Monthly Archives: November 2011

KENYA: Poor Mental Healthcare


NAIROBI, 30 November 2011 (IRIN) – A shortage of mental health specialists and facilities, ignorance and stigma, are among the challenges facing the provision of quality psycho-social care in Kenya, say specialists. 
There is a huge treatment gap in Kenya, where there are currently 81 psychiatrists for a population of 41.6 million,”
” Monique Mucheru-Wang’ombe, a consultant psychiatrist at the Ministry of Medical Services, told IRIN. 

With most psychiatrists in private practice, only about 25 are in the public sector and then largely in the urban areas while the population was primarily rural, said Mucheru-Wang’ombe. 

According to the UN World Health Organization (WHO), in most countries, particularly low- and middle-income countries, mental health services are severely short of resources – both human and financial – with more being spent on the specialized treatment and care of people with mental illness and to a lesser extent on integrated mental health systems. 

Instead of providing care in large psychiatric hospitals, WHO urges countries to integrate mental health into primary healthcare in general hospitals and develop community-based mental health services. 

“Institutionalization is not the way to go,” echoes Mucheru-Wang’ombe, adding that community-based mental health services helped to make the provision of care more accessible and reduced stigma. 

She added that the integration of other health services such as dental or maternal and child services within the same institutions would also help to reduce stigma, as would awareness-raising on the importance of treatment and long-term management. 

Cases of families hiding away mentally-ill patients are common due to the negative perceptions associated with such illnesses. “Mental illnesses are thought to be a consequence of demon possession, evil spirits or curses. It therefore takes long for patients to seek help from the formal health sector,” she said. 

A general misconception in the coastal region where drug abuse is rife, for example, is that most of those suffering from mental illnesses have themselves to blame, exposing them to social ridicule. 

Some families therefore opt to hide their sick relatives to avoid embarrassment. 

The media has also been blamed for helping to perpetuate the stigma. “…It is a shame that coverage is almost always sensationalistic and further dehumanizes people who are already relegated to the fringes of society,” writes Judith E. Klein, the director of the Mental Health Initiative in a blog. 

“The stigmatization of people with mental disabilities runs very deep, and it is very difficult for them to shed it,” says Klein. “Sensationalist media coverage does everybody a disservice because it reinforces the message that disabled people are hopeless, pathetic burdens to society and that if only they received more charitable assistance, perhaps society could take a breath and forget about them – again – at least until the next scandalous story breaks.” 

According to Frank Njenga, a consultant psychiatrist, there is little psycho-social help available to those in acute need, such as survivors of frequent rapid onset disasters in the country, for example, the recent Sinai slum fire. 

Widespread poverty is also a factor, said Njenga. 

Mama Naima* told IRIN that a lack of money to take her 22-year-old son for specialized treatment had forced her to rely on traditional herbal concoctions. 

The provision of mental health services is a relatively new area in Kenya, says Adrienne Carter, a psychotherapist/trainer with the Independent Medico-Legal Unit (IMLU). 

“The usefulness of counselling in the healing of mental health problems is not yet well known, especially in the area of torture and other traumatic events,” said Carter. “There are numerous communities within Kenya that suffered greatly during the post-election violence. Some… managed to get psychological assistance, but most of them continue to suffer, untreated.” 

An experience is considered traumatic if the person never experienced it before, it is overwhelming and it changes one’s life completely, it involves death or serious threat to one’s life. Witnessed events may include observing the serious injury or unnatural death of another person due to violent assault, accident, war or disaster or unexpectedly witnessing a dead body or body parts. 

The disorder developed as a result of traumatic events may be especially severe when the stressor is human (such as in torture, rape). 

With traumatized people often exhibiting various physical reactions such as body aches, sleeping problems, nightmares and numbness, they mostly go to medical doctors to try to ease their pain, she said, “but the medications prescribed by the physicians help only for a short time… unless the root causes are treated, the physical symptoms continue to persist. 

“It is necessary to process the trauma and assist in integrating it within the psyche of the traumatized individual. If the trauma is not integrated within the psyche, the traumatized individual is often found to suffer from Post-traumatic Stress Disorder [PTSD].” 

PTSD is characterized by re-experiencing of the traumatic event or persistent avoidance of stimuli associated with the trauma, numbing of general responsiveness and symptoms of increased arousal. 

