Tag Archives: HIV/Aids

Heightened HIV risk for people with disabilities

Inaccessible health services for people with disabilities (PWD), combined with social stigma and violence, contribute to high HIV risk – a gap that must be filled if the disabled are not to remain disproportionately vulnerable to HIV/AIDS, say health experts and activists.
“People with disabilities are at increased risk for exposure to HIV infection. HIV, in some cases in itself, can cause disability,” said Jill Hanass-Hancock, a senior researcher at the Health Economics & HIV/AIDS Research Division (HEARD), a South African research institute.

Globally there are an estimated one billion people living with a mental or physical disability, according to the UN World Health Organization. Many live in low- or middle-income countries and have poorer health and little formal education compared to the general population.

“We cannot talk about reducing HIV and its co-morbidities if you exclude this 15 percent of the world’s population,” added Hanass-Hancock, speaking at the AIDS 2014 Conference, hosted by the International AIDS Society in Melbourne on 20-25 July.

Data are scarce; most national HIV monitoring or surveillance programmes do not specifically track incidence among people with disabilities.

An 2014 meta-analysis of data and data from STD testing by STDAware.com from Sub-Saharan African countries showed that PWD are 1.3 times (1.48 for women) more at risk of contracting HIV than people without disabilities.

The 2014 “Gap Report” published by the Joint UN Programme on HIV/AIDS (UNAIDS) listed PWD as one of the key populations “left behind” in the global HIV response.

The no sex myth

Central to the struggle of PWD to gain inclusion in HIV response is breaking down the assumption that they are not sexually active and therefore do not need HIV services.

A 2014 Human Rights Watch (HRW) report on Zambia documented PWD describing how healthcare workers thought of them as “asexual”.

“People with disabilities are people first. They have the same needs and desires when it comes to relationships and being sexually active,” said Rosangela Berman Bheler, senior adviser at the UN Children’s Fund (UNICEF).

Others caution that PWD are at greater HIV risk due to other factors.

“PWD are four times more vulnerable to sexual abuse and violence. This increases their risk for HIV infection,” said Muriel Mac-Seing, HIV/AIDS protection technical adviser of Handicap International.

According to UNAIDS, “vulnerability, combined with a poor understanding and appreciation of their sexual and reproductive health needs, places people with disabilities at higher risk of HIV infection.” A 2012 article in The Lancet showed that people with mental and intellectual disabilities were at particularly high risk of abuse and violence.

Access barriers

Betty Babirye Kwagala, a medical counsellor for The AIDS Support Organization in Uganda, said the root of the heightened risk for people with disabilities can be seen in basic infrastructure.

“Services are not accessible – literally. Many health facilities do not have ramps or doors wide enough to accommodate people in wheelchairs,” said Kwagala who has had a physical disability since a car accident when she was 19. Five years ago she was diagnosed with HIV.

In her work as a medical counsellor, Kwagala has seen first-hand the lack of information and education materials suited for the needs of PWD, and a parallel lack of knowledge among health workers about how to communicate.

“How can a health worker who does not know how to use sign language communicate with someone who is deaf? They usually use gestures. But you cannot use gestures when prescribing medication,” said Kwagala.

Hanass-Hancock acknowledges bridging communication and understanding between health workers and PWD is critical to increasing the uptake of HIV services. But, she warns, such interventions need to take social conditions into consideration.

“People with disabilities often depend on a care-giver. This has a great impact on getting information privately and confidentially,” said Hanass-Hancock, adding that strategies such as SMS outreach and counselling for hearing impaired people, or easy-to-understand picture books for people with intellectual disabilities need to be developed.

Data gap

HRW’s research in Zambia, where one in 10 people has a disability, recommends a “twin-track approach starting with existing healthcare services more accommodating to PWD by simple things like widening doors”. PWD-specific interventions should be developed as well, they argue, and needs for either approach should be supported by improved data.

“We need to disaggregate the data to break it down by disability because all disabilities are different and will require different interventions. Then we can talk about creating tailor-fit services for them,” said Rashmi Chopra, a researcher on disability rights at HRW.

Lack of information – including about health and HIV – can leave PWD especially vulnerable inhumanitarian emergencies.

