We need to act now on HIV, says Netherlands ambassador

Ishdeep Kohli, CNS (Citizen News Service)

I interviewed Paul Bekkers, the HIV and AIDS Ambassador of the Netherlands, during the first Asian Consultation on the Prevention of HIV Related to Drug Use on 29 January 2008. Bekkers is also the Director of the Netherlands Social and Institutional Development Department under the Ministry of Foreign Affairs and has served the ministry for more than 15 years. He was named Ambassador for HIV and AIDS in 2005.

Forum on Women’s Health and Rights Opens

Forum on Women’s Health and Rights Opens With Claim on Economic Stimulus Funds:

More than 400 delegates to the Global Partners in Action: Non‐Governmental Forum on Sexual and Reproductive Health and Development began three days of meetings at the Estrel Conference Center to evaluate 15 years of work on those issues since the International Conference on Population and Development (ICPD) issued its landmark Programme of Action in Cairo.

“An additional dollar invested in voluntary family planning comes back at least four times in saved expenses,” said Thoraya Ahmed Obaid, executive director of UNFPA, the United Nations Population Fund, which is co‐sponsoring the Forum with the German government. “It would cost the world only US$23 billion per year to stop women from having unintended pregnancies and dying in childbirth, and to save millions of newborns—less than 10 days of the world’s military spending.”

Gill Greer, Director‐General of the International Planned Parenthood Federation, called on conference participants to demand renewed action from their governments. “By insisting that governments keep their promises of 15 years ago, and by showing that sexual and reproductive health is a cost‐effective long‐term investment, we are playing an essential role in this process,” she said.

“The challenges today are perhaps greater than those of 1994,” said Greer. “These include a world financial crisis, climate change, the HIV/AIDS pandemic, increasing conservatism and fragmented health systems.” A woman dies every minute from complications of pregnancy and childbirth—more than half a million deaths per year—and another 10 million suffer injury or disability.

Greer noted that more than 200 million women now want but have no access to modern methods of family planning while demand for contraception and condoms is expected to increase 40 percent by 2050, in part because of HIV/AIDS.
Read source article...

Ishdeep Kohli-CNS

Sex, rights, and politics—from Cairo to Berlin

Sex happens: 125 million times each and every day. So how is it that in the 21st century this precious element of human existence is still taboo? We are used to seeing sexualised images, yet the reality of sex and reproduction seems as secret as ever. In the political and religious skirmish over sex and morality, we often lose sight of the critical contribution that a realistic approach to sexual and reproductive health makes to our lives. Read source article...

Ishdeep Kohli-CNS

TEMPLES OF LEARNING OR OF RELIGIOUS BIGOTRY

Temples of learning or of religious bigotry

Shobha Shukla

It has become fashionable and customary for our political parties fanatics to give a religious colour to one and everything and revel in creating communal disharmony for narrow partisan gains. It is so easy to whip up sentiments of hatred in the name of religion and so very difficult to douse the fire of fanatic violence.

This is what seems to have happened at St. Xavier’s School ( one of the oldest and most reputed school of Jaipur), whose principal Father Jose Jacob rightly suspended seven students of class XII for misconduct and indisciplined behaviour. These students were reportedly caught offering a mock puja to a poster of Lord Ganesha in their classroom, on the occasion of Ganesha Chaturthi, with the entire class joining in the revelry, shouting and laughing. They thus undermined the sanctity of their own religious festival by treating a sacred ceremony in a derogatory manner. It amounted to disrespecting Lord Ganesha, who is venerated by all as Vighna Harta—solver of all problems.

But the blue eyed activists of Bhartiya Janata Yuva Morcha (BJYM) thought otherwise. They ransacked the school premises and accused the principal of hurting the religious sentiments of the Hindus. The city president of BJYM was naïve enough to demand the arrest of the principal.

It is common knowledge that our schools and universities have become dens of antisocial activities where learning has taken a backseat. Our political parties and dubious religious outfits are abetting the moral degeneration of the country’s youth.

