. We sell a Determine [brand] kit at 3,000 [shillings]," one dispenser at PlusMedic Pharmacy in Wandegeya, a suburb of Kampala, told IRIN.

"I personally buy the kits from the pharmacies. I do HIV self-testing monthly in order to know my status. I don't trust my husband. I believe he cheats without taking consideration of HIV," said Janat*, a local resident.

"The kits are available in several pharmacies. You just walk in and ask for them. I embrace my results, whether it's positive or negative. Once the test shows positive, I will go for a confirmatory test in a health unit," said Hillary, another resident.

Unsanctioned

Several countries are considering [ http://www.unaids.org/en/resources/presscentre/featurestories/2012/july/20120704hometesting/ ] introducing regulated over-the-counter HIV tests. In July 2012, the US Federal Drug Administration [ http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm310542.htm ] approved a rapid HIV test kit for sale to the public.

However, while the Ugandan government is keen to have more people to know their HIV status - just 45 percent of men and 66 percent of women have ever been tested and received results, according to the latest AIDS Indicator Survey [ http://health.go.ug/docs/UAIS_2011_REPORT.pdf ] - senior health officials say they have not approved the private sale of self-test kits and would prefer the public to continue to use the health provider- or client-initiated HIV counselling and testing model recommended by the country's national HIV strategy.

"People need to be careful of these kits. There are several mushrooming health service providers [pharmacies and other unqualified personnel], which are illegal, quack and not genuine at all. They are not approved by us," Christine Ondoa, Uganda's Health Minister, told IRIN.

"Our policy is HIV counselling and testing. As a ministry, we are improving and strengthening our health laboratories services across the country for reliable and accurate results," she added.

"All the HIV kits that enter Uganda through the normal channels meet the required international standards, but the danger of these test kits is misuse," said Gordon Sematiko, the executive director of the country's National Drug Authority (NDA).

"Self-testing is a complicated one. I am not sure whether those who buy the kits know how to use them," said the Wandegeya drug dispenser. "Drawing blood samples and putting them in the strip to get correct results is a hard process. It's better and advisable for the couples to go and test in a health facility."

Sematiko notes that the NDA has concerns about counterfeit test kits being imported into the country. "It's hard for us to test their quality," he said. "Those who default the law, we shall take them to the professional bodies like Uganda Medical and Dental Practitioners Council, the Council of the Pharmaceutical Society of Uganda, and Allied Health Professionals Council of Uganda for disciplinary action."

Counselling critical

Some officials say HIV testing can be highly emotional and should be managed by trained professionals.

"There are usually sentiments depending on the outcome of the results. Imagine a person conducts an individual HIV test and gets a positive result - what happens without counselling?" said Godfrey Esiru, national coordinator for the prevention of mother-to-child transmission of HIV at the Ministry of Health. "Some people can end up attacking or killing their partners if the results show HIV positive."

The country has seen a number of cases [ http://www.plusnews.org/Report/90905/UGANDA-Deadly-consequences-of-inadequate-HIV-counselling ] of people killing their spouses over HIV-positive test results, highlighting the need for proper counselling following HIV testing.

"HIV counselling offered along with testing has been demonstrated to be an effective intervention for HIV infected participants, who typically increase their safer behaviours and decrease their risk behaviours," said Dan Travis, a spokesman for the US Agency for International Development (USAID), which supports HIV testing and counselling services in the country. "HIV testing without such linkage often confers little or no benefit to the patient."

However, senior Ugandan policy makers said they would be open to the idea of self-testing down the line, as long as it was properly regulated.

"It's important for people to know their HIV status in Uganda. I see science moving fast and making it easier for us," said David Kihumuro Apuuli, director-general of the Uganda AIDS Commission. "If we are to reach many people in Uganda, we require more sophisticated means like self-testing. However, we need to regulate it."

