..:: 30 Nov 2005 ::..

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Latest News on HIV/AIDS Related Issues


Special Issue



  1. Essential package for HIV prevention
  2. 'Raise awareness about rights of HIV-positives'
  3. Waking up to Reality
  4. Eyeball Bus Campaign in London to Stop AIDS
  5. World AIDS Day to be Observed in US, UK
  6. The Deadly Shot
  7. AIDS Goal Missed, but Effort by U.N. Branch Is Praised
  8. Sex Education Can Be Creative, Say Experts
  9. OP ED: AIDS: The Strategy Is Wrong
  10. HIV Breeds on Complacent Attitudes Among Youth

News in Details: 

Essential package for HIV prevention

Dr Md Mozammel Hoque, Dhaka, 29 November: HIV/AIDS has been well recognisd to be a serious challenge all over the world. Despite several efforts to address the epidemic, the trend of HIV spread is still unbroken and this is more apparent in poor resource setting countries. The HIV epidemic is leading to significant impact on health, development, and the economy, especially in the developing countries. The HIV epidemic is growing very rapidly in South East Asian region.

   Bangladesh is still a low prevalence country for HIV infection. However, there are reasons for huge anxiety. Inadequate knowledge and education about HIV/AIDS has largely increased the vulnerability. Existence of substance consumption especially the injecting drug use, commercial sex, high rates of sexually transmitted infections (STIs), have made the country at higher risk for HIV epidemic. The geographical location with its close proximity to high HIV prevalence countries (e.g. India, Myanmar, Nepal etc.), porous border at several places associated with frequent legal and illegal migration have increased the vulnerability. Moreover, sexual violence against women, women trafficking etc. are some of the important factors, which can add more fuel to the risk for HIV. About one third of the country’s populations are young people. In many of the cases their lifestyle and behavioral practices (e.g. substance use, unsafe sexual practices etc.) are very much risky for HIV infection. The epidemic has already reached the way to drive around in the country. According to the 6th round of sero-surveillance (2004-2005), the prevalence among the Injecting Drug Users (IDUs) has already reached to 4.9% in central region of Bangladesh, which is very close to a concentrate epidemic. Therefore, it is the high time to contain the epidemic.

   Voluntary Counseling and Testing (VCT) services – a wide-ranging approach for HIV prevention.

   Primary prevention of HIV infection and care and support services to the positive people and their partners and families is very essential in HIV prevention strategies. Voluntary Counseling and Testing (VCT) service is a public health strategy aims to reduce HIV transmission. It is a wide ranging approach that can provide people adequate knowledge, can encourage people to voluntarily participate to know their HIV status, and guide them in planning healthy life style that could protect them from the infection and prevent the transmission to others. The VCT services develop an essential link with proper care and support services in order to support the people who need it. The psychological support provided by VCT services guide the people to contain their stress. People affected by HIV need counseling and testing services for future planning (e.g. planning for marriage and children), emotional support, medical services, and other referral services. It improves the quality of life and may play a key role in reduction of stigma and discriminations relating to HIV/AIDS. Voluntary Counseling and Testing services has been well recognised as one of the few potentially effective and affordable methods for reducing the transmission of HIV in the developing countries.

   Mode of service delivery through VCT centers
   The VCT includes pre-test counseling, voluntary and confidential HIV testing and post test counseling. The person seeking his HIV status is appropriately counseled before the testing for HIV (Pre Test Counseling). It enhances the client’s mental preparedness for a test result. The proper counseling enables the client developing his/her mental strength in reducing the stress for HIV positive status. The Pre Test Counseling emphasises confidentiality. This specialised counseling technique follows specified standard protocol. It includes Pre Test Counseling, Voluntary Testing and Post Test Counseling. Well-trained counselors provide the counseling services at Voluntary Counseling and Testing Centers (VCTCs).

   The Pre Test Counseling includes the discussion about the client’s current knowledge of HIV and the basic facts about HIV/AIDS. The discussion is also done about the reasons of the client for wanting the test. Moreover, discussion about the potential benefit of either test result is also done. It helps the client to plan his/her life, change lifestyle, live positively, look after health and not put others at risk. It also helps the person to decide who would he inform and not inform about his/her positive result, if necessary. The process creates the environment where the client is enabled to voluntarily give consent or request for HIV testing.

   Voluntary Counseling and Testing Centers (VCTCs) apply the Enzyme Linked Immunosorbant Assay (ELISA) technology, which has a high sensitivity and specificity of over 99% and require no special equipment. After the test result, the client is given the Post Test Counseling.

   The method of Post Test Counseling depends on the HIV status. If the test is negative, the client is further counseled for repeating the test after three months, because of the window period, which may prolong up to three months from the date of first entry of the virus to human blood. The client is counseled further to change the risky behavior and lead a healthy lifestyle, which will reduce his/her risk for HIV infection. If the status is positive, the client is assured and counseled in such a empathetic and specified manner, which helps the person enable to plan a lifestyle that can guide him/her towards a productive life. Usually the client is referred to a reference center to confirm the result by doing a superior testing technology (e.g. Western blot). The positive person is counseled for time-to-time follow-up counseling sessions. If necessary he/she is linked with the appropriate care and support services. If the client desires to make his family and/or partner known about his/her status, the family and/or partner counseling also provided from the VCTC.

   The VCTCs link the services with the interventions such as prevention of parent-to-child transmission (PPTCT), prevention of sexually transmitted infections (STIs) and prevention and treatment of opportunistic infections (OIs). It also facilitates early referral to comprehensive clinical and community-based prevention, care and support services, including access to antiretroviral therapy (ART).

   What formulates successful VCT services
   Availability of information, which is accurate and updated regularly to reflect the changing situation, is important to deal with the VCT services. For example, counselors need to know the details, the latest findings and treatment information to be able to provide support. The community also requires information to raise awareness and know what to fear and what not to fear. Good support services and support network is also very important. The informed consent, confidentiality, appropriate counseling, good referral systems, adequate and sustainable supply of kits and other logistics and quality control are the key components for services to be ethical and effective. Advocacy, programme networking, preparing communities for VCT so that they understand its benefits, and provides support for those testing positive is essential. VCT uptake and acceptability will otherwise be limited by fear of discrimination and stigma.

