Time running out for Asian fight to avert HIV epidemic among IDUs

Photo by bobbyramakantHIV spreads fast once it enters a community of injecting drug users (IDUs). Despite the fact that this is well-documented, some attempts to contain the spread of the epidemic among IDUs have been delayed by up to 20 years.

In some Asian countries, such as Thailand, Myanmar, Cambodia and in four Indian states, there is evidence to suggest that HIV incidence is declining. But the number of HIV-positive IDUs in the same countries hasn’t dropped. In some places, it has increased.

After HIV was first found in IDUs in Thailand, the incidence of the disease went up from zero to 45 percent in less than a year. Once HIV was detected in IDUs in India’s Manipur state incidence rates shot up to 50 percent in six months.

Although it has been clear for some time that HIV spreads quickly among IDUs, responses to the growing epidemic have been too slow to avert the tide of IDU-related HIV, Dr Swarup Sarkar, from the Asian Development Bank, told delegates at the Asian Consultation on Prevention of HIV Related to Drug Use in Goa this week.

While the first case of HIV in Thailand was reported in 1987 there are still no comprehensive harm reduction programs in the country. In Myanmar, the first case of HIV was reported in 1988, but it took another 16 years for harm reduction projects to be implemented and most remain funded by external donor agencies. In Manipur, it took 20 years for a government-funded comprehensive harm reduction responses to the crisis to be developed.

Of the 10 Asian countries that have reported being home to IDUs, only six or seven have needle or syringe exchange programs, just three have opioid substitution therapy programs (OST) and only five or six have peer education programs in place.

“In China, because of the urban-rural divide, people who have access to OST don’t have access to needle syringe exchange programs,” said Dr Sarkar.

In Malaysia, comprehensive harm-reduction programs have been operating for the past two to three years but less than 10 percent of IDUs are being reached. OST coverage in Malaysia might be slightly higher but the reach of syringe exchange and peer education programs is very low.

“In Bangladesh, Pakistan, parts of Malaysia, China and India, and few other Asian countries there is a wonderful opportunity to keep HIV incidence in IDU low [using comprehensive harm reduction responses],” said Dr Sarkar.

The limited involvement of IDUs in program design and implementation is a big impediment to the fight against the spread of HIV. The rift between government policy and harm reduction activities aimed at HIV prevention, treatment and care is also hampering progress.

“At least the service provider and IDUs should be immune to the legal issues”, a delegate at the Goa conference said.

Studies have shown that vertical interventions such as needle and syringe exchange programs or OST result in fewer drops in HIV incidence than combined comprehensive harm reduction approaches.

“If we invest and focus on comprehensive harm reduction responses for IDUs, we can avert a large scale HIV epidemic,” said Dr Sarkar.

Needle and syringe exchange programs and OST could potentially prevent up to 80 percent of new HIV infections among IDUs - currently a mandatory national target for governments to achieve before 2010 as part of the Universal Access framework.

Bobby Ramakant-CNS

Don't give us false illusions of hope: injecting drug users

Photo by bobbyramakantRepeated calls for harm reduction approaches to HIV prevention, treatment and care, particularly for injection drug users (IDUs), were answered with a reality check on the second day of the first Asian Consultation on Prevention of HIV Related to Drug Use, in Goa.

During a session that brought together parliamentarians, civil society activists and IDUs, the voices of several users provided delegates with a stark reminder of the reality on the ground.

“Drug users are treated as criminals, as sub-human beings” said Bijaya Pandey from Nepal.

“For the past few years we have been hearing about ‘3 by 5’ and ‘2010’– please, please, don’t give us a false illusion of hope,” Pandey said, referring to the World Health Organization’s (WHO) failed initiative to provide antiretroviral drugs (ARVs) to three million people by end of 2005, and the promise of universal access to prevention, treatment and care by 2010.

Opioid substitution therapy (OST) and needle syringe exchange programmes are not operating or even legal in some Asian countries. Only a handful of states in the region have government-supported OST or syringe exchange programmes.

The combination of the criminalization of injection drug use and a lack of a coherent legal and policy framework on drugs, means that not only are IDUs are at risk while accessing existing services, but service providers are also at risk of being penalized for offering them.

“Bijaya, Tamara and I are the lucky survivors of the war – the war on drugs,” said Fredy Edi, a board member of the International Network of People who Use Drugs and the Indonesian Drug User Network, referring to IDU representatives Pandey and Tamara Speed from Australia. “The war on drugs is also war on health,” Fredy added.

There is evidence to suggest that ‘war on drugs’ has caused a rise in HIV infections, particularly among IDUs, across the region. The number of new hepatitis C (HCV) infections has also increased since the war on drugs was launched. HCV infection rates are believed to have reached epidemic proportions in many parts of Asia, such as Manipur in India.

“We have buprenorphine but distribution is limited to less than 10% of people who need it,” a delegate from Manipur said during the meeting.

Another delegate raised the issue ARV treatment for IDUs. Many IDUs are reportedly being told that they must stop taking drugs before they can receive treatment from ARV centres.

Delegates also expressed concern over the lack of programmes designed to tackle inhaling drug use and the lack of programmes tailored towards women, transgendered users or the partners of male users.

“It is very difficult to find female drug users in public spots,” Dr Tasnim Azim from Bangladesh told the session. About 15% of female IDUs in Bangladesh become pregnant within two years of developing a habit, Dr Azim said, adding that there were no antenatal clinics or services for female drug users.

While we eye the goal of Universal Access for 80% of IDUs, Bijaya’s plea ‘not give a false illusion’ serves as a grim reminder of the reality faced by those who need these services the most.

Bobby Ramakant-CNS

Bribe taken from patient in Balrampur Hospital for issuing medical certificate

Bribe taken from patient in Balrampur Hospital for issuing medical certificate

To read this posting in Hindi language, click here

It is a usual practice in government hospitals to issue medical certificates indicating extent of injuries required to file FIR at police stations in exchange for bribes. In fact for a higher bribe injuries can be shown to be serious so that stronger charges can be brought about against the opponent.

On the other hand if one doesn’t pay a bribe the extent of injury will be shown less because of which proper FIR may not be registered.

On 25th April, 2008 Ram Naresh, s/o Jagannath resident of Village Amrit Kheda, P।S. Mall, Tehsil Malihabad, Dist. Lucknow was admitted to Balrampur Hospital in Lucknow in the evening after suffering injuries in an attack by another villager.

He was asked to deposit Rs. 300 immediately. When he explained the incident he was asked to pay another Rs. 500 in order to issue him an authentic medical report of injuries. He paid Rs. 100 for stitches made on injuries and Rs. 20 later for receiving medicines for his treatment whereas the treatment is supposed to be free for poor patients in government hositals. This is just one incident but every poor person coming to receive medical treatment in government hospitals is charged illegal money by hospital staff.

A complaint has been filed by Ram Naresh with the hospital authorities for the illegal money that was taken from him. After the complaint was filed a ward boy approached him and told him to take his money back from one Chaurasia in Emergency Ward. The money has not been returned so far.

Ram Naresh is admitted in Ward No. 21 on Bed No. 6 of Balrampur Hospital presently. He may be reached through Chunni Lal, 9839422521 or Manish, 9839911648, volunteer of Asha Swasthya Sewa of Asha Parivar who are helping him with his treatment.

Dr Sandeep Pandey
Ph: 0522 2347365, 9415022772
Email: ashaashram@yahoo.com

(The author is the national convener of National Alliance of People's Movements (NAPM), recepient of Ramon Magsaysay Award (2002) for emergent leadership and a noted social activist heading
Asha Parivar)

To read this posting in Hindi language, click here

Published in My News, India

Treat drug users and their representatives as equals, says UNAIDS Asia Chief

Photo by bobbyramakantSpeech delivered by Mr JVR Prasada Rao, Director, Regional Support Team

UNAIDS Regional Support Team, Asia Pacific

at the opening ceremony of the 1st Asian Consultation on the Prevention of HIV Related to Drug Use

(28 January 2008)

Ladies & Gentlemen, Colleagues,

It gives me pleasure to address this Consultation for two particular reasons: firstly because it is the first Asia Pacific Consultation on the specific issue of reducing harm related to injecting drug use, including preventing HIV transmission. It is also special as an initiative entirely undertaken by civil society groups and communities and not by formal organizations in the Government or the UN system. I see in this room a dedicated group of individuals who share a common goal of making HIV prevention, treatment and care for drug users a reality. Congratulations to all the sponsoring agencies and individuals.