“Unfortunately, people experiencing these symptoms are frequently misdiagnosed with schizophrenia and other psychotic disorders… [and] may end up for many years in mental hospitals where they are ‘treated’ with heavy doses of medications that do not and never will cure their symptoms.” 

[Courtesy IRIN]


Tanzania Tightens Borders Over Yellow Fever

Tanzania has announced more rigorous plans to ensure all travellers entering the country have yellow fever certificates, the East African Legislative Assembly (EALA) has been informed.

Tanzania is the only East African Community partner state that strictly enforces the International Health Regulations requirements on yellow fever in respect to regional and international travellers, even though the other four partner states are members of the World Health Organization.

Addressing the EALA sitting in the Burundian capital Bujumbura, the acting chairman of the Council of Ministers, Mr Musa Sirma, said since all partner states are signatories to the International Health Regulations, there was need for them to become vigilant.

However, some legislators accused Tanzanian of double standard, saying the country only implements the surveillance at the Kilimanjaro Airport, leaving all the other entry points unchecked.

“Does yellow fever threaten Tanzania only through one entry point, the Kilimanjaro Airport?” Gen. Mugisha Muntu, Uganda, asked. Meanwhile, Ms Dora Byamukama, also a Ugandan MP, asked if Tanzania had mechanisms of ensuring the yellow fever certificates people carried were genuine.

Ms Margaret Zziwa, Uganda, said it is not necessary for citizens within East Africa to struggle acquiring Yellow Fever certificates, arguing that there has not been any disease outbreak in the region for many years. She said such impediments to peoples’ travels within the community would affect the spirit of the Customs Union Treaty, agreed upon by all the five member states.

“It is to the detriment of the movement of the people, because it adds cumbersomeness of the peoples’ travels. Some people even have to pay bribes to get the certificates which means it abets corruption,” Ms Zziwa said.

However, Mr Sirma, also the Kenyan Minister in charge of East African Affairs, denied any double standards, insisting that Tanzania would implement the yellow fever checks on all boarder points of Nyerere Airport, Mwanza Airport and some inland cross-border ports of entry such as Namanga.

“The Republic of Tanzania will, through implementation of active surveillance and national vaccination strategies protect travellers entering the country which is considered endemic for yellow fever,” Mr Sirma said.

Mr Surma said in one of their previous meetings, the council of ministers agreed that all countries in the community become strict about yellow fever adherence and surveillance to avoid the disease spread.

Yellow fever is one of the diseases considered a stumbling block to economic and social development in Africa, although there has not been a major outbreak in the EAC for a long time now.

A mosquito-borne disease, yellow fever symptoms include; high fever, chills, headache, muscle aches, vomiting, and backache. Last year, Northern Uganda districts of Lamwo, Kitgum, Pader and Abim received vaccinations for yellow fever. Most Ugandan travellers undergo vaccination from health centers where they receive certificates for the disease to aid their travels.

Mr Surma informed the House that in South Africa, he was forcibly immunised because he had forgotten his yellow fever certificate, days after he had been immunised from his home county-Kenya.

“Recently we established a health directory and the regionalisation of all health matters will be considered,” Mr Surma said.


HIV/AIDS: Global Fund cancels funding

JOHANNESBURG, 24 November 2011 (PlusNews) – The Global Fund to Fight HIV, Tuberculosis (TB) and Malaria has cancelled its next round of funding and cut off countries like Russia, China and Brazil after donors failed to deliver US$2.2 billion in previously committed funding. Emergency funding measures will now be put in place for some countries. 

The Global Fund board took the difficult decision of cancelling Round 11 at its latest meeting, which concluded on 22 November in Accra,  Ghana. A reduced pool of eligible countries will now be able to apply for new funding only after the Fund’s next disbursement in 2014. 

A Transitional Funding Mechanism has been established to provide emergency relief to current recipients who will run out of money before 2014. But this will apply only to essential services such as HIV treatment and care, according to a statement issued by the Fund.

However, international medical humanitarian organization Médecins Sans Frontières (MSF) has pointed out that the decision will not allow countries to scale up or improve HIV treatment, and will also limit treatment for drug-resistant forms of TB. 

