Monthly Archives: August 2012

NAMIBIA: HIV-Positive Women Sterilized

The Namibian High Court has ruled that the human rights of three HIV-positive women were violated when they were coerced into being sterilized while they gave birth, but the judge dismissed claims that the sterilization amounted to discrimination based on their HIV status.

“This decision is a victory for HIV-positive women throughout Namibia, as it reaffirms their right over what is done to their body,” said Priti Patel, deputy director and HIV programme manager at the Southern Africa Litigation Centre (SALC), a legal aid group that supported the women. “This judgment makes clear that obtaining consent while a woman is in labour or in severe pain violates clear legal principles.”

The case – the first of its kind in southern Africa – was filed in 2009. The women chose to have caesarean sections at public hospitals to reduce their chances of passing the HI virus on to their children, but said the doctors told them they could only have the procedure if they agreed to be sterilized at the same time.

The judgment allows the women to seek damages from the government. “All medical personnel must obtain informed consent from HIV-positive women prior to any medical procedure,” Patel told IRIN/PlusNews. “This includes, but is not limited to, informing them of the nature of the procedure, the impact of the procedure, and gives the women enough time to consider the information before making a decision.”

The ruling that the women failed to show they were discriminated against based on their HIV status, made the win somewhat bittersweet.

“We were not very happy with the judge’s decision on discrimination – maybe it’s the way we presented the case, focusing more on informed consent than on discrimination – we will talk to our lawyers and strategize on whether to appeal or accept the judgment,” said Jennifer Gatsi-Mallet, executive director of the Namibian Women’s Health Network, which assisted in bringing the case to court.

Gatsi-Mallet told IRIN/PlusNews that her organization had 16 similar cases pending, and had recorded dozens more while conducting research. “We hope the Ministry of Health will now review its policies, providing information circulars on sexual and reproductive health to women in public hospitals so that we don’t see such cases brought up again,” she said.

SALC’s Patel noted that the judgment would have an impact beyond Namibia. She said there were anecdotal reports of similar practices in Swaziland, and documented cases in South Africa, in which SALC was involved.

“This case does have implications in other countries,” Patel said. “It brings the issue to the attention of countries in southern Africa, allowing them to take the necessary steps to ensure the practice isn’t happening in their country, and if it is, that the practice is stopped”

[Courtesy IRIN plus News]


SOUTH SUDAN: Highest Global Maternal Mortality Rate



South Sudan has the worst reported maternal mortality rate in the world.

“More women die in child birth, per capita, in South Sudan, than in any country in the world,” says Caroline Delany, a health specialist with the Canadian International Development Agency (CIDA) in South Sudan which is funding a raft of maternal health programmes.

A 2012 report entitled Women’s Security in South Sudan: Threats in the Home by Geneva-based think-tank Small Arms Survey (SAS) says a national survey carried out in 2006 indicating 2,054 deaths per 100,000 live births may have been an underestimation.

“Many deaths are not reported, in part because 90 percent of women give birth away from formal medical facilities and without the help of professionally trained assistants,” it said.

Childbirth and pregnancy, rather than conflict, are the nation’s biggest killers of girls and women.

“One in seven South Sudanese women will die in pregnancy or childbirth, often because of infections (from puerperal fever and retained placenta), haemorrhaging, or obstructed births, with a lack of access to healthcare facilities playing a large role in their deaths,” SAS found.

“When we talk about security in South Sudan there is a tendency to focus on issues such as guns and militia groups. But real human security means protection from anything that threatens health and wellbeing. In South Sudan there is nothing that poses greater threat to a woman’s life than getting pregnant,” says SAS researcher Lydia Stone.

Lack of midwives

“Midwives can prevent up to 90 percent of maternal deaths where they are authorized to practice their competencies and play a full role during pregnancy, childbirth and after birth,” the UN Population Fund (UNFPA) in South Sudan said in a May report on maternal mortality.

At the maternity ward in Juba Teaching Hospital, staff members say there are not enough (or the right) drugs, and never enough trained staff.

Midwife Julia Amatoko is one of three registered midwives at the country’s ramshackle and constantly overcrowded hospital in the capital.

“We are just a few and a lot of mothers are coming. And beds are not enough for the mothers. We have just eight beds for the first stage of labour and for the post-natal mother,” she said.

According to UNFPA, South Sudan has just eight registered midwives and 150 community midwives.

Amatoko said the lack of professional midwives working alongside traditional birth attendants (TBA) and community midwives caused needless death. “Those who are TBA’s are not able to cope with the serious cases, like when the mothers have post-partum haemorrhage.”
Giving birth even at the country’s leading hospital is a lottery, especially at night. “I’ve been here for three months, and two mothers died, in the night,” she said, due to a lack of human resources.

“Midwives are the backbone for reduction of maternal mortality… but here, with all the midwives and birth attendants put together, there are only around 20,” said consultant obstetrician and gynaecologist Mergani Abdalla.

“If you have professional midwives that can provide basic obstetric care – once South Sudan can deploy those, they can expect progress, but it will happen slowly,” said midwifery specialist for UNFPA Gillian Garnett.

UNFPA is looking forward to the graduation of around 200 midwives next year.

Treatment delays

Many women come to the hospital late, when they are already in the throes of a difficult labour, said Abdalla.