   HIV prevention and VCT services in Bangladesh:
   Bangladesh is lacking in providing a comprehensive system of complete range of voluntary counseling with testing (VCT) services. However, government and some NGOs have developed some VCT centers in Dhaka and other Divisional cities. Though insufficient in number, the initiative is praiseworthy. The number of government and autonomous health facilities initiated to develop voluntary counseling and testing centers (VCTCs) are, - Institute of Epidemiology Disease Control and Research (IEDCR), Mohakhali, Dhaka; Institute of Public Health (IPH), Mohakhali, Dhaka; Bangabandhu Sheikh Mujib Medical University (BSMMU), Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment, Chittagong Medical College, Sylhet MAG Osmani Medical College and Khulna Medical College. Government is planning to develop quality VCTCs in different geographical locations having the populations with high vulnerability towards HIV infection. All the districts will be ultimately covered by the VCT services in a phase wise manner.

   Some NGOs also have established few but exemplary VCT centers. Especially the ICDDR,B has established a full-fledged VCTC at ICDDR,B, Mohakhali, Dhaka. It has also branches in Chittagong and Sylhet managed in collaboration with Marie Stops Clinic Society (MSCS) Bangladesh. Few other organisations are also providing VCT services, e.g. Confidential Approach to AIDS Patients (CAAP) is operating one VCT center at Banani, Dhaka. FHI Bangladesh has planned to develop a substantial number of VCTCs throughout the country during the next three years period through the project “Bangladesh AIDS Programme (BAP)” funded by USAID. However, quality control of all the mentioned VCTCs is very crucial. Provision of anti retroviral treatment (ART) or proper linkage to ART facilities is necessary to incorporate with the exiting VCT facilities. Adequate and continuous supply of commodities is very vital for quality service delivery. Lack of trained counselors is a big problem for the VCT services. NASP, FHI Bangladesh and HASAB have jointly organised training programmes for the counselors. However, it was not enough in terms of the number of counselors trained and developed. More training programmes are needed to amplify the number as well as the quality for the future need.

   Existence of the risk factors for HIV infection is at an upsetting level in Bangladesh. Being a low prevalence country, containing the epidemic in the early stage is very essential. The Voluntary Counseling and Testing (VCT) services for HIV is now acknowledged within the international arena as an efficacious and pivotal strategy for both HIV/AIDS prevention and care. The need for VCT is increasingly compelling as HIV infection rates continue to rise, and many countries recognised the need for their populations to know their sero-status as an important prevention and intervention tool. However, access to VCT services in Bangladesh like many developing countries is limited. People’s participation to receive the services is vital for successful VCTCs. Many people are still very reluctant to be tested for HIV. This reluctance is the result of barriers to VCT, which are: stigma, gender inequalities and lack of perceived benefit. A well-planned joint effort of the government, Development Partners (DPs) and NGOs is very important to establish sufficient quality VCTCs in the country. The Non Government Organizations (NGOs) should come up with more innovation to scale up the VCT services through out the country.

   [The writer, a public health specialist, currently works as deputy programme manager in National AIDS/STD Programme, Bangladesh.]
   E-mail: mozhoque@yahoo.com)

Source: http://www.newagebd.com/oped.html#1

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  'Raise awareness about rights of HIV-positives'

Dhaka, 28 November: Speakers at a discussion yesterday called for extensive media coverage to raise awareness about the rights of HIV/Aids patients.

The HIV-positives are not an isolated segment of the society. Rather, they have equal rights as patients with other diseases, they added.

They also urged the media persons to be more sympathetic while publishing reports on HIV-infected people so that they can protect themselves from stigma and discrimination.

The Internews Network in cooperation with the Unicef and the USAID organised the discussion titled 'Bangladesh Media Leadership Meeting on HIV/Aids' at a city hotel.

The meeting was part of a programme initiative of UNAIDS Asia Pacific Leadership Forum (APLF) on HIV/Aids, according to organisers.

Speaking as the chief guest at the inaugural session, Information Minister M Shamsul Islam said the role of media leaders is crucial to making the people aware about HIV/Aids.

Md Abdus Salam, programme manager, National Aids/STD Programme (NASP), and Shamsuddin Ahmed, an official of Unicef, presented two papers.

Although the prevalence rate of HIV/Aids infections is low, Bangladesh is highly vulnerable because of rapid increase in the number of HIV-positives in neighbouring countries, according to the papers.

According to an official estimate, a total of 465 HIV-infected persons were detected so far, but the number could be as high as 7,500.

Bazlur Rahan, editor of the daily Sangbad, presided over the discussion while Iqbal Sobhan Chowdhury, editor of The Bangladesh Observer, moderated it.

People still hesitate to discuss the HIV issue in public, but they should talk it more in order to reduce the risk of HIV infection, said Maj. Gen. Matiur Rahman, chief advisor to the National AIDS Committee.

Habiba Akhter, executive director of Ashar Alo, called for reducing HIV stigma to prevent spread of the deadly disease.

Abdul Quaiyum, joint editor of the Prothom Alo, Gaziul Hasan Khan, chief editor of BSS, Apel Mahmud, deputy director general of Bangladesh Betar, Shyamal Dutta, acting editor of the Bhorer Kagoj, Naimul Islam Khan, editor of the Amader Somoy, Rashed Chowdhury, editor of the BDNews24, Mostafa Kamal, editor of the New Nation, Abul Asad, editor of the Sangram, M Liakot, editor of the Purbanchal, and Delwar Hossain Khokon, editor of Loksamaj also spoke.

Source: http://thedailystar.net/2005/11/28/d51128060363.htm

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Waking up to Reality

Azfar Aziz , Dhaka, 25 November: Recent surveys reveal that the number of injecting drug users (IDUs) in Bangladesh is rising. What is more frightening is that many of them are HIV positive. Indiscriminate needle sharing and unprotected sex among the IDUs pose a high risk of the virus spreading into the general population. As the World AIDS Day approaches on December1 SWM takes a look at the threat of an epidemic in Bangladesh in the context of inadequate state interventions and the efforts of a few organisations to introduce sustainable methods to rehabilitate IDUs and contain the spread
of the virus.