“The bottom line is that there’s $2.2 billion in outstanding pledges that haven’t been paid by the donors,” said Global Fund board member Shaun Mellors of South Africa’s Foundation for Professional Development. “If those pledges had been turned into contributions we’d obviously be in a very different situation, but there just isn’t enough money for Round 11, or even Phase II renewals of grants.” 

Global Fund grants have usually been disbursed in two phases: in Phase I, countries qualified for two years of initial funding; in Phase II they could apply for an additional three years of funding as part of a renewal. 

In the developing world, treatment for 70 percent of HIV patients is financed by the Global Fund. Countries like Zimbabwe, Malawi and Mozambique, which rely heavily on Global Fund money to support national HIV programmes, will now be encouraged to use their drafted Round 11 proposals as a basis for funding requests in 2014. 

Swaziland’s decision to forgo Global Fund money contributed to shortages of antiretroviral (ARV) medication earlier in 2011 after the government was unable to generate enough revenue to fill the gap. Its country coordinating mechanism, which distributes Global Fund money nationally, called Round 11 a “do or die” moment, and had begun work on its Round 11 application. 

South Africa’s HIV lobby group, the Treatment Action Campaign (TAC), is largely dependent on Global Fund money to sustain its operations. Delays by South Africa’s Department of Health in disbursing US$ 760,000 in Global Fund money to TAC led the group to issue a on 23 November that without this money, TAC will be forced to close its doors and retrench all its employees at the end of January 2

 The group, which recently helped formulate South Africa’s new national strategic plan on HIV, TB and sexually transmitted infections, urged the Global Fund to make sure that all sub-recipients were paid by the first week of January. 

Round 11 had been postponed twice due to insufficient funding, partly because lower interest rates were achieved on the Global Fund’s World Bank account. According to MSF, countries Kenya, Lesotho and South Africa had also been told that they would not be eligible for Round 11 funding due to financial shortfalls despite the fact that none of these countries had yet reached international universal ARV access targets of 80 percent uptake. 

Mellors told IRIN/PlusNews the Fund had also been forced to stop signing Round 10 grants two weeks ago. A funding deficit of up to US$.6 billion meant board members were faced with tough decisions at the meeting, and no one was pleased with having to find what seemed the least painful solutions. 

Cutting Round 11 was not enough. To finance the Transitional Funding Mechanism and some Round 10 applications, the board had to cut deeper, cutting  future funding for upper-middle-income countries without large HIV epidemics such as Argentina, Mexico and China. 

Countries reclassified as upper-middle-income nations will also no longer be afforded a one-year grace period during which they would still have been eligible for support. China has an emerging HIV epidemic and would have been eligible for about $880 million in grant renewals, according to Aidspan’s Global Fund Observer news service. 

More stringent funding requirements – part of the Fund’s new strategy after a high-level panel to review financial oversight – will now apply to Phase II applications of current grants. Money will be disbursed annually to countries qualifying for Phase II renewals, rather than the multi-year instalments originally envisioned as part of these renewals. 

During 2011, several donors – including Sweden, Ireland and Germany – suspended funding to the Global Fund after media reports about grant mismanagement found by the Office of the Inspector General of the Global Fund. Spain made no pledges in 2011 and Italy has not been contributing to the Fund, according to Fund spokesperson, Marcella Rojo. 

Nevertheless, Sweden resumed funding the Global Fund in early November 
2011 and Germany announced on 23 November that it would pay its 2011 
instalment, confirming its full pledge for 2012. Global Fund executive director Michel Kazatchkine noted that the percentage of countries fulfilling their stated commitments has been falling in recent years. 

According to the Global Fund Observer, in 2009 almost 15 percent of donor pledges were not fulfilled. Last year, this percentage nearly doubled. 

MSF has called on the Fund and donors to immediately raise the resources necessary for emergency funding as well as more sustained financial support. 

“Donors are really pulling the rug out from under people living with HIV/AIDS at precisely the time when we need to move full steam ahead and get life-saving treatment to more people,” said Dr. Tido von Schoen-Angerer, executive director of MSF’s Access Campaign in a statement. 