Today, we have the means needed to make a real difference tackling HIV related to injecting drug use. We have high level commitment to address the epidemic; we have the science, meaning we know what works and we have the resources to scale up interventions.

Injecting drug use as a catalyst of HIV epidemics and transmission of hepatitis among IDU in Asia

In the past, HIV responses in the Asia-Pacific region were guided by global strategies on prevention, treatment and care. The global strategies were based on early experiences in high prevalence regions which witnessed extremely high growth rates within a matter of a few years. Only later was there recognition that the risk factors and the underlying social determinants of the epidemic in this region are totally different to those in other parts of the world.

Injecting drug use has acted as a catalyst for HIV epidemics at the onset of the pandemic in many Asian countries. Sharing of injecting equipment is a very efficient way to transmit HIV from one person to the next. Once HIV enters the IDU network, it spreads very rapidly and a drug-use related HIV epidemic kicks off in a country. This is what happened in China, Indonesia, Vietnam and the north east of India, to mention a few of the countries thus affected. Soon after that happens, we start finding HIV among sex workers and sexual partners of drug users, as we saw in Manipur, And within five years of the initial epidemic among people injecting drugs, it had spread to children.

Already, globally, three million injecting drug users are living with HIV. In our region, prevalence of anywhere between 20% and 85% has been reported among injecting drug users in several of the countries, including China, India, Thailand, Myanmar, Nepal, and Vietnam. And countries, such as the Philippines, which reported no injecting drug use related to HIV transmission before 2005, have since detected HIV among this population.

The good news is that we have the science and we know what we have to do. The first golden rule in preventing a fast spreading HIV epidemic in any country is early intervention to halt transmission. Countries that report injecting drug use need to start prevention before HIV is reported among injecting drug users. I cannot stress this fact enough. Countries that waited and hoped that information, education and communication programmes for the general population would show results did not see them. In these countries, HIV prevalence among injecting drug users sky-rocketed up to 90%. On the other hand, countries, such as Bangladesh, that acted early and implemented focused interventions aimed at preventing transmission among people who inject drugs, have been rewarded with prevalence of around five percent or below, a level comparable level to Australia, Europe and the US.

Universal Access and barriers to access among drug users

On the basis of past experience we also have more detailed blueprint for responses to work with. Last year, UNAIDS and its cosponsors endorsed a practical guideline on prevention interventions. It recommends giving priority to interventions reaching people who inject drugs in all countries that report injecting drug use and it provides practical guidance on the core package of interventions for prevention of HIV related to drug use. By a comprehensive package we mean a full range of treatment options and relevant services. These include substitution treatment, needle and syringe programmes, peer education and outreach, voluntary HIV testing and counseling, prevention of sexually transmitted infections, primary health care and anti retroviral therapy.

On top of this, we have a more supportive political environment. In the political declaration made at the high level meeting of the UN General Assembly in June 2006, countries committed to developing targets for Universal Access, while recognizing that the targets have to be cognizant of the realities at country level. Supporting countries to meet these targets has become a major focus of the international efforts, led by UNAIDS and its cosponsors.

Ladies & gentlemen, with these guidelines and the political commitment we have a strong platform to take action. You might even think we’re on course to solve the problem. But let me now give you a brief snapshot of what’s actually going on. It’s not a comforting picture.

Take the latest data on coverage and access to the essential services by people who inject drugs. It shows that only a tiny proportion of injecting drug users in need of harm reduction programs (3% in South-East Asia and 8% (1 country only, China) in East Asia, actually have access to these services.

Only a few countries provide access to substitution treatment, and where it is available, it is mostly at a pilot stage, for example in Indonesia, Nepal, Malaysia, and Myanmar. Only one country, China, has demonstrated a significant scale up effort.

Even though it has been quite some time ago that WHO included both Methadone and Buprenorphine to the WHO List of Essential Drugs, yet, as of today, Methadone is legally available in only five countries in Asia (China, Hong Kong, Indonesia, Lao PDR, Myanmar) and Buprenorphine is available in only three: (India, Pakistan and Nepal). Moreover in five countries, namely Bangladesh, Bhutan, Cambodia, Japan and Singapore, both Methadone and Buprenorphine are still illegal.

The priority now is to see that all countries which report injecting drug use make methadone legal, include it in the list of essential drugs and expand access to drug substitution treatment sites on the ground.

However, a comprehensive HIV response also means that drug users have access to needle and syringe exchange and distribution programmes. Scientific evidence shows that easy and consistent access to sterile injecting equipment cuts transmission of HIV and hepatitis. Countries that took the initiative to implement needle and syringe programmes before a drug use related HIV epidemic took off have succeeded to date in averting a generalized epidemic, saving lives and a huge burden of cost.

Yet, only 10 countries in Asia and the Pacific have at least one dedicated needle and syringe exchange programme and only two countries (Malaysia and China) have both NSP and substitution treatment programs in place.

Countries that report injecting drug use need to significantly scale up the number of needle and syringe program sites if they are to attain the goal of Universal Access.

Another issue of concern is equity, or should I say, the lack of equity, in access to HIV treatment by people who inject drugs. Of all injecting drug users receiving treatment globally, an astonishing 90% live in just one country, Brazil (WHO, 2007).

Too often people who use drugs are denied the services that they need and have a right to. We hear that drug users are being told by physicians that “as long as you use drugs you cannot have ART”. Similarly, we have heard that drug users on methadone treatment have been denied access to ART.

I find this situation unacceptable. ,Denial of treatment is a denial of basic human rights. But let us be clear, it is also bad practice. Current or past drug use cannot be used as a criteria for deciding who can and cannot access treatment.

To curb and reverse the spread of AIDS, treatment needs to be provided based on clinical criteria, not on moral grounds. Second; health care services need to be comprehensive, with good referral mechanisms between general medical care, drug dependence treatment, harm reduction services, HIV testing and counseling and psycho-social support.

Delivery of anti retroviral therapy for IDUs through public healthcare services alone will not work. We need to expand access to anti retroviral treatment through community based organizations and experience shows us that the more we can involve people who use drugs in the design and delivery of treatment and care programmes, the more successful those programmes will be. Treatment services also need to reach HIV positive persons in closed settings, such as prisons and drug rehabilitation centres. Lessons learned from prison in Bali, Indonesia, show that it is feasible to make available comprehensive treatment and care services in a closed setting.

Ladies & gentlemen, in 2010 we will take stock of the progress made towards achieving Universal Access. So our main challenge in the next two years is to increase access from 3% to 80% for all injecting drug users in need of these prevention and treatment services. This is a tall order, but unless we have the vision from the beginning, we will not go very far. To be successful, everyone needs to work together to scale up harm reduction programs and make universal access for drug users a reality at country level.

Stigma and discrimination, involvement of drug users

But let us consider some of the obstacles we must tackle to get there. One of the main barriers for access to prevention, treatment and care services by people who inject drugs continues to be the stigma and discrimination associated both with HIV and injecting drug use. The prejudice encountered by people living with HIV is well documented. But people who use drugs also report stigma and discrimination, and being an HIV-positive drug user brings with it a “double-stigma” that makes it all the more difficult to access relevant services.

We also know that in several countries drug users and positive people’s networks are still not allowed to organize themselves and that drug users and their networks are excluded from decisions that affect them. This needs to change. The stigma and discrimination associated with drug use and HIV need to go, communities and governments need to embrace the reality of what works in curbing the epidemic.

By treating drug users and their representatives as equals, by including them in consultative processes and the decision-making and policy-making bodies that shape the HIV, drug, and other relevant policies, we are more likely to succeed. We also need to support direct involvement of drug users in provision of services, such as outreach, substitution treatment, needle and syringe programmes, delivery of anti retro viral treatment, and prevention of overdose due to drug use. After all, who understands the health and social needs of drug users better than the drug user?