*name changed

so/kr/rz

]]></body><pubDate>Wed, 06 Feb 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97419/Ugandan-authorities-concerned-as-HIV-self-test-kits-hit-the-market</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2011/201101050941290039t.jpg"/></td><td valign="top">KAMPALA 06 February 2013 (IRIN) - The sale of HIV test kits to the public by private chemists in Uganda is causing concern among health officials, who feel that HIV testing should remain in the hands of professionals and be accompanied by counselling.</td></tr></table>]]></content:encoded></item><item><title>Uganda begins rollout of provider-initiated HIV testing</title><pubDate>Wed, 30 Jan 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2008/20080704t.jpg" />]]>KAMPALA 30 January 2013 (IRIN) - All people who seek treatment in health centres in Uganda will be offered HIV testing and counselling under a new plan to increase access to HIV prevention and treatment.</description><body><![CDATA[KAMPALA 30 January 2013 (IRIN) - All people who seek treatment in health centres in Uganda will be offered HIV testing and counselling under a new plan to increase access to HIV prevention and treatment.

The acting programme manager of the AIDS Control Programme at the Ministry of Health, Alex Ario, says the campaign, 'Know your Status', will be rolled out in phases to accommodate the country's struggling health system [ http://www.irinnews.org/report/96332/uganda-patients-go-private-as-state-sector-crumbles ] and low health worker numbers.

The system has been tested [ http://www.irinnews.org/Report/78691/UGANDA-Routine-HIV-testing-boosts-uptake ], with promising results, in selected districts since 2006. The UN World Health Organization issued guidelines [ http://www.who.int/hiv/pub/guidelines/9789241595568_en.pdf ] for healthcare provider-initiated counselling and testing in 2007.

"This is provider-initiating counselling and testing to a person attending healthcare facilities. The patient will be counselled and educated before the tests," Ario told IRIN/PlusNews. "I call upon Ugandans to embrace the campaign and accept it."

Uganda employs a number of testing strategies, including: routine HIV testing for pregnant women; client-initiated counselling and testing; home-based HIV testing; couples HIV testing; mobile HIV testing; and moonlight (night-time) testing for high-risk groups such as sex workers.

According to government statistics [ http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_UG_Narrative_Report[1].pdf ], HIV testing is available in 80 percent of county-level health centres but only 22 percent of sub-county-level health centres. The number of people tested for HIV annually has gone up from 1.1 million in 2008 to 5.5 million in 2011.

Multiple benefits

The new strategy is part of efforts to lower Uganda's HIV prevalence, which climbed from 6.4 percent to 7.3 percent between 2006 and 2011. Studies [ http://www.ncbi.nlm.nih.gov/pubmed/20059356 ] have shown that beyond the benefits of having HIV-positive people identified and referred for treatment, provider-initiated counselling and testing may also result in less risky sexual behaviour, reducing levels of HIV transmission.

"There are so many benefits of knowing their HIV status. Those who are HIV-negative will be careful and avoid engaging in risky behaviours. They will carry out preventive options such as partner notification, abstinence and safer sex," Ario said. "Those who are HIV-positive will be enrolled in antiretroviral treatment and have increased opportunities for social support to live normally."

AIDS activists have welcomed the start of the new programme, but warn that the government must improve the health system in order to cope with the likely increase in treatment numbers.

"It's a good initiative. It will enable people to guard and take care of themselves. But our health system is struggling. It has not measured up. We have serious shortages of health workers in the health facilities," Florence Buluba, the executive director of the National Community of Women Living with AIDS (NACWOLA), told IRIN/PlusNews. "The government first needs to address the challenges the health sector is facing before rolling out the programme."

She also stressed the need for adequate health worker training to ensure patients' rights were respected. "How are they going to handle the repercussions of those found to be HIV-positive? How can they handle the blame or abandonment issues? They need to educate, persuade, encourage and prepare people before the results are released," she said.

The AIDS Control Programme is currently training health workers in routine HIV testing and counselling; the training involves pre-test information, counselling, testing, disclosure of results, post-test information, initiation on HIV care, treatment and follow-up. It is hoped that by December 2013, all public health facilities will offer routine HIV testing.

