Tag Archives: International

INDONESIA: HIV traps women and girls in poverty

The number of reported HIV cases has tripled in Indonesia in recent years, curtailing productivity and trapping affected girls and women, especially, in poverty, according to a recent UN Development Programme (UNDP) report.

Women, representing a quarter of all people living with HIV in Indonesia, shoulder family finances when their partners can no longer work, or when they face education and employment discrimination, said the report.

“Discrimination against people with AIDS is still very strong in Indonesia, especially for women. Many HIV-positive women are being called ‘bad women’ or ‘bad girls’, but at the same time, many of them have to work more after their husbands were diagnosed with HIV,” said Chya Wibisono, an HIV-positive officer at the local NGO,Indonesia Women’s Positive Network.

Women in HIV-affected households put in longer hours but were less likely to own their homes, livestock and vehicles. They were also more likely to be widowed and denied inheritance rights – the case for 71 percent of all HIV-affected widows.

Across all countries covered by the study (Cambodia, China, India, Indonesia and Vietnam), HIV-affected households experienced significant drops in incomes, savings, assets, and ability to buy protein-rich food.

Compared with non-HIV-affected families, affected families in Indonesia were 38 percent more likely to live below the international poverty line of US$1.25 per person per day – the second highest of all the countries surveyed – with more than a quarter of these households reporting having to sell assets to pay medical costs, the report says.

While antiretroviral therapy (ART) for HIV is provided free, the medication has reached about half of patients in need, compared with 94 percent in Cambodia, where free ART coverage has proven to be effective in reducing households’ financial burden, according to the UNDP report.

“Real [progress] has been made to improve ART coverage in Indonesia. The percentage of coverage has increased significantly from 25 to 50 percent over the last three years, but this is still far from enough,” said Nancy Fee, country coordinator of UNAIDS in Indonesia.

As of December 2009, some 18,000 people had reported HIV at an advanced stage, of whom 6,653 were receiving ART, according to the government.

People were going without medication mostly because they had not tested for HIV and did not know their status; in addition, continuity and availability of ART stock as well as availability of certified health workers to administer the drugs were challenges, according to the government.

Daughters in HIV-affected families were also more likely to be pulled out of school than sons to take care of their sick family members.

“It is most often [girls] who are removed first. This is both to save resources spent on schooling, as well as to utilize the girl child for labour,” said Clifton Cortez, health and development practice leader at the Bangkok-based UNDP Asia-Pacific Regional Centre.

The UNDP report suggested conditional cash transfers – paying children based on their school enrolment and attendance – to encourage parents to keep children in school.

According to the World Bank, the risk of HIV infection is more than halved for young people, particularly girls, who stay in school and complete a basic education.

In Indonesia, 28 percent of women surveyed between the ages of 15-24 had not heard of HIV and had little knowledge of condom usage, said the UNDP report.

However, Nafsiah Mboi, secretary of the government’s National AIDS Commission, dismissed concerns that women and children bore the economic brunt of HIV.

“There is no specific scheme for HIV-affected families or women, but everyone who is poor can ask for assistance. There is no discrimination,” she said.

While a National Social Security System (SJSN) has been in place since 2004 – a basic framework for reforming the country’s social security programme covering health insurance, employment injury, pensions and death benefits – the International Labour Organization estimated 54 percent of the country’s population (mostly workers in the informal economy, employees without contracts and their families) were still excluded in 2011 from the national social health protection scheme.

Instead of small government-funded isolated projects, Fee from UNAIDS said the country needed a “universal social protection floor” – a minimum level of essential social services and income security for all in times of economic and financial crisis – to ensure everybody, including those affected by HIV, had equal access to healthcare and other social services.

Parliament approved legislation on 28 October that aims to implement SJSN and provide universal health insurance coverage by 2014.

[Courtesy IRIN Plus News]

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AFRICA: HIV-positive women infant-feeding confusion

ADDIS ABABA, 9 December 2011 (PlusNews)
The latest guidelines on infant-feeding options for HIV-positive mothers in Africa have not been disseminated in many countries, leaving women dangerously confused about the best nutritional path to protect their children from contracting the virus, a new report shows.

The UN World Health Organization’s (WHO) 2010 guidelinesrecommend exclusive breastfeeding with an antiretroviral (ARV) treatment intervention for the first six months of a child’s life to reduce transmission, and continued breastfeeding – with complementary feeding – until the child is at least a year old. Alternatively – where it is acceptable, feasible, affordable, sustainable and safe – WHO recommends complete avoidance of all breastfeeding.

For HIV-positive mothers in most sub-Saharan African nations, exclusive breastfeeding is the most practical option. According to a large African study, Kesho Bora, giving HIV-positive mothers a combination of three ARVs during pregnancy, delivery and breastfeeding cuts HIV infections in infants by 43 percent by the age of 12 months and reduces transmissions during breastfeeding by 54 percent compared with WHO’s 2006 recommendations, where ARV drug regimens ended at delivery.

