By, Chief K.Masimba Biriwasha, Zivizo.com, March 25, 2008
The natural process of menstruation comes as a big problem to women and girls in many parts of Africa, contributing to both disempowerment and health risks. For young girls, menstruation is an addition to the heap of gender disparities they have to face in life.
In order to stem the flow of monthly periods, the women and girls use anything from rags, tree leaves, old clothes, toilet paper, newspapers, cotton wool, cloths or literally anything that can do the job. Most girls from poor, rural communities do not use anything at all.
Menstruation is perhaps one of the most regular individual female experiences, but in sub-Saharan Africa, the experience impacts general society negatively due to the absence of products required by women and girls to cope with menstrual flow.
To state it bluntly, menstruation has become like a curse not only to the women and girls but to society in general on the continent. Because menstruation is largely a private act, the social damage is hidden and never makes the news headlines. Also, there are cultural and social attitudes that render discussion of menstruation almost impossible.
Affordable and hygienic sanitary protection is not available to many women and girls in Africa, and governments have done very little to address this reproductive health issue which has serious public health consequences.
In sub-Saharan Africa, millions of girls, in particular, that reach the age of puberty are highly disempowered due to the lack of access to sanitary wear. Many of the girls from poor families cannot afford to buy sanitary pads.
Hence they resort to the use of unhygienic rags and cloths which puts them at the risk of infections. Some of the girls engage in transactional sex so that they can raise the money required to buy sanitary pads, putting themselves at the risk of HIV and STI infection.
Alternatively, young girls are forced to skip school during the time they experience monthly periods to avoid both the cost of pads or use of cloths.
UNICEF estimates that one in 10 school-age African girls either skips school during menstruation or drops out entirely because of lack of sanitation.
“Less-privileged girls and women who represent substantial percentage in our contemporary Africa will continue to suffer resulting to school absenteeism and also compromising their right to health care,” says Fredrick W. Njuguna, Program Director of Familia Human Care Trust in Kenya.
A girl absent from school due to menstruation for 4 days in 28 days (a month) loses 13 learning days equivalent to 2 weeks of learning in every school term.
It is estimated that within the 4 years of high school the same girl loses 156 learning days equivalent to almost 24 weeks out of 144 weeks of learning in high school.
Consequently, a girl child potentially becomes a “school drop out” while she is still attending school. In addition, the girl child has to deal with emotional and psychological tension associated with the menstrual process.
To make matters worse, according to Familia Human Care Trust, many schools in underprivileged areas lack sufficient sanitation facilities which are vital not only during a girl’s period but at all times generally such as water, adequate toilet facilities and appropriate dumping facilities for sanitary wear.
As a result, menstruating girls opt to stay at home due to lack of facilities to help them manage their periods than go to school.
For orphaned girls, the prospect of coping with bodily changes can be a significant challenge because they have no-one to turn to for information or advice. In addition, due to the use of improper methods to contain their menstrual flow, young girls may develop bodily odors that will lead to social exclusion within peer groups thereby impacting negatively on the young girl’s confidence.
The need for affordable sanitary wear for women and girls in Africa is indeed a major public health issue that governments need to prioritize in their planning.
On the other hand, there is need for social innovation around this issue because the need for sanitary wear among girls and women will forever be there, at least in the long term future.
The bottom line is that no girl child must be disadvantaged by the natural process of menstruation, and governments, civil society organizations and other players need to work together to ensure that the appropriate services are made available.
As it is, menstruation has becomes the undeclared basis for the social exclusion of young girls. Sanitary protection is an urgent need among women and girls and needs to be made affordable so that poor and marginalized groups can have access.
Global alliances between women in the rich and poor worlds can be a key solution to the problem of access to sanitary wear. But governments also need to recognize that ensuring women and girl’s access to sanitary wear has positive public health implications.
Access to affordable, sanitary is human right but one that is never discussed in our male dominated world. Whatever the case, the fact remains: every woman should be able to have access to the right products which can enable them to happily experience menstruation.
No woman should be cursed to disempowerment by the natural act of monthly periods.
Source: http://zivizo.com/2008/03/25/how-menstruation-curses-young-girls-to-the-margins/
Wednesday, March 26, 2008
Tuesday, March 25, 2008
The tragedy of mother-to-child HIV transmission
By, Courtenay Bartholomew, Trinidad and Tabago Express, March 26, 2008
The most biologically intimate association between two individuals is that of a mother and the foetus developing within her womb. Indeed, one of the most tragic consequences of HIV infection in women, who become pregnant is the transmission of that deadly virus to their unborn offsprings.
Alarmingly, more than 60,000 babies worldwide inherit HIV from their mothers every year. Can you really fathom the dimension of this tragedy? It is indeed a tragedy when the mother does not know that she is HIV-infected at the time of her pregnancy as is frequently the case, but it is a felony when she knows that she is HIV-infected and still becomes pregnant while neither on treatment nor taking other precautions.
Now, without treatment, the overall risk of transmission from an infected mother to her infant is around 30 per cent but there are wide variations. In the early stages of infection and in the more advanced stages with severe immuno-suppression, the viral load is greater than at other times and transmission from mother to child is therefore considerably higher during these periods.
Infection may be transmitted in utero or during the delivery process (intrapartum) as the baby moves down the birth canal and is bathed with the mother's blood.
Infection may also be acquired after birth (postpartum) by breast feeding and so, we advise all HIV-positive mothers not to breast feed their babies and milk formulae are given free of charge. About 23 per cent of infections occur in utero and as early as the first trimester of pregnancy, however, most transmissions occur at the time of delivery or during the birth process.
Antibodies to a virus are a legacy of and a response to previous infections and remain in the blood indefinitely even when the virus has disappeared. These antibodies then protect the individual from being re-infected with the same virus. Not so with the retrovirus of AIDS. Viruses and antibodies co-exist in these patients because the antibodies are not powerful enough to suppress or kill the virus. Therefore, to test for the presence of HIV, we only need to test for the antibodies, which is much simpler and less dangerous than testing for the virus itself (much cheaper also).
