CNS: July 2012

Calling for an "AIDS free generation" but trading away our lives

Some of the loudest and most passionate demonstrations at the XIX International AIDS Conference (AIDS 2012) condemned the United States and European Union trade agreement negotiations which aim to protect the profits of pharmaceutical companies and let people in low and middle income countries die for their sake. During her address to the conference, Hillary Clinton, US Secretary of State, with an air of optimism, joined the call for an "AIDS free generation", highlighting the fact that the tools for its achievement exist. At the same time, her government, through negotiations for the Trans Pacific Partnership Agreement (TPPA), is pushing to radically expand pharmaceutical company monopolies and therefore maintain high prices on and limited access to life-saving medicines for HIV and associated co-morbidities. "Today US trade policy is threatening to undermine US AIDS policy," said Peter Maybarduk of Public Citizen, a prominent US consumer rights group.

Despite alarming HIV rates amongst the men who have sex with men (MSM) and transgender people, many countries, community leaders, media and society at large continue to hold discriminating stereotypes against them. "Punitive laws will drive MSM and transgender populations underground" rightly said Aradhana Johri of Department of AIDS Control, Government of India. In US alone, according to the Centers for Disease Control and Prevention (CDC) report, although Black American MSM people represent only 13 percent of the US population but they account for about 44 percent of the new HIV infections particularly among those aged 13 -19.

The XIX International AIDS Conference (AIDS 2012) reminds us how punitive laws and criminalizing policies keep most affected communities disengaged. Due to the policy block in US, sex workers and injecting drug users (IDUs) weren't able to participate in AIDS 2012 from around the world. In their own countries, IDUs are struggling as well with policies that criminalize drug use and drive populations underground. There are an estimated 16 million Injecting Drug Users (IDUs) in 151 countries, and they are very often unable to access HIV and TB related services due to punitive policies and discriminatory attitudes. Many of them are infected with the Hepatitis C Virus (HCV) as well.

Michel Kazatchkine, appointed as the UN Secretary-General's new Special Envoy for HIV/AIDS in Eastern Europe and Central Asia (EECA) before the XIX International AIDS Conference (AIDS 2012) opened in Washington DC, responded to a suggestion during a meeting with EECA conference participants to emphasize access to HCV care, noting that the region’s epidemic is not only a dual epidemic of HIV and drug use but rather a quadruple epidemic of HIV, drug use, TB and HCV. Similar dynamics are seen many countries Eastern Europe and Asia where sharing unsterile injecting equipment is driving HIV epidemics.

Nineteen years after female condoms were approved by the US FDA in 1993, they are not yet available as widely as one would have wished. What could have delayed their optimal utilization to meet the unmet prevention needs: was it because female condoms were not rolled out under a robust enough and well resourced comprehensive programme and strategy, or potential users didn't prefer using it? The delegates of the XIX International AIDS Conference (AIDS 2012) vote for female condoms sending a clear message that female condom introduction must be supported by strong, well resourced and strategic scale up programmes in countries and communities where unmet need is acute. Carol Nawina Nyirenda, from Zambia CITAM Plus, has been living with HIV for several years. She shared her perspective about using the female condom. It makes her "feel sexy" and she can wear it even five hours before sex, she said.

In communities where sharing of injecting equipment drives the HIV epidemic, a parallel epidemic of hepatitis C virus (HCV) often lurks quietly. A couple of days before the World Hepatitis Day, 28 July, Dr Victor Lo Re, an infectious disease researcher at the University of Pennsylvania, presented data on the impact of HIV and HCV co-infection at the XIX International AIDS Conference (AIDS 2012). His work shows that, despite effective antiretroviral therapy, people co-infected with HIV and HCV remain at higher risk of liver deterioration and other liver-related complications than those with HCV alone.