Legislation and policies; management of national programs

But the one, overarching bottleneck I hear of whenever I meet and work with colleagues who are dedicated to increasing access to the programmes reducing drug related harm, is how current legislation and policies hamper implementation. There is an urgent need to harmonize drug policies with HIV policies. Criminalization of drug users hampers access to treatment and prevention services.

In most countries, the HIV program is managed by the Ministry of Health while the national narcotics control bodies have been left out of the response and as a result often lack understanding and ownership of the national HIV programs. Ministries responsible for controlling narcotic drugs should come forward to participate in these programmes and work closely with the national AIDS programs. China is a good example of such collaboration.


Despite such challenges, we now have a clear roadmap with which to address this crucial but neglected area of the region’s epidemic. The Asia AIDS Commission, recognizing the vital importance of tackling the IDU-related spread of HIV, has given priority to a review of this dimension of the Asian epidemic. Its findings and recommendations will be coming out very soon. I strongly believe that if all of us, the Governments, the parliamentarians, the UN agencies, civil society and drug user organizations implement these recommendations as a matter of urgency we can not only change the current ground reality but alter the course of the epidemic in Asia.

Call for Action

Ladies & Gentlemen, Colleagues,

Let us use this consultation as a platform from which to call on all those who are involved in the response to HIV to move for concerted action on the following agenda:

To review and revise laws that criminalize drug use

To tackle the stigma associated with drug use and HIV

To ensure comprehensive coverage of IDUs with prevention, treatment and care interventions

To involve networks of drug users and community based organizations in delivery of prevention, treatment, care and support services

To maximize financial and technical resources for prevention, treatment and care programs for injecting drug users

And finally to promote and facilitate organizations of people who use drugs.

We have over 20 years of experience at hand, we have the evidence, we have the resources, we have the commitment. So let us just do it , lets get on and make Universal Access a reality.

Bobby Ramakant-CNS

Asians who use drugs: Nowhere to turn for HIV services

Photo by lucasreddingerDespite the well-documented benefits of harm reduction approaches to HIV prevention, particularly among injection drug users (IDUs), service coverage is abysmally low throughout Asia.

With about 30% of new HIV infections in the region associated with drug use, there is a very real and urgent need to scale-up harm reduction services. This is one of many issues being discussed by delegates at the first Asian Consultation on the Prevention of HIV Related to Drug Use being held this week in Goa.

“Injecting drug use has acted as a catalyst for HIV epidemics at the onset of the pandemic in many Asian countries. The sharing of injection equipment is a very efficient way to transmit HIV from one person to the next,” Dr JVR Prasada Rao, Director of the Regional Support Team of the Joint United Nations Programme on HIV/AIDS (UNAIDS), said during the consultation.

“Once HIV enters the IDU network, it spreads very rapidly and an injecting drug use-related HIV epidemic kicks off in a country. This is what happened in China, Indonesia, Viet Nam and the north-east of India.”

With HIV prevalence rates of between 20 and 85% among IDUs in some Asian countries, governments have no excuse for not responding to the issue by integrating harm reduction approaches into HIV prevention and treatment programmes and scaling up interventions.

“Injecting drug use is increasing in many parts of [India] and its association with HIV is well documented,” said Dr Sujatha Rao, director-general of the National AIDS Control Organization (NACO) in India. But harm reduction approaches to HIV prevention, treatment and care are not being scaled up, even in India.

“About 3000 IDUs are receiving OST [opioid substitution therapy] in India,” Dr Sujatha Rao told a Key Correspondent during an interview on the sidelines of the Goa consultation, adding that “more than 40,000 IDUs may need to be put on OST in India.”

Although the World Health Organization (WHO) list of essential medicines includes both methadone and buprenorphine – commonly used opiate substitution drugs – many countries in Asia continue to list these drugs as illegal. India is one of them and methadone is still illegal in the country. “A policy stand on OST is yet to be taken,” Dr Sujatha Rao said.

Buprenorphine is legally available in India, Pakistan and Nepal. Methadone is legally available in only five Asian countries: China, Hong Kong, Indonesia, the Lao People’s Democratic Republic and Myanmar.

“The priority now is to see that all countries that report injecting drug use make methadone legal, include it in the list of essential drugs and expand access to drug substitution treatment,” said Dr Prasada Rao of UNAIDS.

Legal reforms that support policies for HIV prevention, treatment and care for communities at risk, especially IDUs, are another pressing need. The criminalization of injecting drug use has made it harder to reach many communities at risk of HIV infection. The revision of laws criminalizing injecting drug use is clearly vital, not only to improve HIV responses in the region but also to ensure the achievement of Universal Access targets by 2010.

All 189 signatories to the Declaration of Commitment at the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS, further committed in 2006 to expand harm reduction services to 80% of the IDU population by 2010. Currently, these services reach about 3% of those in need.

“It is riskier to access HIV prevention, treatment and care services for IDUs than to get illegal drugs,” one delegate at the Goa consultation said.

Harm reduction approaches to HIV prevention, treatment and care need to be scaled up significantly and rapidly. Without decisive action, it is not clear how Asian countries can achieve this.

Bobby Ramakant-CNS

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Bobby Ramakant-CNS

Raising tobacco taxes will not cause loss of revenue in India: new study

Raising tobacco taxes will not cause loss of revenue in India: new study

[To read this posting in Hindi language , please click here ]

The tax on beedis can be increased to Rs. 100 per 1000 sticks compared with the current Rs. 14 and the tax on an average cigarette can be increased to Rs. 3.5 per stick without any fear of losing revenue, according to a new study.

However in the Indian Budget 2008-2009, excise duty on both filter and non-filter cigarettes was brought on par by applying higher rates on non-filter cigarettes. However before the Finance Minister P Chidambaram announced the budget, this is what Dr Ramadoss (Health and family welfare minister) had said: "We have requested the finance minister to increase the taxes on (tobacco) products so that the alarming figures of its consumption as compared to other countries can come down."

The current system of taxing cigarettes in India based on the presence of filters and the length of cigarettes has no justification on health grounds, and should be abolished, if reducing tobacco consumption and the consequent disease burden is one of the objectives of tobacco taxation policy, argues the researcher. Attempts to regulate tobacco use without effecting significant tax increases on beedis may not produce desired results, adds the researcher.

Interestingly 85% of the tobacco tax comes from cigarettes (15% of tobacco consumption in India is in form of cigarettes) and rest of the 15% tax comes from the non-cigarette tobacco productsin India (about 85% of tobacco consumption is non-cigarette forms of tobacco products like gutkha, beedis etc).

Article 6 of the global tobacco treaty - FCTC (Framework Convention on Tobacco Control) to which India is a party by signing and then ratifying the FCTC, also supports price and tax measures to reduce the demand for tobacco. just to recall, Article 6 of FCTC says:

"1. The Parties recognize that price and tax measures are an effective and important means of reducing tobacco consumption by various segments of the population, in particular young persons.

2. Without prejudice to the sovereign right of the Parties to determine and establish their taxation policies, each Party should take account of its national health objectives concerning
tobacco control and adopt or maintain, as appropriate, measures which may include:

(a) implementing tax policies and, where appropriate, price policies, on tobacco products so as to contribute to the health objectives aimed at reducing tobacco consumption; and

(b) prohibiting or restricting, as appropriate, sales to and/or importations by international travellers of tax- and duty-free tobacco products.

3. The Parties shall provide rates of taxation for tobacco products and trends in tobacco consumption in their periodic reports to the Conference of the Parties, in accordance with Article 21."

Let us hope that the Indian policy makers keep-their-promises and prove true vanguards of public health and interests.

After 1.5 years, RTI provided NREGS documents to Unnao residents

After 1.5 years, RTI provided NREGS documents to Unnao residents

After ten hearings at the Uttar Pradesh (UP) State Information Commission and 1.5 years from first filing the Right to Information (RTI) application to seek documents related to National Rural Employment Guarantee Scheme (NREGS) in Miyaganj block of Unnao district in UP, the people of Miyaganj are finally relieved to get those documents pertinent to the NREGS work done in their block.