“There are delays at the community level, with a lot of cultural and other kind of issues; there are delays in getting to the hospital because of the transport infrastructure, the lack of ambulances, the roads; and then there are delays in the hospital as well,” said Garnett.

Mariam Kone, a medical coordinator for a Médecins Sans Frontières (MSF) hospital in Aweil, Northern Bahr-el-Ghazal, echoed the problem. “We are receiving ladies at a really late stage… They’re usually in a septic condition or they’re anaemic, and many have malaria,” she said.

MSF admits around 6,000 people a year to the maternity ward and had 18 deaths last year, mainly due to postpartum haemorrhage, septicemia and eclampsia.

Blood, scissors and gauze

At Juba hospital, UNFPA is supplying kits for mothers, surgical instruments and life-saving drugs such as oxytocin to stop bleeding, but Amatoko bemoans the lack of basics: “We need scissors for delivery, and browns for packing. We don’t have even cottons in the ward; gauze-we don’t have.”

The nation’s first blood bank has been built but not filled at the hospital, which only has a family-size fridge full of blood (mostly allocated by relatives for patients due for surgery).

“The biggest need is blood transfusion, because most of the [maternal mortality] cases are due to post-partum haemorrhage”, said Abdalla.

Garnett says that if these were normally healthy women, blood loss would not be so tragic, but a combination of poor health and the delays at community and hospital level to seek health care puts most women at risk even before they go into labour.

In a country where girls are often married off in their early teens, the number of children they have is often not up to them.

“A married woman of childbearing age is expected to become pregnant at least once every three years, and to continue until menopause,” the SAS report found.

[Courtesy of IRIN]

HIV/AIDS: Growing Old with HIV

It’s hard enough dealing with the aches and pains that usually come with getting older, but when you’re HIV-positive, ageing brings more chronic illnesses and even more medication; many health systems are not ready to cope with this relatively new phenomenon.
Data on ageing with HIV is largely restricted to the developed world and very little is known about older Africans living with virus, despite the high caseload in this region. A July 2012 supplement of the medical journal, AIDS, notes that an estimated 3 million people in sub-Saharan Africa aged 50 and older are HIV-positive – 14 percent of all infected adults.

Joel Negin, a researcher at the University of Sydney School of Public Health and one of the supplement’s co-authors, said this was because most demographic and health surveys use 49 years as their endpoint for data collection. Speaking at the 19th International AIDS Conference in Washington DC on 25 July, Negin warned that the global research and policy community could no longer afford to neglect this older age group.

“We need to start talking about [the fact that] sex doesn’t end at 50 and address [our] ageist assumptions about sexual behaviour,” he said. Older adults accounted for 15 percent of new cases of HIV in the United States in 2005. The South African government has included men over 50 as one of the most at-risk populations after the latest national HIV prevalence survey revealed that infection among men and women aged between 50 and 60 was over 8 percent – higher than among men in the 20-24 age group.

“The thinking is that women over 50 are not able to engage sexually and don’t have feelings. I’m still sexually active, and of course other women are… When you go to a clinic, especially in the rural areas… you are seen as a grandmother… The healthcare provider is wondering what is happening to this granny, why would she be coming to the clinic for an STI [sexually transmitted infection] or a condom because you are supposed to have stopped having sex at that age,” said 55-year-old Dorothy Onyango, the executive director of Women Fighting AIDS in Kenya (WOFAK).

Nils Daulaire, the director of the Office of Global Health Affairs in the United States Department of Health and Human Services, said not only do older people still have sex, but it is mostly not safe sex and is frequently with multiple partners. As a result of being left out of HIV awareness campaigns, older people often did not know enough about HIV and preventing it.

HIV-positive people may also be at greater risk of certain illnesses associated with old age – studies suggest they may contract them sooner – but health systems in developing countries are still grappling with the burden of HIV/AIDS and are not equipped to deal with this added dimension.

A higher number of bone fractures and osteoporosis, a dramatic rise in the risk of hypertension and cardiovascular disease, as well as higher levels of depression, suicide and frailty are some of the long list of ailments that confront older adults living with the virus.

“It’s so early in the research that it’s very hard to separate which of these problems are associated with side effects from medication – not just antiretrovirals (ARVs) but other medicines that HIV patients may be taking – or which are direct biological effects of the virus itself over time, and are due to the misalignment of the immune system,” said Laurie Garrett, senior fellow for global health at the Council on Foreign Relations, a think-tank. “Ageing – it ain’t for sissies,” she added.

In the developed world, worries about money, increasing ill-health and feelings of loneliness or isolation are common among older people with HIV. John Hock, an Australian activist who has been living with HIV for over 30 years, said those diagnosed at the start of the epidemic may have been forced to give up work due to ill health, and many stopped making provision for old age because they did not expect to live that long.

Money is an even greater concern for older Africans living with the virus. Ruth Wayeru, now 65, was diagnosed with HIV when she was 48; in her home country of Kenya, only first- and second-line ARVs are freely available.

Wayeru told delegates that “Once the second-line says ‘no’ to your body, there is nothing else to do but start arranging your funeral,” because the cost of third-line medicines is prohibitive and out of reach for pensioners.

[Courtesy of IRIN Plus News]