CNS: November 2013

Research On The Community By The Community

Shobha Shukla - CNS
India HIV/AIDS Alliance, through a Global Fund supported Pehchan (meaning identity) project is working to build the capacity of 200 Community Based Organizations in 17 Indian states by reaching out to 453, 750 MSM, transgenders and hijras (MTH) using a community driven and rights based approach. Pehchan conducted a cross sectional midline study across 23 districts in 6 Indian states to understand the demographics, behaviour, programme impact and needs of the MTH ensuring protection of rights of these communities by involving them in this research. Active community involvement was prioritised at all steps of the study right from its design to report finalisation. The research instrument was developed using a community led process and the 601 MTH respondents were interviewed by community members and engaged in data analysis and report writing.

Bobby Ramakant - CNS
According to Jim Pickett, Chair of International Rectal Microbicides Advocates (IRMA): Rectal microbicides are products currently under research – that could take the form of gels or lubricants – being developed and tested to reduce a person's risk of HIV or other sexually transmitted infections from anal sex. The risk of becoming infected with HIV during unprotected anal sex is 10 to 20 times greater than unprotected vaginal sex because as the rectal lining is only one-cell thick, the virus can more easily reach immune cells to infect.

Shobha Shukla - CNS
According to a new UNAIDS report on HIV in Asia and the Pacific, there is mixed progress on eliminating new HIV infections in infants. Cambodia, Malaysia, Myanmar and Thailand have over 50% coverage of all services to prevent PTCT (parent to child transmission) of HIV while Pakistan, Nepal and Sri Lanka lag behind with less than 30%. All countries in the region are trying to introduce WHO recommended PPTCT treatment option B to provide early and immediate ARV treatment to all HIV+ positive mothers. Yet overall there has been only 9% reduction in new infections among infants between 2010 and 2012. Cutting down the number of such infections by 90% requires great effort.

Shobha Shukla — CNS
Based on pre-ICAAP interviews conducted by Jeanne Marie Hallacy: Voices of affected community representatives
Repeal punitive laws
“Almost 90% of countries in the Asia Pacific region have retained laws that come from colonial times and are not progressive. They are making it difficult for the communities to access services or even address stigma and discrimination. Repeal of punitive laws in this region is very important.”
Moi Lee Liow, Asia Pacific Council of Aids Service Organizations (APCASO)

Nenet Ortega - CNS
Two decades ago, people living with HIV and AIDS (PLHIV) including their families had been stigmatized in all areas of social life, from communities where they lived and in areas where they normally do their daily grind.

Shobha Shukla - CNS
The Regional assessment of HIV, STI and other health needs of transgender people in Asia and the Pacific (jointly developed by the WHO and the Asia Pacific Transgender Network, and the United Nations Development Programme) identifies a clear need to scale up and improve sustained, comprehensive and effective HIV prevention efforts for transgender people (people whose gender identity differs from their biological sex assigned at birth). The assessment reports that ‘HIV prevalence among transgender women in the Region appears to be very high, ranging from 7.5% in Australia, 13.5% in Thailand and 31.6% in Indonesia to 41% in India. Throughout Asia and the Pacific region, transgender people are still very much underserved by health services…, putting them at increased risk for HIV….’

Lwin Lwin Thant - CNS
Since the launch of the Global Commission on HIV and the Law report in July 2012, there have been significant positive outcomes shaping in the Asia-Pacific region. “Today there are 82 countries across the world where UNDP, UN partners, civil society organizations among others have been working together and followed up on the recommendations of this report. We assume this is a good follow up which includes reviewing legal environments in the country, working with judiciary, police, and parliamentarians, and increasing access to justice programmes. There has been very interesting follow-up in the Asia Pacific region too on a range of issues including key populations, intellectual property (IP) and treatment access, among others” said Mandeep Dhaliwal, Director (HIV, Health and Development Practice), UNDP.

Citizen News Service - CNS
Zimbabwe has the dubious distinction of having an estimated 15% of all 15- to 49-year-olds to be living with HIV and 74% of the 38,720 tuberculosis patients co-infected with HIV. A TB-HIV integrated care project managed by The Zimbabwe Office of the International Union Against Tuberculosis and Lung Disease (The Union) has shown in its second-year results, significantly improved care for people requiring simultaneous treatment for both diseases. The Union project, which was launched in October 2011, is being implemented in 23 clinics in 17 urban areas in Zimbabwe with funding from the US President’s Emergency Fund for AIDS Relief (PEPFAR). The aim is to strengthen both TB and HIV diagnostic and treatment through decentralisation and integration of TB-HIV services in urban primary health care clinics.