Challenges

The Ministry of Health will have to conduct large-scale media campaigns to educate the public about the voluntary nature of the programme; already, a number of media outlets in Uganda have wrongly described the programme as "mandatory" or "forced" HIV testing.

An upcoming HIV prevention and control bill [ http://www.scribd.com/doc/31680838/HIV-and-AIDS-Prevention-and-Control-Bill-2010 ] criminalizes the deliberate transmission of HIV, makes HIV testing mandatory for pregnant women and allows health workers to disclose one's HIV status to their sexual partner. Analysts worry that if this bill is passed, it could affect [ http://www.plusnews.org/Report/81636/UGANDA-Draft-HIV-bill-s-good-intentions-could-backfire ] the uptake of provider-initiated HIV testing and counselling.

"Institutionalizing this practice is good, but it will not reduce the HIV/AIDS prevalence rate in Uganda unless it... makes use of other platforms like collaborating with the media and other networks to publicize the proposed strategy," said Joan Esther Kilande, administrative and programmes assistant for the NGO Action Group for Health, Human Rights and HIV/AIDS (AGHA) Uganda.

A 2010 study [ http://www.ncbi.nlm.nih.gov/pubmed/20387980 ] of the challenges of provider-initiated counselling and testing in Uganda found some of them to be: counselling HIV-discordant couples; poor follow-up of HIV-infected clients; low levels of male involvement; frequent stock-outs of supplies; and shortages of counsellors, lab personnel and referral services.

"These challenges must be addressed in order to optimize the success of [provider-initiated testing and counselling] programs at providing universal access to HIV testing and counselling services," the authors recommended.

so/kr/rz

]]></body><pubDate>Wed, 30 Jan 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97367/Uganda-begins-rollout-of-provider-initiated-HIV-testing</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2008/20080704t.jpg"/></td><td valign="top">KAMPALA 30 January 2013 (IRIN) - All people who seek treatment in health centres in Uganda will be offered HIV testing and counselling under a new plan to increase access to HIV prevention and treatment.</td></tr></table>]]></content:encoded></item><item><title>In Swaziland, child marriage still a grey area</title><pubDate>Tue, 29 Jan 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201301141403190744t.jpg" />]]>MBABANE 29 January 2013 (IRIN) - The relief felt by health officials and activists several months ago at the apparent outlawing of child marriages now appears to have been premature, with Swaziland’s traditional leadership recently declaring that such unions are acceptable under customary law.</description><body><![CDATA[MBABANE 29 January 2013 (IRIN) - The relief felt by health officials and activists several months ago at the apparent outlawing of child marriages now appears to have been premature, with Swaziland’s traditional leadership recently declaring that such unions are acceptable under customary law. 

“I have not received any instructions that [‘kwendzisa’] [the custom of a man marrying an underage girl] should be abolished,” Velebantfu Mtetwa, the country’s top traditional leader, told the Swazi press. As governor of Ludzidzini royal village, where the traditional seat of government is located, Mtetwa is known as Swaziland’s traditional prime minister. 

Little attention was paid to the country’s traditional leadership last year when the powerful royal counsellors to King Mswati III said they would review the Child Protection and Welfare Act of 2012 and, if need be, raise objections. 

Instead, attention was focused on Deputy Prime Minister Themba Masuku’s declaration [ http://www.irinnews.org/Report/96347/SWAZILAND-Child-marriages-banned ] that any man found to contravene the act by marrying a girl under the age of 18 faced arrest and prosecution. The marriages would be annulled and the former husband could be fined R10,000 (US$1,100). A man guilty of raping a girl faces a R20,000 (US$2,200) fine and prison term of up to 20 years. King Mswati, a strict traditionalist, approved the law in September 2012. 

Damaging to girls 

UNICEF estimates that, globally, about 70 million women aged 20-24 were married before reaching 18 years old. Of these, some 23 million were been married before turning 15. The consequences of child marriage can be life threatening: 50,000 girls aged 15-19 die of pregnancy- and childbirth-related causes each year. 