It is high time for all right minded people to help teach our children some discipline and the real meaning of being religious. They need to learn to respect authority and not cock a snook at them .s Classrooms should be treated with respect and venerated as temples of learning and not vandalized at one’s free will. Students should not be applauded for taking the law in their hands. The parent of one of the students indirectly admitted to the wrong doing of his ward. He thought that instead of suspending the students, the principal should have taken a milder action.

If the behaviour of the BJYM activists is condoned it would send wrong signals to honest and upright principals of schools who are struggling to keep their schools free from the vitiated atmosphere of insolent and wayward behaviour, so rampant amongst our youth today. Communal frenzy needs to be stopped immediately, irrespective of the caste and the creed of perpetrator and the victim.

Shobha Shukla

The author teaches Physics at India's Loreto Convent and has been writing in English and Hindi newspapers since past 30 years. She serves as Editor of Citizen News Service (CNS).

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TEACHERS' DAY: THE SACRIFICIAL GOAT

Teachers' Day: The Sacrificial Goat
Shobha Shukla

Once again the nation will gather dutifully this year on the 5th of September to pay tribute to the hard work put by the teachers all year long. Once again teachers will be exhorted to show exemplary competence, dedicated hard work and unwavering commitment in their onerous task of nation building.

Indian tradition compares a teacher to God. So like any other god she is installed on a pedestal and then best forgotten. Hers is a life meant only for selfless service to others. A good teacher should be able to stand high above her students and yet be on their level; she should be able to do 101 things other than teach her subject well; she needs to be tough and soft at the same time.

And God forbid if she expects anything in return---not even the respect/goodwill of the students( as the guru-shishya parampara has given way to the student being her paymaster), not even a modestly comfortable life style ( as that is not for godly beings like her).
The Kothari Commission had long recognized that there is nothing more important for a healthy educational system than having a sufficient number of highly qualified and motivated teachers. Yet education has remained the most neglected of subjects by central and state governments alike. Gone are the days when teachers commanded respect in society.

Teaching has now become a much denigrated profession with slow upward mobility and poor financial rewards. This has resulted in a dearth of quality teachers at all levels (especially at the middle school level in the science/maths streams.. A recent survey has revealed that less than 10% of the teaching work force is there for the sheer love of it. Even premier institutes like the IITs and IIMs are facing serious faculty crunch, what to talk of the primary and secondary education level schools. The condition of private school teachers ( including those of Christian missionary schools) is even more pathetic. These schools are like ‘education shops’. The teachers here have no access to government scales/facilities (which have improved recently, albeit marginally).

They are supposed to survive on salaries worse than that of an unskilled labourer and yet mould the character of their pupils with uncanny precision. They do not enjoy any medical/ pension benefits. The Pay Commission bonanzas are not for them. So teaching has become the last refuge of the incompetent. Talented youngsters are distancing themselves from this noble profession. They would rather join a call centre job given a choice.

All this does not auger well for a country which is poised to become a knowledge economy. It is the teachers who are to be credited with the academic progress which India has made and it is high time they get due recognition for their valuable services. I agree that there are a few black sheep/wolves( like politicians/businessmen owners of private institutes) who have made education a ‘sweat shop’ commodity. But by far and large, we teachers have only sacrificial goats in our fold.

In this age of money, economy and private enterprise , it is foolish to expect that teachers alone should rise above the spirits of time. Let there be sincere efforts to improve their dismal social status, frustrated hopes, poor salaries and deplorable working conditions, before expecting them to fulfil their noble duties. Till then, they will have to remain happy with the cards/ flowers/ prayer services and, perhaps, a lunch offered to them by children/ school authorities on this day.

A Very Happy Teachers’Day to all of us teachers.

( incidentally, Christian missionary schools have been directed not to celebrate Teachers' Day this year, in protest against the violence in Orissa against their community).