 MoniIruzzaAman a farmer from Elaipur village in Rupsha upazila and his wife were in for the greatest shock of their lives when they took their sick son to Khulna Shishu Hospital. Blood tests revealed that the infant was HIV positive. This prompted the doctors to get blood samples from the other family members. All of them - the father, mother and two other children were tested positive for HIV. A physician who knows the family, suspects that the mother may have been infected with the virus when she received six bags of blood 11 years ago during the complicated delivery of her first child.

This frightening tale gives a glimpse of the gravity of the problem. First, of the complete lack of awareness about HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immune Deficiency Syndrome) and secondly that we have no idea about how fast and how widely it is spreading. While sexual intercourse is the most obvious way for the virus to be transmitted from one person to the other, needle sharing between drug users has been found to be the most common cause for the spread of the virus.

Last year, a survey detected a near HIV epidemic among injecting drug users (IDUs) in a pocket of central Bangladesh. The fifth round of HIV surveillance by the Centre for Health and Population Research of the ICDDR,B (International Centre for Diarrhoeal Disease Research, Bangladesh) reports, "The HIV epidemic in Bangladesh, from an epidemiological perspective, is evolving rapidly. While still a low prevalence country for overall HIV rates, a small pocket of IDUs under second generation surveillance, has shown an HIV prevalence increase from 1.4% to 4% to 8.9% (in one locality) in the past three years." The prevalence rate is what health experts consider a concentrated epidemic in a particular social section. It also means there is too high a risk of the epidemic fanning out for the society to remain complacent about.

But, Bangladesh continues to remain indifferent to the frightening report. Since the first case detected in 1989, only 465 cases of HIV infection were officially reported until December 2004. Of the infected, 87 have developed AIDS and 44 have died. On the other hand, even back in 2002, UNAIDS estimated that some 13,000 adults and children were HIV positive in the country, which by now should have increased at least three-fold, considering the upward trend detected in the ICDDR,B survey. Explaining the chasm between the government and the UN estimates, National AIDS/STD Program (NAP) states, "Significant underreporting of cases occurs because of the country's limited voluntary testing and counseling capacity. The social stigma attached to the disease is a further impediment."

When we consider the five unfortunate members of the farmer family, this is even more relevant. Many IDUs sell their blood to get money to buy drugs, increasing the risk of spreading the virus. As the NAP says, "Bangladesh relies on professional blood-sellers to meet most of the transfusion needs of its people" Referring to the jump of HIV prevalence among a section of IDUs from 1.4 percent to 8.9 percent over just three years time, NAP observes the virus can spread rapidly within the group, then through their sexual partners, many of them sexual workers and their clients into the general population.

There are lessons for us to learn from what happened in Vietnam and Nepal as a consequence of reluctance of the authorities to intervene quickly in similar situations. According to a November 2001 NAP document, "No drug injectors in the northern Vietnam city of Haipong were infected with HIV just two years ago. Now, HIV prevalence in this group has risen above 60 percent. Since new data confirm that drug injectors in Bangladesh share needles even more frequently than they do in Vietnam, similar rises are inevitable here at some point in the future, unless needle sharing falls drastically."

Even at that time, in 2001, when the third round of sero and behavioural surveillance on HIV infection found its prevalence among IDUs to be 1.7 percent, brothel-based sex workers 0.3 to 0.5 percent and floating sex workers 0.5 percent, NAP cautioned, "The information now available should set alarm bells ringing for Bangladesh."

Now, at the end of 2005, the alarm bells should be clamouring even louder. The latest Behavioural Surveillance Survey (BSS) data indicates an increase in risk behaviour such as sharing of needles and a decline in condom use in sexual encounters between IDUs and female sex workers. Around 70 percent of the IDUs routinely share needles. The BSS data also indicates that the IDU population is well integrated into the surrounding urban community, socially and sexually, thus raising a grave concern about the spread of HIV infection.

The fifth BSS shows a large proportion of the IDUs to have commercial and non-commercial female sex partners and condom use is infrequent. A significant number of IDUs - 4.3-6.7 percent - has also sold blood over the last year. Moreover, IDUs travel from other cities to the capital to inject drugs, increasing the chance of spreading the virus.

While passing by the Dhaka Medical College Hospital (DMCH) one cannot miss seeing a number of people looking like they have just come out of hell. Their skin ashen, with ill-health, they wear tattered dirty rags and sit around in scattered groups, sharing a syringe or two to get their daily 'fix'. A particularly dangerous practice of the IDUs is called 'shooting gallery', says Iqbal Faruk, a director of Crea, a pioneering rehabilitation service provider to drug addicts in Bangladesh. "In fear of getting caught red--handed by the police, they share a large syringe to inject drugs very quickly. This practice is particularly widespread in Rajshahi and also in some pockets of Dhaka," he elaborates.

Another alarming aspect is the very high prevalence of Hepatitis C (HCV) among the IDUs, which the NAP puts at 83 percent. NAP says, "This is comparable to levels in countries that are experiencing a concentrated and growing HIV epidemic." Hepatitis C causes damage to the liver and can lead to fatal diseases such as liver cirrhosis and liver cancer. The hepatitis C virus can be contracted through transmission of infected blood or body fluids by transfusions, needleshaving, sexual intercourse or from an infected mother to her baby.

The fifth sero survey also reveals that about 8 percent of heroin addicts often switch to injectable drugs as an alternative. Thus they too should be counted among those who share needles in shooting drugs.

Barely two months old, Modhu, a baby boy, lives in a rehabilitation centre for drug addicts at Lalbagh in Old Dhaka. He is actually lucky to be alive. His mother, an intravenous drug user resorted to prostitution to sustain her habit and was admitted at the centre in an advanced stage of pregnancy. If she were not here, Modhu might not have seen the light of life at all or might have ended up forsaken on a footpath. His mother certainly could not have borne the costs of a caesarean or the subsequent complications of a premature baby. She was also in no state to take care of a child, being preoccupied with how to get her next fix.