All babies of infected mothers, whether the mother's virus is transmitted to the child or not (and remember, as I said above, only about 30 per cent of mothers transmit their HIV virus to their babies), carry "passively" the antibodies of the mother through the cord blood.
However, these harmless passively-acquired maternal antibodies may take up to 18 months in some cases to be cleared from the baby's blood and it is only then that one can say with certainty that the baby does not carry the virus. However, for the past two years we now have more sophisticated equipment in our MRF laboratory and use the ultra-sensitive polymerase chain reaction (PCR) technique, which can identity viral infection within two months.
Because of the ridiculously high price of antiretroviral drugs, which third world countries could not afford and about which history will have a lot to say in years to come, there was a time when we were only able to prevent the baby from being HIV infected by giving the mother a short course of a single drug treatment (AZT) from 28 or 32 weeks of her pregnancy, during labour, and for a week to the baby after delivery. This reduced the percentage of HIV-positive babies drastically from about 30 per cent to about 6.8 per cent.
Unfortunately, therapy was then stopped and so, while many of the babies survived, the mother was not able to get long-term treatment. The tragedy of this is not worth recalling.
Now, all mothers attending the antenatal clinics of hospitals are tested for HIV antibodies (with their consent). This being so, we have found that 8 per cent of the mothers first became aware of their HIV positivity this way. This is interesting. Once they are tested positive they are then referred to the Medical Research Centre where we assess the immunological status of the mothers (CD4 counts) and their viral loads. Depending on those levels, we then treat the mothers at a certain time in their gestation period and treatment continues during labour, after labour and onwards. In other words, we now treat both mother and child. We use the World Health Organisation's (WHO) therapeutic recommendation for mother to child transmission. To date we have treated 203 mothers and only 7 (3.4 per cent) of their babies have been infected. But even that is not good enough.
We are now considering a more aggressive approach by treating the mothers with triple therapy earlier in their pregnancy although we are very concerned that since non-compliance of therapy increases with time, we may theoretically be putting the mothers at risk of developing drug resistance in time to come the earlier we begin treatment. Whether our concern is valid would only be determined in comparative long-term studies. In the meanwhile, we are aiming for a zero transmission of virus from mother to child without compromising the mother in the long-term.
- Prof Bartholomew is the Executive Director of the Medical Research
Source: http://www.trinidadexpress.com/index.pl/article_opinion?id=161298516
The most biologically intimate association between two individuals is that of a mother and the foetus developing within her womb. Indeed, one of the most tragic consequences of HIV infection in women, who become pregnant is the transmission of that deadly virus to their unborn offsprings.
Alarmingly, more than 60,000 babies worldwide inherit HIV from their mothers every year. Can you really fathom the dimension of this tragedy? It is indeed a tragedy when the mother does not know that she is HIV-infected at the time of her pregnancy as is frequently the case, but it is a felony when she knows that she is HIV-infected and still becomes pregnant while neither on treatment nor taking other precautions.
Now, without treatment, the overall risk of transmission from an infected mother to her infant is around 30 per cent but there are wide variations. In the early stages of infection and in the more advanced stages with severe immuno-suppression, the viral load is greater than at other times and transmission from mother to child is therefore considerably higher during these periods.
Infection may be transmitted in utero or during the delivery process (intrapartum) as the baby moves down the birth canal and is bathed with the mother's blood.
Infection may also be acquired after birth (postpartum) by breast feeding and so, we advise all HIV-positive mothers not to breast feed their babies and milk formulae are given free of charge. About 23 per cent of infections occur in utero and as early as the first trimester of pregnancy, however, most transmissions occur at the time of delivery or during the birth process.
Antibodies to a virus are a legacy of and a response to previous infections and remain in the blood indefinitely even when the virus has disappeared. These antibodies then protect the individual from being re-infected with the same virus. Not so with the retrovirus of AIDS. Viruses and antibodies co-exist in these patients because the antibodies are not powerful enough to suppress or kill the virus. Therefore, to test for the presence of HIV, we only need to test for the antibodies, which is much simpler and less dangerous than testing for the virus itself (much cheaper also).
All babies of infected mothers, whether the mother's virus is transmitted to the child or not (and remember, as I said above, only about 30 per cent of mothers transmit their HIV virus to their babies), carry "passively" the antibodies of the mother through the cord blood.
However, these harmless passively-acquired maternal antibodies may take up to 18 months in some cases to be cleared from the baby's blood and it is only then that one can say with certainty that the baby does not carry the virus. However, for the past two years we now have more sophisticated equipment in our MRF laboratory and use the ultra-sensitive polymerase chain reaction (PCR) technique, which can identity viral infection within two months.
Because of the ridiculously high price of antiretroviral drugs, which third world countries could not afford and about which history will have a lot to say in years to come, there was a time when we were only able to prevent the baby from being HIV infected by giving the mother a short course of a single drug treatment (AZT) from 28 or 32 weeks of her pregnancy, during labour, and for a week to the baby after delivery. This reduced the percentage of HIV-positive babies drastically from about 30 per cent to about 6.8 per cent.
Unfortunately, therapy was then stopped and so, while many of the babies survived, the mother was not able to get long-term treatment. The tragedy of this is not worth recalling.
Now, all mothers attending the antenatal clinics of hospitals are tested for HIV antibodies (with their consent). This being so, we have found that 8 per cent of the mothers first became aware of their HIV positivity this way. This is interesting. Once they are tested positive they are then referred to the Medical Research Centre where we assess the immunological status of the mothers (CD4 counts) and their viral loads. Depending on those levels, we then treat the mothers at a certain time in their gestation period and treatment continues during labour, after labour and onwards. In other words, we now treat both mother and child. We use the World Health Organisation's (WHO) therapeutic recommendation for mother to child transmission. To date we have treated 203 mothers and only 7 (3.4 per cent) of their babies have been infected. But even that is not good enough.