The RTI application asking for information (like muster rolls and measurement books) under the RTI Act, 2005, was filed on 4 December 2006 by Miyaganj block resident Yeshwant Rao at the local Block office. He received a reply after more than six months (June 2007) asking him to submit Rs. 1,58,400 (at an arbitrarily fixed rate of Rs. 2,400 per village panchayat for 66 panchayats of the Miyaganj Block).

This followed a long battle in the State Information Commission of UP where after more than ten hearings ultimately an order was passed directing the Block officials to provide information free of cost. The people of Miyaganj finally started getting the documents on 6 April 2008.

After a year and a half of struggle residents of Miyaganj Block of Unnao led by Asha Parivar local activists Yeshwant Rao and Virendra Singh, have been successful in obtaining documents related to implementation of NREGS in their Block.

Now the people of Miyaganj block are going a step further. During 20-28 May 2008, they will be conducting a social audit based on the information provided by the block authorities on NREGS implementation. The people will go to each one of the 66 village panchayats, document and verify the NREGS records themselves. Earlier similar social audits of NREGS have been conducted in Bharawan, Sandila and Behender Blocks of neighbouring district of Hardoi.

Social Audit is a process where in an open meeting of the village physical verification of the records is done with the help of officials, people’s representatives and the people. In fact, the citizens of the Gram Sabha are supposed to perform this audit. In addition to the verification of financial details it is also ensured that other provisions of the NREGA are being followed. It is an opportunity for the people to evaluate the entire scheme and also determine the quality of development works in their village. In a new democratic culture building up in the country since the Right to Information Act has been implemented, it is a chance for citizens to intervene and check the rampant prevalent corruption and irregularities in the system.

Also in February 2006, the Rural Development Department of the Andhra Pradesh Government had conducted the social audit of the Andhra Pradesh Rural Employment Guarantee Scheme which was being implemented under the NREGA which had come into force from 2 Februray 2006.

Andhra Pradesh was probably the first state in the country where such a process took place and the credit for this goes entirely to the then Principal Secretary of the Rural Development Department, K. Raju. It is normally unheard of that any government department would subject its performance to public scrutiny, especially a department dealing with development works where huge siphoning off of resources has become the norm rather than exception. Fake muster rolls are one of the biggest sources of corruption in this country. “By mentioning fictitious names, names of upper caste people who never perform manual labour, names of people who have migrated to cities long time back, names of people who are too old to work or exaggerating the number of days of work for labourers who have performed work, it is a common practice to withdraw huge sums of money from the government exchequer. In addition to the abovementioned discrepancies, it might also be the case that the work being shown on paper was never actually performed. In Hardoi District of U.P., recently is was discovered that a canal was being de-silted on paper in 2004-05 by using the funds of Bharawan Block Panchayat whereas the Irrigation Department had taken a decision five years back not to release water in this canal. Over Rs. 3 lakhs were embezzled in this instance” said Dr Sandeep Pandey, Ramon Magsaysay Awardee (2002) for emergent leadership and National Convener of National Alliance of People’s Movements (NAPM).

However, if the initiative of social audit remains in the hands of the government or administration, there is a danger that ultimately it’ll be subverted. How many cases of corruption do we know where an enquiry was set up and because the individuals who were conducting the investigation were from the same class of people as they were investigating, the results of such exercises did not yield the desired result and the matters were covered up? We would not like to see the social audit process currently being undertaken in A.P. to degenerate to a state where the social auditors develop vested interests shared with the people responsible for implementing the APREGS. Hence it is very important that the initiative of the social audit process remains in the hands of common people. The Gram Sabha is the appropriate body to conduct this exercise and not some externally chosen professionals” cautioned Dr Sandeep Pandey.

Those interested in seeking part in this social audit exercise (20-28 May 2008) in Unnao district of UP, are welcome to contact Dr Sandeep Pandey at: ashaashram@yahoo.com

Published in

News Blaze, US

Assam Times, Assam, India

RTI India

The Seoul Times, Seoul, South Korea

Central Chronicle, Madhya Pradesh, India

HIV consultation to call for urgent action on Asian drug-related epidemic

Photo by Hi yAAvA HiFor the first time in Asia, AIDS experts, parliamentarians, civil society and drug user organisations have gathered together for a consultation on HIV prevention and treatment for drug users.

Organised by the Asian Consortium on Drug Use, HIV, AIDS and Poverty, the consultation is being attended by more than 400 delegates from 27 countries with the aim of addressing the political, legal and social barriers to HIV interventions for injecting drug users (IDUs).

Delegates are also expected to advocate for the types of expanded harm reduction programs promoting drug substitution treatment, needle and syringe exchanges and peer education projects that have proven effective in stemming the spread of HIV.

The Joint United Nations Programme on HIV and AIDS (UNAIDS) estimates that 30 percent of all new infections worldwide, excluding in Africa, are associated with injecting drug use. Nearly half of the world's estimated 13 million drug users live in Asia where injecting drug use is a major factor fuelling HIV transmission.

Most of the global supply of opium and heroin is produced in Asia where vulnerable groups who inject drugs form a significant percentage of people engaged in high-risk behaviours such as sharing contaminated injecting equipment and unprotected sex.

Some Asian countries have reported HIV prevalence rates as high as 85 percent among IDUs while others that had previously reported few or no cases of HIV in IDUs have now detected the virus among some users.

"We will address the vulnerability related to drug use and HIV and AIDS affecting millions of people in Asia and the related social hazards including criminalisation, incarceration and their linkages to poverty," said Luke Samson, Co-Chair of the consultation and Executive Director of the New Delhi-based advocacy group SHARAN.

Across the region, the criminalisation of drug use, severe stigma and discrimination and law enforcement practices that marginalise and penalise drug users have driven them underground and deterred them from accessing life-saving HIV prevention and treatment services.

Gary Lewis, Representative of the United Nations Office on Drugs and Crime (UNODC), stressed at the conference that successful models of community-based HIV prevention through outreach and counselling needed to be adopted if HIV was to be addressed as a social as well as a public health issue.

"In Asia, the need of the hour is to scale-up interventions to reach out to populations at risk and to save lives. We know what to do, but we need to do more of it," Lewis said.

Delegates at the consultation will review the alarming spread of HIV in prison and custodial settings and advocate for reformed legislations, engagement with law enforcement and narcotics agencies and national AIDS policies that allow services to access incarcerated people and those in compulsory rehabilitation programs.

"We must ensure access to prevention and treatment services and protect the rights of the most at risk populations, such as people who inject drugs by involving them and their communities in every stage of the AIDS response," said UNAIDS Asia Pacific Regional Director, Prasada Rao.

The consultation also aims to engage key players from the governmental, corporate and civil society sectors in attempts to define an Asia-specific HIV prevention and treatment strategy in order to achieve universal access to treatment for people injecting drugs.

"Regional collaboration for HIV preventions is the most effective mechanism to combat the growing pandemic. This consultation is a unique opportunity to generate enduring solutions to HIV and AIDS issues affecting drug users across Asia," said Shri Oscar Fernandes, Minister of State for Labour and Employment and Convener Parliamentary Forum on HIV and AIDS.
For more information, please contact:
Ishdeep Kohli, Media Representative
Email: ishdeep@yahoo.com
Website: www.responsebeyondborders.com

Bobby Ramakant-CNS

Use 'both sides of the brain' to respond to AIDS

Photo by babasteveHIV prevalence dropped from about 20% in 1991 to less than 1% by end of 2005 in Phayao. Suwat, who headed the team conducting HIV surveillance studies in this region of northern Thailand, is also an ardent Buddhist, advocating holistic approaches to life, in order to respond effectively to AIDS. The opportunity to interact with Suwat presented during the recent SALT Visit facilitated by The Constellation for AIDS Competence, when we went to ‘Suwat Land’ - The house of nature and of life in Phayao.

How did Phayao made the landmark shift in reversing the HIV tide?