“All governments must chip in to the effort to curb HIV, but especially those with the capacity to really make a difference must urgently step up and support a new funding opportunity for countries by the Global Fund.” 
[Courtesy of IRIN]

SIERRA LEONE: Fistula Hotline Launched


FREETOWN, 22 November 2011 (IRIN) – Nurse Zainab Blell’s mobile phone has been ringing all morning at the Aberdeen Women’s Centre, a clinic in Freetown, Sierra Leone’s capital. After explaining to countless callers that this is a hospital line, Blell gets a genuine request for help and tries to get more details. “When did you give birth? When did you start having a problem?”
The woman on the phone is in a remote Sierra Leonean town. She says her sister leaks urine uncontrollably, and suffers from rashes and peeling skin on her inner thighs.

Blell is one of three nurses answering calls on a newly launched “fistula hotline”, a free phone number for women who suffer from this debilitating condition that is seldom spoken about.

Fistula, also known as vesico-vaginal fistula or VVF, is a hole in the birth canal that leaves women with chronic incontinence, and often a stillborn baby. It is usually caused by several days of obstructed labour. It affects an estimated two million women in developing countries; and 50,000-100,000 women worldwide each year.

The fistula hotline, which is run by the centre, is the result of a public-private partnership between the Gloag Foundation, USAID, the United Nations Population Fund (UNFPA) and telecommunications company Airtel.

In the last month more than 8,000 calls have been received, but so far just 0.1 percent have been about cases of fistula.

The Aberdeen Women’s Centre provides the only comprehensive fistula repair service in the country. Despite the small number of calls concerning the condition, Jude Holden, the centre’s Country Director, is pleased with the result. “We have received 90 cases since the hotline opened, and this is a great success,” she told IRIN.

Shortly after the hotline opened in October, radio messages were broadcast in the local Krio language and in English, describing fistula and telling anyone who thinks they are affected to call 555.

“There is very little awareness of fistula and why it happens. Women are stigmatized and often blamed for their condition. Because of this we found it difficult to get women with fistula to the centre for treatment.”

Fistula occur most often in young women (15 to 30 years old), most of whom come from rural areas with poor access to healthcare, according to a 2005 Ministry of Health survey.

In Sierra Leone, some estimates put fistula prevalence at a similar rate to maternal mortality – one in eight women – but there is little research to back up these estimates.

Free healthcare services for lactating mothers and pregnant women were launched in 2010, but the maternal health infrastructure is inadequate and the Ministry of Health is struggling to implement the policy. Only 137 trained midwives practice in the country, and there are just 16 emergency obstetric facilities.

During and after Sierra Leone’s decade-long civil war, widespread rape trauma was a major cause of fistula, according to Sarah Walker, VVF programme manager at the Aberdeen Women’s Centre. Most of the resultant traumatic fistula cases have been dealt with, she said, and the problem now stems mainly from poor ante-natal care and a high level of teenage pregnancy.

“Most of the [women with fistula] are uneducated farmers… They don’t have access to any sort of healthcare, pre-natal or post-natal. We see it a lot in young girls, mostly because their bodies are not developed yet, and so when they’re in labour the child gets stuck in the pelvis,” said Walker.

In Njala town in the Southern Moyamba district, Kadiatu Ngegba’s husband heard the radio advert and called the number. Ngegba, now aged 24, developed a fistula when she was just 15 years old, after being in labour for two days before a doctor came to perform a caesarean section.

“My baby died,” Ngegba says. “After the operation, the doctor pulled out the catheter and I was covered in urine.”

When she got home, Ngegba’s first husband abandoned her and she was sent to live with relatives. “I was really unhappy. Everyone made fun of me. I wanted to go back to school but because of this problem I had, I couldn’t.”

Ngegba had fistula repair surgery in 2006, but when she gave birth to her second child without a caesarean, the fistula reappeared.

Experts say prevention, rather than treatment, is the key to ending fistula. This means providing women with family planning, ante-natal care, skilled birth attendants and emergency obstetric care, according to the UNFPA Campaign to End Fistula.

“We need a preventative as well as a therapeutic approach,” Sas Kargbo, Director of Reproductive Health at Sierra Leone’s Ministry of Health, told IRIN, adding that the free phone line is an important step to finding the women and treating the problem.

Sierra Leone is currently finalizing a strategic plan to tackle fistula and will appoint a focal person by the start of 2012.

