Facing the Challenges of HIV/AIDS

Kh. Zahir Hossain, M & E Specialist (BWSPP), The World Bank, Dhaka, Bangladesh

Around the world, more than 47 million people are now infected with the HIV/AIDS, It is now a weapon of mankind destruction. It has killed more than 30 million people worldwide according to UNAID and WHO reports since the 1st of December 1981 when it was first recognized. This makes it the worst recorded pandemic in the history of pandemics against mankind. In 2006 alone, it was reported to have killed between 2.5 to 3.5 million people with more than 380000 as children. The large number of these people killed is from the sub Saharan Africa. In some Sub-Saharan African countries, HIV/AIDS is expected to lower life expectancy by as much as 25 years.

AIDS is no longer a problem of medication. It is a problem of development. It is not just an individual hardship. It also threatens to decimate the future prospects of poor countries, wiping away years of hard-won improvements in development indicators. As a result of the disease, many poor countries are witnessing a worsening in child survival rates, reduced life expectancy, crumbling and over-burdened health care systems, the breakdown of family structures and the decimation of a generation in the prime of their working lives.

Bangladesh's socio-economic status, traditional social ills, cultural myths on sex and sexuality and a huge population of marginalised people make it extremely vulnerable to the HIV/AIDS epidemic. Everyone buying sex in Bangladesh is having unprotected sex some of the time, and a large majority don’t use condoms most of the time. Behaviors that bring the highest risk of infection in Bangladesh are unprotected sex between sex workers and their clients, needle sharing and unprotected sex between men.

Though the country overall has a low prevalence rate, it has reported concentrated epidemics among vulnerable population such as IDUs. There are already localized epidemics within vulnerable groups in, and the virus would spread among the IDUs’ family or sexual partner.

In many poor countries, commercial female sex workers are frequently exposed to HIV and other sexually transmitted infections (STIs/STDs). Where sex workers have poor access to health care and HIV prevention services, HIV prevalence can be as high as 50-90%. Evidence shows that targeted prevention interventions in sex work settings can turn the pandemic around.

Bangladesh is a high prevalence of sexually transmitted diseases, particularly among commercial sex workers; there are available injection drug users and sex workers all over the country, low condom use in the general population. Considering the high prevalence of HIV risk factors among the Bangladeshi population, HIV prevention research is particularly important for Bangladesh. It is very awful, several organization in Bangladesh are working only to prevent HIV/AIDS but few of them like as ‘Rainbow Nari O Shishu Kallyan Foundation’ try to develop proper strategic plane, so should increase research based organization recently.

Poverty in Bangladesh is a deeply entrenched and complex phenomenon. Sequentially, the HIV/AIDS epidemic amplifies and become deeper poverty by its serious economic impact on individuals, households and different sectors of the economy. Poverty is the reason why messages of prevention and control do not make an impact on a vast majority of the vulnerable population.

Sources: World Bank, UNAIDS, UNICEF.

New listserv member from Uganda

Rebecca Birungi, Journalist, Mama Radio, Kampala, Uganda

I am currently working as a news reporter with Mama Radio, a women’s community radio station with a focus on promoting a greater understanding of health issues across Uganda, where I have worked as a volunteer since graduating from university five years ago. Although I report on a wide range of issues including politics and business the main focus of my journalistic activities is related to health issues, which I combine with my passion of radio.

In producing and presenting health programs I have covered issues such as HIV prevention, antiretroviral therapy, discordance results, environmental pollution and softer areas such as aromatherapy.

I hold a bachelor’s degree in Mass Communication from Makerere University in Uganda. Though I am dealing with public health issues from a communication strategy side. Currently Iam pursing a Masters degree in Public Health and Leadership at Mukono Christian University. The course in public health has enabled me to understand the dynamics of public health from a broader perspective so as to better apply my communication knowledge.

I also freelance with The Sunrise Newspaper by contributing articles on health, business among others. My experience in communication, I have learnt that for communication programs to succeed there is need for a thorough understanding of the various dynamics at play in people’s health and these can make a major contribution to the role of women in Ugandan society in building up civic society groups and activities.

In this respect, it is important to understand the dynamics and empirical facts underpinning behavioral patterns of communities and this is best done through research.