The child protection act notes that children forced into marriage face serious psychological and social damage, and that girls’ educations tend to cease as they take up household duties. 

Activists have welcomed the law, which is seen as a means of curbing HIV transmission. “The longer young women put off childbirth, the more likely they are to stay in school and, of course, avoid HIV,” said Sophia Mukasa Monico, country representative for UNAIDS. 

“Such practices spread AIDS and contribute to Swaziland having the highest HIV prevalence in the world. It’s unfortunate that AIDS activists appear to be ‘anti-culture’ because, as Swazis, we love our culture. But some practices need reforming, and this seems impossible to do,” said Sylvia Dube, director of an AIDS testing and counselling centre. 

Law made powerless 

But the new statutory law, originating in the cabinet and passed by parliament, has been rendered powerless by the superiority of Swazi Law and Custom if a man chooses to marry in a traditional ceremony. The law appears now to apply only to “Westernised” Swazis who wed in civil ceremonies before a magistrate after having acquired a marriage license. 

Swazi Law and Custom has never been written down but is interpreted by traditional leaders whose primary authority is Mtetwa. Cabinet officials, including Deputy Prime Minister Masuku, are appointed from the recommendations of royal counsellors, and these politicians are aware of their power relative to the country’s traditional authorities. 

Mtetwa came out with the traditionalists’ stance on child brides following the arrest of a local soccer star for the rape of a 14 year-old girl. The accused stated that the girl was his bride, and that their families had agreed to the marriage. “If the parents and the girl have agreed, the authorities never penalize anyone,” Mtetwa said. 

In terms of modern law, an underage girl cannot make such a decision. But in terms of tradition, she also has no say because marriages are arranged between families by the girls’ parents or older relatives. In addition, official records for traditional marriages can be incomplete because many go unreported. 

With no national awareness campaign to educate Swazis about the Child Protection and Welfare Act, it remains unclear whether Swazi girls are aware of their rights. People who choose to challenge such unions have nowhere to go to lodge a complaint. 

“What is most disturbing is the fact that most of these ‘marriages’ are forced, with the young girls having little or no say in being married to much older man,” said Maureen Littlejohn, communications officer for the Swaziland Action Group Against Abuse, an NGO that counsels survivors of gender-based and child violence. Littlejohn noted that poor families are often influenced by gifts of cattle and money to give up their daughters. 

jh/kn/rz 

]]></body><pubDate>Tue, 29 Jan 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97360/In-Swaziland-child-marriage-still-a-grey-area</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201301141403190744t.jpg"/></td><td valign="top">MBABANE 29 January 2013 (IRIN) - The relief felt by health officials and activists several months ago at the apparent outlawing of child marriages now appears to have been premature, with Swaziland’s traditional leadership recently declaring that such unions are acceptable under customary law.</td></tr></table>]]></content:encoded></item><item><title>Ugandan HIV campaign targets &quot;cheaters&quot;</title><pubDate>Wed, 23 Jan 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2013/201301231226290910t.jpg" />]]>KAMPALA 23 January 2013 (IRIN) - A new Ugandan HIV-prevention campaign that frankly addresses sexual infidelity is generating heated debate over the direction the country&apos;s HIV strategy should take.</description><body><![CDATA[KAMPALA 23 January 2013 (IRIN) - A new Ugandan HIV-prevention campaign that frankly addresses sexual infidelity is generating heated debate over the direction the country's HIV strategy should take. 

Billboards erected in various parts of the capital, Kampala, by Uganda Cares - a programme of the US NGO AIDS Healthcare Foundation (AHF) [ http://www.aidshealth.org ] - bear the image of a broken heart and the lines "Cheating? Use a condom" and "Cheated on? Get tested". 