At the Aberdeen Women’s Centre, almost 10 years after developing her first fistula, Ngegba waits for surgery. She smiles and hugs Naomi, her two-year-old daughter. “When I get well,” she says, “my husband will send me back to finish school.”

[Courtesy IRIN News]

AFRICA: Sanitation Targets “two centuries away”

It will take two centuries for sub-Saharan Africa to meet the Millennium Development Goal (MDG) to reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation, according to NGO WaterAid, which calls on national leaders to commit 3.5 percent of their annual budget to the sector.

Water, sanitation and hygiene (WASH) are being sidelined as governments concentrate on health and education, says the WaterAid report. Meanwhile, people’s lack of access to clean water and basic sanitation services is holding back social and economic development in the region, costing around 5 percent of gross domestic product (GDP) every year.

Inadequate WASH services cost sub-Saharan Africa more than the whole continent receives in development aid – US$47.6 billion in 2009 – according to WaterAid.
The World Health Organization (WHO) estimated the financial impact of inadequate WASH facilities by looking at the health issues linked to poor hygiene, child mortality, waterborne tropical diseases, the time people spend collecting water; and reductions in educational achievement due to illness and girls’ attendance rates at schools.

“Diarrhoea, 90 percent of which is attributable to inadequate sanitation and dirty water, is the single biggest killer of children in Africa, and yet sanitation targets are off-track,” Tom Slaymaker, one of the report’s authors, told IRIN.

Every day, 2,000 children die from diarrhoea in sub-Saharan Africa. Four out of 10 people do not have access to safe water, while seven out of 10 do not have appropriate sanitation facilities.

The disparity between rich and poor is stark. Poor people in sub-Saharan Africa are more than 15 times more likely to practice open defecation due to inadequate or poorly maintained toilets.
“Unless this changes, we won’t see educational progress and it will hold back progress on child health. If you look at development in industrialized countries, sanitation has been key to enabling economic growth and achieving acceptable living standards,” said Slaymaker.

Progress has been slow partly because WASH is not “sexy”, he commented. “On one level it’s just a question of political will. Sanitation is not a sexy topic – politicians much prefer to say they’re opening a hospital or school, rather than building some toilets.”

Most policy-makers in charge of WASH “have access to clean water and good sanitation, so they may not be motivated to address it in a distant rural part of the country,” said WaterAid senior policy analyst John Garret.

Slaymaker noted that “The water ministry is generally less powerful relative to the education and health ministries – which [tend to] have more civil servants and more leverage with the ministry of finance during and after the budget process – [so] in the scramble for funds, the water ministry and sanitation organizations lose out. This all contributes to the sector being a low priority.”

Water and sanitation is not an easy sector to reform, given it is usually spread across different ministries, and there is often “no single unified voice in the national budget process for sanitation”, he added.

WaterAid calls on donors to double the global aid flow to WASH with an additional $10 billion per year in the run-up to 2015, the deadline for achieving the MDGs.

African governments need to commit at least 3.5 percent of GDP to sanitation and water to get back on track, Slaymaker told IRIN. Only Lesotho, Kenya, Niger and Tanzania are currently spending more than 0.9 percent of GDP on WASH. In Côte d’Ivoire, Ghana, Liberia, Madagascar, Nigeria, Uganda and Zambia, the most recent expenditure figures fall well below the original 2009 commitment of 0.5 percent of GDP.

“Despite all the political commitments, we haven’t seen the finances to back it up,” Slaymaker told IRIN. African heads of state met in the Rwandan capital, Kigali, earlier in 2011, and although many of their governments had made a commitment in 2009 to spend 0.5 percent of the annual budget on sanitation, “only one or two countries… realized that,” he said.

Despite this challenge, Slaymaker still thinks the MDG goal can be met if politicians drastically change course. “This is the last chance to make an effort to get back on track,” he told IRIN. “It’s a question of… concerted partnership between donors, governments and the private sector. What’s lacking at the moment is that concerted drive.”
[Courtesy IRIN]

NIGERIA: Gay Rights Bill Threatens Imprisonment

LAGOS, 15 November 2011 (IRIN) – Rights groups in Nigeria fear an anti same-sex marriage bill being discussed in parliament could boost already prevalent discrimination against homosexuals. The bill goes much further than banning same-sex marriage; it threatens to ban the formation of groups supporting homosexuality, with imprisonment for anyone who “witnesses, abet[s] or aids” same-gender relationships, and could lead to any discussion or activities related to gay rights being banned.