Modhu was born in the small hours of October 2. "His mother had been in labour since the previous evening," says Lavlu, Crea-Modhumita rehab centre-in-charge. "We took her first to Azimpur maternity centre. But when the hospital staff learnt about her drug addiction and her occuptaion, they refused to admit her. The same thing happened when we went to Bangladesh Medical College and Hospital. At last we managed to get her admitted to Ibne Sina Hospital."

"The amniotic sac was ruptured, and it was a pre-mature delivery at only seven and a half months of pregnancy. The birth weight was low, too only 1.9 kg," pitches in Dr. Baquirul Islam Khan, who left his prestigious job as programme manager of Grameen Kalyan to manage the Crea-FHI HIV Prevention Project. "So, we had to go for a caesarean section and keep the child in an incubator for several days. Then he caught bronchopneumonia and we had to transfer him to Shishu Hospital," he adds.

When the woman returned to the rehab centre with the baby, the 30 plus inmates including 11 women and the 25 staff members felt a sudden shift in the environment. Two months into its launching, the centre seems more like a home than a detention camp. They decided to name the boy Modhu and if any girl-child is born here in future to name her Mita.

Modhu-Mita has become the brand name of a range of HIV/AIDS prevention services such as the needle exchange programme, drop-in and crisis support centres for drug addicts, medical facilities for sex workers etc. These services are provided under the IMPACT project of Family Health International (FHI). IMPACT works with government and non-governmental organisations (NGOs) at the community level to strengthen the care and support systems, to prevent HIV transmission and to promote behavioural change among the high-risk groups.

The fifth Behavioural Surveillance Survey found virtually no change in the behavioural patterns of the most high-risk groups between 1997 and 2004. This has shaken up all the agents associated with HIV/AIDS, prevention and control. The FHI and its partners including the government, CARE, Marie Stopes and USAID have realised the urgency of a new and more comprehensive approach to combat the menace.

Formerly most of the government, NGO-run and private sector clinical facilities used to offer short-term, usually 14-day, detoxification services to drug addicts including the IDUs, leaving out a crucial follow up rehabilitation. Detoxified patients, without having psychological therapy, social and financial rehabilitation, and counselling, went back to their addiction, particularly those who had lost their means of livelihood. Considering the new findings, IMPACT early this year, decided to launch a completely free and comprehensive package of physical, social and financial rehabilitation for the drug addicts. This initiative offered for the first time an opportunity for the dirt-poor addicts to return to the social mainstream.

IMPACT has contracted three renowned organisations Apon, Crea and Ahsania Mission working with the rehabilitation of drug addicts, to provide this service in Dhaka, which is the most high-risk zone in terms of an HIV epidemic. Preference is given to the destitute, IDUs and women. The government, too, is going to expand its 40-bed central treatment centre for drug addicts to a 250-bed one, of which 100 beds will be for patients seeking detoxification and 150 beds for rehabilitation. Of the three IMPACT partners working with the Modhumita brand, Apon will launch a rehab centre exclusively for female drug addicts and Ahsania Mission for males only. They are in the process of setting up the centres.

Crea has already opened its centre at Lalbagh that tends to both male and female patients. The patients are referred by CARE drop-in centres but can also seek treatment voluntarily, by themselves, Crea Executive Director Tarun Kanti Gayen, a psychologist working for around two decades in this field.

The basic rehab process takes six months, followed by support services, said Gayen. Of the six months, 14 days are for detoxification, then three months for various rehab therapies and training, and the rest are for day-care services, followed by after-care. Again, the detox service is available in three categories: in-house, home and community detoxification. The last two categories are particularly novel. Home detoxification is most suitable for certain categories of addicts such as women, elderly people and service-holders, to whom taking admission to a rehab centre poses the risk of getting stigmatised by society. However, in home detox, the family members of the patient have to be intensely involved in caring for the patient. The patients also are required to go through the rest of the programme at the centre, with leave to stay at home only overnight.

In community detoxification, on the other hand, the entire community becomes involved by providing the accommodation for a detox camp, volunteer staff, etc. The Crea-Modhumita has already carried out a community detox programme at Hazaribagh in the city, says Dr. Khan. The October 14-27 programme held at the local community centre started with 24 patients. The local city corporation ward commissioner, Mujibur Rahman, played a key role in arranging the venue, while a local youth club came up with the volunteer staff. Of the initial 24 patients, one had to be transferred to the DMCH as his condition became medically critical and one was expelled for violent behaviour. The remaining 22 successfully completed the course.

Gayen says the community detoxification method has proved to be highly successful and sustainable in India, particularly in the southern states. It is because, after detoxification, the patients are helped to get a job and more importantly are treated with compassion and understanding by community members. Thus it also helps eradicate the stigma and segregation attached to drug addiction. This approach, Gayen noted, has the potential to revolutionise the drug addiction and HIV scenarios in Bangladesh, where the government, NGO and private-sector interventions are either too meagre or too ineffectual to make any real difference.

Elaborating on the difference between the previously available interventions and that of Crea-Modhumita, Dr Khan says, "They did not link other essential psycho-social services for relapse prevention, for changing behavioural pattern and mindset, and for increasing self-efficacy with detoxification, which we are doing. After admission to the centre, we screen the patients for sexually transmitted infection (STI) and provide abscess management, bio-safety, counselling to the patients and their family members, as well as vocational training."

 At present, patients get in-house training in block printing, tailoring, embroidery and carpentry. Dr Khan says the range of training area will be widened gradually. Those who already have some kind of vocational skills will be referred to higher training institutes. "We will get the patients graduating the course to form self-help groups and are trying to get funds to provide them with micro-credit to set up small businesses or enterprises so that they can survive financially. We are also considering launching a sort of recovery home for the women who have no shelter or family or have lost it to drug addiction, to help them stay clean," Khan adds.