The Sphere Standards, which set out best practice in the delivery of humanitarian aid, encourage humanitarian actors to disaggregate data in their assessments, programming, and monitoring and evaluation tools by, among other things, noting if there is a disability involved.

However, Handicap International has critiqued the Sphere recommendation as insufficient to “mainstream a highly heterogeneous group such as [people with disabilities]”, and says recording the type of disability is crucial.

Despite the data gap, campaigners remain hopeful, saying the discussion has advanced from the days when the intersection between HIV and PWD was not even recognized.

“We must not forget that this is a dignity and human rights issue: most countries in the world – including donor countries – have ratified the UN convention on the rights of persons with disabilities (CRPD). It’s time for them to be responsible for their disabled citizens,” said Muriel Mac-Seing, HIV and AIDS protection and technical adviser for Handicap International.

CRPD, which has been ratified by 147 countries, mandates that governments “provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes.”
[Courtesy IRIN]

Draconian Law setback for Uganda’s HIV response

Kampala, 23 December 2013 (IRIN) –
The draconian Anti-Homosexuality Bill passed by Uganda’s parliament on 20 December would deliver a major blow to the response to HIV/AIDS if it was enacted by President Yoweri Museveni, activists have warned.
Those found guilty of homosexual acts can be jailed for up to 14 years under the new law, a sentence that increases to life in “aggravated” cases, such as those committed by an HIV positive person, or those involving minors, the disabled and serious offenders.

Civil society activists fear that high-risk groups such as men who have sex with men (MSM) and sex workers – whose HIV prevalence is 13.7 and 33 percent respectively – will see their already limited access to prevention and treatment further eroded.

Amnesty International called the law “a grave assault on human rights [which] makes a mockery of the Ugandan constitution.

“President Museveni should avoid the trap of scapegoating a vulnerable minority in the interests of short-term political gain,” said Daniel Bekele, Africa director at Human Rights Watch.

“He should recognize that this repugnant bill is of no benefit to Ugandans – that it only serves to jeopardize basic rights – and reject it.”

The United States government has also called for the bill not to be enacted.

Here is a selection of reactions from those working on the front-line of the response to HIV/AIDS:

Pepe Julian Onziema, programme director, Sexual Minorities Uganda (SMUG), a local rights group

“It’s with deep disappointment that I receive the news of the Anti-Homosexuality Bill passing in our Parliament.”

“If the bill is assented to, the Act would spell a major setback for Uganda’s gains against HIV/AIDS as it will compromise doctor-patient confidentiality, which will push affected LGBTI (lesbian, gay, bisexual, transgender and intersex) persons further underground for fear of prosecution.”

Asia Russell, Director of International Policy, Health GAP

“This harmful and blatantly unconstitutional bill will deal a devastating blow to evidence-based efforts to end the AIDS epidemic in Uganda – a country that is almost unique among aast and southern African countries in that it has rising rates of new HIV infections. Why? Because existing criminalization provisions have meant prevention and treatment services aren’t reaching populations like MSM, who have much higher HIV prevalence.”

“Under this new bill, providing those services would now be illegal – we will see new infections continue to rise as populations get excluded further and further from life-saving treatment, prevention, information and support.”

Milly Katana, veteran activist and board members of the Global Fund to Fight HIV, Tuberculosis and Malaria

“Totally disheartening! It is one of those moments where as a country we move one step forward in realizing civil liberties and public health common sense, [then] we take 10 steps back.”

“The little achievements of the Ministry of Health starting to think of making services available to people who are most at risk of contracting HIV are put in total jeopardy. I hope the president, who has announced himself as a champion for HIV prevention by encouraging Ugandans to test for HIV and knowing their status, will see the non-wisdom in this Act and not assent to it.”

Alice Kayongo, Regional Policy and Advocacy Manager, AIDS Healthcare Foundation – Uganda Cares

“The effects of this (bill) will be felt in almost all sectors but most especially in the health sector and particularly for HIV/AIDS where over 80 percent of the AIDS response is funded externally.”

“Even with amendments, the proposed law will have an impact on the quality of healthcare and health education to be provided to gay people living with HIV for the fact that treating someone or providing them with HIV related information will be seen as a promotion act, yielding to imprisonment. While there have been indications of forward movement in this country’s AIDS response, we are at risk of losing so much of what we have gained in the recent past.”