Diana Esther Wangari - CNS
Recently, the international media was flooded with reports of a baby in Mississippi who was cured of HIV. The miraculous procedure was performed by Dr. Gray, a pediatrician with the University of Massachusetts alongside Dr. Persaud of John Hopkins University. The daring move to treat the child was done thirty hours after the child’s birth, even before getting confirmatory test results of infection. In addition, Dr. Gray went a step further to use three drugs instead of the usual one. This could have posed a health risk, but against all odds the child survived and even after 30 months was found to have no viral load despite her antiretroviral therapy being discontinued at 18 months as reported by the mother.

Nenet Ortega - CNS
Gender diversity has a long and rich history in the Asia-Pacific region. Most societies are patriarchal, leaving women in general as second-class citizens who face significant economic, social and health challenges compared with men. The situation is even worse for transgenders and sex workers. Stigma and discrimination force most to live on the margins of society. Due to fear, discrimination and isolation, they are often unable to seek out and obtain adequate health and social services. Partly for those reasons, they have long experienced HIV and TB prevalence far above national averages.

Jamie Uhrig - CNS
As many people from around the region head to Bangkok to be on time for the opening of the ICAAP 11, those from Indonesia carry a special piece of news with them. Quietly, The Ministry of Health is encouraging the practice of Test and Treat.

Bobby Ramakant - CNS
At 11th ICAAP, all delegates must have heard the words: stigma and discrimination. But often we refer to external factors that contribute to stigma and discrimination for key populations living with HIV, and might fail to look inside. “We also need to look at stigma and discrimination keeping the ‘self’ factor in mind - on how young men who have sex with men (MSM) and transgender people absorb external stigma and discrimination for instance” said Tung Duy Bui from Viet Nam. Bui is also the Regional Coordinator of “Youth Voices Count (YVC)” which is a network of young MSM and transgender people in Asia Pacific. He spoke to 11th ICAAP Insight team after the symposium on self-stigma among young MSM and transgender.

Bobby Ramakant - CNS
Despite significant momentum to responding to childhood TB in 2013 with launch of first-ever roadmap, are we groping in the dark with very little data on TB in children? Charalambos Sismanidis, a noted expert who was speaking at the 44th Union World Conference on Lung Health, said that childhood TB data was first reported by countries to the WHO in 2012 but this is not enough. There are gaps in surveillance system as childhood TB does get under-reported (and under-diagnosed).

Hara Mihalea - CNS
In response to the numerous unmet needs of women, girls, and transgender people-- especially those affected by HIV, TB or malaria—the Women4GF (women for Global Fund) initiative was launched earlier this year (2013) as part of The Global Fund Gender Equality Strategy. Preceding the 11th ICAAP held recently in November 2013 in Bangkok, a two day workshop on Gender Equality for advocates and activists of Key Affected Populations (KAPs) was organized by the AIDS, Strategy Advocacy and Policy (ASAP) and funded by the Global Fund for TB, AIDS and Malaria (GFTAM or simply GF).

Citizen News Service - CNS
Recent guidelines by the International Diabetes Federation (IDF) state that metabolic surgery is a treatment option for any overweight person with a Body Mass Index (BMI = weight in kilograms/ height in metre square) of more than 30 and with co- morbidities like cardiovascular disease risk factors, uncontrolled diabetes, hypertension, hyperlipidaemia and obstructive sleep apnoea.

Photo credit: Vinai Dithajohn/UNAIDS

Hara Mihalea and Bobby Ramakant
Signalling an essential shift away from tokenistic participation of young people in HIV programming to encouraging genuine leadership by them was given strong emphasis at the first ICAAP media briefing ahead of the opening ceremony. “We should put the responsibility of fighting AIDS in the hands of people who have a future, rather than in hands of people who had a history,” declared Mechai Veravaidya, Chairperson of the ICAAP local host organization, The Population and Community Development Association.

Sumita Thapar – CNS
“A man is not a financial plan”, a website advises young women in the Philippines. “Babies are not blessings” it further asserts. Through active use of social media and mobile phone ‘apps’ the web site sexandsensibilities.com reaches out to young, middle class girls with positive notions about sexuality. “Sexuality is about self-identity, self-worth, it is our ‘divine’ right – it is part of being human,” asserts Ana P Santos, the journalist and sex educator who runs the site.

Shobha Shukla - CNS
The complexity in addressing sexual orientation and gender identity in the HIV response has marginalized the issues and needs of transgenders (TGs). While HIV programming in the Asia and the Pacific has scaled up considerably, TGs do tend to get subsumed under the MSM (men who have sex with men) category. Calls to separate programming and resource allocation to address their specific needs and concerns are growing louder.