As of end-October, 38 patients including 11 women joined the Modhumita course, says Tuheen, a staff member of the centre, against the target of treating 475 in-house patients a year. Half of them, he says, are IDUs. The identity of patients who know they are HIV positive as well as those who are found so in tests are kept strictly confidential. They are completely free to decide whether to get treatment and/or counselling or not. The HIV/AIDS services are provided by Jagori of the ICDDR,B while Marie Stopes helps treat the STI cases.

Mariam (not her real name) a patient, says that she has not been taunted or harassed by the male-in-mates of the centre. She was referred to this centre by a CARE drop-in centre in September. After the 14-day detoxification, she went home for a day and relapsed when she heard her husband had married again. For two days she lived her former life of addiction, but then realised her mistake and returned to the centre to start recovering once again.

Mariam was introduced to drugs at a very young age. "I was married at the age of 17. My husband used to drink, smoke ganja and take other stuff. We lived in City Palli. I started to smoke pot with him. After two/three years I began to drink Phensidyl and then started taking heroin." To feed her addiction, she started to steal from her mother and relatives' homes. Every day, she needed at least 300 taka and sometimes spent up to 1,000 taka on drugs. Eventually, she fell into prostitution and injecting drugs with others in the profession.

Mariam has a nine-year-old boy who does not live with her. Only her mother may give her shelter now on the condition that she stays off addiction and returns to normal life. "I want to be good again, so that nobody can blame me anymore. Then I will bring my son to me." She is learning embroidery and tailoring, and hopes to make a living from it someday.

Under the IMPACT-Modhumita drive, Apon, Crea and Ahsania Mission together aim at rehabilitating at least 3,000 drug addicts in three years from now. But, considering the huge number of drug addicts _ around 4600000 in the country according to FHI estimates (including some 25 to 30 thousand IDUs) _ 3,000 is just a drop in the bucket. The intervention appears even more inadequate as a recent baseline survey by CARE in 20 districts reports the tendency of drug injecting to be rising rather than falling.

The government must acknowledge the extent of the threat of the spread of HIV. While the prevalence is higher among marginal groups such as IDUs and sex workers; it is from these groups that the virus will reach the general populace because of lack of knowledge about the risks of needle-sharing, unprotected sex and transfusion of untested blood. Along with state interventions, communities must take responsibility to educate its members about HIV and take care of them when they are sick.

Source: The Daily Star Magazine, 25 November. www.thedailystar.net

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Eyeball Bus Campaign in London to Stop AIDS

Abdul. Hai, November 29: On the occasion of World AIDS Day 2005, Students Partnership Worldwide (SPW) and its co-organization Students Stop AIDS (SSA) arranged weeklong programs. As a part of the program, SPW and SSA conducted Eyeball Bus Campaign at the premises of University of London Union. Members of Bangladesh Advanced Students Alliance (BASA), co-organization of CCD Bangladesh actively took part in the campaign.

AIDS activists of SPW, SSA and BASA wore red T-shirts, held long white box of eyeball and invited the pedestrians and city commuters to draw attention of the world leaders through their comments and signature to take immediate step to ensure treatment for HIV/AIDS infected people by 2010. They also played on drums and musical tune round the bus to draw the attention of the city people to express their solidarity with the humanitarian demand for the AIDS vulnerable people.

Among others, Coordinator of CF Project in British Council, UK Sally Anderson, Campaign and Network Coordinator of SPW Finnuala Murphy, SSA Member Sahil Dutta and Katy Athersuch and BASA Members A S M Anisur Rahman and A H M Abdul Hai attended the campaign program with much commitment.

Notably, the 2-member BASA delegation is now working with SSA to observe World AIDS Day 2005 in different cities of UK. Under the Connecting Futures (CF) project, the British Council is supporting this exchange visit of BASA in UK.

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World AIDS Day to be Observed in US, UK

Abdul  Hai, Sussex, 29 November: Students Stop AIDS (SSA), co-organization of Students Partnership Worldwide (SPW) chalked out elaborate program to observe World AIDS Day 2005 in a befitting manner in the premises of University of Sussex (US) in United Kingdom (UK). The members of Bangladesh Advanced Students Alliance (BASA), co-organization of CCD Bangladesh actively took part in all the preparatory and key-activities relating to the day in US campus in UK.

A planning and weekly meeting of SSA was held at the US Students Union conference room in the afternoon on Monday. SSA members including Sahil Dutta, Katy Athersuch, Kelly Zimbler, Rebecca Ashley, Romy Dervis, Camilla Alfred, BASA members A S M Anisur Rahman Litu and A H M Abdul Hai and UNISEX Representative Tom Borne addressed the meeting.

Speakers expressed solidarity and commitment to work together to combat HIV/AIDS considering it a global crisis for the humanity. They also recommended developing more communication programs to improve mutual respect and understanding among the youths of two countries.

BASA members expressed gratitude for the cordial hospitality and sincerity of SSA members. In their speech, BASA members focused on HIV/AIDS scenario and AIDS prevention activities of BASA and other GO and NGOs of Bangladesh.

It was decided in the meeting that SSA will arrange Red Fair, Sex Quiz and music function ‘Let’s make Eastslope Red’ in Library Square in the morning, Candle Vigil in the afternoon and film show ‘A Closer Walk’ in the evening on December 01.

The BASA members also visited the main office of UNISEX in the university campus in the evening and expressed interest to work together to promote AIDS prevention movement more in the concerned countries.

Notably, the 2-member BASA delegation is now working with SSA to observe World AIDS Day 2005 in different cities of UK. Under the Connecting Futures project, the British Council is supporting this exchange visit of BASA in UK.

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 The Deadly Shot

Millions of people in poor countries get sick and die from a common tool for getting well: the hypodermic syringe. In some countries, most injections are done with needles that are reused without sterilization.
Twenty-one million people each year get hepatitis B this way, two million get hepatitis C and 650,000 get infected with H.I.V.

As third-world health problems go, this one seems solvable. Single-use syringes, whose plungers break or are blocked after first use, cost about 6 cents apiece. Countries could simply follow the lead of Botswana and Uganda and ban all other kinds of syringes.