“Evidently, with such developments in the political and legal environments, Uganda is miles away from attaining [the UN-backed target of] zero new HIV infections, zero AIDS-related deaths and zero discrimination. It will not be a surprise if Uganda’s prevalence rate stagnates around 7.3 percent in 2017. However, we still have some hope, His Excellency President Yoweri Kaguta Museveni should reject the passing of this bill into law and everything else will fall into place.”

Flavia Kyomukama, director of the Global Coalition on Women and HIV/AIDS in Uganda

“At a time when the country is trying to implement the national HIV prevention strategy that has underscored the sex workers and MSM as key in the reduction of the epidemic, the legislature thinks it’s a waste of time to have these people access services.”

“A mother, a teacher, a health worker, an employer is by obligation expected to report any LGBT within 72 hours of notice and confirmation that someone is LGBT.”

“How do I report my son? As a teacher how do I report my student who comes to me in confidence? And as a health aide how do I abuse the confidence of the patient? All of us are going to be imprisoned.”
“If the proponents of the bill claim homosexuality is a mental disorder, is it logical to [give] life imprisonment? The [logical] approach would be counseling and treatment.”

And here are some reactions from champions of the new legislation:

Simon Lokodo, Uganda’s state minister for ethics and integrity

“This bill is going to cater for the lacuna which has been existing in the current law and legal frameworks in Uganda concerning this unnatural act. Having passed this bill, a lot has been done to protect our children and innocent victims who would be lured into these western cultures and behaviours, which are totally unacceptable to us.”

“The law is going to condemn any recruitment, promotion and financing of the activities related to these malpractices.”

“On the threats from donors and development to withdraw their financial assistance over this bill, we don’t care and are not bothered at all. We prefer to lose that money than our culture and people.”

“We have an obligation as a sovereign state to protect our people against this unnatural act.

Michael Lulume Bayiga, shadow health minister

“I am happy and excited this bill was passed. We are waiting for the president to assent to it in order for it to become a law. I am particularly happy with the provision that bans the promotion of this cult (homosexuality). This provision will ensure this act will doesn’t take root in our country.”

“No health worker asks patients whenever they seek treatment from a health facility about their sexual orientation, unless he/her chooses to do so. For all the years I practiced medicine, I have never known any sexual orientation of my patients. There is no discrimination in the health service provision.”

[Courtesy of IRIN]

South Africa: HIV/Aids Vaccine Research Hope

13 November 2013

South Africa is the only country in the world where a large AIDS vaccine trial is being planned, as the global scientific community struggles to find a way to eradicate HIV.

Announced at this week’s international AIDS Vaccine Conference in Barcelona, the South African trial will involve the only vaccine shown to have some effect on the virus when it was tested among 16,000 people in Thailand. Released in 2009, the Thai trial’s results showed that HIV infection rates were 31 percent lower in participants who had received the vaccine than those who had not.

“On the eve of some of the most important vaccine trials, I am proud of the critical role that the people of South Africa will play,” said Ntando Yalo from the Networking AIDS Community Of South Africa, speaking at conference opening.

But the trial’s researchers are cautious.

Glenda Gray is the South African trial’s lead researcher and executive director of the Perinatal HIV Research at the University of the Witwatersrand. She told conference delegates that trial would begin by testing the Thai vaccine on a small group of people to confirm the vaccine worked as well in South African populations as it did in Thai participants.

“It might not show the same efficacy as in Thailand,” Gray said. “For example, South African women are bigger, and have different (levels of) exposure to the virus.”

With a national HIV prevalence rate of about 17 percent, South Africans are likely to have had much more exposure to the HIV than people in Thailand, where just one percent of the population is HIV-positive. The modest protection offered by the Thai vaccine might be too weak for South Africa, Gray added.

If the vaccine is effective within this smaller group, researchers will modify it for use against the predominant strain of HIV found in South Africa. This modified vaccine would be tested on about 240 people and, if successful, move to a larger trial involving about 5,400 people.

Chasing a “Machiavellian” virus

But the virus, described as “Machiavellian” by scientist Dr Scott Hammer at the start of the conference, continues to evade almost all attempts to eradicate it.