Washington DC is the host to the 19th International AIDS Conference (AIDS 2012) with about 24,000 registered delegates coming from all around the world. International conferences such as this one is an opportunity and a venue to get updates, innovations and new strategies in addressing HIV and turn the tides to achieve the 2015 targets of zero HIV infection, zero HIV related death and zero HIV related stigma and discrimination. US President Barack Obama had earlier made a call that AIDS free generation is possible. The conference provided loads of information on practices that worked in communities all over the world, including bio-medical breakthroughs and the latest innovations on treatment for people living with HIV (PLHIV).

One of the clear messages from the XIX International AIDS Conference (AIDS 2012) in Washington DC is that HIV prevention research is progressing ahead with thrust to meet needs of most at risk populations such as sex workers, men who have sex with men (MSM), transgender populations, injecting drug users, women and men with high risk behaviours, among others. However a lot more needs to be done in the regional, country and local contexts to bring in unique perspectives of most at risk populations so that their prevention needs can be met. One such initiative that brings in African regional voices of those women, men and transgender women who practice anal sex into main discourses on HIV prevention research and advocacy is Project ARM (Africa for Rectal Microbicides).

At home, Bhekizitha Sithole, a Swazi student at the Stellenbosch University based in Cape Town, South Africa, and currently on TB treatment for extrapulmonary TB, was fortunate to be awarded a scholarship by the John Hopkins University through American Foundation for AIDS Research (AmfAR). It was his first time to attend the International AIDS conference in Washington DC. Like many other delegates, he was elated to be greeted by AIDS 2012 opening ceremony marked by the presence of great people like veteran actress Sharon Stone and other United Nations and political figures. This year’s conference has attracted about 24,000 registered delegates and about 2000 accredited journalists.

MDR-TB pill+inj burden

India is a very high burden TB country, accounting for 21% of the global incidence. It is estimated that TB kills 300,000 Indians annually: one death every 2 minutes. The situation is no better when it comes to multidrug-resistant TB (MDR-TB). India, with about 100,000 of its TB patients having drug-resistant strains, represents over 20% of the world’s MDR-TB burden. Globally 440,000 MDR-TB cases emerge and 150,000 people die of MDR-TB every year. Citizen News Service (CNS) gathered perspectives and opinions on MDR-TB and HIV from a range of experts and advocates attending the XIX International AIDS Conference (AIDS 2012) in Washington DC.

Whilst there has been great progress in rolling out access to antiretroviral treatment (ART), there are also many challenges in ensuring that patients adhere to treatment, especially those living in complex social situations. Here at the 19th International AIDS Conference in Washington, DC, today, a press conference held by Médecins Sans Frontières (MSF) drew attention to a range of initiatives for traditionally hard to reach populations – including mobile populations and adolescents living with HIV – whose success confirms that tailoring programmes for specific groups and populations can result in higher levels of retention and adherence than other ‘easier to reach’ groups.

HIV related epidemiological trends in Asia are no less alarming than those in Africa. With increasing number of new HIV cases among the men who have sex with men (MSM) and transgender populations in the region; the critical need to sustain responses, programmes and mobilize optimal resources to address needs of sex workers and injecting drug users (IDUs), and growing requirement to provide life-long treatment, care and support for all people living with HIV (PLHIV) in the region, the XIX International AIDS Conference (AIDS 2012) cannot afford to ignore HIV in the Asian region.

Recent advances in bio-medical prevention of HIV, such as a daily pill to reduce infections for people at high risk, have been cause for celebration at the XIX International AIDS Conference (AIDS 2012) in Washington DC. Yet advocates note that structural and environmental factors influence how well medical advances will fulfill their promise. The STRIVE Research Consortium, launched this week, will demonstrate the ways in which social and economic forces drive vulnerability to HIV and hinder effective prevention and treatment efforts.

Condom-compatible lubes are a rarity in Africa forcing transgender women, gay men and other men who have sex with men (MSM) and heterosexual populations that engage in anal sex to utilize alternative methods that potentially exposes them to a range of sexually transmitted infections including HIV, the virus which causes AIDS. Following a meeting of Africa for Rectal Microbicides (Project ARM) held in Addis Ababa, Ethiopia, in December 2011, participants decided to create the Global Lube Access Mobilization (GLAM) initiative to support increased access and availability of condom-compatible lubes throughout the world, beginning with a focus on Africa, employing the tagline "And Lube!"