Shobha Shukla – CNS
Born in 1948 in India, Shivananda Duncan Khan migrated to the UK when he was ten years old. In 1988 he founded an organization for South Asian LGBTs in London called Shakti, followed by health support groups for MSMs across India, Bangladesh and other South Asian countries. After losing a close gay Muslim friend to AIDS in the early 1990s, Mr Khan became active in the AIDS response and founded the Naz Foundation International based in London and Lucknow.

Ishdeep Kohli – CNS

A number of countries in the Asia and the Pacific are showing commitment and leadership by increasing domestic investments for HIV. Malaysia currently funds 97% of its own AIDS response, China 88% and Thailand 85%; India too has committed to increase domestic funding to more than 90% in its next phase of the AIDS response.

Nenet Ortega - CNS
The Global Fund has helped governments and civil society organizations to ‘jump start’ their programmes by funding national HIV, tuberculosis (TB) and malaria initiatives. This has included support to community work, and ART provision etc. This has also helped stimulate domestic health spending, as governments are expected to provide counterpart funds, and eventually to address issues of longer-term sustainability.

Citizen News Service - CNS
You may think that superheroes only fight crime, but they can also fight serious public health issues like drug overdose – a major and often overlooked cause of death among people who inject heroin or other opioids. Armed with naloxone the safe, effective, and easy-to-use antidote to opioid overdose, I travel the world fighting the overdose epidemic. And I’m not the only superhero with naloxone. Drug users, their families, outreach workers, and police around the globe have been trained to use naloxone to save lives.

Nenet Ortega – CNS
“Getting to Zero” is UNAIDS’ strategic mantra for attaining zero new infections, deaths and discrimination. To get there, countries are expected to adopt innovating preventive approaches, scale up and scale out treatment care and support, and advance human rights while capitalizing on gender equality to mitigate discrimination and stigma.

Le Nguyen – CNS
Discussions and split opinions about the next ICAAP are swirling around the corridors of the Queen Sikirit Convention Center. On Wednesday, they crystallized in the form of debate session entitled: The future of ICAAP: Do we need one in 2015? That the question is being openly asked is healthy. The AIDS ‘community’ must be confident that investment of collective time, attention and resources is made for the best impact. And even though the decision about ICAAP2015 will most likely be made behind firmly closed doors, such a debate should be welcomed.

Ishdeep Kohli - CNS
Many developed countries in Asia and the Middle East rely on migrant workers to keep their economies functioning. Migrants send back valuable economic resources to their origin countries and contribute to the economies of the destination countries. Migrant populations are vulnerable to violence, discriminations and lack of social and healthcare services. In some countries the policy and practice of mandatory HIV testing for migrant workers is discriminatory and violates the migrant’s human rights.

Sumita Thapar - CNS
“As religious leaders we tend to believe we have a direct line to God, we tend to think we know it all. We don’t. We need to learn. Religious leaders don’t even know their own sexuality, never mind homosexuality,” said Rev Mabizela Phumzile, Executive Director, INERALA+ (International Network of Religious Leaders Living with or Affected by AIDS).

Bobby Ramakant – CNS
HIV co-infections were in the spotlight at a few sessions on the second day of ICAAP. Neglecting infections with hepatitis C virus (HCV), hepatitis B virus (HBV), visceral leishmaniasis (VL), tuberculosis (TB), among other HIV co-infections and co-morbidities, threatens to reverse gains made by remarkable scale up of HIV-specific services.

Ishdeep Kohli - CNS
In the race for a cure for HIV, we have the Berlin Patient, the Mississippi Baby, the Visconti Cohort - 14 patients in France - and most recently, two men in Boston who were declared to be HIV- free. Through a variety of mechanisms and treatments including bone marrow stem-cell transplants and gene therapy, all of these people were able to shake the virus and stop taking the drugs that HIV-infected patients ordinarily need to survive. They represent possibility - that modern science is capable of curing a deadly infection.

Shobha Shukla – CNS
Beginning with the Lord’s Prayer, HE Ratu Epeli Nailatikau, President of Fiji began the ‘Pacific Islands Voyage’ with a celebration of the united efforts of the 22 countries comprising the Pacific Island Countries and territories (PICTS) in response to HIV and other sexually-transmitted infections (STIs). With a population of around 10 million, the region is home to one third’s of the world languages and a rich cultural diversity. PICTS has a low HIV prevalence rate of < 0.1% (with the exception of Papua New Guinea, which has prevalence of 0.9%) with three countries reporting no HIV at all.