Johnson & Johnson Head of Research Dr Jerry Sadoff said he had been involved in creating 11 vaccines, none of which had taken more than seven years to develop. HIV was the exception, he said.

“You can make a career out of the AIDS vaccine – I have been researching it for almost 30 years,” he joked.

Most vaccines train the body to recognise and kill viruses by injecting people with small, non-toxic “deactivated” parts of the virus.

The body learns to make antibodies to fight the deactivated virus, so that when it is faced with infection from the live, dangerous virus, it is able to recognise and fight it.

But HIV’s constant mutation once it is the body makes it a moving target that is hard to pin down.

About two percent of people infected with HIV are able to contain the virus so that they don’t get sick. Scientists have been studying these “elite controllers,” including sex workers in South Africa, for years but still don’t yet know how their immune systems manage to do this.

Unlocking how our immune systems can produce “broadly neutralising antibodies” to fight HIV is “one of the holy grails of vaccine design,” according to Hammer.

But as scientists struggle to unlock the secrets of our immune systems and HIV, AIDS Vaccine Conference organisers have decided to move away from narrow focus on vaccines.

About 13 years after the first AIDS Vaccine Conference was held, the Global HIV Vaccine Enterprise will open next year’s conference to a wider range of scientists working on HIV prevention methods, including antiretroviral (ARV)-based vaginal or rectal gels – or microbicides – as well as other forms of ARV-based prevention and medical male circumcision.

This much larger gathering of HIV prevention experts will convene in Cape Town next year.

Organisers also raised the issue of a therapeutic HIV vaccine for the first time. Unlike the vaccine being tested in South Africa, a therapeutic HIV vaccine would aim to treat HV infections, not prevent them. A small therapeutic HIV vaccine trial is currently underway in the United States.

[Courtesy AllArica News]

Uganda:HIV Study Reveal Rampant Stigma

061511 Health Aids News

Last year, a primary school teacher in Masaka, Florence Najjumba, lost her job after she declared that she was HIV-positive.

Had the media and Uganda Human Rights Commission not intervened, Najjumba would have lost her livelihood. Yet she is only one of the luckier ones. According to the People Living with HIV Stigma Index, 2013, most HIV-positive people are still discriminated against at work.

The study, released last week by the National Forum of People Living with HIV Networks in Uganda (Nafophanu), surveyed 1,110 people living with HIV.

“[Some] 255 of the people living with HIV reported losing jobs or incomes within the past year preceding the survey and 27 per cent of these attributed it to [their] HIV status,” reads the study report.

Among those that reported losing their jobs, more than half were men. Some 288 reported that their job descriptions had changed due to a combination of factors, including poor health.

Some were discriminated against at work by either co-workers or employers. Eight percent of the respondents reported that they had been barred from work in the previous 12 months.

Supported by UNAIDS and Uganda Aids Commission, Nafophanu conducted the survey in 18 districts.

“This stigma prevents people from getting tested for HIV, seeking medical care and adherence to treatment and follow-up. A biased attitude towards people living with HIV must be stopped,” said Stella Kentusi, Nafophanu executive director.

Consequently, the study states that income levels among people living with HIV are relatively low, with 60 per cent of those surveyed earning less than Shs 250,000 every month.

Home, work

Gossiping, according to the survey, was the most prevalent form of stigma, with 60 per cent (666) of people living with HIV, convinced that they had been gossiped about at least once within the previous year. Also, nearly one in five of the surveyed people said they had been subjected to psychological pressure or manipulation by their husband or wife at least once.

Some 21 percent said they had experienced sexual rejection at least once in the last 12 months before the survey. About 10 per cent had been excluded from family activities such as eating together or sharing rooms.

The study suggests fear of stigma and discrimination are major reasons why people are unlikely to declare their status in public, let alone taking an HIV test.

“This means that disclosure is done selectively or not done at all. People are not free to seek and take up treatment,” Kentusi says, adding that victims of stigma soon develop internal stigma – negative feelings about oneself.

UNAIDS Country Director Musa Bungudu says to reduce such stigma and discrimination, people living with HIV should enjoy economic empowerment and receive updated education about HIV.