Under a colonial-era law, sodomy is punishable by a 14-year jail sentence; and in the country’s mainly Muslim northern states, where a version of Shar’ia law applies, the penalty is death by stoning, although this has never officially been carried out. 
The National Assembly began debating the latest version of the Same Sex Marriage (Prohibition) Bill in November. Most high-ranking officials have voiced their approval of the bill, signalling it is likely to pass.

Analysts see the bill, which has been shelved twice in five years, as a potential boost to the popularity of a government whose approval ratings have stalled since elections in April this year.

A 2008 survey by non-profit, Nigeria’s Information for Sexual and Reproductive Rights, of 6,000 Nigerians on their attitudes to homosexuality, found that only 1.4 percent of respondents said they felt “tolerant” towards sexual minorities.

A university student in the northern state of Jigawa was killed in 2002 when classmates set upon him after rumours that he was gay. 

In September 2008, several national newspapers published the names, addresses and photographs of the pastor and congregation of a church in the port city of Lagos that ministered to sexual minorities. A few days later a mob that included policemen attacked the church. Members of the congregation lost jobs and homes and had to go into hiding; others are still harassed and threatened with physical harm, Human Rights Watch said in a statement. 

“Homosexual and lesbian practices are considered offensive to public morality in Nigeria. The… bill is crucial to our national development because it seeks to protect the traditional family, which is the fundamental unit of society, especially in our country,” said the influential newspaper, This Day, in its editorial on 10 November. “It will be difficult to import practices and lifestyles which are alien to our country and the majority of our people.”

Homosexual rights are narrowing across Africa. In Uganda, gay rights activist David Kato was killed in January 2011 after opposing the Anti-Homosexuality Bill in 2009. 

In Malawi a gay couple was imprisoned for “gross indecency”. The United States and British governments have threatened to cut off aid money to African countries seeking to curb gay rights. 
Leaders of Nigeria’s main religions – Islam and Christianity – rarely promote tolerance of homosexuality, according to Damian Ugwu, a rights activist at the Lagos-based Social Justice Advocacy Initiative.

“There is no religion that welcomes the same-sex marriage, whether Islam or Christianity,” National Tourism Director Olusegun Runsewe told reporters on 7 November. ”We need to be careful and do all it takes to shun this practice, because same-sex marriage is satanic and it can destroy any system, as well as cause bad image for any country.” 
Religious disapproval can have a devastating impact on gay people, said Ugwu. “The church has zero tolerance for homosexuality. The only time they will accept someone being homosexual is if they come to ‘confess’ and ‘repent’ of it, to say they are cured so they can be forgiven.” 

Fear of “coming out” also means many homosexuals – who are at high risk of HIV – are unable to access medical services or receive adequate treatment, as they give incomplete personal information, activists say. 

“Gay people who are courageous enough to come out have reported being humiliated by medical staff,” Ugwu noted. At least two homosexuals who spoke to IRIN on condition of anonymity said they feared even going to hospitals for fear of being “outed” by staff.

NGOs and activists say the bill could have serious implications even for people who aren’t gay. Migrants in search of work in bigger centres are a vulnerable group. “It’s going to give the Nigerian police, who are already known for abusing their power, a license to violate the rights of both gay and non-gay people. It’s going to create an avenue where young men and women, who often live together in big cities for financial reasons, will become targets for extortion,” Ugwu said.

“This is an insidious bill that appears to be limited to same-gender marriage, but is actually an attack on basic rights,” said Human Rights Watch spokesperson Graeme Reid. “The definition of ‘same-gender marriage’ is so broad as to include anyone even suspected of being in a same-sex relationship. And it threatens human rights defenders by targeting people who support unpopular causes.”

Nigerian gay author and campaigner Unoma Azuah told IRIN the government should be focusing on other priorities. “I think it’s a distraction from real issues at hand, and an absolute waste of time and resources… How does what two consenting adults do in the privacy of their spaces provide a solution to the crippling problems of unemployment in Nigeria? There are few major good roads; education is in shambles; there’s extremely poor electricity supply, food and oil have to be imported by the ton – and legislators are busy debating same sex marriage?”