Photo credit: Sumita Thapar - CNS

Sumita Thapar - CNS
Leaders from different walks of life – politics, bureaucracy, private sector, gay activism, entertainment – who have demonstrated shared responsibility to the 3 zeros, shared their diverse perspectives on the way forward. Mumbai-based Indian film and stage actor Rahul Bose, known for his commitment to issues of gender and injustice, spoke of the need to raise boys differently in order to address gender inequality.

Dr BB Rewari, NACO

Bobby Ramakant - CNS
Expanding access to antiretroviral therapy (ART) and HIV care services have helped people living with HIV (PLHIV) to survive and lead a better quality of life, but closing our eyes to other non-HIV healthcare needs can also reverse health benefits. “PLHIV on ART are at an elevated risk of cardiovascular diseases [CVDs],” said Nazisa Hejazi, from the University of Kebangsaan, Malaysia. “PLHIVs often have traditional NCD risk factors such as taking high fat intake, smoking, physical inactivity among others. We also know that ART medications affect the liver, potentially leading to metabolic disorders”

Citizen News Service - CNS
Civil society networks, United Nations agencies and other partners in Asia and the Pacific are urging a rapid increase of voluntary confidential community-based HIV testing and counselling for key populations at higher risk in the region – including men who have sex with men, transgender people, sex workers and people who use drugs – to help ensure more people in need are able to access life-saving antiretroviral treatment.

Sumita Thapar - CNS
Oral substitution therapy (OST) saves lives, improves quality of life, and helps people who use drugs to lead functional lives, advocates say. It is like “insulin for a diabetic,” argues Dr M Suresh Kumar, a psychiatrist from Chennai, India, who has worked on substance use disorder for over 30 years. Beneficiaries of OST agree that it turns drug use into a chronic condition, which can be managed with medical and psychosocial help. “By taking care of withdrawal, it saves them from doing ‘desperate’ things.”

Ishdeep Kohli - CNS
In line with the UNAIDS campaign to achieve the 'Three Zeroes' -- Zero new infections, Zero new deaths and Zero discrimination, the Community Programme Committee for ICAAP11 came up with the 'Community Three Zeroes' -- Zero funding, Zero political will and Zero legal reform.

Bobby Ramakant - CNS
“One of the positive developments since the 10th ICAAP (held in Busan, South Korea in 2011) is that national governments have put more money into HIV/AIDS programmes - be it India, Indonesia or China. It is the national governments’ input and acceptance of the responsibility to finance the domestic HIV programme that has become more of a reality now than it ever was. Money from external donors for financing HIV programmes has dropped significantly so this positive change of upping domestic funding is important. We can of course argue that the money is not enough and we need more investment in HIV programmes” said Dr NM Samuel, President, of AIDS Society of Asia and the Pacific (ASAP) and former Professor of Experimental Medicine, Dr MGR Medical University. “The negative aspect since last ICAAP is that we have to put more money as current investment in HIV programmes is not enough.”

11th ICAAP official daily conference newspaper (English and Thai: November 2013): During the 11th International Congress on AIDS in Asia and the Pacific (ICAAP), held in Bangkok, Inis Communication partnered with Citizen News Service (CNS) to produce a daily on-site newspaper covering sessions and issues around the event. Eleven experienced health reporters from India, Vietnam, Philippines, and Myanmar were deployed for on-site reporting throughout the conference, with a team of three from Inis providing editing, graphic design and coordination support. Issue 1, Issue 2, Issue 3, Issue 4

Intellectual property and decriminalization: Don't have to wait for laws to be changed

Anand Grover is a lawyer from India who is known for his legal activism in Indian law relating to HIV. He is a co-founder member of the Lawyers Collective and has been UN Special Rapporteur on the Right to Health since 2008. He spoke with the ICAAP11 Insight team as the 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP) got underway, stressing two points that are likely to feature in discussions this week.

Le Nguyen - CNS
A female Interpol officer–wannabe and a former male sex worker. They hug and admire each other for their sharing and their strength. Just one of many inspiring moments from the youth preconference that took two days before the opening of 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP).

Craig Knowles and Ani Lamont
Asia and the Pacific faces enormous challenges if it is to arrest rapidly rising rates of HIV infection among men who have sex with men (MSM), APCOM's 'Foreplay – the final push towards the Three Zeros' event heard at 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP). The numbers of new infections among MSM continue to rise, despite treatments having been available for almost two decades.

Swapna Majumdar - CNS
Despite a 26% overall reduction in new HIV infections in Asia and the Pacific since 2001, the epidemic still outpaces regional responses. According to a new UNAIDS report on HIV in Asia and the Pacific, the rate of new infections remains the issue of most concern. According to the report, the fastest-growing epidemics in the region are among men who have sex with men (MSM). HIV levels are particularly high in this key population, with between 15% and 25% MSM living with HIV, largely in major cities.