We are now considering a more aggressive approach by treating the mothers with triple therapy earlier in their pregnancy although we are very concerned that since non-compliance of therapy increases with time, we may theoretically be putting the mothers at risk of developing drug resistance in time to come the earlier we begin treatment. Whether our concern is valid would only be determined in comparative long-term studies. In the meanwhile, we are aiming for a zero transmission of virus from mother to child without compromising the mother in the long-term.
- Prof Bartholomew is the Executive Director of the Medical Research
Source: http://www.trinidadexpress.com/index.pl/article_opinion?id=161298516
Preventing mother-to-child transmission to fight HIV/AIDS in Malawi
By, Gaelle Sevenier, UNICEF, March 25, 2008
Mwanza District Hospital, located near the southern border of Malawi, provides crucial care to many of the country’s most vulnerable families. Among them were two young couples who recently arrived at the hospital days apart with different stories but similar needs.
The couples were anxious to visit with staff in the hospital’s prevention of mothers-to-child transmission (PMTCT) programme, which tackles a broad range of issues presented by HIV and AIDS.
After a quick pin prick and a wait of less than an hour, a nurse took one of the couples, Mary and Devison, behind closed doors to give them their results. Both were HIV-positive, and Mary was four months pregnant.
Living with HIV, expecting a child
As part of the initiative to promote HIV testing and counselling for couples, the hospital was eager to provide them with the full range of PMTCT services. In most cases, a lack of spousal and family support is one of the major obstacles facing people with HIV and AIDS. Providing testing for couples is a way to mobilize such support, within the community.
The other couple, Mavis and James, were also living with HIV and expecting a child. Because of the Mwanza hospital’s programme, they had taken all the preventive steps available, and Mavis received medical guidance throughout her pregnancy.
When Mavis finally delivered her daughter, she immediately handed her over to the medical staff so that they could administer to her the antiretroviral drops that have proven effective in preventing HIV infection. This medical intervention is known to cut the risk of mother-to-child transmission in half.
The road to prevention
The groundbreaking PMTCT programme, supported by UNICEF, helps health workers administer services related to AIDS education and awareness, infant and young child feeding, antiretroviral treatment and social support.
“More and more people are tested because the policies and guidelines for health workers are now in place” says UNICEF Representative Aida Girma. “Testing is the key to both prevention and treatment. Since men take a critical role in deciding about the treatments, it is important to involve them.”
In a population of only 12 million, Malawi has almost 1 million people living with HIV/AIDS, more than 90,000 of whom are children. These alarming numbers underscore the necessity of providing women like Mary and Mavis affordable early diagnoses and treatments to prevent mother-to-child transmission.
Every year, an estimated 30,000 newborns in Malawi are infected with HIV by mother-to-child transmission, and UNICEF aims to markedly reduce that number. Given the magnitude of the problem, UNICEF allocates 30 per cent of its Malawi budget to fight HIV/AIDS; the hope is that PMTCT services will pave the way for a decline in paediatric infection rates.
‘HIV is everybody’s business’
Today, there are more than 152 PMTCT sites located throughout Malawi. Led by the Ministry of Health with support from development partners, the PMTCT Acceleration Plan intends to reach all maternal and child health facilities in order to ensure that every pregnant woman knows her HIV status and receives the proper care.
“There is a strong political will to fight HIV/AIDS in Malawi” said UNICEF Representative in Malawi Aida Girma. “There is still a lot of work to be done. UNICEF has to think universally, making sure that all children in all districts are addressed, and linking what is on the ground with the policy level. UNICEF has been actively campaigning to make sure children are given attention. We want to make sure HIV is everybody’s business.”
UNICEF hopes that by supporting HIV/AIDS services such as PMTCT, couples like Mary and Devison, Mavis and James will have access to the education and medicine that they so undeniably deserve and so desperately need.
Source: http://www.unicef.org/infobycountry/malawi_43369.html
Mwanza District Hospital, located near the southern border of Malawi, provides crucial care to many of the country’s most vulnerable families. Among them were two young couples who recently arrived at the hospital days apart with different stories but similar needs.
The couples were anxious to visit with staff in the hospital’s prevention of mothers-to-child transmission (PMTCT) programme, which tackles a broad range of issues presented by HIV and AIDS.
After a quick pin prick and a wait of less than an hour, a nurse took one of the couples, Mary and Devison, behind closed doors to give them their results. Both were HIV-positive, and Mary was four months pregnant.
Living with HIV, expecting a child
As part of the initiative to promote HIV testing and counselling for couples, the hospital was eager to provide them with the full range of PMTCT services. In most cases, a lack of spousal and family support is one of the major obstacles facing people with HIV and AIDS. Providing testing for couples is a way to mobilize such support, within the community.
The other couple, Mavis and James, were also living with HIV and expecting a child. Because of the Mwanza hospital’s programme, they had taken all the preventive steps available, and Mavis received medical guidance throughout her pregnancy.
When Mavis finally delivered her daughter, she immediately handed her over to the medical staff so that they could administer to her the antiretroviral drops that have proven effective in preventing HIV infection. This medical intervention is known to cut the risk of mother-to-child transmission in half.
The road to prevention
The groundbreaking PMTCT programme, supported by UNICEF, helps health workers administer services related to AIDS education and awareness, infant and young child feeding, antiretroviral treatment and social support.
“More and more people are tested because the policies and guidelines for health workers are now in place” says UNICEF Representative Aida Girma. “Testing is the key to both prevention and treatment. Since men take a critical role in deciding about the treatments, it is important to involve them.”
In a population of only 12 million, Malawi has almost 1 million people living with HIV/AIDS, more than 90,000 of whom are children. These alarming numbers underscore the necessity of providing women like Mary and Mavis affordable early diagnoses and treatments to prevent mother-to-child transmission.