The campaign aims to address the growing vulnerability to HIV of couples in long-term relationships. Studies [ http://siteresources.worldbank.org/INTHIVAIDS/Resources/375798-1103037153392/UgandaMoTCountrySynthesisReport7April09.pdf ] show that some 43 percent of new HIV infections in Uganda occur in such unions. 

"Let's be realistic... The HIV infections among married couples are high. So what we are putting across is that if you must cheat, remember to use a condom in order to protect your partner," Mina Nakawuka, AHF's regional director of advocacy and public relations, told IRIN/PlusNews. "Those who cheat must use condoms correctly and consistently. Those who feel cheated [on] must take an HIV test. If we don't do that, we shall not be able to reduce HIV infections in Uganda." 

But the Uganda AIDS Commission (UAC), the main government body tasked with managing the country's HIV response, has ordered the billboards be removed on the grounds that they oppose the messages of faithfulness that the government is trying to promote. 

"It's totally unacceptable. It's a wrong message. They are confusing people on which HIV prevention messages to follow," said David Apuuli Kihumuro, director general of the UAC. "I have talked to them [AHF]. I have directed them to remove all their billboards. They didn't consult us or the Ministry of Health." 

He added, "We are going to talk to the Uganda Communications Commission to regulate such messages and campaigns in the media and public. They shouldn't be allowed. We need messages that encourage people to have faithful lives and live [HIV] negatively." 

AHF's Nakawuka said, "We have some issues with UAC, which [we] are sorting out." 

ABC 

Uganda's health minister, Christine Ondoa, told IRIN/PlusNews that the national HIV prevention strategy continues to embrace 'ABC' - a prescription for Abstinence, Being faithful, and consistent and correct Condom use - as well as an array of biomedical interventions. She said her ministry would be investigating "why they [AHF] jumped to C". 

The ABC strategy was largely credited with reducing HIV prevalence from 18 percent in the early 1990s to about 6 percent in 2000. However, since then, prevalence has begun to rise again, going from 6.4 percent in 2005 to 7.3 percent in 2011, according to the most recent AIDS Indicator Survey [ http://health.go.ug/docs/UAIS_2011_REPORT.pdf ]. And despite years of HIV prevention messages, condom use remains erratic [ http://www.plusnews.org/Report/96359/UGANDA-Condom-use-infrequent-despite-rising-HIV-rates ]. 

The government has, in the past, been accused of bowing to pressure [ http://www.americanprogress.org/wp-content/uploads/issues/2010/01/pdf/pepfar.pdf ] from the US President's Emergency Plan for AIDS Relief, which encouraged HIV messages to focus more on abstinence and fidelity and less on condom use, to the detriment of the country's response to the epidemic. 

Traditionally, government-backed HIV prevention campaigns targeting couples have focused on less controversial messages such as faithfulness [ http://www.plusnews.org/Report/91875/UGANDA-Can-love-wheel-stop-infidelity-in-marriage ] and getting tested [ http://www.africomnet.org/events/practicum/2010/x/Day2/GoTogetherKnowTogetherHTCUganda.pdf ]. 

A 2010 review [ http://www.ncbi.nlm.nih.gov/pubmed/18843530 ] of couples-focused behavioural HIV-prevention interventions found that while these interventions can reduce unprotected sexual intercourse, there is a need for "stronger theoretical and methodological basis for couples-focused HIV prevention". The authors also recommended that future interventions "pay closer attention to same-sex couples, adolescents and young people in relationships". 

Encouraging immorality? 

The "cheating" billboard has stirred intense debate both on the streets of Kampala and on social media networks like Facebook and Twitter; many hold the view that the campaign's message is tantamount to encouraging infidelity, while others see it as a pragmatic approach to HIV prevention. 

"What is their moral motive? I can assure you, it's absolutely wrong and inappropriate to erect such campaign billboards," said Christine Shimanya, an associate vicar at Church of Resurrection, Bugolobi Church of Uganda. "As a church, we don't encourage immorality. If couples have gone off their marriages, the most appropriate intervention is by talking to them, not encouraging cheating. We need Christian post-marital counselling to help them in their morals." 