Country's first HIV+ couple's son is HIV-

by Md Saiful Islam Shameem, Bangladesh’s national news agency, [BSS]

DHAKA, July 26 - The son of Bangladesh's first known HIV positive couple has been tested for the HIV virus and found to be negative. The couple, who publically announced their positive status before getting married in an effort to encourage other couples to be more open with their HIV status.

Born in 2005, the 30-month old boy is now fully safe and sound with a14- kilogram weight and a good body mass index (BMI), doctors said, disclosing the confirmed test report to BSS today, after hiding the preliminary ELISA (Enzime Linked Immunosorbent Assay)test report for almost a year.

The boy, whose name is synonymous to `fortunate', was given formula milk up to the age of two years to check mother-to-child transmission of the human immunodeficiency syndrome virus (HIV) from breast milk and being given normal food for last six months.

Before the birth of the boy, the mother was given anti-retroviral (ARV) therapy and nutritional food by an international NGO for a year during pregnency.

"My son is quite normal and healthy now, although we were afraid in the first two years because of his frequent illness from diarrhea, cold and fever," said the father of the boy, who got HIV infected during his overseas employment in the Middle East 14 years ago. He said they have taken all out precautions to minimize the risks of HIV transmission to child at the womb.

Physicians say there is a 33 percent possibility of transmuting HIV to baby at the infected mother's womb, but it can be minimized through nutritional support, precaution and proper drugs, which is expensive in the context of developing country like Bangladesh. A child can also be infected from mother during delivery and breast-feeding.

"I am lucky because I got every support starting from ARV to surgery to formula milk from my employing organization," said the proud mother, who once had lost all hopes and aspirations soon after she was diagnosed with HIV in 1999. The mother, who has a
low level of CD4 blood cell counts, now uses triovix of ARV, which is a combination of three drugs- lamivudine, nevirapine and ziduvudine.

Unlike the baby and his parents, all other people living with HIV (PLHIV) are not so fortunate. The wedding of the first couple have encouraged many to tie knots among their peers and give births to kids subsequently, but all are not fortunate to have prenatal and post natal care, scissoring delivery at good hospitals and ARV therapy, a drug that costs Taka 4,200 per month here.

Sources said at least 10 PLHIV couple has become parents after the birth of the boy (mr. fortunate), which drew the media attention in 2005, and five more women are expecting their kids by this year. However, the doctors and NGOs fear that if the trend continues in a poor setting like Bangladesh, the number of child HIV positive may go up.

A baby is a dream for every couple, said another PLHIV mother, who gave birth to a daughter six months ago without proper supports from any quarters. All positive women expect a child, she said, because children are the `candlelight in darkness' for a HIV positive people.

But PLHIV can seldom dare to opt kids due to fear of poverty, pregnancy complexities and future of the child, who might also become another PLHIV and would die after a certain period of time. A child from PLHIV mother is being tested for HIV after 18 months of age.

According to the government statistics, a cumulative total of 874 cases of HIV/AIDS have been confirmed and reported at hospitals as of 1st December 2006, the World AIDS Day. Out of them, 240 have developed AIDS and 109 have died already. But only over 100 of the total PLHIV have access to ARV through a generous arrangement of a private bank's corporate social responsibility (CSR), a new concept flourishing in Bangladesh.

The country has a low level of HIV prevalence (less than 1 percent) among general population, but virologists and interventionists fear the situation may explode anytime because of conductive socio-economic factors and high-risk behavior by injecting drug users (IDU), commercial sex workers (CSW), male having sex with male (MSM), and tansgenders.

There are also low levels of HIV and AIDS awareness; migration and trafficking; poverty gaps; low nutritional status; gender inequalities that place women and young girls at risk; and gaps in the healthcare delivery system. The government estimates the number of HIV/AIDS cases is 7,666 in Bangladesh, a number which others say much lower than the actual figure.

Media job at Medecins sans Frontieres, SA

Jean-Marc Jacobs, Medecins sans Frontieres, Belgium

Médecins sans Frontières, South Africa, is looking for a talented communications officer to help raise awareness of the work of MSF with core target audiences via generating positive coverage in South African media, with the aim of supporting the recruitment of SA field staff, fundraising activities, and to increase awareness of MSF’s work with regard to international humanitarian and medical issues.