“The six months of exclusive breastfeeding is what is crucial for mothers to understand – that not doing it is what raises the child’s HIV risk; but we are finding that while many countries have officially adopted the WHO guidelines, they have not trickled down, and health centres, policy-makers and communities are still unclear on what advice to give mothers,” said Aditi Sharma, of the International Treatment Preparedness Coalition (ITPC), and coordinator of a report, The Long Walk: Ensuring comprehensive care for women and families to end vertical transmission.

Based on new research by community health workers from Cameroon, Cote d’Ivoire, Ethiopia and Nigeria, the report – launched at the 16th International Conference on AIDS and STIs in Africa (ICASA) in Addis Ababa, Ethiopia – found that prevention of mother-to-child transmission programmes were focused too narrowly on the provision of ARVs to HIV-positive pregnant women, rather than more comprehensive approaches that involved family planning, maternal healthcare and exclusive breastfeeding.

“Nutritional counselling doesn’t exist in rural areas,” the report quoted one Cameroonian woman as saying. “Health personnel are not trained and women do not know how to care for their children.”

Although the Nigerian government had revised guidelines to comply with the WHO, consensus did not exist in support of the recommendations, and some clinicians and researchers continued to oppose breastfeeding because they believed it deliberately exposed babies to possible HIV infection. Several focus group participants indicated they assumed that replacement feeding was preferable to breastfeeding, and that it had been recommended by health practitioners.

“The guidance on infant-feeding options needs to urgently get into the curriculum and training of health workers and other people who support community healthcare, such as traditional birth attendants,” said Sharma, adding that efforts needed to be made to support mothers to exclusively breastfeed their children.

“It is not enough to issue guidelines – in places where women may complain of insufficient breast milk or inadequate nutrition, they need nutritional support to ensure they can continue to exclusively breastfeed,” she added.

Conference speakers said community health systems were crucial to the success of prevention of mother-to-child HIV transmission services, as community health workers and traditional birth attendants were often the first port of call for a confused mother. Community health systems can also be used to engage men – frequently absent from ante-natal visits – in their wives’ experiences.

Beatrice Ochieng, author of a study on infant feeding choices in poor settings in the Kenyan capital, Nairobi, noted that just 23 percent of 357 women in the study discussed their chosen feeding option with their partners. “There is a need to support partner involvement through partner counselling and testing, during antenatal and postnatal care,” she said.

According to Ncumisa Vika, who works with the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) in South Africa, male involvement in reproductive health services, including PMTCT, remains low, creating challenges and barriers around disclosure of HIV-positive status to a partner, psychosocial support, adherence to treatment, and infant-feeding decisions. In 2010, in collaboration with community health organizations in South Africa’s Tshwane District, EGPAF was able to send invitation letters to the partners of all HIV-positive women who attended antenatal clinics, which boosted male participation in reproductive and family health matters.

Overall, ITPC’s Sharma said, there was a need for more comprehensive delivery prevention of mother-to-child services in Africa. “Countries must ensure that policy filters down to the women in all aspects of PMTCT – from HIV prevention for women to family planning, to the best ARV prophylaxis option to proper infant feeding to proper healthcare for the mother, child and family,” she said. “It is the only way we can achieve the 2015 targets of reducing vertical transmission by 90 percent.”

[Courtesy IRIN]

BURUNDI: Women risk HIV rather than starvation

Desperate and displaced, some Burundian women will do anything, including have unprotected sex for money, to escape the dreadful living conditions in the Bujumbura suburb of Sabe, where more than 480 families of internally displaced persons (IDPs) have lived for several years.

Burundi has more than 100,000 IDPs as a result of several years of political turmoil; most of the families in Sabe are returnees from neighbouring countries.

“I know cases of parents whose daughters go into town or elsewhere every night to look for money from men who offer big money [for sex],” Ferdianne Bukuru, vice-president of the Sabe IDP site, told IRIN/PlusNews. “Young girls are attracted by wealthy men and are drawn into prostitution as IDPs have no means to survive.”

For many of these girls and women, the fear of HIV is dwarfed by the immediate need for money to buy food and other necessities.

“Do not talk of AIDS… I don’t fear [it]; I would rather get food and die in the future instead of dying hungry today,” said 18-year-old Jacqueline*. “I have been at this site since 1993; nobody has come to help me to improve my life and especially go back to school.”

Madeleine*, 32, feels the same way. “When I came across a man who feeds me and clothes me, I must accept, for food,” she said. “Who can refuse a large sum of money when she is in poverty like this?”

Madeleine said NGOs fighting HIV/AIDS visited the site occasionally, but not enough to have an impact on people’s behaviour. Condom use – perceived to be less profitable than unprotected sex – is not as consistent as it should be.