It is indeed promising to note the momentum rectal microbicides research and development has attained, more so when there is a global call to end AIDS at the XIX International AIDS Conference (AIDS 2012). Turning the tide of HIV is not possible unless we have safe and effective HIV prevention options for women and men who practice anal sex. Just before the AIDS 2012 opened in Washington DC, the researchers at Microbicide Trial Network (MTN), University of Pittsburgh, USA, got a green signal to go ahead with a major rectal microbicide clinical trial.

Well, that is the difference of cost in treating a simple tuberculosis (drug susceptible TB) patient to the one suffering from drug resistant TB (DR TB) according to Lucica Ditiu, Executive Secretary of The Stop TB Partnership, who made a fervent appeal for ending tuberculosis and called for zero TB and HIV deaths, while appearing on a live web-cast talk show on ‘tuberculosis and HIV: protecting the vulnerable women and children’ presented by The Stop TB Partnership and the International Federation of Red Cross and Red Crescent Societies (IFRC) during the XIX International AIDS Conference in Washington DC. She was optimistic that just by scaling up the existing tools and services in TB we can save one million lives by 2015.

Here at the 19th International AIDS Conference in Washington, DC, Médecins Sans Frontières (MSF) released an important report tracking progress in implementing policies, strategies and tools to roll out coverage of anti-retroviral treatment (ART) in 23 countries. Results suggest there has been critical progress, but that in some countries, access to ART remains lamentably low, reflecting a paucity of policy around specific initiatives – such as task shifting – vital to ensure people living with HIV (PLHIV) receive the treatment they require.

UGANDAN AIDS activist and medical doctor, Paul Semugoma, 42, said that rectal microbicides have a potential to save the unnecessary loss of lives among men who have sex with men in Uganda and across Africa. According to a study titled, "HIV Infection among Men Who Have Sex with Men in Kampala, Uganda – A Respondent Driven Sampling Survey," it is estimated that the adult male HIV prevalence in Kampala is 4.5 per cent but the prevalence estimates among men who have sex with men (MSM) is 13.7 per cent. Most MSM still have sex with women, many are married, co-habit with women, and have biological children. MSM in Kampala appear firmly embedded in the general population.

At the XIX International AIDS Conference (AIDS 2012) the message is clear: it will be the task of the activists, implementers, policy makers, scientists, and each one of us to work together to turn the tide so that everyone who needs high-quality treatment and prevention interventions for the global HIV, hepatitis C virus (HCV), and tuberculosis (TB) pandemics receive them. "The 2012 Pipeline Report: HIV, HCV, and TB Drugs, Diagnostics, Vaccines, and Preventive Technologies in Development" which was released at AIDS 2012 by HIV i-Base and Treatment Action Group (TAG) reveals the deepening gulf between new scientific advances that make it possible to prevent, treat, and in some cases cure people living with HIV, HCV, and TB; and access to these where they are most needed.

At the first full day of the 19th International AIDS Conference in Washington, DC (AIDS 2012), we’ve already seen a plethora of statements and presentations detailing progress in the fight against HIV. There’s a distinct ‘milestone’ feeling, with many speakers offering a retrospective of the last 30 years, highlighting just how far we’ve come. A series of presentations addressed issues facing one particular group living with HIV –which over the years has often been neglected, falling between the monoliths of paediatric and adult HIV – young people and adolescents. They continue to experience significant gaps in services and facilities, even three decades in to the HIV pandemic.

At the XIX International AIDS Conference (AIDS 2012) in Washington DC, the Regional Inter-Agency Task Force on Children and AIDS of eastern and southern Africa (RIATT-ESA) argued that children affected by AIDS also have rights to essential services but HIV often threatens their access to services. This is so because it impoverishes families and reduces the parents' ability to care for their children as they would have wished otherwise. Children become more vulnerable to adverse HIV related impact because adults often fail to behave responsibly despite so much of investment and efforts to sensitize adults on preventing transmission, stigma, discrimination among other impacts of HIV. The response to meet the HIV related treatment, care and support needs of children is appalling and urgently require strategic interventions that cater for early childhood, pre-school age and teenage ages.