“We look at the human life and not just AIDS. People living with HIV are not living with HIV alone. People with or without HIV, live with their families, in their respective communities, with their sorrows and joys, and so when we talk to them we need a more holistic approach” said Suwat.

We need to talk about other issues too because not only HIV but other things effect the life as well. “AIDS is just one part of the life” said Suwat.

He further shares that “When I go to office, people keep telling me that AIDS is the most leading cause of death”. Suwat focuses on ‘leading causes’ to stay alive and healthy. “We have to take care of people’s lives not just limited to the AIDS-related care. People without HIV too sometimes die earlier than people with HIV. Everybody without HIV will get sick sometimes during their lives and may develop similar symptoms too” said Suwat. He focuses on a range of issues affecting the quality of one’s life. “People should eat properly, get diagnosed and treated for opportunistic infections properly, take good care of themselves… take care of others with HIV in the community as they look after their relatives or friends” ponders Suwat.

Dr Jean Louis Lamborey, from The Constellation for AIDS Competence, who had worked in northern Thailand for years earlier, said that Suwat produces a detailed report with HIV prevalence data every six months using military conscripts which is classified as per indicators like the district, pregnant women, age, society, sexual behaviours, number of sexual encounter, and a range of other indicators.

Once Suwat brought all data on Dr Lamborey’s desk, and asked “Dr Lamborey, here are your data. Do you think we will ever understand AIDS with this data? We should use ‘both sides’ of the brain”.

Why was HIV prevalence high in northern Thailand?

Suwat responds that values of people in northern Thailand were different, and they wanted to have fun. Initially sex-work was stigmatized in this part of the country as well, but when money started coming in due to sex-work and families prospered on this money with material benefits, the stigma associated with sex-work became non-existent making sex-work as an economic status.

When this part of the country was worst-hit by AIDS, nearly every family had a person living with AIDS. Communities in northern Thailand had no choice but to learn to live with AIDS.

But why doesn’t this seem to happen in other places hard-hit by AIDS?

Suwat had no clear answer. He said possibly it might be due to the different religious or cultural contexts in different countries.

Suwat advocates a comprehensive, integrated and holistic approach to a healthy life. He says government often have contradictory policies or programmes. For example in Thailand, there is a policy making it legal to brew alcohol locally, and another policy to encourage Thai people to quit alcohol use. So unless policies are congruent to each other, the desired effect will not be seen in the society.

“Some diseases don’t have a social impact like diabetes, hypertension, but some like alcohol, AIDS and drugs have a profound social impact. So when one person is impacted by alcohol, drugs or AIDS, whole family or affected community should be considered to be ‘sick’ or ‘ill’ because all of them have to face the consequences. Therefore they all need to understand how to manage and respond to the ‘illness’ effectively” explains Suwat.

There are different responsibilities we all need to shoulder to effectively respond to AIDS.

Suwat shares the findings of a study in a small group of individuals in Thailand conducted few years back. These men were using glass penile inserts while having sex. The study participants said that they use it ‘for fun’. ‘Because women scream’, since these glass penile inserts might be cutting through the condom and hurting women’s vagina. This stimulated and aroused these men. Suwat’s study changed the policy and an active awareness campaign was targeted at the above-mentioned group explaining the negative consequences of using glass inserts including cancer, infections, and a higher risk of surgical removal of the outer skin or scrotum.

In 1990s, when the AIDS had worst-hit this region, the healthcare workers were finding it difficult to cope with the onslaught and overwhelming grief around them. Dr Petshri Sirinirund, who was then working with the Health office of the Phayao, took all the healthcare workers on a retreat to help them come to terms with AIDS. They reflected on AIDS in their personal lives, as a spouse, a parent, a lover or a child, and also on their own vulnerabilities and risks to HIV. The order of that day was ‘understand yourself, then you will be able to understand others’.

Bobby Ramakant-CNS

Learning from youth groups in Ban Pang Lao on AIDS response

Photo by Tom (hmm a rosa tint)When young people get organized at the community level, have an open and fair representation in the ‘youth working group’, have access to information, hold genuine dialogue sessions among themselves and with the grown-ups, and use participatory approaches in their advocacy events on a range of issues around AIDS and risky behaviours that make young people vulnerable to HIV, the AIDS pandemic can be checked.

The visit to Ban Pang Lao community in the northern-most province of Thailand, Chiang Rai, closer to the Myanmar border, as part of the SALT visit facilitated by The Constellation of AIDS Competence, was truly inspiring.

Sustained local responses strengthened by the needed services and supportive policies brought down the HIV prevalence in Thailand from 18% in 1991 to 1.4% by end of 2005 (Source: UNAIDS Report on the global AIDS epidemic 2006). However in this community of Ban Pang Lao, the HIV prevalence remained low even when the country was hard-hit by AIDS in a generalized manner. The credit goes to the local responses undoubtedly.

Ban Pang Lao community began organizing themselves to respond to HIV in April 1994. This was led by two local school teachers Mr Sirin and Ms Sumalee Wanarat. The AIDS Education Programme (AEP), Faculty of Education at Chiang Mai University, provided technical support to Sirin and Sumalee as they initiated to develop a community-based prevention and care model for people living with HIV with a particular focus on mobilizing young people and community leaders.

In 1994, AIDS was still in the shadows in Chiang Rai. Thankfully the community responses in Chiang Rai started gaining strength before AIDS had worst hit the country later. Although communities around Ban Pang Lao were struggling to deal with treatment, care and support services for people living with HIV in 1994, there wasn’t a single person living with HIV in Ban Pang Lao. The foresight of Sirin and Sumalee could see the threat AIDS posed, especially to the young people, and had therefore began working on the much-needed community-preparedness to build an effective AIDS response.

Ban Pang Lao community spreads over 23 villages. Young people in every village were mobilized to elect two representatives to the youth working group. These two youth representatives elected from every village, took leadership not only in working on an ongoing basis with youth in their respective village but also to participate at the community-level advocacy initiatives regularly. It is amazing to note how these young people can manage a fair and open representation process in every village and provide many opportunities to un-learn for us ‘grown-ups’.

The young people had regular discussions on a range of issues including those on sex, sexuality and HIV/AIDS. During an informal interaction with the young people from this community, they did share culturally it was inappropriate (and still is) to talk openly about sex and sexuality issues with their parents, however they feel more comfortable to talk to their school teachers and fellow youth. They did face resistance from some of the youth in their community who was reluctant to join them in their fight against AIDS. The youth of this community felt that these youth were indulging in risky behaviours and needed help. In such circumstance they try to approach the youth-gang leader to convince on the need to come together for their own benefit and inherent interest.

Interestingly the visitors from different Asian and European countries shared that there wasn’t any similar youth support programmes in their own nations to provide information and support on sex, sexuality and/or HIV/AIDS issues to young people. The manner in which the young people in Ban Pang Lao community have organized themselves to improve the AIDS response is certainly inspiring. For instance in India, many states are still considering a ban on sex education in schools. The young people in this small community in northern-most part of Thailand are certainly way ahead and have lot of lessons for other AIDS programmes in the region.

They have been using participatory theatre, music and traditional folk dance performances on themes around HIV prevention, care and support to raise more awareness and understanding of key issues in the community. They also use this opportunity to link with the adults or grown ups.

It is also interesting how the young people write their own ‘proposals’ to raise financial resources at provincial level to meet the costs of the performances or advocacy events. To see a good financial management capacity in these young people from the villages of Ban Pang Lao is indeed interesting to note. This also speaks volumes on sustainability of local responses.?

Bobby Ramakant-CNS

AIDS NGOs from northern Thailand have their say in new government report

Photo by sergis blogEarly next year, Thailand must report to the UN on its progress towards it previous commitments and international AIDS-related goals. The national report to the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS is due next month, and efforts by civil society to get involved in its preparation appear to be finding a receptive hearing in Bangkok.

Recent meetings in Chiang Mai had led to calls for more participation from northern Thailand. Then came the surprise message: For the first time, the Royal Thai Government was inviting a civil society representative from the HIV community in the North to take part in their initial discussions, taking place in the capital on 26 November 2007.