Shobha Shukla

The author teaches Physics at India's Loreto Convent and has been writing in English and Hindi newspapers since past 30 years. She serves as Editor of Citizen News Service (CNS).

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News Blaze, USA
Media for freedom, Kathmandu, Nepal
Pakistan Post, Karachi, Pakistan
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Assam Times, Guwahati, Assam

Central Chronicle, Madhya Pradesh/ Chhattisgarh

The Seoul Times, Seoul, South Korea
Khabar Express, Bikaner, Rajasthan
Bihar Times, Patna, Bihar

Oxfam ups the response to Bihar floods

Oxfam ups the response to Bihar floods

Amit Dwivedi

Senior Rashtriya Janta Dal (RJD) leader and Union Minister of State for Water Resources Jaiprakash Narayan Yadav accused the Bihar government of massive flood in the state by being "totally negligent" in taking preventive measures.

According to a media briefing on 3 Septemer 2008, Yadav alleged that Bihar State Water Resources Department, till August 17, kept on giving reports from the flood control cell that all the embankments under its jurisdiction were safe. However, when a breach in the east Kosi embankment at Kusaha in Nepal occurred on August 18, Yadav said, the Bihar Government came up with a report that erosions were taking place at the Kosi dam in Upper Nepal on Bahothan embankment for the past several days.

"This is how the government played with its own report to steer clear of its responsibility. This is not a hearsay disclosure but facts based on documents," Yadav said showing the copies of the Bihar Government reports to the reporters.

Regardless of who-so-ever may get the blame, the severity with which one of the worst floods in Bihar has devastated the lives of millions of people, will not diminish. Enormous rehabilitation and relief work, needs to be done. Many civil society organizations are rushing in to contribute towards the relief and rehabilitation work. One of them is Oxfam India. Oxfam has been working in India since the 1952 famine in Bihar and also undertakes long-term development work.

Oxfam India issued an appeal on Monday (1 September 2008) for funds to support its rescue and relief work in flood-hit Bihar. The money will be spent on delivering emergency shelter, food, hygiene items, clean drinking water and safe sanitation.

Oxfam and its local partner organisations have been rescuing people and responding to the crisis since August 18, when waters rushed into six eastern districts of Bihar from a 3 Km breach in River Kosi on the Nepal-India border. The worsening floods, with more rains predicted by the meteorological department, have already affected over 30 lakh people in 16 north-eastern districts of Bihar. The Prime Minister has declared the floods a national catastrophe.

Oxfam is using its motorboats to rescue stranded men, women and children from Supaul, the worst affected district. Contingency stocks of tarpaulin shelter sheets, water purification kits, buckets and Oral Rehydration Sachets (ORS), kept in readiness in flood prone districts, have also been moved to provide preliminary support to the affected. Staffers from Oxfam and two local organisations, Bihar Sewa Samiti and Abhigyan Disha, as well as trained volunteers, are working round the clock in Supaul.

"Oxfam is preparing to reach out, to being with atleast 20,000 families in Basantpur and Pratapganj, two of the worst affected blocks of Supaul," said Nisha Agrawal, CEO, Oxfam India. "We are scaling up our response on temporary shelter, food, water and sanitation. Women and children are particularly facing the brunt in cramped camps or are exposed to heat and the rains under the open sky. Pregnant and lactating mothers are not getting safe water and are forced to defecate in floodwaters. The need for hygiene and sanitation is imminent to prevent the spread of any water-borne epidemic."

Oxfam rapid assessment team toured the worst affected areas in the first few days and has recommended shelter, food and public health as the key needs. Oxfam is also coordinating from the start with other aid agencies and the government through the state-level Inter-Agency Coordination Group to ensure there is no duplication in response and that relief reaches all the needy people.

The public can donate to Oxfam by calling in on +91 11 46538000 or by sending a check in the name of Oxfam Trust, addressed to Oxfam India, Plot Number 1, 2nd Floor(above Sujan Mohinder Hospital), New Friends Colony, New Delhi - 110065 (www.oxfam.org).