[Sign the petition] The term 'male circumcision' implies that female circumcision also exists. Females who are subjected to genital cutting are said to have undergone female genital mutilation (FGM) or cutting (and not circumcision). Responsible professionals no longer use the term female circumcision. That is why the word 'male' is redundant. All circumcision is performed on males only. Growing number of activists at the XIX International AIDS Conference (AIDS 2012) are signing a petition for replacing the term 'male circumcision' with 'circumcision'. The petition will be submitted to the World Health Organization (WHO) and the Joint United Nations programme on HIV/AIDS (UNAIDS) asking them to replace the term 'male circumcision' with 'circumcision' and treat women with respect, said Jamie Uhrig, who also manages HIV Information for Myanmar (HIM).

A study published on 23rd July 2012 in the medical journal 'The Lancet' has raised hopes for a novel combination drug regimen that promises to make multidrug-resistant TB (MDR-TB) treatment shorter, simpler, safer, and more cost effective. The findings of this study from researchers and the non-profit Global Alliance For TB Drug Development (TB Alliance), which were presented at the XIX International AIDS Conference (AIDS 2012) reveal that a novel TB drug combination PaMZ (consisting of PA- 824, moxifloxacin and pyrazinamide) has shown the potential to dramatically shorten the length of multi drug resistant TB treatment by 80%, from the existing 24 months to 4 months; reduce the pill burden by 97%, from the existing 12,600 pills to 360 pills; and eliminates the need of injections and daily powdered drug formulations completely. (Currently patients have to take a daily dose of very painful injections for 6 months).

Unprotected anal sex has long been regarded as a key driver of HIV transmission in many parts of the world, especially among men who have sex with men. In many contexts, the practice is surrounded with stigma and discrimination which is a key barrier to developing protective measures, and largely pushes affected populations to go underground far from the reach of public health services as well as HIV prevention tools.

Microbicide research has gained momentum in recent years with focus largely on products to prevent HIV during vaginal sex. However, there is a growing momentum to develop rectal microbicides for women, men, and transgender individuals around the world who engage in anal intercourse. Microbicides are products (currently under research) designed to prevent or reduce the sexual transmission of HIV or other sexually transmitted infections when applied inside the vagina or rectum. Most vaginal microbicides are being tested as gels or rings, while rectal microbicides are primarily being tested as gels.

On 23rd July 2012, about 30 miscreants tried to invade Sex Workers Freedom Festival venue at Swabhumi in Kolkata. They raised slogans against conference and organisers and tried to disrupt the proceedings. However, intervention from the conference participants and police prevented the miscreants from disrupting our peaceful gathering. Dr Samarajit Jana, Chair of the Conference strongly condemned the incident, "This goes against democratic spirit of the country. It reflects negative attitude and level of disrespect towards sex workers and their right to raise their voice."

The XIX International AIDS Conference (AIDS 2012) opened in Washington DC on 22nd July 2012, twenty two years after the 6th International AIDS Conference had taken place on the US soil in 1990 (San Francisco, USA). The US had imposed a travel ban on people living with HIV (PLHIV) in 1987, when the US Department of Health and Human Services added HIV to a list of communicable diseases prohibiting PLHIV from entering the country. When Barack Obama became President he lifted the travel restrictions on PLHIV in January 2010, allowing the conference to take place on US soil after twenty two years.

The fight against HIV/AIDS is currently viewed with considerable more optimism than in the past years because powerful interventions have been developed, proven effective and refined. If these tools are made widely available to those who need them, an AIDS-free generation may be possible. Speaking on an AIDS free generation before the opening of XIX International AIDS Conference (AIDS 2012), Dr Anthony S Fauci, Director, National Institute of Allergy and Infectious Diseases (NIAID), said ending the global HIV pandemic may be possible.