But nothing is ever simple in places where health care is disorganized and threadbare. The biggest problem is that many poor countries are injection-crazy. For every injection given as a vaccination, 20 are given as cures. Many injected medicines are snake oil, and even effective injections are mostly unnecessary, as a pill would work just as well. But patients demand injections because they think the medicine is stronger, and health care workers like to give them because they can charge more.

It is hard for governments to change dearly held beliefs about medicine. Dirty needles kill many years after a shot. In some places, it took a health crisis to bring progress. In Romania, people became aware of the problem of unsafe injection after children in orphanages had been given contaminated blood and vaccinated with dirty needles, resulting in the infamous wave of AIDS infection.

In Burkina Faso, a severe meningitis outbreak helped, paradoxically, by producing an extreme shortage of medicines and syringes. This led the government to reform its medical-supply system. Small pharmacies stocked with essentials including single-shot syringes now exist in health posts throughout the country. From
1995 to 2000, the percentage of injections with reused needles declined in Burkina Faso to 4 percent from 55 percent.

The most direct course is to ban reusable needles. But in countries spending $10 a year per capita on health care, 6 cents a shot is a lot when a traditional syringe can be reused some 200 times.

The Safe Injection Global Network, backed partly by the World Health Organization, is trying to help countries develop educational programs for health care workers and doctors. The Bush administration also works on injection safety as part of its AIDS efforts overseas. But more needs to be done, particularly since such a small amount of money can save so many lives.

Sent by: Mariette Correa
Email: mariette@sancharnet.in

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AIDS Goal Missed, but Effort by U.N. Branch Is Praised

LAWRENCE K. ALTMAN, 29 November: The World Health Organization's failure to meet a goal of treating
three million H.I.V.-infected people by the end of this year owes to inadequate international coordination and lack of national leadership, a group of leading advocates for AIDS patients said yesterday.

Although the health agency has said it cannot meet the goal, the
advocacy group, the International Treatment Preparedness Coalition, credited it with bold efforts.

The world agency has missed its goal by more than a million, and
millions more infected people urgently need treatment, the group said in a report.

W.H.O., a Geneva-based United Nations agency, helped show that
antiretroviral treatment can be delivered effectively, extending the
lives of hundreds of thousands of people, even in the poorest
settings, the coalition said.

Still, efforts by the United Nations and nongovernmental groups are unevenly coordinated and would benefit from a more pragmatic strategy to meet their goals in treating the tens of millions of people in need of antiretroviral therapy, the report said.

Crucial to that strategy is "a much more systematic approach to
setting goals, measuring progress, and assessing and addressing
barriers" to providing AIDS treatment, the report said.

In citing a pledge by leaders of the Group of 8 countries to come as close as possible to providing universal access to AIDS treatment by 2010, the coalition said it would be a hollow promise unless governments and international agencies learned lessons from the World Health Organization's successes and failures.

More effective collaboration among agencies and groups within
countries, eliminating existing bureaucratic barriers and providing
more money will be vital to meeting the G-8 goal.

The more pragmatic approach recommended by the coalition includes country-specific strategies and goals with dedicated timelines and milestones as well as clear assignments of responsibility for specific tasks. Some financing agencies have taken steps toward that approach.

The coalition said its report was the first systematic analysis of
efforts to scale up antiretroviral therapy based on the research of
people living in communities in six of the countries most devastated by AIDS: the Dominican Republic, India, Kenya, Nigeria, Russia and South Africa.

The group found inadequate national leadership that failed to dedicate enough resources or mobilize government agencies; bureaucratic delays; procurement and logistic challenges; a global system that did not collaborate speedily and efficiently to address such bottlenecks; inadequate and uncertain financing levels; and pervasive stigmatization of people with H.I.V.

Critics say efforts to increase antiretroviral therapy will not be
useful in the long-term if they fail to improve the countries' health

The report also criticized countries for missing opportunities to
detect and treat tuberculosis and H.I.V., two diseases that are
strongly related, and failing to establish coordinated health care

The coalition said that President Bush's emergency plan for AIDS
relief should deliver treatment to thousands more people within six
months and cite specific examples of how it is building sustainable
health care systems in its 15 target countries.

The coalition urged all countries that told W.H.O. they wanted to be part of its goal of treating three million people by now to provide detailed action plans to improve their future responses.

"National governments must be the primary engine for increasing access to care," the report said.

In Africa, the continent hardest hit by AIDS, countries need to live
up to their commitment made in a declaration in 2001 to devote 15
percent of their budgets to addressing AIDS and other health

In challenging countries and agencies to abide by their pledges, the coalition said they could not set goals of improved access to
treatment and then underfinance the response by billions of dollars.

Efforts should include more than technical support because the
infected "people need to know how the drugs work, why adherence is important and the risks of resistance," Greg Gonsalves of the Gay Men's Health Crisis in New York, and an author of the report, told reporters in a telephone news conference.

In Russia, nongovernmental groups have made important contributions in programs to prevent H.I.V., and some have made innovative suggestions about how to scale up treatment, said Shona Schonning who represented a group of people living with AIDS.

Last week, the lower house of Russia's Parliament moved to impose greater control over charities and other private organizations. If the Russian crackdown affects groups that are supporting efforts to prevent and treat AIDS "it could be very damaging to scale up antiretroviral" programs, Ms. Schonning said in the news conference.

Coalition leaders said they planned to meet with government officials.

"The delivery of antiretroviral therapy will only be possible with a
revolution in global public health, which makes primary care available to those who have never had it before," the report said, and success in AIDS "will pave the way for treatment of many other diseases that are now left untreated."

The report is available online at aidstreatmentaccess.org.

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Sex Education Can Be Creative, Say Experts

KUALA LUMPUR, Nov 20 (IPS) - Many Asian countries now have sexual health education in schools, but teachers often focus on health and biology and leave out the very issue they need to address -- sexuality, said experts at a regional conference here, this week.
Teachers are wary of talking about sex with young people because they are uncomfortable with the subject or fear encouraging-- or being seen as encouraging-- youngsters to have sex at an early age, says Hathairat Suda, senior programme assistant with the Bangkok- based Programme for Appropriate Technology on Health (PATH).