A donation of Rs 2000 would give a shelter kit for a family; Rs 850 would give a hygiene kit for 5 families; and Rs 1000 would give a safe latrine to 2 families.

The hope that efforts of organizations like Oxfam will help the most affected communities, lives on.

Amit Dwivedi

(The author is a Special Correspondent to Citizen News Service (CNS) and can be contacted at: amit@citizen-news.org, website: www.citizen-news.org).

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Bihar Times, Patna, Bihar

Scoop Independent News, New Zealand

Media for Freedom, Kathmandu, Nepal

Assam Times, Guwahati, Assam

Thai Indian News, Bangkok, Thailand

My News, Delhi

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Bihar and Jharkhand News Service (BJNS)
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News Blaze, USA
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Central Chronicle, Madhya Pradesh/ Chhattisgarh

Oxfam India issues appeal; scales up response to Bihar floods

Oxfam India issues appeal:

Scales up response to Bihar floods

Oxfam India issued an appeal on Monday (1 September 2008) for funds to support its rescue and relief work in flood-hit Bihar. The money will be spent on delivering emergency shelter, food, hygiene items, clean drinking water and safe sanitation.

Oxfam and its local partner organisations have been rescuing people and responding to the crisis since August 18, when waters rushed into six eastern districts of Bihar from a 3 Km breach in River Kosi on the Nepal-India border. The worsening floods, with more rains predicted by the meteorological department, have already affected over 30 lakh people in 16 north-eastern districts of Bihar. The Prime Minister has declared the floods a national catastrophe.

Oxfam is using its motorboats to rescue stranded men, women and children from Supaul, the worst affected district. Contingency stocks of tarpaulin shelter sheets, water purification kits, buckets and Oral Rehydration Sachets (ORS), kept in readiness in flood prone districts, have also been moved to provide preliminary support to the affected. Staffers from Oxfam and two local organisations, Bihar Sewa Samiti and Abhigyan Disha, as well as trained volunteers, are working round the clock in Supaul.

“Oxfam is preparing to reach out, to being with atleast 20,000 families in Basantpur and Pratapganj, two of the worst affected blocks of Supaul,” said Nisha Agrawal, CEO, Oxfam India. “We are scaling up our response on temporary shelter, food, water and sanitation. Women and children are particularly facing the brunt in cramped camps or are exposed to heat and the rains under the open sky. Pregnant and lactating mothers are not getting safe water and are forced to defecate in floodwaters. The need for hygiene and sanitation is imminent to prevent the spread of any water-borne epidemic.”

Oxfam rapid assessment team toured the worst affected areas in the first few days and has recommended shelter, food and public health as the key needs. Oxfam is also coordinating from the start with other aid agencies and the government through the state-level Inter-Agency Coordination Group to ensure there is no duplication in response and that relief reaches all the needy people.

The public can donate to Oxfam by calling in on +91 11 46538000 or by sending a check in the name of Oxfam Trust, addressed to Oxfam India, Plot Number 1, 2nd Floor(above Sujan Mohinder Hospital), New Friends Colony, New Delhi – 110065 (www.oxfam.org).

A donation of Rs 2000 would give a shelter kit for a family; Rs 850 would give a hygiene kit for 5 families; and Rs 1000 would give a safe latrine to 2 families.

For further information and to make a donation please contact:
Pamela Srivastava( for donations) : 0091-11-465380000(extension 118)
Aditi Kapoor (for media enquiries): 0091-11-465380000, 9810306200 or aditi@oxfamindia.org; akapoor@oxfam.org.uk

Notes to editors:
Oxfam India is an Indian organisation with an Indian Board and is part of the larger Oxfam International family (www.oxfam.org). Oxfam has been working in India since the 1952 famine in Bihar and also undertakes long-term development work. Oxfam believes in equality and justice for all and works by empowering communities to fight for their rights.