Every year, an estimated 30,000 newborns in Malawi are infected with HIV by mother-to-child transmission, and UNICEF aims to markedly reduce that number. Given the magnitude of the problem, UNICEF allocates 30 per cent of its Malawi budget to fight HIV/AIDS; the hope is that PMTCT services will pave the way for a decline in paediatric infection rates.
‘HIV is everybody’s business’
Today, there are more than 152 PMTCT sites located throughout Malawi. Led by the Ministry of Health with support from development partners, the PMTCT Acceleration Plan intends to reach all maternal and child health facilities in order to ensure that every pregnant woman knows her HIV status and receives the proper care.
“There is a strong political will to fight HIV/AIDS in Malawi” said UNICEF Representative in Malawi Aida Girma. “There is still a lot of work to be done. UNICEF has to think universally, making sure that all children in all districts are addressed, and linking what is on the ground with the policy level. UNICEF has been actively campaigning to make sure children are given attention. We want to make sure HIV is everybody’s business.”
UNICEF hopes that by supporting HIV/AIDS services such as PMTCT, couples like Mary and Devison, Mavis and James will have access to the education and medicine that they so undeniably deserve and so desperately need.
Source: http://www.unicef.org/infobycountry/malawi_43369.html
Monday, March 24, 2008
HIV+ women start self-help groups
By, The Times of India, March 23, 2008
Their life began after they sensed death. And now after successfully running their own micro enterprises, about a hundred HIV-positive women are looking forward to forming their own self- help groups (SHG).
These women from slums across the city gathered at Ishwani Kendra in Wadgaonsheri on Thursday to take inspiration from those 'affected' women who are running their own SHGs successfully. They are wives of HIV-positive men and in some cases there is high probability that their children might also get infected.
The attempt was to help these women overcome the social stigma and discrimination which is a bigger killer than the deadly virus. The meet was aimed at those who run individual enterprises and want to form SHGs taking inspiration from the existing ones.
The members of Pragati Group narrated their success story of supplying tea powder to companies and locals in the area. "We started the business about four years ago with 10 members. Today we are generating sustainable income for our families and take good care of our children and their studies. Earlier, we earned a profit of Rs 35 per day per person, which has now gone up to Rs 100," said Lalita Arnekar, president of Pragati Group.
Most of these women are either widows or are on the verge of becoming one. Despite all the sorrow, group meetings are cheerful. Their only worry is their children's future. They fear their wards will not be accepted.
Kiran Mahamuni, an out-reach worker associated with the Family Saving Groups said, "We help build bridges between group members and their families. The group meetings are held on rotation basis at every member's house, which helps them develop camaraderie."
The meet, that was organised by an NGO – Sarva Seva Sangh (SSS), has been running micro enterprises for infected women in slums and with the growth of SHG movement, they wish to work in groups and expand their business.
Most of these women were housewives with no job skills. The going has been rough, but they persisted and now earn well. Earlier the stigma of being 'infected' prevented these women from participating in weddings or auspicious events. "Yet, they have managed to break away. Some women sell vegetables or fish and some have trained at beauty salons," says Mahamuni.
Renuka S (name changed), a participant said, "This group was my saviour- it became a part of me, and the members are my family. I noticed that I was no longer alone, that others had the same experience and found a way back. Suddenly I felt this strong feeling that I had to help others who are in a similar situation. To be a volunteer is being a better human being."
Source: http://timesofindia.indiatimes.com/Pune/HIV_women_start_self-help_groups/articleshow/2890224.cms
Their life began after they sensed death. And now after successfully running their own micro enterprises, about a hundred HIV-positive women are looking forward to forming their own self- help groups (SHG).
These women from slums across the city gathered at Ishwani Kendra in Wadgaonsheri on Thursday to take inspiration from those 'affected' women who are running their own SHGs successfully. They are wives of HIV-positive men and in some cases there is high probability that their children might also get infected.
The attempt was to help these women overcome the social stigma and discrimination which is a bigger killer than the deadly virus. The meet was aimed at those who run individual enterprises and want to form SHGs taking inspiration from the existing ones.
The members of Pragati Group narrated their success story of supplying tea powder to companies and locals in the area. "We started the business about four years ago with 10 members. Today we are generating sustainable income for our families and take good care of our children and their studies. Earlier, we earned a profit of Rs 35 per day per person, which has now gone up to Rs 100," said Lalita Arnekar, president of Pragati Group.
Most of these women are either widows or are on the verge of becoming one. Despite all the sorrow, group meetings are cheerful. Their only worry is their children's future. They fear their wards will not be accepted.
Kiran Mahamuni, an out-reach worker associated with the Family Saving Groups said, "We help build bridges between group members and their families. The group meetings are held on rotation basis at every member's house, which helps them develop camaraderie."
The meet, that was organised by an NGO – Sarva Seva Sangh (SSS), has been running micro enterprises for infected women in slums and with the growth of SHG movement, they wish to work in groups and expand their business.
Most of these women were housewives with no job skills. The going has been rough, but they persisted and now earn well. Earlier the stigma of being 'infected' prevented these women from participating in weddings or auspicious events. "Yet, they have managed to break away. Some women sell vegetables or fish and some have trained at beauty salons," says Mahamuni.
Renuka S (name changed), a participant said, "This group was my saviour- it became a part of me, and the members are my family. I noticed that I was no longer alone, that others had the same experience and found a way back. Suddenly I felt this strong feeling that I had to help others who are in a similar situation. To be a volunteer is being a better human being."
Source: http://timesofindia.indiatimes.com/Pune/HIV_women_start_self-help_groups/articleshow/2890224.cms
Sunday, March 23, 2008
HIV and life for rural women in South Africa
By, Newsvoa.com, March 23, 2008
South Africa has the highest number of H.I.V. cases of any country in the world. An estimated five and a half million people are infected with the virus that causes AIDS. Fifty-five percent of them are women.
Last May, the cabinet of President Thabo Mbeki approved a five-year plan to guide efforts against AIDS in South Africa. For the plan to succeed, officials agreed that the nation had to deal with poverty, violence and discrimination facing women.