During the opening plenary session of XIX International AIDS Conference (AIDS 2012), Secretary of State of USA Hillary Rodham Clinton made a fervent appeal to end the epidemic of AIDS and hoped to be able to stop the AIDS Memorial Quilt (which has the names of all those Americans who have died of AIDS) from growing any further. It is disappointing that not one of the distinguished speakers made even a passing reference about the need to control the spread of the tuberculosis (TB) bacteria, which stalks the earth hand in hand with the HIV virus and is the biggest cause of deaths among people living with HIV (PLHIV). Activists and health advocates however used this major opportunity to draw attention to TB/HIV by wearing face masks when Clinton was speaking. This activism has put the spotlight once again on the urgent need for better access to and research on life-saving tools and programs to fight TB/HIV.

Most men, women and transgender people who practice anal sex use some kind of a lubricant (lube) ranging from expensive and commercially marketed branded lubes to saliva or oil. According to the United Nations joint programme on HIV/AIDS (UNAIDS), anal sex considerably increases risk of HIV acquisition. People practicing anal sex are also at a high risk of other sexually transmitted infections (STIs) and condoms alone are not enough to protect them from HIV or other STIs. People practicing anal sex, for example, need condoms with safer, affordable, accessible lubes to protect them from HIV and STIs. Marc-Andre LeBlanc, Secretary of International Rectal Microbicides Advocacy (IRMA) who is also a member of Lube Safety Working Group, said to CNS before XIX International AIDS Conference (AIDS 2012) opened in Washington DC: "Many men, women and transgender people use lubricants (lubes) during sexual intercourse. Yet we know very little about their safety when used during anal intercourse."

Gender Based Violence Drives HIV Epidemic Among Women: US Study

One out of every four people living with HIV in the US is a woman according to a new study by the University of California, San Fransisco (UCSF). Further, it is estimated that 30 percent of women living with HIV in the country experience post traumatic stress disorder compared to 5,2 per cent in the general population.

The dual HIV-TB epidemic has posed a challenge for both TB and HIV efforts at all levels. Although the number of people living with HIV (PLHIV) screened for TB increased almost 12-fold, (from nearly 200 000 to over 2.3 million people) and testing for HIV among TB patients increased 5-fold (from 470,000 to over 2.2 million) between 2005 and 2010, almost a quarter of all AIDS deaths every year are still caused by TB despite it being preventable. An estimated 910,000 lives were saved globally over the last six years through the implementation of collaborative TB/HIV activities, yet only 46% of TB patients living with HIV received ART in 2010. Not all people living with HIV who enrolled into care were screened for TB and a far smaller proportion received isoniazid preventive treatment (IPT). In many high burden countries there has been little progress in the implementation of collaborative TB/HIV activities.

The six-days alternative XIX International AIDS Conference (AIDS 2012), dubbed as the Global Hub of the official AIDS 2012, opened with a pre-event gathering of sex workers from over 30 countries who gathered in Swabhumi in vibrant and colourful attires after a short walk through the streets of Salt Lake shouting slogans like 'Sex work is work.' The AIDS 2012 which begins in Washington DC on Sunday 22nd July will have a live digital link with the global sex workers' hub overlapping for a few hours after 6pm. Titled as Sex Workers Freedom Festival, the unique event is being co-hosted by Durbar Mahila Samanwaya Committee, Global Network of Sex Work Projects (NSWP) and All Indian Network of Sex Workers (AINSW).

Over 550 representatives of sex workers' collectives from across the world have arrived for the first-ever Global Hub of the XIX International AIDS Conference (AIDS 2012) co-hosted by Durbar Mahila Samanwaya Committee, Global Network of Sex Work Projects (NSWP) and All India Network of Sex Workers (AINSW). Dr Samarajit Jana, Chair of this Sex Workers' global hub of AIDS 2012, said: "the time has come to deliberate the many violations and privations the sex workers community is facing in different parts of the world. This Conference which has been, for the last 25 years, a three-way dialogue between the scientists/planners, the people living with HIV and the most at risk communities has been thwarted for the first time by the US government."