"(But) If you wait to talk about sex with your children it might be too late, since your children might be already at risk of reproductive health and sexual health problems," Hathairat said at the 3rd Asia-Pacific Conference on Reproductive and Sexual Health, that ended Sunday.

Early education on reproductive and sexual health -- especially during adolescence-- was widely discussed here, given that young people in Asia are having their first sexual experiences earlier than ever and information is needed to protect them from risky behaviour.

However, in many Asian societies, sex is taboo for public discussion, due to social, cultural and religious factors.

Yet, groups are trying innovative ways of getting across messages on reproductive health. In Malaysia, there are television shows promoted by Marina Mahathir, daughter of former prime minister Mahathir Mohamad, in the Philippines there is the use of theatre and in Indonesia there is lobbying by progressive religious groups.

It is about creativity and pragmatism. Indonesia’s Jery Lohy says the programme he is involved with conveys sensitive information about safe sex to Christian youngsters but "we can’t say the word ‘sexual’, we just say biological or reproductive health."

In Sri Lanka, the United Nations Population Fund (UNFPA) is trying out a pilot project on teaching sex education to children from the first grade and building on these sex-education messages in an appropriate fashion for each grade level, thereafter.

"We start with health issues like cleanliness for grade one and then add more messages in the upper grades and finally talk about safer sex," said Asela Ramjet Kakugampitiya, UNFPA’s monitoring and evaluation officer. "However, we are not sure whether we can talk directly about safe sex. Sex education is a controversial issue in our country (Sri Lanka)too.''

When a candid teen manual on sexuality was published a few years ago in Thailand, it drew the wrath of conservatives, from academics to policymakers, who said it promoted promiscuity and wrong values.

The furore showed that while it has become an option for some schools to teach sex education, its implementation has not always been carried out successfully. Sex education classes in Thailand emphasise anatomy and biology topics.

In Vietnam, sex education is part of biology class for high school students and starting from sixth grade, students learn about body parts and the reproductive system.

In Laos, there are no direct lessons on sex education but biology classes in high school do discuss body parts and the reproductive system. In Burma, there are no lessons about sex education at all.

While local beliefs and culture can be a barrier to intervention on safer sex, statistics cited during the conference suggest a need for better information on reproductive and sexual health at a young age.

One million women have died in eight Asian countries from unsafe abortion, pregnancy or childbirth, according to a just- released report on progress on the reproductive and sexual health goals since the 1994, International Conference on Population and Development (ICPD) held in Cairo.

Millions more have suffered due to unsafe abortion and childbirth and lack of access to quality health services, added the study by the Kuala Lumpur-based Asia-Pacific Resource and Research Centre for Women (ARROW), covering Cambodia, China, India, Indonesia, Malaysia, Nepal, Pakistan and the Philippines.

The failure of sex education is one of the causes of unsafe abortion and other problems, says Rashidah Abdullah, co-founder of ARROW and a member of its board of directors.

People need to understand that sex education is not only about sexual intercourse and safer sex, but also about life and reproductive health, campaigners stressed.

Haithairat listed six factors in sex education: discussion of organs involved, relationships with partners and other people, communication skills, understanding of the socio-cultural context, acceptance of the diversity of human behaviour and sexual orientation and prevention and health care.

"All points should come together. If you know how your body works and how you can protect yourself from disease but you don’t know the level of your relationships and don’t know how to communicate with your partner for safer sex, it is not useful at all," Haithairat added. 

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OP ED: AIDS: The Strategy Is Wrong

Richard Holbrooke, 29 November: Thursday is the 18th annual World AIDS Day, a time for countless statements of concern and commitment from world leaders, thousands of commemorations and remembrances, and reams of statistics. One important article has already appeared on this page, by Jim Yong Kim, the highly respected director of the HIV-AIDS Department of the World
Health Organization [Nov. 23]. After recounting the grim statistics 
3 million deaths in the past year alone, 5 million new infections this
year, rising infection rates in nearly every part of the world and an
admission that "good news is hard to find in the new U.N. report" 
Kim wrote that he was nonetheless "optimistic that the epidemic can be stopped."

I respect Kim and admire his commitment, as well as that of every foot soldier in this war. I share that commitment. With respect, then, to my friends and colleagues in the field -- most far more qualified than I am I must nonetheless mark World AIDS Day with a word of pessimism that they will not necessarily welcome. We have to face the truth: We are not winning the war on AIDS, and our current strategies are not working. Every year since the first World AIDS Day, the number of people affected has increased. The very best that can be said is that we are losing at a slightly slower rate. The huge, and very expensive, international effort has saved the lives of a growing number of people. I have seen some of the beneficiaries of these efforts firsthand in places as remote as rural eastern Uganda  and it is inspiring. The international assistance effort must be continued, indeed increased.

But as Kim acknowledges, "fewer than one in five people at risk of HIV infection has any access to HIV prevention information," and this must be addressed with larger internationally supported programs. (But remember, once a person is on the drugs, it's for life; to stop taking them is to be hit with a mutant of the original virus.) Until a vaccine is found -- and that is probably more than a decade away  we must focus on prevention and treatment. Providing treatment is essential, of course, but it is also a bottomless pit as long as the disease continues to spread so fast.

As a strategy, losing more slowly is simply a recipe for an
ever-more-expensive, disastrous and deadly failure, which will require more anti-AIDS drugs at ever-greater cost -- a modern version of the old story of the boy with his finger in the dike. Moreover, as Kim points out, current policies require "building and strengthening health care systems in the developing world." This is an essential long-term task with or without the AIDS crisis, but one so daunting that linking it so closely to stopping the spread of AIDS only compounds the odds against reaching either goal.

Only effective prevention strategies can stop the spread of AIDS. Yet it is precisely here that current policies have failed most seriously.
In the long chain of actions required to stop the spread of AIDS,
attack on all fronts is necessary. But on one vital front, the world
health community has been shamefully quiet for two decades: testing and detection. Because of legitimate concerns about confidentiality and the risk of stigmatization, testing has always been voluntary, and it has been systematically played down as an important component of the effort.