Now, a report from Amnesty International looks at the struggles of poor rural women living with H.I.V. in South Africa. The human rights group says the women face oppression and human rights abuses. And it says other women who feel socially and economically weak are at a higher risk of becoming infected with H.I.V.
Amnesty researcher Mary Rayner says rural women have little control in their relationships with men. Amnesty gathered statements from thirty-seven women in Mpumalanga and KwaZulu Natal provinces. They said that sometimes, when they tried to ask their sexual partners to use protection, they might experience verbal aggression or violence.
The report says many rural women with H.I.V. do not have enough money to travel to health centers for treatment. They might not even have enough money for food. Unemployment is a major problem.
Amnesty International released its report in London last week. Also in London, Scottish singer Annie Lennox promoted her new charity single called "Sing." The aim is to raise money for the Treatment Action Campaign, an H.I.V./AIDS organization in South Africa.
Source: http://www.voanews.com/specialenglish/2008-03-23-voa1.cfm
South Africa has the highest number of H.I.V. cases of any country in the world. An estimated five and a half million people are infected with the virus that causes AIDS. Fifty-five percent of them are women.
Last May, the cabinet of President Thabo Mbeki approved a five-year plan to guide efforts against AIDS in South Africa. For the plan to succeed, officials agreed that the nation had to deal with poverty, violence and discrimination facing women.
Now, a report from Amnesty International looks at the struggles of poor rural women living with H.I.V. in South Africa. The human rights group says the women face oppression and human rights abuses. And it says other women who feel socially and economically weak are at a higher risk of becoming infected with H.I.V.
Amnesty researcher Mary Rayner says rural women have little control in their relationships with men. Amnesty gathered statements from thirty-seven women in Mpumalanga and KwaZulu Natal provinces. They said that sometimes, when they tried to ask their sexual partners to use protection, they might experience verbal aggression or violence.
The report says many rural women with H.I.V. do not have enough money to travel to health centers for treatment. They might not even have enough money for food. Unemployment is a major problem.
Amnesty International released its report in London last week. Also in London, Scottish singer Annie Lennox promoted her new charity single called "Sing." The aim is to raise money for the Treatment Action Campaign, an H.I.V./AIDS organization in South Africa.
Source: http://www.voanews.com/specialenglish/2008-03-23-voa1.cfm
Friday, March 21, 2008
Why Nepal's women are more prone to AIDS
By, America Chronicle, March 20, 2008
The rising trend of HIV/AIDS infections among Nepali women is suddenly being discussed at emergency levels by various international development agencies after their plight has been highlighted in the international media. Often Nepali health experts blame the AIDS rise on gender, sexual discrimination, and the lack of enough awareness on availability of safe reproductive health choices for Nepali women, an their poor knowledge based on AIDS prevention. According to UNAIDS Nepal statistics, as of 2006-2007, the coverage of HIV services for people most at risk was 15% for harm reduction; 22% for men who have sex with men; 68% for female sex workers; 27.5% for migrant laborers; 6% for personnel of the uniformed services; 4.5% for antiretroviral therapy; and 82% for prevention of mother-to-child transmission.
Women as an HIV/AIDS core prevention target however are found neglected purely on the basis of their silence. In Nepal, women contribute to 60% of national agriculture yield, have less than one-half access to incomes for the same category of jobs than men, work longer hours and produce nearly 55% of the national per capita income yield.
In 2008, primary AIDS service barriers to helping Nepali women include an inadequacy of public health infrastructure (facilities and logistics system), lack of female personnel trained in HIV services outside urban district headquarters and in critical areas where high-risk behaviors are prevalent; limited capacities of nongovernmental organizations for scale-up; and, fear of stigma and discrimination at health facilities.
Although Nepal´s Ministry of Health and Population has adopted a policy of decentralization of resources to capacitate district-level services, these efforts still lack core mainstreaming as an overall health intervention among donors and government counterparts. A whole big bureaucratic mess surrounds systematic referral service of women with HIV/AIDS and STIs in the rural areas. Due to these factors, AIDS mainstreaming into non-health ministries is limited, the education and labour implications are not considered, and there is parallel donor programming which makes them compete among themselves rather than work with one unified purpose.
In fact, UNAIDS Nepal Country Office stated recently that its overall effort in mainstreaming HIV/AIDS and targeting Nepali women with special programs was hampered by the April 2006 Jan Andolan which brought about a new government and several changes in the MOHP setup.
Overall, it appears in 2008, that Nepal has failed in properly integrating HIV interventions and services into other health components, though many agencies are expanding pilot efforts in HIV and sexual and reproductive health integration. According to UNAIDS, in 2008, tuberculosis and HIV units in various health institutions are working more closely together, while the World Bank has re-tailored the majority of its program outputs to adjust to rural demands for AIDS prevention and knowledge building services. More linkages definitely need to be created between key strategic communications and behavior change interlinkages so that various AIDS affected target groups can interact more openly among themselves as well as with the Ministry of Health and Population at the central and district level.
How can the Nepali problem be solved when it comes to giving women better HIV/AIDS treatment, care and support? It is felt by most donors that the low and inequitable coverage of HIV prevention and services must be reversed and a more equitable distribution network developed. Currently, only a fraction of Nepali women at high risk have access to AIDS prevention services in Nepal. Similarly, coverage must expand to provide more adequate VCT sites, solve resource constraints in antiretroviral drugs disbursement, develop timely logistical correction in drugs distribution taking into consideration geographical inaccessibility, and infuse proper distribution of brochures and other information and communication material in the Nepali and other local languages, that appears lacking. AIDS interventions, in short, must be gender specific in Nepal's context.