"We don't know the audience the campaigners are targeting," Linda, a news anchor at a local radio station, told IRIN/PlusNews. "They are encouraging people to continue cheating instead of stopping the immoral act. Such messages can't help. Why should people cheat in the first place?. Why should someone risk and put your life, loved ones and relatives at stake?" 

The flip side 

But a number of Ugandans say the campaign is a welcome shot in the arm for the country's flagging HIV-prevention efforts. 

"My impression is that this is a campaign to promote condom use and HIV testing, while acknowledging that multiple, concurrent partnerships are one of the key drivers of new HIV infections in the country," Milly Katana, a long-time HIV activist, told IRIN/PlusNews. 

"It needs to be backed up by the message that it is not only those that think their partners have extra sexual partners that need to use condoms or test for HIV, but anyone who has sex with someone whose HIV status they do not know must always and correctly use a condom, and routine testing is a gateway to prevention and eventual elimination of HIV," she added. 

Florence Buluba, the executive director of the National Community of Women Living with AIDS, said the campaign's emphasis on condom use was necessary. "If we are to prevent new HIV infections in Uganda, those who cheat and engage in risky sexual behaviours should use condoms, especially if [they] don't know the other person's HIV status," she said. "We should encourage the use of both male and female condoms. The condoms should be made available to all eligible persons and consistently used. The government must invest in it." 

James Onen, a popular radio personality, said the message on the billboards was "realistic". 

"I think the message will offend the moral hypocrites out there. People tend to pretend on the surface. but cheating is rampant," he told IRIN/PlusNews. "The campaign reminds people to live responsibly and act wisely, which make sense to me." 

But both sides of the debate agree that Uganda needs a fresh take on HIV prevention in order to reduce new infections. "We need a new, aggressive and attractive campaign that will reawaken Ugandans about the high HIV infections. People are used to the past messages, which are now stale," said Shimanya. 

so/kr/rz

]]></body><pubDate>Wed, 23 Jan 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97317/Ugandan-HIV-campaign-targets-quot-cheaters-quot</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2013/201301231226290910t.jpg"/></td><td valign="top">KAMPALA 23 January 2013 (IRIN) - A new Ugandan HIV-prevention campaign that frankly addresses sexual infidelity is generating heated debate over the direction the country&apos;s HIV strategy should take.</td></tr></table>]]></content:encoded></item><item><title>Bringing HIV/AIDS out into the open in Liberia</title><pubDate>Tue, 22 Jan 2013 00:00:00 GMT</pubDate><description><![CDATA[<img src="http://www.irinnews.org/images/2010/201010061008180671t.jpg" />]]>MONROVIA 22 January 2013 (IRIN) - Stigma, discrimination and difficulty in reaching health clinics has led over half of new HIV cases in Liberia to go untreated, says the National AIDS Control Programme of Liberia, which calls the situation “alarming”.</description><body><![CDATA[MONROVIA 22 January 2013 (IRIN) - Stigma, discrimination and difficulty in reaching health clinics has led over half of new HIV cases in Liberia to go untreated, says the National AIDS Control Programme of Liberia, which calls the situation “alarming”.

From 2006 to 2013 some 26,000 HIV cases were reported, but of that number just 10,911 patients are enrolled in treatment centres, according to the Aids Control Programme manager Sonpon Blamo Sieh.

“They are doing this because of stigma, denial, discrimination and distances they have to travel to access treatment,” he told IRIN.

A health worker in the Kru town neighbourhood of the capital, Monrovia, told IRIN that when patients contract HIV “the community will still isolate you. Your family may isolate you. You could be denied a job,” though he noted attitudes have improved over the past five years.

According to Liberia's demographic health survey, 1.5 percent of Liberia's 3.5 million people are HIV-positive, with 60 percent of those being women or girls.