Latest research, published on 11 July 2012, on the effect of deworming drugs on nutrition and school performance in children, commands our attention. The World Health Organization (WHO) report that more than a quarter of the world's population is infected with one or more of the soil-transmitted intestinal worms. WHO promote community and school programmes to give deworming drugs to all children in low-income countries regularly to improve nutrition, haemoglobin, cognition, school attendance, school performance and promote economic productivity.

A Global Scientific Strategy Towards an HIV Cure, developed by a group of 34 leading HIV scientists and clinicians on behalf of the International AIDS Society (IAS), was launched in Washington DC on 19th July, 2012, ahead of the XIX International AIDS Conference amid renewed optimism that prospects for finding an HIV cure are increasing. The vision for the IAS strategy is that a safe, affordable and scalable cure for HIV will improve the health and quality-of-life for those with living with the infection, and reduce the risk of transmission of virus to those not infected. The strategy identifies seven important priority areas for basic, translational and clinical research and maps out a path for future research, collaboration and funding opportunities.

Lack of Resources Hinder Zim’s TB/HIV Response

While the problem of TB/HIV co-infection has long been recognized in Zimbabwe, limited resources, poverty and brain drain among others continue to hamper efforts to address the matter. Zimbabwe’s Ministry of Health and Child Welfare even has an AIDS and TB Unit aimed at coordinating the national response to the two epidemics. In the past few years, however, TB has emerged as a leading killer, especially among HIV positive people, who are often not identified though long-established TB tests. Statistics shows that the success rate of directly observed treatment is just 74 percent, far below the WHO recommended rate of 85 percent.

Zimbabwe Battles HIV and TB Epidemics

Harare, Zimbabwe – Charles Raradza, 44, fell seriously ill in 2001, coughing uncontrollably. He went to get tested for tuberculosis (TB) at a hospital in Kadoma, Zimbabwe but the bacteria that causes the disease was not detected in his sputum. Determined to get to the bottom of his illness, Raradza went to another hospital where a sputum and lung X-ray test revealed that he was indeed TB-infected. “I was immediately enrolled into the hospital’s directly observed treatment therapy (DOTS), and had to take 13 tablets a day. The tablets were very painful. I guess because I love life so much I never defaulted during the six months that I was on the course,” said Raradza. But after two years, Raradza started coughing uncontrollably again. He went to get tested for TB again. “At the hospital, it was discovered that I had TB for the second time, so I was given 60 injections and tablets – it was painful but I stuck through it. I was put on the 6-month long DOTS programme again,” he said.

Integrating TB/HIV Services in Zimbabwe: A Key Public Health Priority

Harare, ZIMBABWE - In Zimbabwe, there is a wide recognition of the need to integrate TB and HIV services but for people living with HIV (PLHIV), it is not evident, said Martha Tholanah, Coordinator of the International Community of Women Living with HIV (ICW) Zimbabwe Chapter. While Zimbabwe has made progress in implementing collaborative TB/HIV activities, much work still remains to be done to make them an integral part of the health service. Tholanah said that civil society in had also failed to spearhead the integration of TB and HIV in the country. “There is too much fragmentation. National AIDS Council (NAC) needs to strengthen coordination. I think we (CS) have always made much noise about demanding NAC to be accountable, but I do not think we have been accountable ourselves,” said Tholanah.

At least half a million children become ill with tuberculosis (TB) and up to 70 000 children die of it every year. The World Health Organization has estimated that around 10% of global TB caseload occurs in children (0-14 years). However, there are reports that children account for up to 40% of all cases being treated for TB. Children are also susceptible to the dual epidemic of TB-HIV. Most children will catch tuberculosis from a family member and if they are living with HIV they are even more in danger of developing more severe forms of tuberculosis with higher mortality rates. HIV-infected children are at 20 times greater risk of TB disease than HIV-negative children and at much higher risk of TB-related deaths. Paediatric TB has until recently not been a main priority of global TB control efforts for various reasons.