Nepal already faces increased levels of HIV infection among excluded populations and people exposed to HIV. The Nepal government's estimated number of people living with HIV is around 75,000, which comprised 0.5% of the 15 to 49 age group. However the Ministry of Health and Population is more comfortable quoting the 90,000 benchmark that other donors use, considering it a more realistic estimate. Taking the older figure of 75,000 AIDS infected, Nepali women comprise around 16,000 cases. Official deaths registered so far due to AIDS are around 5,100. There are nearly 2,500 AIDS cases identified among children under 16 in various hospitals in 2007. But Nepali epidemiologists and health experts believe the figure could be at least four to five times higher if every woman returning from India particularly those engaged in the commercial sex trade took an AIDS test in a nearby VCT. In other words, expect nearly 15,000 deaths every year for the next half decade due to HIV/AIDS infection in Nepal until figures stabilize due to current interventions as the curve stabilizes at some point in 5-7 years!
Nepali women have had to face the majority of infections because they happen to be the weaker sex, subjugated and dominated in the overall Nepali gender context. The number of migrant workers working in India, particularly in Mumbai, New Delhi, Bangalore and Kolkata has intensified. Nearly 8 million Nepali migrants live in India now, and at least one-sixth that number is known to visit their relatives and families' back home each year during the Hindu Dashain festival. Similarly nearly 100,000 Nepali women out of nearly 250,000 Nepali female commercial sex workers working in the major Indian cities have returned to Nepal in the past decade, of which nearly 40% are estimated to be HIV positive according to a 2003 BBC special report estimate. The trafficking of young women and children to India goes unabated despite stringent cross-border monitoring, and their ages range from 12-29 years old. Middle men charge anywhere between US$ 40 to US$ 600 to sell young Nepali women and girls to Indian brothels.
Similarly, many civil conflict displaced women and children, particularly those who have lost their husbands, or been driven away due to poverty in their homes and villages, have also no alternative but to migrate to the bigger cities and serve in various Nepali tea stalls, massage parlours, cabin restaurants and hotels. Some end up as maids but still low paid. In fact, the entire 28 KM ring road that circulates Kathmandu and Patan is full of cabin restaurants and cheap hotels meant for truck drivers and migrant communities from surrounding towns and villages around Kathmandu valley that come to sell vegetables and other raw commodties. International aid agencies working in HIV/AIDS impact mitigation believe that nearly 60,000 Nepali commercial sex workers are serving in these venues, all of them women employed in meager wages that range less than $3-5 a day.
After the Nepali civil conflict ended in 2006, some of the above detail slowly started surfacing and international donors started acting faster focusing on post-conflict rehabilitation and recovery efforts with some acknowledgment of the problem. While focusing on humanitarian interventions, they started focusing on Nepal, but with a 'Bangladesh in the 70s slant'. In short, Nepal became to many donors a new humanitarian and human crises zone, but where AIDS held sway over the country´s destiny in some undefined manner. This is the simple emerging truth of Nepal, its open border system, and the resulting increased feminization of HIV/AIDS cases.
In 2008 and the oncoming period, what Nepal needs is a high level of political commitment to get itself out of this unanticipated health rout. Instead of opting for fragmented and short term program outputs, Nepal must opt for a high level AIDS interventions, political commitment and visible national strategy solely concentrated in containing the feminization of the flow and defeating AIDS. HIV/AIDS must now be mainstreamed into Nepali society no doubt.
It is known that Nepal´s Prime Minister Girija Prasad Koirala is very much concerned with the health and education situation of most Nepali and he has repeatedly stated in the recent past, that these ought to be the national priorities, not politics. Despite, battling AIDS is not a national priority in the Nepali development agenda, though it is now acknowledged by the National Planning Commission as an acceptable crisis that needs some sort of socio-political intervention. It is imperative donors concentrate more on HIV prevention education for children, women, young people and young adults than spend endless sums of money in traditional capacity building activities of Nepal Government, where usually civil servants go abroad for a week or two on educational trips and come back with little experience to share at the national scale.
Advocacy, behavior change communications interventions must similarly be tailored to engage a strategic information parley with the infected population, particularly women, not trying to impose donor values and judgments that might be rejected as non-cultural specific, but knowledge transfer that includes cultural transformation. Service delivery must focus on prevention of mother-to-child transmission, harm reduction among drug users and joint national program management and support.
Above all there must be stronger civil society leadership, prioritization of workable strategies, strengthening data uniformity and relevance, monitoring and evaluation of all major government and donor activities, and systematizing technical support to government by the implementing partners aimed at technical soundness. Young people must be involved in reproductive health choices, enhancing life skills-based HIV education, and technical guidance on how to bear more successful results from the gender angle. These might be some, not an exclusive list of solutions, that might work best in Nepal´s context, based on the current weaknesses exhibited in fighting HIV/AIDS at the national level.
Source: http://www.americanchronicle.com/articles/55967
The rising trend of HIV/AIDS infections among Nepali women is suddenly being discussed at emergency levels by various international development agencies after their plight has been highlighted in the international media. Often Nepali health experts blame the AIDS rise on gender, sexual discrimination, and the lack of enough awareness on availability of safe reproductive health choices for Nepali women, an their poor knowledge based on AIDS prevention. According to UNAIDS Nepal statistics, as of 2006-2007, the coverage of HIV services for people most at risk was 15% for harm reduction; 22% for men who have sex with men; 68% for female sex workers; 27.5% for migrant laborers; 6% for personnel of the uniformed services; 4.5% for antiretroviral therapy; and 82% for prevention of mother-to-child transmission.
Women as an HIV/AIDS core prevention target however are found neglected purely on the basis of their silence. In Nepal, women contribute to 60% of national agriculture yield, have less than one-half access to incomes for the same category of jobs than men, work longer hours and produce nearly 55% of the national per capita income yield.
In 2008, primary AIDS service barriers to helping Nepali women include an inadequacy of public health infrastructure (facilities and logistics system), lack of female personnel trained in HIV services outside urban district headquarters and in critical areas where high-risk behaviors are prevalent; limited capacities of nongovernmental organizations for scale-up; and, fear of stigma and discrimination at health facilities.