Le Nguyen - CNS
Halong Bay, one of Vietnam's UNESCO-recognized Natural Heritage, located in northern Quang Ninh province, about 120 km east of Vietnamese capital Hanoi, is full of colors: deep blue skies, turquoise ocean, white wakes behind the faster boats, brown fishing craft roaming the bay. The green of the islands blends with the colors of skin, eyes and hair of tourists from all over the world. All these bright colours create such a dazzling picture that impresses so many visitors.

Le Nguyen - CNS
Statistics by the HIV/AIDS Prevention Department of the Ministry of Health (MOH) of Vietnam shows that currently there are about 170,000 drug users in the listed record of the country. Vietnam is urging more methadone treatment for people who use drugs nationwide as it is seen as an effective method in helping prevent HIV/AIDS, according to the MOH.

Swapna Majumdar – CNS
"Why wouldn't you want to share my chocolate?" What would be your answer if a young five year old girl infected with the Human Immunodeficiency Virus (HIV) asks this innocent question? The Indian government Department of AIDS Control (DAC) is hoping that thought provoking questions like this on HIV and AIDS printed on tickets to the popular annual international trade fair held from14 to 30 November in New Delhi will give visitors something more than just entry to the exhibition.

Chhatra Karki, Nepal
(First published in Kapan Online, Kathmandu, Nepal on 13 November 2013)
It is believed that tuberculosis (TB) is no more a death causing disease and few months of medical treatment can cure the disease. But, the Multidrug Resistant (MDR)-TB has become a major challenge all over the world. MDR-TB is a type of disease which resist to the drugs ‘Rifampicin’ and ‘Isoniazid’. As the MDR-TB resists the drugs, its treatment has turned expensive. As per the experts, It takes a more than two years of treatment to cure the disease.

Lwin Lwin Thant, Myanmar
Had it not been for community volunteers, a person co-infected with TB and HIV would not have been able to get proper care in Myanmar. When the thin and faded seventy years old mother asked, "Mg Swe…..How are you feeling today?". Mg Swe, lying in bed and writhing with pain, answered "I am alright, A May (Mum)." Mg Swe is a 46 years old, single man who has only one leg. He joined the army in 1985 out of despondency due to his parents’ divorce. Four years later, when there was the sea-island battle with Kayin People in Tanitaryee Division, he lost his left leg in that war.

Lwin Lwin Thant, Myanmar
[Lwin Lwin interviewed a person living with HIV, drug-resistant TB and Hepatitis B Virus in Myanmar. She is presenting the story as was told to her below]
“Ma Mya!.. Ma Mya!.. Ma Mya!” I heard my name being called out loud and impatiently from the street while I was busy with housekeeping for my family. Worried, I rushed out of my house and found a nurse from the township medical clinic waiting for me.

World Pneumonia Day is observed on 12 November every year since 2009 to bring awareness to this leading killer of children below 5 years of age. An editorial in this month’s International Journal of Tuberculosis and Lung Disease (IJTLD) highlights that pneumonia is a lung disease that affects not only children but people of all ages. Authors Dr Stephen Graham of The Union and Prof Guy B Marks, IJTLD Editor-in-Chief for Lung Disease, write that “pneumonia has been an important cause of death for centuries”.

Carolyn Kavita Tauro, India
It was a casual sit-in with some of my friends back home when one of them who is a mother of a three-year old boy said to me, “Hey tell me! As soon as I get to know that one of my son’s friends is ill, I already give him some antibiotics so that he doesn’t get ill… is this ok”? By the time she had asked me the question, she had realized that maybe it was not ok for her to do it, but like most people she did not know why. Another young mother quickly adds, “But anyway the doctor give so many medicines nowadays”.

Alice Tembe, Swaziland
It is common labour practice that sick leave is fourteen days with full pay, followed by another fourteen days of half pay and thereafter, it is unpaid leave. This made practical sense about a decade if not more years ago. With the rising toll of TB, industries lose on average an estimated thirty days to six months of paid sick leave a year, when one staff member gets infected with TB. The productivity time lost is becoming even greater, with MDR-TB. In the interest and respect of human rights, most industries are failing to control and manage productivity in the face of this dreaded disease.

The air around us has been riddled with so much of dirt that it is increasingly becoming unfit for consumption. And yet we cannot survive if we do not breathe. The theme of the 44th Union World Conference on Lung Health organised by the International Union Against Tuberculosis and Lung Disease (The Union) held recently in Paris was very apt - 'Shared air, safe air?'