Bungudu proposes “a cascade of training of trainers workshops” not only to address attitudes and practices but also to meet information needs and HIV-related supplies.

On his part, the acting programme manager, Aids Control Programme, Dr Joshua Musinguzi, wants more resources dedicated towards access to anti-retroviral drugs for all HIV-positive people.

Today, 566,000 people have access to ARVs out of the 745,000 expected to be put on treatment by the end of this year.

“We need to disseminate the findings to the lowest level so that the health ministry and stakeholders may roll out programmes, reducing new infections and fighting for the rights of people living with HIV effectively, efficiently and transparently,” Musinguzi says.

Namibia Winning HIV Fight

July 2013:

Namibia is rank as one of only seven countries – out of the total of 22 sub-Saharan countries – that made “a marked increase in progress in stopping new infections in children,” as part of the UN Global Plan to eliminate new HIV infections among children by 2015.

Namibia has reduced new HIV infections among children by 58 percent since 2009, according to the UNAIDS progress report released yesterday. Together with Botswana, Ethiopia, Ghana, Malawi, South Africa, Zambia, Namibia is one of the countries that “have rapidly decreased new HIV infections among children by 50 percent.”

The Global Plan is an initiative by the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the United States President’s Emergency Plan for AIDS Relief (Pepfar), unveiled in June 2011 during the UN General Assembly High Level Meeting on AIDS. The report has two main targets to be achieved by 2015, which is to have a 90 percent reduction in the number of children newly infected with HIV, and a 50 percent reduction in the number of AIDS related maternal deaths. The Global Plan focuses on 22 countries that account for 90 percent of all new HIV infections among children. Among those countries are India, Nigeria, the Democratic Republic of Congo, Cameroon, Tanzania, Zimbabwe, Kenya, Chad, Angola, Uganda, and Burundi.

The report shows that the number of new HIV infections among children in Namibia in 2012 was 700. One out of ten pregnant women living with HIV did not receive antiretroviral medicines to prevent mother to child transmission of HIV, the report highlights.

Meanwhile, four out of ten women or their infants did not receive antiretroviral medicines during breastfeeding to prevent mother to child transmission of HIV, the report indicates. The report also reveals that 13 000 children were eligible for antiretroviral therapy in 2012 and that nine out of ten children are receiving HIV treatment.

In 2009 the HIV transmission rate from mother to child including breastfeeding was 19 percent and it has decreased every year since then, to reach 9 percent in 2012. Although there is a marginal increase in the number of women who acquired HIV from 2009 to 2012, the number of women acquiring HIV infection is largely constant, the report indicates. In 2009, 4 700 women reportedly acquired HIV and increased to 5 100 in 2012, while 94 percent of all pregnant women are receiving HIV treatment, according to the report.

The report hints that that improved access to family planning could further reduce the number of new HIV infections among children and improve maternal health. About 59 percent of pregnancy related deaths were attributed to HIV. In addition, there is a 21 percent unmet need for family planning, the report adds.

Countries reported to have achieved a moderate decline are Burundi, Cameroon, Kenya, Mozambique, Swaziland, Tanzania and Zimbabwe. Those with reported slow declines are Angola, Chad, Ivory Coast, the Democratic Republic of Congo, Lesotho and Nigeria.

UNAIDS Executive Director, Michel Sidibé said the progress in the majority of countries is a strong indication that with focused efforts every child can be born free from HIV. “But in some countries with high numbers of new infections progress has stalled. There is a need to find out why and remove bottlenecks, which are preventing scale-up,” Sidibé said.

The Deputy Permanent Secretary in the Ministry of Health and Social Services, Dr Norbert Forster on Monday said over 92 percent of public health facilities in Namibia are providing prevention from mother to child transmission (of HIV) services. Forster made the remarks at the launch of Namibia’s first national public health laboratory policy.

“Namibia is actually at the threshold of eliminating mother to child transmission. I commend all the women, especially those in far remote rural areas, often with no transportation to take them to health facilities, for all their efforts to access prevention from mother to child services,” Forster said.