The barriers to acceptance are hard to breach. “Gay people face discrimination from their families, from religious groups and from society,” Ugwu said. “So it’s quite understandable people aren’t speaking out [in support of them].” 
[Courtesy IRIN] 


HIV/AIDS: Clinton sets out new US focus

US Secretary of State Hillary Clinton’s announcement that the American government now prioritizes creating an AIDS-free generation could be more than just political lip-service: it may also shape the next several years of US global health programming and funding, analysts say. 

Clinton’s 8 November speech at the National Institute of Health reflects recent scientific breakthroughs. She said a three-pronged approach – eliminating mother-to-child transmission of HIV, scaling up male circumcision procedures and expanding early treatment for people living with HIV and AIDS – offered a combination prevention strategy that would help reach the goal of having virtually no child born with HIV within three years. 

“It’s the first time the US has outlined a policy goal on how to reach an AIDS-free generation,” explained Jennifer Kates, director of HIV policy at the Washington DC-based Kaiser Family Foundation. 

“We’re starting to think about this and talk about this and with some of the recent studies, it is really changing the way we are approaching the epidemic… this provides reorientation for how programmes are approached and trying to figure out combination prevention on the ground.” 

Clinton also committed an additional US$60 million to rapidly scale up combination prevention in four unspecified countries in sub-Saharan Africa to measure the impact of this approach. 

About 53 percent of pregnant women living with HIV in the developing world receive antiretroviral drugs to prevent transmission to their infants, according to the UN Children’s Fund (UNICEF). Last year, the US President’s Emergency Plan for AIDS Relief(PEPFAR) helped prevent 114,000 babies from being born with HIV, Clinton said. 

Recent studies have shown that male circumcision can help reduce a man’s risk of becoming infected with HIV by 60 percent during heterosexual sex, according to the World Health Organization (WHO). Earlier this year, the HIV Prevention Trial Networks 052 study found that men and women living with HIV reduced their risk of transmitting HIV to their partners by up to 96 percent if they received an early initiation of combination antiretroviral therapy. 

Kates cautioned that it may be too soon to tell how much these three new policy priorities – the first the US has put forth since the Bush Administration’s approach of abstinence, fidelity and condoms – will guide US foreign programmes, and that interventions will have to be tailored to different populations.

But some women’s and girls’ sexual and reproductive health advocates are concerned that these new priorities sideline reproductive rights. Clinton did not specifically discuss family planning or access to safe abortions. 

That exclusion might be reflect the domestic agenda, where reproductive rights continue to play a divisive role between liberal and conservative politicians, says Serra Sippel, president of the NGO Center for Health and Gender Equity (CHANGE). 

“There is a legitimate fear that Congress controls the purse strings, so if the Secretary thinks this could give them an inclination to think PEPFAR money would be supporting programmes addressing these rights, Congress can at any time step back and decide to use that as a way to pull that money back,” said Sippel. 

Ann Starrs, co-founder and president of the NGO Family Care International, says Clinton’s prevention-as-treatment approach could have been furthered by presenting contraception as an option to HIV-positive women, instead of just prevention of transmission interventions. 

“Studies done by a number of researchers show that 50 to 85 percent of HIV-positive women don’t want a baby,” Starrs told IRIN/PlusNews. “You provide them with contraception and you have a greater impact in terms of reducing the number of HIV-positive infants born at a greater cost.” 

But programmes under the umbrella of USAID and the $63 billion Global Health Initiative, which stresses country-led ownership and focuses on women’s and girls’ health, may well continue to foster a holistic approach on their own, said Sippel. 

Natasha Billmoria, president of the Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, which advocates for US partnership with the Global Fund, says she hopes Clinton’s “incredibly strong message” will be backed by strong funding commitments for the next financial year. 

America continues to be the largest donor to the Global Fund, but between 2010 and 2011, kept its contribution flat at $1.05 billion. Kates of the Kaiser Foundation says the financial crisis makes the ability to back up strong words with even bigger money unclear. 

“There’s an irony of having these new tools before us to combat HIV, and at the same time there’s a downward pressure on the budget, so it isn’t clear,” she said. 
 NEW YORK, 14 November 2011 (PlusNews) 

[Courtesy IRIN}