A declaration calling for global support to end the AIDS epidemic was announced recently (10.7.2012) by the International AIDS Society (IAS) and the University of California, San Francisco (UCSF). This Washington, D.C. Declaration, which seeks to build broad support for beginning to end the AIDS epidemic through a 9-point action plan, will be the official declaration of the XIX International AIDS Conference (AIDS 2012), which will take place in Washington, D.C. from 22 to 27 July 2012, and bring together some 25,000 delegates, including HIV professionals, activists, global and community leaders and people living with HIV. The conference is co-chaired by Elly Katabira, President of the International AIDS Society and Diane Havlir, MD, chief of the UCSF Division of HIV/AIDS at San Francisco General Hospital and Trauma Centre.

TB-HIV co-infection a challenge in Thailand (Thai language)

Duangkamol Donchaum - CNS writes this in-depth feature interviewing experts from the International Union Against Tuberculosis and Lung Disease (The Union) on Tuberculosis (TB) and HIV co-infection in Thailand. To read the article in Thai language, click here, and to listen to audio podcast in Thai language, click here.

Let Me Be Myself As I Walk Together With You

It has been three years since Section 377 of Indian Penal Code drafted in 1860, (which reads as 'Whoever voluntarily has carnal intercourse against the order of nature with any man, woman or animal, shall be punished') was repealed by the Delhi High Court on July2, 2009, as the Division Bench of Justice A P Shah and Justice S Muralidhar noted that the provision of Section 377 which criminalised consensual sexual acts of adults in private, violated the fundamental right of life and liberty and the right to equality as guaranteed in the Constitution.

The action of the Delhi High Court to repeal the 150 years old Indian Penal Code (IPC) Section 377 legislation was a landmark legal decision to strike down a punitive barrier and impediment to effective public health action. July 2012 marks the third anniversary of this ground-breaking judgment. Since July 2009 Delhi High Court judgment, there are fifteen Special Leave Petitions (SLPs) filed against this judgment in the Supreme Court and five SLPs filed in support of the Delhi High Court judgment. The decision from the Supreme Court is yet to come. In a very timely roundtable consultation, The Road Ahead Section 377 Judgment, organized by the United Nations Development Programme (UNDP) India, Naz Foundation International (NFI), Article 39: Centre for Legal Aid and Rights, and Project DIVA, different experts and participants raised key issues for what lies ahead of this judgment.

“We have found that the biggest problem with punitive laws is that they drive the affected populations underground” said Aradhana Johri, Additional Secretary, National AIDS Control Organization (NACO), Department of AIDS Control, Government of India. She was speaking as one of the panelists at the ‘The Road Ahead Section 377’ roundtable organized by the United Nations Development Programme (UNDP) India in association with Naz Foundation International (NFI), Article 39: Centre for Legal Aid and Rights, and Project DIVA.

As I speak to the emaciated bone forms, the golden rays of sunlight streaking across the well ventilated and very clean TB wards of the King George’s Medical University (KGMU) surprise me pleasantly and lift my sagging spirits. What I see here is very different from the generally filthy and unkempt general wards of government hospitals in India. Perhaps it is the dynamism of Professor (Dr) Surya Kant, who heads the Department of Pulmonary Medicine at King George's Medical University (KGMU), which ensures the best of care to the lowliest of the TB patients admitted in the hospital.

Despite the fact that TB is curable and HIV is treatable, an estimated 8.5 million new and relapsed TB cases were reported in 2010, and an estimated 1.4 million died, which included 350,000 people living with HIV and co-infected with TB. The two diseases are closely linked because TB is frequently the first opportunistic infection in people living with HIV (PLHIV) and is the leading cause of death among them too, with one in four AIDS-related deaths caused by TB. Yet in 2010, only 34% of TB patients (1.7 million) were screened for HIV, and only 5% of HIV patients were screened for TB worldwide.