“Condoms do not allow us to have enough money; if a man offers his money, he insists on intercourse without a condom,” said one 17-year-old student.

Women who do not turn to sex work often wind up becoming second or third wives to the few men in the site who are able to support more than one wife.

“I already understand what HIV is, but I don’t think my force is enough to stand against it,” said Nzeyimana*, a mother of two girls. “These men may have more than three women – as they brandish [currency] notes, no one can resist.”

he few organizations working to prevent HIV/AIDS say their work is hampered by poor funding.

“For a long time we had collaborators at this site and its surrounding areas in the fight against AIDS in IDPs sites, but now things have changed. We had targeted IDPs sites in Bujumbura and elsewhere, but we are forced not to work at these sites due to limited resources and logistics,” said Basilisse Ndayisaba, coordinator of the Society of Women Against AIDS-Burundi, one of the largest HIV NGOs in the country. “These IDPs no longer have the advice or training of our staff.”

Ndayisaba said her organization last worked in Sabe in May 2010.

Burundi has an adult HIV prevalence of 3.3 percent; the country’s fight against HIV has been hit with delays in Global Fund grants holding up activities and most recently, the World Bank’s withdrawal of its HIV funding.
[Courtesy of IRIN PlusNews]
*Only one name provided to protect the source’s identity

ZIMBABWE: $45 million fund for HIV/Aid Maternal Health

About 13 percent of pregnant women in Zimbabwe are HIV positive, one of the highest rates of infection in Africa, according to EGPAF.

Marc Rubin, deputy country representative for the UN Children’s Fund (UNICEF), said eliminating paediatric HIV in Zimbabwe would require a massive scale-up of the PMTCT programme.

“New HIV infections are still occurring at alarmingly high rates, particularly amongst young women, and AIDS-defining conditions are the leading contributing factor to both maternal and child mortality,”

Read More Here

INDONESIA: Swamp Fever Outbreak

Bantul regency in Indonesia’s central Java region has declared a state of emergency and health agencies nationwide are on alert following an outbreak of leptospirosis, commonly known as swamp fever, a fatal animal-borne disease that can result in high fever, internal bleeding and organ failure, said the Health Ministry.

Four of 15 people reported to have been infected with the bacterial disease have died since the onset of the outbreak in late January, a case fatality rate of 27 percent.

Read More Here

SOUTH AFRICA: 55% of HIV Patients Go Missing Before Treatment

A study has found that about 55 percent of HIV patients in South Africa who are not eligible for treatment at the time of diagnosis will disappear from clinics within a year of initial monitoring, leaving a serious gap in HIV care and prevention, say researchers.
Most patients in South Africa must have a CD4 count – a measure of the immune system’s strength – of 200 or less to be eligible for antiretrovirals (ARVs), but previous research has shown that about two-thirds of people will not meet ARV treatment criteria at diagnosis.

Read More Here

MYANMAR: Mass Vaccination Target Rare Polio Strain

YANGON, 17 February 2011 (IRIN) – A rare strain of the polio virus is re-emerging in Myanmar after three years, say health workers. One case was confirmed in Myanmar last December – followed by two more of unknown origin reported but not yet confirmed in January – prompting health officials to organize a mass vaccination campaign to target millions of under-five children.

A seven-month old infant was infected with vaccine-derived poliovirus (VDPV) in December in central Myanmar’s Mandalay division in Yamethin Township, according to the UN Children’s Fund (UNICEF) office in Myanmar.

“But one case is enough [to require] an emergency response,” said Marinus Gotink, UNICEF’s chief of health and nutrition in Myanmar.

The Department of Health has already immunized 10,000 children living in or around the area where the December polio case was diagnosed.

“But the campaign should be much bigger,” Gotink said, adding that UNICEF and the World Health Organization (WHO) were planning a mass vaccination national campaign, expected to target 3.34 million children in 109 of the country’s 325 townships.

In January two more polio cases were detected but not yet lab-confirmed in Mandalay Division’s Yamethin Township and Mon State’s Thanbyuzayut Township.

VDPV comes from a strain of polio contained in oral polio vaccines that mutates into a form that can paralyze. The only way to fully protect children from either the more common wild polio strain or VDPV is full vaccination, according to the WHO.

From 1997-2007, nine countries with low levels of polio immunization worldwide reported outbreaks of VDPV that resulted in fewer than 200 polio infections, according to the world health body. In the same period, 33,000 children were paralyzed by the wild poliovirus.

VDPV first appeared in central Myanmar in 2006 in Mandalay Division. The following year, four more cases were confirmed in Yangon Division, home of the economic capital, Yangon, as well as Mon and Kayin State bordering Thailand in the east and Bago Division East.
[Courtesy of IRIN]