For more details on the application process or to apply, please go to: http://healthandmedia.org/resources/jobs/msf.html

or contact Binwell Keshi, HR coordinator on office@joburg.msf.org or +27 76 6201 567

Hot debate on HIV trasmission at Uganda meeting

By Pius Sawa Murefu, Kampala, Uganda

(Three items)

Hot debate on whether HIV/AIDS is an STI

Presenting a gender analysis of the Health Sector Strategic Plan 2 at Grand Imperial Hotel in Kampala on 2nd July, during the launch of the revised National Action Plan on Women, an official from the ministry of gender, labor and social development, Crescent Turinawe, says some of the indicators of poor reproductive health are STI and HIV/AIDS. Here he pauses and emphasizes,

“You must know that HIV/AIDS is not a sexually transmitted infection”

It is time for questions and one member asks,

“I am Collins Juuko from central broadcasting Service Radio. You said HIV/AIDS is not an STI, and stopped there. You really left us in suspense. As a reporter, what will I tell my listeners when they hear that?”

The moderator, Mabuya Mubarak from the same ministry interjects,

“It is good that we have doctors here and other experts who will tell us whether AIDS is an STI or not. May be we go straight to doctor Josephine Kasolo, from the faculty of medicine at Makerere University.”

Doctor Kasolo, “I think it depends on how you look at it. It could be an issue of stigmatization that maybe AIDS should not be called an STI, because if you say so and so has AIDS, people may say wow she/he must have been sexually active. For a long time we have known that a disease like gonorrhea is passed on through sexual intercourse, but we hear of oral gonorrhea. That is against the law of nature!"

There is confusion in the hall and the microphone is passed on to the presenter.

Turinawe, “You know very well that the only way one can contract AIDS is through blood contact.”

Noooo. There are shouts of protest in the room.

“Yes let me tell you. Do you know that you can have sex with a person who is HIV positive and you don’t get it? But you cannot escape when you blood gets in contact? That is food for thought”.

But everyone is confused and there is murmuring allover. The moderator decides to stop the debate and moves on with other questions.

Another participant raises the issue of circumcision as a way of reducing infections among men. He argues that caution should be taken when preaching such a gospel lest men go on spree thinking they will not contract AIDS. Since the research was published, there have been an increased number of Ugandan men lining up at hospitals for circumcision.

Cervical Cancer. 100,000 women die each year in Uganda.

Dr. Nsubuga also working in the ministry of gender labor and social development revealed that one hundred thousand women die each year of cervical cancer in Uganda comparing the number to six coaster buses crashing with people every day.

The rate is alarming to an extend that government has started a pilot study of immunizing women against Human Papilloma Virus said to expose women to high risks of cervical cancer. Another research is going on at Naguru hospital in Kampala where girls are being followed up to establish the natural cause of cervical cancer.

The cancer is directly linked to HIV/AIDS, said Dr. Josephine Kasolo from the faculty of medicine at Makerere University. This is a new trend that needs to be addressed immediately. According to Dr. Kasolo cancer of the cervix used to appear in women above the age of thirty, but now even young girls are getting infected. Dr. Nsubuga said the exact cause of the cervical cancer just like cancer of the breast is not known but there is a link in the family history. He said there must be routine check because everyone is a potential cancer patient but the difference was time. Cancer, he said is the abnormal growth of normal cells in the body.

Mainstreaming gender in adolescent health

Reproductive health is defined as a state of complete physical, mental and social well being and not merely the absence of disease, in all matters related to reproductive health system and its function.

Sexuality for adolescent’s results in early pregnancies, vulnerability to STIs and poor health. The major contributor to this is the lack of information. In Uganda 211 out of 1000 girls give birth at teen age. High HIV/AIDS prevalence is among 15-19 years where girls are at 2.6 percent while boys are 0.3 percent.

This report revealed that poor health of women was due to; limited control over their sexuality, early marriages and pregnancies among adolescents, poor access to emergency health services, limited awareness about sexual rights and responsibility and capacity to enforce them and above all the inequalities in power relation at household level that affects women’s decision making on health issues.

It was observed that males involvement in maternal and child health care with reproductive health information will lead to improved family health through reduction in fertility rates.