Sex Trafficked Girls at High Risk of HIV Infection

Women and girls trafficked into the sex industry in Southeast Asia are at greater risk of contracting sexually transmitted infections (STIs) including HIV than other groups of female sex workers. Titled “Sex Trafficking and STI/HIV in Southeast Asia: Connections between Sexual Exploitation, Violence and Sexual risk”, a new independent regional research study by the Harvard School of Public Health and UNDP, was released at the International Congress on AIDS in Asia and the Pacific, in Bali, Indonesia.

The study reveals the extent of sexual exploitation, physical, sexual and psychological violence experienced by trafficked women and girls. Trafficking victims, many of them under 17 years of age, are raped, locked up, denied food, water and medical care and/or forced to take narcotics and alcohol. Girls who are trafficked into sex work suffer different levels of sexual risk as compared with non-trafficked sex workers, and are less likely to be reached by HIV prevention programmes. The report includes studies covering Thailand, Cambodia and Indonesia.

In Thailand, trafficked Female Sex Workers (FSWs) reported higher number of male clients and greater incidence of anal sex encounters that increased their risk to HIV infection. Women who reported having been trafficked were far less knowledgeable regarding HIV transmission. Trafficked women were three times as likely to experience violence at initiation to sex work as compared to non-trafficked women and girls, as well as being more likely to report recent violence or mistreatment in the context of sex work.

The prevalence of HIV among those trafficked within Indonesia was found to be 5.4%. 1 in 7 trafficking survivors tested for at least one of 4 sexually transmitted infections, including HIV, were infected. 75% of trafficked women and girls experienced sexual violence. Conditions and treatment were oppressive and most survivors were denied all movement, many were forced to use drugs or alcohol. Notably a substantial number experienced trafficking for sexual exploitation at very young ages, with approximately one quarter of survivors trafficked under 15 years of age. Malaysia being the destination for the majority of those trafficked across national borders.

In Cambodia, 73 percent of women and girls who were rescued tested positive for sexually transmitted infections. That number increased to 90 percent among those rescued after less than two months, indicating tremendous exposure to STIs during initiation into sex work. The majority of female sex trafficking survivors identified were under the age of 17 at the time of trafficking. Sexual violence was prevalent, with 1 in 4 reporting forced sex acts in the context of trafficking and sex work.

The study demonstrates that denial of the most basic elements of human dignity, health and wellbeing are associated with the trafficking of women and girls for sexual exploitation. According to Jeff O’ Malley, Director, HIV/AIDS Practice, UNDP, New York, “It calls for a rights-based approach rather than an inappropriate law enforcement approach, which can result in victimising trafficked women, driving sex work underground, and making it even more difficult to reach sex workers and trafficked women to protect their rights and health.”

Mr. Hakan Bjorkman, Country Director, UNDP, Indonesia, said, “Women in the sex industry are already highly at risk of HIV. But women who are sex trafficked experience even more extreme levels of HIV risk, abuse and violence. This screams out for action.”

There is an urgency of creating a space for dialogue across partners, Caitlin Wiesen, Regional HIV/AIDS Team Leader and Programme Coordinator for Asia-Pacific at UNDP Regional Centre in Colombo said, “Partnerships across these communities, that engage Ministries of Justice, Health, Interior, are indispensable to preventing HIV and protecting the rights and health of women who have been trafficked as well as the rights of women in sex work.”

The study calls for an integrated approach to prevent trafficking and HIV in the context of sex work. Dr. Jay Silverman, Director of Violence Against Women Prevention Research at the Harvard School of Public Health and lead author of the study, said “This work further confirms the high risks for HIV infection faced by those coerced or forced into sex work. To confront this reality, anti-trafficking and HIV prevention professionals must work together to develop programs that can both reduce HIV risk among all those involved in sex work and assist women and girls trapped in these settings.”