Awareness-raising programmes have not always taken root in rural areas, where many Liberians still continue to deny the disease’s existence, said Sieh. The AIDS Control Programme is currently carrying out an in-depth study to find out why people are dropping out so that it can target its improvements.

Martha Porka, a nurse at the Moonplay Clinic in Bong County, central Liberia, said HIV-positive people in rural areas have to walk up to three hours to reach their nearest clinic. And when they get there, they often have to wait the rest of the day to see a health worker. “For these reasons, they don’t come back,” she said, despite treatment being free.

“We have more drugs, but no one seems to be coming for them,” she added.

Treatment needs to be taken closer to people’s villages to improve continuity of care, she said.

Healthcare workers also need to change their attitude to people living with HIV, she stressed. “Some of the health workers are in the constant habit of demonizing HIV-positive people… Patients daily complain the way some health workers talk to them. I think we need to change our attitudes to these people and create love and care for them.”

Surveys undertaken by the AIDS Control Programme in the past have revealed that HIV-positive people are hesitant to access treatment due to the stigma involved in going public about their condition. Many seek care from traditional or spiritual healers, who are popularly consulted for all varieties of illness in Liberia.

Women speak out

Given that women disproportionately suffer from the disease more than men, they have to take a lead role in changing attitudes, say health workers.

To date, women have been relatively quiet about raising awareness of the dangers of HIV. But recently this has shifted, as women’s groups all over the country have launched an assertive campaign to raise awareness of the disease, refute common myths about HIV, and break down persistent stigma.

One group runs the “Jehovah’s Witness Campaign” whereby women go door to door like Jehovah’s Witnesses to spread the word on how to avoid infection.

Teneh Smith, 25, lives in the Monrovia suburb of Paynesville and heads a local campaign group called Women Against AIDS Movement, which includes nurses, journalists, stall-holders and students. This group also goes from community to community to discuss what the HIV virus is and why it is killing women. This group and others are using poster campaigns, word of mouth, text messages and radio programmemes to raise awareness of the disease.

People’s behaviour is starting to change as a result, she said.

"We cannot sit and see our young women keep coming down with this virus,” said Smith who lost her sister to the HIV virus in 2011. "When she died I did not lose hope. I began working with Liberian women. We have spread the news like wildfire across Liberian communities. Our women are on the move.”

Stigma and discrimination persist but people discuss the illness much more openly now than they used to, said health workers.

Radio

Several popular radio talk shows, such as HIV and You on community radio station Gedeh FM, are also discussing the issue. Presenter Marie Brown runs a weekly 20-minute slot targeting girls aged 15-25.

“I tell them about the danger of AIDS and how it is killing more young women in Liberia. I open the telephone lines for them to call and ask questions.” She often gets at least 50 calls a show. “I think it’s opening up people’s minds.”

Temah Kollie, 16, who attends the Donplay Community School in Kakata, in central Liberia, told IRIN: "From the first day I listened to the show, I changed my sexual behaviour. I learned that HIV is real and that we girls must stay away from sex, especially we teenagers… I have begun telling my school mates how AIDS is killing schoolgirls in Liberia."

For Sieh this is just the beginning. “The current statistics are alarming,” he told IRIN. “We are making progress [on fighting AIDS]… Now we know that the bigger challenge is to reach [and treat] the rest of the positive cases.”

pc/cb/aj

]]></body><pubDate>Tue, 22 Jan 2013 00:00:00 GMT</pubDate><link>http://www.irinnews.org/Report/97307/Bringing-HIV-AIDS-out-into-the-open-in-Liberia</link><content:encoded><![CDATA[<table cellpadding="3"><tr><td valign="top"><img src="http://www.irinnews.org/images/2010/201010061008180671t.jpg"/></td><td valign="top">MONROVIA 22 January 2013 (IRIN) - Stigma, discrimination and difficulty in reaching health clinics has led over half of new HIV cases in Liberia to go untreated, says the National AIDS Control Programme of Liberia, which calls the situation “alarming”.</td></tr></table>]]></content:encoded></item></channel></rss>