[Courtesy of AllAfrica News]

Children with Disabilities Report launched by UNICEF

Download  - Download the report30 May 2013

Entitled Children with Disabilities, the report examines the discrimination and deprivations that these children  Children with Disabilities and their families confront. It describes the progress that is being made, albeit unevenly, in ensuring that children with disabilities have the fair access to services and opportunities that is their right. And it urges governments, their international partners, civil society, and employers to take concrete steps to advance the cause of inclusion – as a matter of equity and for the benefit of all.

In order to achieve this goal, international agencies and donors and their national and local partners should include children with disabilities in the objectives, targets and monitoring indicators of all development programmes.

Exclusion is often the consequence of invisibility. Few countries have reliable information on how many of their citizens are children with disabilities, what disabilities they have or how these disabilities affect their lives. As a result, few are capable of knowing what types and amounts of support these children and their families need – much less how best to respond. One of the report’s chapters is therefore devoted to exploring challenges, progress and opportunities in the area of data collection and analysis.

The report also contains a series of personal essays by young people with disabilities and some of the people who work with children and adolescents with disabilities – among them, parents, caregivers and advocates.

It is our hope that this report will inform the dialogue and nurture the action that is necessary to create a world in which children with disabilities enjoy their rights on a par with other children, even in the most remote settings and the most deprived circumstances.

[Courtesy of UNICEF]

Africa: 7 Million on HIV/Aids Antiretroviral Treatment

23 May 2013:

The number of people in Africa receiving antiretroviral treatment increased from less than 1 million to 7.1 million over seven years, according to a United Nations report which documents the progress in the AIDS response in the world’s second largest continent.

“Africa has been relentless in its quest to turn the AIDS epidemic around,” said the Executive Director of the Joint UN Programme on HIV/AIDS (UNAIDS), Michel Sidibé.

Antiretroviral treatment increased from less than 1 million in 2005 to 7.1 million in 2012, with nearly 1 million added in the last year alone. AIDS-related deaths were also reduced by 32 per cent from 2005 to 2011.

The UNAIDS Update on Africa, which was released to coincide with the beginning of the African Union’s (AU) 21st summit in Addis Ababa, which began Sunday and runs through 27 May, attributes this success to strong leadership and shared responsibility in Africa and among the global community. It also urges sustained commitment to ensure Africa achieves zero new HIV infections, zero discrimination and zero AIDS-related deaths.

“As we celebrate 50 years of African unity, let us also celebrate the achievements Africa has made in responding to HIV–and recommit to pushing forward so that future generations can grow up free from AIDS,” Mr. Sidibé said.

The report states that 16 countries–Botswana, Ghana, Gambia, Gabon, Mauritius, Mozambique, Namibia, Rwanda, São Tomé and Principe, Seychelles, Sierra Leone, South Africa, Swaziland, Tanzania, Zambia, and Zimbabwe–now ensure that more than three-quarters of pregnant women living with HIV receive antiretroviral medicine to prevent transmission to their child.

Despite positive trends, Africa continues to be more affected by HIV than any other region of the world, and accounts for 69 per cent of people living with HIV globally. In 2011 there were still 1.8 million new HIV infections across the continent, and 1.2 million people died of AIDS-related illnesses.

In the report, entitled Update, Mr. Sidibé emphasizes that sustained attention to the AIDS response post-2015 will enhance progress on other global health priorities. He also identifies five lessons in the AIDS response that will improve the world’s approach to global health. These are: focusing on people, not diseases; leveraging the strength of culture and communities; building strong, accountable global heath institutions; mobilizing both domestic and international financial commitments; and elevating health as a force for social transformation.

“These strategies have been fundamental to Africa’s success at halting and reversing the AIDS epidemic and will support the next 50 years of better health, across borders and across diseases,” he said.

The report also stresses AU leadership is essential to reverse the epidemic. At this year’s Summit, AIDS Watch Africa, a platform for advocacy and accountability for the responses to AIDS, tuberculosis and malaria founded by African leaders in 2001, will review progress on health governance, financing, and access to quality medicines, among other areas, and measure whether national, regional, continental and global stakeholders have met their commitments.

The AU, UNAIDS and the New Partnership for Africa’s Development (NEPAD) will also launch the first accountability report on the AU-G8 partnership, focusing on progress towards ending AIDS, Tuberculosis and Malaria in Africa.

[Courtesy AllAfrica News]