Strengthening Maternal and Child Healthcare is crucial for HIV control

Every year, many children are newly infected with HIV, mainly through mother-to-child transmission. An overwhelming majority – more than 90 per cent – of HIV infections in infants and children are passed on by mothers during pregnancy, labour, delivery or breastfeeding. In 2010, an estimated 1.49 million (1.3–1.6 million) pregnant women in low- and middle-income countries were living with the human immunodeficiency virus (HIV). Also in 2010, globally around 390 000 children were born with HIV.

The Indian state of Uttar Pradesh (UP) has close to 20% of patients with active TB disease in India. According to the recent TB report published by the Revised National TB Control Programme (RNTCP), 277,245 patients were registered in one year (2010) for TB Treatment in UP out of 15,22,147 total new TB cases in entire country (source: RNTCP report, December 2011). According to the drug surveillance reports, UP state might have up to 17% of these TB patients as drug-resistant. With drug susceptibility testing (DST) services available in only few cities (such as Agra and Lucknow) and alarming levels of other risk factors such as high tobacco use, malnutrition, weak health systems, irrational use of drugs, and diabetes to name a few, UP might be in for a serious battle ahead with TB and drug-resistant TB.

According to the Microbicides Trials Network (MTN), HIV continues to disproportionately affect racial minorities and men who have sex with men (MSM). MTN estimates that 5 to 10 percent of the world’s population engages in anal sex and globally, MSM are 19 times more likely to be infected with HIV than the general population. Unprotected anal sex is the primary driver of the HIV epidemic among this population. The risk of becoming infected with HIV during unprotected anal sex is 10 to 20 times greater than unprotected vaginal sex, because the rectal lining being only one-cell thick, it allows the virus to easily reach immune cells to infect.

Despite the fact that tuberculosis (TB) is curable and human immunodeficiency virus (HIV) infection is treatable, 350,000 people co-infected with the two diseases died in 2010, according to the World Health Organization (WHO). For most healthy people, the risk of developing active TB disease is very low, but, for people living with HIV (PLHIV), the risk is 20-30 times higher because HIV weakens the immune defence system. The two diseases are closely linked because TB is frequently the first opportunistic infection in PLHIV. Globally, millions of PLHIV are also at risk of developing TB. According to the WHO, TB caused one in four HIV/AIDS-related deaths in 2010.

We have been fighting against the Koodankulam Nuclear power Project (KKNPP) since the late 1980s. This Russian project was shelved right after the Soviet Union's collapse and taken up again in 1997. The Indian government and Russians have constructed two huge reactors of 1000 MW each without any consent of or consultation with the local people. We have just obtained the outdated Environmental Impact Assessment (EIA) report after 23 years of long and hard struggle. The Indian nuclear authorities have not shared any basic information about the project with the public. They do not give complete and truthful answers for our questions on the 'daily routine emissions' from these reactors, the amount and management of nuclear waste, fresh water needs, impact of the coolant water on our sea and seafood, decommissioning costs and effects, Russian liability and so forth.

It is heartening to see one full coloured page in the local edition of a national newspaper highlighting the message of Sri Akhilesh Yadav, the Chief Minister of Uttar Pradesh on the occasion of the statewide celebration of the Van Mahotsav Saptah (Forestry Week) from 4th to 10 July, 2012. To quote our young and dynamic Chief Minister—“we all know the importance of tress and forests in our lives. Forests are not only life line for all living creatures and environment but they also play a very important role in conserving and increasing the water level of the earth. With growing urbanization of the modern civilization, the forests are diminishing day by day. In such times we must not only understand the importance of forests but should also strive to garner public participation for a massive and sustained TREE PLANTATION drive. I hereby appeal to all citizens of the state to come forward and participate in the VAN MAHOTSAV and plant as many TREES as you can, as it is your pious responsibility towards the present and future generations.”

Imagine a life confined to imprisonment for years and sometimes a life time in that predicament. A person is removed from society, cut off from family and friends and turns into a lonely soul made into a convict to repent for his actions. The very thought conjures up images of sad people living aimlessly within the four walls of the prison they are housed in. With no hope of respite from boredom, loneliness and guilt, and in absence of a support or care system, their situation is indeed worrisome.