Jutatip Dechaboon, from Partners Thailand (the national partnership platform for information, dialogue and advocacy on AIDS and TB), duly took her place at the table, representing a Working Group formed during a recent NGO gathering in Chiang Mai.

Returning home, Jutatip understood why some people have been unwilling to represent civil society at the national level.

“It is very difficult when a small number of people have to take decision on behalf of a very large number of people," she said. "After all, these decisions will affect every member of civil society. But existing mechanisms to nominate civil society delegates are not appropriately or systematically used, often resulting in the random selection of representatives that will have a say in national level decision-making she said.

But Jutatip and the other four members of the meeting's civil society delegation are aware of this gap and as a response are planning to disseminate as much information about the UNGASS 2008 report as possible beyond the meeting rooms. Guided by its Coordinator Channarong Wongwichai, the Thai NGO Coalition on HIV/AIDS (TNCA) is putting together a civil society preparedness document to be distributed through its network. Later this month, assemblies will be organized to distribute these documents, so that civil society understands the UNGASS process and can organize itself to participate in the national review.

“Not just in Thailand, governments of all countries are being pushed to engage civil society at every step of UNGASS review” Jutatip added.

Others fear that in some countries opportunities for involvement might be tokenistic.

“In Thailand, fortunately, the current leader of UNGASS review, Dr Petsri, has been actively working with civil society for a long time," Jutatip noted. "She very well understands the significance of civil society involvement. At the same time, it would be better if the government liaises with and involves civil society much earlier – rather than just two months before the UN report submission deadline.”

General awareness and understanding in Thailand about the AIDS review process remains limited. The recent example of the robust civil society response in support of compulsory licensing should be a source of encouragement. Despite the issues surrounding compulsory licensing being fairly technical and complex, a core group did the back-room research, analysis and simplified the messaging around the campaign

Jutatip feels a similar mechanism might be helpful for UNGASS review to genuinely engage civil society at a much broader level in Thailand. This includes a comprehensive awareness raising campaign, using simplified technical language, sharing regular updates and initiating dialogue at the community level via such opportunities as the existing monthly NGO Forum in northern Thailand.

The Thai Government is convening multi-stakeholder groups to draft specific sections for the 2008 UNGASS report.

"This is another huge opportunity to work closely with the government, build a credible relationship by being effective partners in putting together the 2008 UNGASS review report, and utilize this opportunity to build momentum for greater civil society preparedness towards UNGASS 2010 and other such similar review processes,” said Jutatip. “It is about lives. We urgently need to act.”

The initiative by Thailand’s government to involve civil society in UNGASS preparations has opened a doorway for civil society to organize itself for genuine participation around the final UNGASS review in 2010 and beyond.

Background information

In June 2001, UNGASS on HIV/AIDS was convened. Thailand is one of the 189 Member countries which had adopted the Declaration of Commitment on HIV/AIDS (DoC). The DoC reflects global consensus on a comprehensive framework to achieve the Millennium Development Goal of halting and beginning to reverse the HIV/AIDS epidemic by 2015 (MDG#6). All national governments, including Thailand, who have signed the DoC, are required to submit progress reports periodically to the UNAIDS Secretariat in Geneva. The Thai government submitted progress reports in 2003 and 2006. The next report is due in 2008. For more information please click here

Northern NGOs on HIV/AIDS in Thailand had dedicated their monthly NGO Forum in October 2007 to mobilize a civil society response to the UNGASS process. This was organized by the Northern NGO Coalition on AIDS (NNCA) and Health & Development Networks (HDN), and Mr Sompong Chareonsuk, Country Programme Advisor, UNAIDS, Thailand, was one of the key speakers.

The civil society Working Group in Northern Thailand was then formed at the October NGO Forum, to increase civil society representation and participation from northern Thailand in UNGASS report-writing process on HIV/AIDS. One of the first decisions taken by the Working Group was to provide access to all available UNGASS-related information and documents via the Partners Thailand eForum (with 1,100+ members) and website, and at face-to-face meetings.

For more information about action in Northern Thailand:

Mr Titus Paipilai
Coordinator of Northern NGO Coalition on AIDS (NNCA)
Cell: +66-(0)85-037 7344 begin_of_the_skype_highlighting              +66-(0)85-037 7344      end_of_the_skype_highlighting
NNCA Office: +66-(0)53-350 683 begin_of_the_skype_highlighting              +66-(0)53-350 683      end_of_the_skype_highlighting.

Bobby Ramakant-CNS

Advocacy and campaigning 'days'

World Population Day: 11 July

International Youth Day: 12 August

World Lung Day: 25 September

International Safe Abortion Day: 28 September

World Heart Day: 29 September

INVITE: 7th Convention of National Alliance of People's Movements (NAPM)

7th Convention of National Alliance of People's Movements (NAPM)

National Alliance of People's Movements (NAPM)

[To read this posting in Hindi language, please click here]

Venue: Kushinagar, Uttar Pradesh (UP)
Date: 7 - 8 June 2008

Dear Friends,

You may know that the National Alliance of Peoples' Movements is a coming of various Peoples' Movements fighting for the toiling peoples' right to Life and Livelihood, and as also those working on various alternatives in the fields of Agriculture, Water, Energy etc. The Alliance, over the years has brought together diverse groups engaged in struggles across the country and drawn people's attention to the marginalization of the majority of the people for the benefit of the wealthy and influential few.

We realise that the situation is becoming ever grimmer, by the day, be it any party ruling at the Centre or in the States. The stark reality is:

While the 'powers that be' boast of a high growth it is at best a jobless, or rather a 'job-loss' growth.

The Agriculture sector has been destroyed and labour laws decimated at the bidding of the Global Financial Institutions and Corporate interests.

All basic services and Utilities such as Water, Electricity, Health care, Education, Roads, Railways, Ports, Public transport have or are in the process of being turned over into private hands through a cruel onslaught on peoples' resources.

Caste violence, religious fundamentalism and ethnic strife are being perpetrated so as to destroy our social fabric.

What has been unleashed on the people - farmers, fisher people, adivasis, dalits, minorities, workers is 'development terrorism'

Whether it is Nandigram, Singur, Kalinganar, Ayodhya, Posco, Gorai, Plachimada, Chengara, Kakinanda, the cruelest violence is used to displace, dispossess, dis-employ and dehumanize people killing the democratic space and social justice sought to be enshrined in our Constitution. Anyone raising a voice against this is labelled 'anti-development', 'anti-national', 'naxalite' 'foreign-funded' etc. These hundreds of land and resource grab exercises, actively indulged in by corporate bigwigs and ably manoeuvered by state machinery have revitalized with renewed rigour the need for and demands by nation wide struggles groups to give flesh and blood to Article 243 in the Constitution, which provides the framework for "development" (in whose name all the tamasha of Special Economic Zones (SEZ) are happening) and locates the Gram Sabhas and Ward Committees in villages and towns as the epicentres of any developmental planning.

National sovereignty, democracy and governance are virtually being outsourced and sub-contracted in the name of Public Private Partnership. How far away is this to practical realization, more particularly, in the wake of draconian definitions of 'public purpose' creeping into enactments, as is being witnessed in the recently proposed Land Acquisition Bill, 2007 and Resettlement and Rehabilitation Bill, 2007 is the challenge before peoples movements and struggles all across the country.

Over the last 12-14 years, NAPM has been at the forefront of people's struggles be it the slum-demolitions in Mumbai and other cities and towns, displacement by various dams and projects, the Enron struggle, the various anti-SEZ struggles, fisher peoples' struggles, WTO and World Bank Bharat Chodo campaigns, Desh Bachao Desh Banao campaigns etc. Similarly, its various constituents have led successful struggles of fisher people, those displaced by dams, those fighting globalization in its various manifestations.