Although Nepal´s Ministry of Health and Population has adopted a policy of decentralization of resources to capacitate district-level services, these efforts still lack core mainstreaming as an overall health intervention among donors and government counterparts. A whole big bureaucratic mess surrounds systematic referral service of women with HIV/AIDS and STIs in the rural areas. Due to these factors, AIDS mainstreaming into non-health ministries is limited, the education and labour implications are not considered, and there is parallel donor programming which makes them compete among themselves rather than work with one unified purpose.
In fact, UNAIDS Nepal Country Office stated recently that its overall effort in mainstreaming HIV/AIDS and targeting Nepali women with special programs was hampered by the April 2006 Jan Andolan which brought about a new government and several changes in the MOHP setup.
Overall, it appears in 2008, that Nepal has failed in properly integrating HIV interventions and services into other health components, though many agencies are expanding pilot efforts in HIV and sexual and reproductive health integration. According to UNAIDS, in 2008, tuberculosis and HIV units in various health institutions are working more closely together, while the World Bank has re-tailored the majority of its program outputs to adjust to rural demands for AIDS prevention and knowledge building services. More linkages definitely need to be created between key strategic communications and behavior change interlinkages so that various AIDS affected target groups can interact more openly among themselves as well as with the Ministry of Health and Population at the central and district level.
How can the Nepali problem be solved when it comes to giving women better HIV/AIDS treatment, care and support? It is felt by most donors that the low and inequitable coverage of HIV prevention and services must be reversed and a more equitable distribution network developed. Currently, only a fraction of Nepali women at high risk have access to AIDS prevention services in Nepal. Similarly, coverage must expand to provide more adequate VCT sites, solve resource constraints in antiretroviral drugs disbursement, develop timely logistical correction in drugs distribution taking into consideration geographical inaccessibility, and infuse proper distribution of brochures and other information and communication material in the Nepali and other local languages, that appears lacking. AIDS interventions, in short, must be gender specific in Nepal's context.
Nepal already faces increased levels of HIV infection among excluded populations and people exposed to HIV. The Nepal government's estimated number of people living with HIV is around 75,000, which comprised 0.5% of the 15 to 49 age group. However the Ministry of Health and Population is more comfortable quoting the 90,000 benchmark that other donors use, considering it a more realistic estimate. Taking the older figure of 75,000 AIDS infected, Nepali women comprise around 16,000 cases. Official deaths registered so far due to AIDS are around 5,100. There are nearly 2,500 AIDS cases identified among children under 16 in various hospitals in 2007. But Nepali epidemiologists and health experts believe the figure could be at least four to five times higher if every woman returning from India particularly those engaged in the commercial sex trade took an AIDS test in a nearby VCT. In other words, expect nearly 15,000 deaths every year for the next half decade due to HIV/AIDS infection in Nepal until figures stabilize due to current interventions as the curve stabilizes at some point in 5-7 years!
Nepali women have had to face the majority of infections because they happen to be the weaker sex, subjugated and dominated in the overall Nepali gender context. The number of migrant workers working in India, particularly in Mumbai, New Delhi, Bangalore and Kolkata has intensified. Nearly 8 million Nepali migrants live in India now, and at least one-sixth that number is known to visit their relatives and families' back home each year during the Hindu Dashain festival. Similarly nearly 100,000 Nepali women out of nearly 250,000 Nepali female commercial sex workers working in the major Indian cities have returned to Nepal in the past decade, of which nearly 40% are estimated to be HIV positive according to a 2003 BBC special report estimate. The trafficking of young women and children to India goes unabated despite stringent cross-border monitoring, and their ages range from 12-29 years old. Middle men charge anywhere between US$ 40 to US$ 600 to sell young Nepali women and girls to Indian brothels.
Similarly, many civil conflict displaced women and children, particularly those who have lost their husbands, or been driven away due to poverty in their homes and villages, have also no alternative but to migrate to the bigger cities and serve in various Nepali tea stalls, massage parlours, cabin restaurants and hotels. Some end up as maids but still low paid. In fact, the entire 28 KM ring road that circulates Kathmandu and Patan is full of cabin restaurants and cheap hotels meant for truck drivers and migrant communities from surrounding towns and villages around Kathmandu valley that come to sell vegetables and other raw commodties. International aid agencies working in HIV/AIDS impact mitigation believe that nearly 60,000 Nepali commercial sex workers are serving in these venues, all of them women employed in meager wages that range less than $3-5 a day.
After the Nepali civil conflict ended in 2006, some of the above detail slowly started surfacing and international donors started acting faster focusing on post-conflict rehabilitation and recovery efforts with some acknowledgment of the problem. While focusing on humanitarian interventions, they started focusing on Nepal, but with a 'Bangladesh in the 70s slant'. In short, Nepal became to many donors a new humanitarian and human crises zone, but where AIDS held sway over the country´s destiny in some undefined manner. This is the simple emerging truth of Nepal, its open border system, and the resulting increased feminization of HIV/AIDS cases.
In 2008 and the oncoming period, what Nepal needs is a high level of political commitment to get itself out of this unanticipated health rout. Instead of opting for fragmented and short term program outputs, Nepal must opt for a high level AIDS interventions, political commitment and visible national strategy solely concentrated in containing the feminization of the flow and defeating AIDS. HIV/AIDS must now be mainstreamed into Nepali society no doubt.
It is known that Nepal´s Prime Minister Girija Prasad Koirala is very much concerned with the health and education situation of most Nepali and he has repeatedly stated in the recent past, that these ought to be the national priorities, not politics. Despite, battling AIDS is not a national priority in the Nepali development agenda, though it is now acknowledged by the National Planning Commission as an acceptable crisis that needs some sort of socio-political intervention. It is imperative donors concentrate more on HIV prevention education for children, women, young people and young adults than spend endless sums of money in traditional capacity building activities of Nepal Government, where usually civil servants go abroad for a week or two on educational trips and come back with little experience to share at the national scale.