The results are predictable  and fatal: According to U.N. figures,
over 90 percent of all those who are HIV-positive in the world do not know their status. Yet there has never been a serious and sustained campaign to get people to be tested. That means that over 90 percent of the roughly 12,000 people around the world who will be infected today  just today!  will not know it until roughly 2013. That's plenty of time for them to spread it further, infecting others, who will also spread it, and so on. No wonder we are losing the war against AIDS: In no other epidemic in modern history has detection been so downgraded.

When I first suggested, about three years ago, that testing and
detection was the weak link in the strategy against AIDS, I was
sometimes criticized for ignoring human rights. Having worked in
support of human rights for more than three decades, I understand this issue and the passion it arouses. I have met monogamous women who were thrown out of their homes for a disease they got from their husbands, and people who lost jobs and friends once their condition became known.

But the spread of the disease cannot be stopped, and we cannot offer drugs to those who need them, unless people know their status. That knowledge changes people's behavior; many who learn that they are HIV-positive behave more carefully, and they can act on the information to save themselves and their family members. Isn't this the most important human right of all?

Quick and reliable saliva and blood tests, which give results within
20 minutes, are available, increasing the opportunity for
confidentiality. Some companies, such as the South African diamond giant DeBeers SA and its affiliated mining company, Anglo-American Corp., have started to strongly encourage testing, using these quick and confidential methods. But governments have been slow to use the tests. In an important breakthrough, three small countries in Africa  Botswana, Malawi and especially Lesotho recently moved from purely voluntary testing to what is called "opt-out": Testing becomes routine in certain circumstances unless the patient opts out by refusing to be tested.

This seemingly small change has had immediate results. Testing has increased dramatically. And with increased testing has come increased awareness, less stigma, safer sex practices and more people on treatment. Without question, a reduction of the prevalence of HIV-AIDS will follow. Yet the great and influential international organizations fighting AIDS have not yet, for the most part, embraced "opt-out" as part of their core strategies.

On this World AIDS Day, many empty words and promises will be heard. I am gratified that additional money will be pledged and, as a result, more lives saved. But unless the current, failing strategy is changed, we will have to spend even more money later, to treat AIDS victims who might never have been infected had testing been more widespread.
Numbers don't lie: Everyone agrees that the number of people infected is still growing sharply, and not just in Africa. Widespread testing is not a single-bullet solution  there is none  but without knowing who is HIV-positive and who is not, there is no chance we can win this war.

The writer, a former U.S. ambassador to the United Nations, is
president of the Global Business Coalition on HIV/AIDS, a
nongovernmental organization, and writes a monthly column for The Post.

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HIV Breeds on Complacent Attitudes Among Youth

Suvendrini Kakuchi, Tokyo, 30 November: Eri Iwase, 19, a pretty first year university student, says she is not worried about being infected with HIV virus that causes Acquired Immuno Deficiency Syndrome (AIDS), even though she is sexually active.

''I just feel AIDS is a disease that has nothing to do with me," she said, explaining that her studies, part-time work, hobbies and meeting her boyfriend, keeps her too busy to learn more about the virus that is believed raging across Japan.

Such a complacent attitude, among sexually active young people, represents the uphill struggle that Japan faces in trying to control AIDS in a country where not only the population but also the government, continues to ignore the danger of the virus spreading.

Japan has over 10,000 officially known cases of AIDS/HIV, low compared to other industrialised nations but troubling because new infections reached a record, 1,165 in 2004 -- making it the only G7 country in which new infections have been increasing since 1993.

Moreover, government statistics indicate about 40 percent of the new figures represent people in their teens or twenties --a 24 percent rise from 2003. Condom use has also decreased 20 percent in 2005, say doctors.

''Despite various programmes, we are finding it really hard to penetrate the younger generation and already the statistics show nearly half of 17- year-olds have experienced sex," says Hideko Fujimori, who heads Action Against AIDS, a small grass-root organization involved in promoting protection against AIDS.

Fujimori attributes this situation to various problems. He cited as key issues poor sex education programmes in schools, the lack of frank discussion of sex, especially between parents and children, and low financial support from the government.

"When I visit schools to talk about HIV/AIDS, there is a renewed interest among the students but that dies down a week later. New measures to make it "cool" to talk about AIDS protection is the best way to empower children to help themselves," he said.

Fujimori is planning to launch a new project next April where high-school students will be trained to develop programmes geared to raise awareness.

Takuya Togawa, director of the AIDS program at the Health and Welfare Ministry, acknowledges the lack of progress in combating HIV in Japan.

''There are barriers in our current projects aimed at reaching youth. We are requesting a larger budget from 2006 to strengthen AIDS awareness projects that will, from now on, involve more activists rather than rely too heavily on doctors and health centres manned by local municipalities," he said.

Japan's AIDS/HIV budget is around 80 million US dollars per year. Activists say a large part of the funds is spent on research and treatment, leaving insufficient money to finance protection programmes that are geared specially to youth.

For instance, HIV testing centers manned by municipalities also cover various other diseases and are based on appointments restricted to once or twice a week. Activists say that despite testing being conducted on an anonymous basis, the formal atmosphere turns young people away.

Dr Masaki Kihara, a well-known AIDS expert, has developed sex education classes that incorporate social issues affecting children such as lack of peer support, problems with parents, and the importance of being able to develop close and equal intimate relationships with the opposite gender.

''My research has shown that freewheeling sexual habits among youth usually stems from their poor personal relationships. By being able to talk about these social issues in class, we aim to help children develop self-confidence that will protect them from risky sexual behaviour,"

Kihara's methods have found support among teachers and parents who oppose explicit education in schools such as condom usage, a major problem for advocates who see the gap between attitude towards sex between he older and younger generation in Japan as working towards the AIDS crisis in Japan.

Kihara also hopes to tackle the lucrative sex industry in Japan that employees young women, some in high school, which he says is linked to the Japanese AIDS problem.

Police reports this year indicate that the sex-delivery business--where customers are offered services over their mobile phones--has now reached more than 2,700 businesses employing around 500,000 people each.

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