Probably, never before has there been in the history, so much a need, as also an opportunity, for all democratic forces, including like-minded individuals, groups, alliances and movements, with the struggling masses at large, to come together and challenge the claims of those who hold seats of power in various ways, both within and outside the framework of the State and reclaim back not just legitimate democratic spaces, denied and robbed hitherto, but also assert positive claims to natural and other resources and strive for societal and political recognition of the non-destructive, equitable ways of harnessing those new economics and politics of reconstruction. The inevitable task, ahead for presently sectoral people's struggles, is to strike at the root of inequality at various levels within existing power-structures and the future pre-condition for that would be the strategic coming together of all the concerned and their democratic supporters, across the country and around the world.

Over the years, NAPM has come to grow as a broad-based platform of diverse groups articulating the concerns of various marginalized peoples and communities.

It is in this context that the NAPM is hosting its 7th bi-annual convention and invites you, along with your friends and allies, to join us at this convention, who are ready to struggle for ensuring democracy, equality, secularism, and justice.

The 7th NAPM Convention is therefore an opportunity for all those struggling with the people and those desirous of bringing about an alternative development paradigm through various sustainable alternatives and experiments.

Yours sincerely,

Arundhati Duru, Sandeep Pandey, Medha Patkar
Sr. Celia, D. Gabriela, P. Chenniah
Anand Mazgaonkar, Thomas Kocherry, Aruna Roy
Sanjay MG, Ulka Mahajan, Mukta Srivastava
Geeta Ramakrishnan, PT Hussain, Uma Shankari
Subhash Ware, NB Kohli, Amarnath Bhai

For further programme and travel details contact:

Keshav: 09839883518, email: napmup@gmail.com
Nandlal Master: 09415300520
Udhay Bhan: 09935445489
Mukta: 09969530060

Other emails: napmindia@gmail.com, mumbainapm@gmail.com
Simpreet: 09969363065

VENUE: Kushinagar, Uttar Pradesh (50 km from Gorakhpur and 30 km from Devaria)

A detailed schedule of the travel and transport details and particulars of trains plying from various parts of India may be obtained from the above contacts. The above contact persons would be waiting at the Gorakhpur and Devaria Railway Stations, with the NAPM banners.

1) 6th June would be the Preparatory Meeting of the Present Conveners and 9th June would be the Meeting of newly elected Conveners.

2) There will be an exhibition on alternative development put up from the 6th of June itself. All those committed to alternate and sustainable development, please bring along with you models, banners, literature, posters, for the exhibition.

[To read this posting in Hindi language, please click here]

Tribute to Mildred Mpundu

Photo by a.e.wolfOf Mildred Mpundu, journalism and HIV/AIDS

A Dedication by Henry Kabwe

Before Mildred Namwiinde Mpundu became a journalist, she existed as a child, a school girl and a responsible young lady.

Before she became open about her HIV status, she was one of the journalists doing their daily routines of writing to the publics that they served.

She worked for the Times of Zambia newspaper and was one of the first Zambian Key Correspondents of the Health and Development Networks (HDN) based in Thailand.

(Mildred is 3rd from left)

On November 13, 2007, I received a call from another journalist, Felistus Chipako that she had died.

November 13th is my birthday and I was on the way to Lundazi District, over 800 kilometers from Zambia’s capital city of Lusaka.

When I broke the news in the vehicle carrying an entourage of colleagues from the Media Institute of Southern Africa (MISA) Zambia that were heading to add value to a local community radio station, Chikaya, it became apparent that a great person had been lost.

The delegation leader, Brian Lingela, the head of broadcasting at MISA Zambia, made the situation more emotional. He narrated that Mildred taught him in primary school before they both met again as media practitioners.

“She was like a mother to me. She used to call me ‘son’,” decried Brian, who later disclosed that he had plans to take Mildred to some herbal clinic which had promised miracles for people that need immune boosting.

When a lady called Dorcas died in bible days, a number of women she had helped tried everything to ensure that she lived and had unusually believed that God would to resurrect her from the dead through Peter, the apostle. And, it worked.

This is what everyone that saw Mildred’s health fail wanted to do to ensure that she continued living and being good to society.

For Mildred, wearing a smile even in the most challenging moments was as natural as blinking the eye.

She was a darling of everyone. “Yes dear,” was her catch word and the spirit behind the voice was so soothing and reassuring.

Whenever she rebuked you, it was like funny. She never offended in her correction but she did with so much emphasis and fortitude that it was difficult to ignore or disobey ‘the order’.

On my birthday last year, my life had become a nightmare. I was beaten economically, socially and emotionally.

Everything had gone wrong. My grandmother and mother had died within two months, and I was battling some financial challenges coupled with a bit of personal social issues.

The birthday that was supposed to be celebrated had become a bitter reminder of the people that were responsible of my being brought to this earth.

By this time, Mildred had become financially challenged. She and her child – that darling called Mate – had come to my office.

She could not watch me look like a bear deprived of her children and invited me to her favorite eating spot in town for a meal.

When I looked at her failing health and the sacrifice she made to just make me feel better, it made me shed tears whenever she was not focusing her attention on me.

That was my birthday last year and on this year’s birthday, she said ‘Bye’.

I had earlier called her a week before, on a Friday to be specific, to inquire about her whereabouts and how she was doing.

She told me that she had traveled to her father’s home in Kalomo District and was supposed to be back the following week, especially Monday.

On Monday, I remembered to call her and the sister indicated to me that she was not talking.

I thought it was one of those little relapses that come to those infected with HIV and are taking antiretroviral (ARV) drugs.

However, it was not to be; the following day, she died.

I first met with Mildred when a features reporter under her desk, Gethsemane Mwizabi introduced me to her and told her that I was leading the Media Network on Orphans and Vulnerable Children.

She immediately inquired about the Media Network ostensibly referred to as OVC Media Network in two minutes and the next thing I saw was her hand reaching into her bag to pay the membership fee into the network.

I did not realize the amount of value, insight and hard work Mildred was going to bring to the organization, but it had definitely appealed to me that her commitment to children’s was unheard of.

She was soon to be elected treasurer and took up the responsibility of organizing events. I can imagine her budget for the last come together we had in that graceful handwriting.

The budget contained too many details but I knew how time wasting it was to try to compromise on the amount of things to buy for any event. In the end, she was doing the tedious lot and needed to be backed in all manner of ways.

Mildred was held dearly by both veteran, ‘middle-class’ and inexperienced journalists, including students.

She had mastered her art of writing so wittily but never thought of her position in the ranks of journalism when it came to getting advice on how she could do an article or some report better.

It used to beat me to get ‘bothered’ (I told her word was a command) to go to her lap top and go through her article or report to confirm whether it was good or not, and suggest possible corrections.

With no qualms at all, she would get on with her work and made her win a lot of awards in the journalism sector.

She was also a well traveled journalist. If there was one person I used to wonder how they kept moving to from one country another, it was Mildred Mpundu. I would sometimes rant against the idea of going to another country. Jokingly, of course!

It was in this period that we started noticing her health failing. She was always complaining of one aspect of ill-health or another.

Her food patterns also changed as she resorted to more health foods but rebutted anyone who indulged in junk food. Didn’t I start changing my eating habits when I did a long winding project with her? Well, I was commanded to and I did it with pleasure.

To her, eating the right food was vital to living with HIV. Although, she did not tell us her status by then, she emotionally condemned ARVs as a business venture by the West.

I was so scared of her words just in case she needed the ARVs.

Afterwards, her health became so bad that she could not walk and was confined to bed. When we visited her one day, she could not come out of the bedroom. We were asked to go in.

On her bed, she struggled to speak and Mwiika Malindima from the Zambia Institute of Mass Communication (ZAMCOM), who is also a Key Correspondent for HDN, Glory Mushinge, the chairperson for training at MISA Zambia and Pastor Joe Mulenga were so touched.

She now started saying there she saw no need to remain in denial. She was going to face it and test for HIV. She went ahead to praise ARVs and how they had helped people living with HIV/AIDS.

It was a soothing experience that had left us hopeful that once she got on ARVs, things could get better. While chatting, her youngest daughter kept shifting among the three male visitors as from one husband to another and made the situation a little lighter.

When we left, it was clear that we had a big challenge and started wondering how we could of help.

She went to Teba Hospital where she was confirmed that she had HIV.