Advocacy, behavior change communications interventions must similarly be tailored to engage a strategic information parley with the infected population, particularly women, not trying to impose donor values and judgments that might be rejected as non-cultural specific, but knowledge transfer that includes cultural transformation. Service delivery must focus on prevention of mother-to-child transmission, harm reduction among drug users and joint national program management and support.
Above all there must be stronger civil society leadership, prioritization of workable strategies, strengthening data uniformity and relevance, monitoring and evaluation of all major government and donor activities, and systematizing technical support to government by the implementing partners aimed at technical soundness. Young people must be involved in reproductive health choices, enhancing life skills-based HIV education, and technical guidance on how to bear more successful results from the gender angle. These might be some, not an exclusive list of solutions, that might work best in Nepal´s context, based on the current weaknesses exhibited in fighting HIV/AIDS at the national level.
Source: http://www.americanchronicle.com/articles/55967
Thursday, March 20, 2008
Woman with HIV warns others to get tested
By, Ashley Andyshak, Fredericknewspost.com, March 21, 2008
Jessica Haidon was three months pregnant when she found out she had HIV.
At the start of her relationship with her son's father, he told her he didn't have it. When she confronted him again after her diagnosis, he confessed he'd been infected for six years.
Haidon got the necessary treatment, and she's thankful the virus was not passed to her son, Nicholas, now 14 months old. She said she's speaking out now so the same thing doesn't happen to more women.
"The most important thing is to go get tested together," Haidon said. "You can't trust what people say, and some people don't even know they have it."
Debbie Anne, the HIV/AIDS program supervisor at the Frederick County Health Department, said most couples who come to the department to get tested for HIV are young, and she wishes more would do the same.
People younger than 30 reported a quarter of the state's 2,000 new HIV cases in 2006, and the highest number of diagnoses over the last several years has been among women ages 15 to 39, according to statistics from the health department. More than 18,000 Marylanders have HIV, and in another 14,000, the virus has progressed to AIDS.
The presence of other sexually transmitted diseases increases the likelihood of acquiring or transmitting HIV, and these diseases are prevalent among young women. A study released this month by the Centers for Disease Control and Prevention shows that one in four teenage girls have at least one STD.
"The gap that once existed between the number of men contracting HIV and the number of women has now closed," Anne said, and heterosexual contact is now the No. 1 method of transmission in Maryland.
Haidon and her son moved from Buffalo, N.Y., to Frederick in August to be closer to her mother, and she's been continuing her treatment at the health department.
She meets with Anne at least once every three months to monitor her immune system's functioning and the amount of virus in her bloodstream, both indicators of the disease's progression.
On a typical day, Haidon feels as healthy as she did before her diagnosis, just more tired, she said. It's a common symptom of those in early stages of the disease, and Haidon's lucky she was diagnosed when she was, Anne said.
"Many people don't get tested until they end up in the ER," Anne said, at which point the disease has likely progressed to AIDS. "It's much better to get diagnosed earlier." With treatment, those infected with HIV can die of old age, instead of AIDS, Anne said.
Fear of a positive diagnosis may keep some people from getting tested for HIV, but getting treatment and preventing transmission of the disease to someone else should trump the fear of finding out, Haidon said.
The fear of reactions from others can cause some young people to resist testing as well. After Haidon was diagnosed, her family and friends were supportive, but she's seen others in her situation who haven't been as fortunate.
"If somebody tells their family, they shouldn't turn them away," she said. "It doesn't make you a bad person."
Source: http://www.fredericknewspost.com/sections/news/display.htm?storyID=72724
Jessica Haidon was three months pregnant when she found out she had HIV.
At the start of her relationship with her son's father, he told her he didn't have it. When she confronted him again after her diagnosis, he confessed he'd been infected for six years.
Haidon got the necessary treatment, and she's thankful the virus was not passed to her son, Nicholas, now 14 months old. She said she's speaking out now so the same thing doesn't happen to more women.
"The most important thing is to go get tested together," Haidon said. "You can't trust what people say, and some people don't even know they have it."
Debbie Anne, the HIV/AIDS program supervisor at the Frederick County Health Department, said most couples who come to the department to get tested for HIV are young, and she wishes more would do the same.
People younger than 30 reported a quarter of the state's 2,000 new HIV cases in 2006, and the highest number of diagnoses over the last several years has been among women ages 15 to 39, according to statistics from the health department. More than 18,000 Marylanders have HIV, and in another 14,000, the virus has progressed to AIDS.
The presence of other sexually transmitted diseases increases the likelihood of acquiring or transmitting HIV, and these diseases are prevalent among young women. A study released this month by the Centers for Disease Control and Prevention shows that one in four teenage girls have at least one STD.
"The gap that once existed between the number of men contracting HIV and the number of women has now closed," Anne said, and heterosexual contact is now the No. 1 method of transmission in Maryland.
Haidon and her son moved from Buffalo, N.Y., to Frederick in August to be closer to her mother, and she's been continuing her treatment at the health department.
She meets with Anne at least once every three months to monitor her immune system's functioning and the amount of virus in her bloodstream, both indicators of the disease's progression.
On a typical day, Haidon feels as healthy as she did before her diagnosis, just more tired, she said. It's a common symptom of those in early stages of the disease, and Haidon's lucky she was diagnosed when she was, Anne said.
"Many people don't get tested until they end up in the ER," Anne said, at which point the disease has likely progressed to AIDS. "It's much better to get diagnosed earlier." With treatment, those infected with HIV can die of old age, instead of AIDS, Anne said.
Fear of a positive diagnosis may keep some people from getting tested for HIV, but getting treatment and preventing transmission of the disease to someone else should trump the fear of finding out, Haidon said.
The fear of reactions from others can cause some young people to resist testing as well. After Haidon was diagnosed, her family and friends were supportive, but she's seen others in her situation who haven't been as fortunate.
"If somebody tells their family, they shouldn't turn them away," she said. "It doesn't make you a bad person."
Source: http://www.fredericknewspost.com/sections/news/display.htm?storyID=72724
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