Before long, I received a text message while in a church in Mansa District tipping me to read The Post newspaper for that day. We had gone to visit relatives and watch the Mutomboko Traditional Ceremony of the Lunda people.

After church, we struggled to get the newspaper until we found a man who had it in a shop at a filling station.

We saw the story, Mildred Mpundu had come out about her HIV status and we got so emotional that our rather congenial trip turned out to become somber and quiet.

The following day, an indicator of the impact Mildred had created was to come.

Harriet Mulenga, a beautifully bouncing lady who had deteriorated in health due to HIV/AIDS called me.

She said she saw Mildred’s story in The Post and wanted to talk about her five years experience on ARVs.

I met with Harriet some three years earlier at a ZAMCOM media workshop on HIV/AIDS supported by the United States President George Bush’s HIV/AIDS program.

Since before of us are busy people, it was difficult to get in touch and get the story running somewhere, but Harriet kept my phone ringing and I kept reassuring her on the other side.

However, I did not know that The Post had graciously offered Mildred an opportunity to be contributing articles.

So when Harriet called me on a day when I was with Mildred, I talked to her about Mildred’s work and I handed the phone to Mildred.

They talked and became friends right there.

The following day, I was Mildred’s aide when we went to the Comprehensive HIV/AIDS Management Program (CHAMP) and the two women hugged like they had known each other for a long time.

Then we proceeded to the boardroom where the interview was to be conducted.

There was Mildred doing her work. She got her notebook and started interviewing Harriet.

How touched I was! I could not hold it and I sent a text message to the one who made me get closer to Mildred, Gethsemane, who later confessed that I was a strong man. Whatever, he meant.

This interview was very encouraging to Mildred as she confessed that she would also get better.

“Muzakaniona Henry nizakaina so. Ma hips yazachoka aya (You will see Henry how I will get big like this. My hips will protrude),” she said while showing how big she would become with her hands and we all laughed.

After the interview, the two people living with HIV kissed each other with Mildred carrying a bunch of pictures that showed Harriet as a ‘finished’ (her own words) and weak, and a happy ending of the now bouncy and beautiful lady.

I jokingly said “How about me?” and Harriet said mine was not supposed to be public. The laughing frenzy continued.

It was sad that Mildred died while I was in Lundazi. Monalisa Haundu, her friend and colleague in the OVC Media Network tried to organize a number of people to go and mourn our colleague, but it was too late.

I traveled from Lundazi, Chipata and Petauke Districts under a strictly rescheduled program but the long journey between Lusaka and Kalomo District where Mildred was buried betrayed me.

In Lundazi, those that knew her were beaten. Former ZAMCOM Director Mike Daka, the director of Breeze FM in Chipata said it was sad that a committed journalist like Mildred had died.

He confessed that she was the first journalist to start consistently writing about HIV/AIDS.

When I arrived in Kalomo around 11 30 hours, I called her number and I was told that the procession had already started off for burial at a farm.

I was told that it was difficult to know where the farm was and could do better to wait for the procession to come back.

I was in Kalomo for an extended period of time for the first time and my emotions could not allow me to stay on for the sake of Mildred.

I saw an ode to Mildred by Dr. Robert Mtonga after buying the Times of Zambia and when I tried to read, it was too much to bear.

Even the call boys at the bus station discovered that I had gone to mourn ‘Ba Mpundu’ when they heard talking on the phone.

The whole area had a sense of solitude and sent a strong indication of what Mildred meant to people out there.

Beyond one person living with HIV/AIDS like Harriet, a lot others have been encouraged by Mildred.

Beyond one journalist like me, a lot other journalists are inspired by the life and work of Mildred. Her advice to the media was blunt but helpful. “Never mess with the sources” and “I wish I listened to my parents” come out as strong conclusions of her advocacy.

And beyond one call boy, one Dr. Mtonga and one reader, Mildred’s impact will live as a testimony for all who have read and continue reading her articles.

Though dead, Mildred will continue speaking and touching lives.

Having shared a hope of the resurrection of Christ and the eventual glorifying of those that believe, she hoped for that better place; the place of rest and comfort.

We shall then see each other one day, “My dear.”

Bobby Ramakant-CNS

USA policing TB in prisons

Photo by arlenCore facts/news that make this article important:

    * TB is not an unavoidable consequence of imprisonment and can be controlled through the application of Directly Observed Treatment Short-course (DOTS) based programmes and improvements in prison conditions
    * Effective TB control in prison protects prisoners, staff, visitors and the community at large.
    * The level of TB in prisons has been reported to be up to 100 times higher than that of the civilian population.

Two most significant quotes from the article:

    * Prisoners have the right to at least the same level of medical care as that of the general community. Catching TB is not part of a prisoner's sentence
    * Prisons act as a reservoir for TB, pumping the disease into the civilian community through staff, visitors and inadequately treated former inmates. TB does not respect prison walls.

Web-links to relevant documents:

TB in Prisons (World Health Organization): click here

International Centre for Prison Studies

Prison and TB (Centre for Disease Control and Prevention (CDC) guidelines): click here

WHO: Health in prison document: click here

WHO: Manual for Programme Managers: TB control in Prisons: click here

Global TB Control Report 2007: click here
Global Plan to Stop TB (2006-2015): click here


A 71-year old man in Colorado US who was arrested and served a six-day sentence for contempt of court on a municipal charge last month, was later diagnosed for TB upon release, sending shivers down the spine of police officers. 15 police officers in Colorado, USA, have filed casualty reports already.

As many as 22 officers and some jail personnel may have come into contact with the man, a news report said. All of them are undergoing a skin reaction test. If they test negative they will be tested against in 10 to 12 weeks. A second negative test will clear them. A positive test, while not meaning the person has the disease, will result in further tests.

TB is not an unavoidable consequence of imprisonment and can be controlled through the application of DOTS based programmes and improvements in prison conditions. Effective TB control in prison protects prisoners, staff, visitors and the community at large.

According to the World Health Organization, the level of TB in prisons has been reported to be up to 100 times higher than that of the civilian population. Cases of TB in prisons may account for up to 25% of a country’s burden of TB. Late diagnosis, inadequate treatment, overcrowding, poor ventilation and repeated prison transfers encourage the transmission of TB infection. HIV infection and other pathology more common in prisons (e.g. malnutrition, substance abuse) encourage the development of active disease and further transmission of infection.

A disproportionate number of prisoners come from socio-economically disadvantaged populations where the burden of disease may be already high and access to medical care limited e.g. substance abusers, homeless, mentally ill, ethnic minorities, asylum seekers, immigrants. Prison conditions can fan the spread of disease through overcrowding, poor ventilation, weak nutrition, inadequate or inaccessible medical care, etc.

High levels of Multi-drug resistant (MDR)-TB have been reported from some prisons with up to 24% of TB cases suffering from MDR forms of the disease. Factors that encourage the spread of TB in prisons also promote the spread of MDR forms.

Another document by WHO says that ‘Prisons act as a reservoir for TB, pumping the disease into the civilian community through staff, visitors and inadequately treated former inmates. TB does not respect prison walls.’

Improving TB control in prisons benefits the community at large. Community TB control efforts cannot afford to ignore prison TB.

“Prisoners have the right to at least the same level of medical care as that of the general community. Catching TB is not part of a prisoner’s sentence” says another WHO Document on TB and prisons.

We don’t need to reinvent the wheel. WHO publications outline some recommendations to fight TB in prisons:

    * The priority strategy must be the widespread implementation of the DOTS package in the incarcerated population. Every prisoner should have unrestricted access to the correct diagnosis and treatment of TB.
    * Delays in the detection and treatment of TB cases must be minimised to reduce further transmission of infection and pressures to self-treat TB.
    * Unregulated, erratic treatment of TB in prisons should cease.
    * Urgent action is needed to integrate prison and civilian TB services to ensure treatment completion for prisoners released during treatment.
    * Measures to reduce overcrowding and to improve living conditions for all prisoners should be implemented to reduce transmission of TB.
    * Where MDR-TB is established and a functional DOTS programme is in place and accessible to all prisoners, a DOTS-Plus pilot programme should be considered.

Bobby Ramakant-CNS