Ishdeep Kohli-CNS

Pictorial warnings on tobacco products in India from 30 November

Pictorial warnings on tobacco products in India from 30 November

All tobacco products will display approved pictorial warnings from 30 November 2008, as per a notification issued by the Indian Ministry of Health and Family Welfare (dated 27 August 2008), in accordance with the Cigarettes and Other Tobacco Products (Prohibition of advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003.

Grim images of diseased lungs will appear on cigarette, bidi and gutkha packets, as per the notification, covering 40 per cent of the surface area of the tobacco packets, with the message: 'Tobacco kills/Smoking kills'.

The warnings were finally approved by a Group of Ministers (GoM), including the Union External Affairs Minister - Pranab Mukherjee, the Union Information and Broadcasting Minister - PR Dasmunsi, the Minister of State for Labour and Employment - Oscar Fernandes the Union Minister for Commerce and Industry -Kamal Nath, Union Minister for Culture and Urban Development -Jaipal Reddy and Union Health and Family Welfare Minister Anbumani Ramadoss.

Now, the tobacco industry has been given three months time to put up the pictorial warnings

The implementation of pictorial warnings on tobacco products in India was initially planned for February 2007, but got deferred four times thereon.

The GoM formed in 2007 by the Government of India was tasked to review the pictorial warnings on tobacco products. This GoM decided earlier this year (February 2008) to go for mild pictorial warnings on tobacco products. This GoM declined to accept the pictorial warnings (skull and bones) on tobacco products that surveys conducted in India had shown to work towards tobacco control, rather picked up weaker warnings. The GOM in an earlier meeting this year headed by India's External Affairs Minister Mr Pranab Mukherjee had agreed for two mild images of a scorpion signal depicting cancer or an x-ray plate of a man suffering from lung cancer as pictorial warning to deter people from smoking.

Not only this is in compliance with the Cigarettes and other Tobacco Products Act, 2003, but also with the provisions of the global tobacco treaty. On 5 February 2004, India had signed and ratified World's first corporate accountability and public health treaty - the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). Article 11 of the FCTC states that warning messages should cover at least 50% of the principal display areas of the package (i.e. both the front and back), but at a minimum must cover at least 30% of the principal display areas. In India, these warnings will cover 40% of the principal display area of tobacco packets.

Several nations have implemented strong health warning label requirements. Examples include:
- Canada, whose health minister recently proposed enlarging the labels from 30% of the package face to 60%;
- Thailand, which has added the message "SMOKING CAUSES IMPOTENCE" to its list of required warnings; and
- Australia, which was the first nation to require that "how to quit" information be printed on every pack.
- South Africa, Singapore and Poland also require strong warning labels.

These pictorial warnings provide smokers with helpful information on the health effects. Most smokers want this information, and certainly want their children to have this information too. The tobacco industry is continuing its decades-long strategy of trying to minimize the effectiveness of package warnings. The tobacco industry is no friend of smokers - and ironically it's true that 'the tobacco industry kills its best customers'. The Indian Council of Medical Research (ICMR) says tobacco use causes 10 lakh deaths (a million) in India every year.

Also package warnings on tobacco products are a good public health strategy because the cost of package warnings is paid for by tobacco companies, not government. Also this should not be looked upon as an isolated initiative rather has to be supported by comprehensive healthcare, legislations and education programmes to attain long-run public health gains. Hopefully this time, these pictorial warnings will get enforced from November 30, and not deferred any further.

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Bihar and Jharkhand News Service, Bihar and Jharkhand
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Pakistan Post, Karachi, Pakistan

Women in Asia Risk HIV Transmission from their Intimate Partners

The evidence from almost all the countries in Asia indicates that women are acquiring HIV not because of their own sexual behaviours but because of the unsafe behaviours that their partners engage in. The intimate partners of men who have sex with men, injecting drug users or clients of sex workers constitute the largest vulnerable population in Asia. The report ‘HIV Transmission in Intimate Partner Relationships in Asia’, by UNAIDS, its Cosponsors and civil society partners, released at the 9th International Congress on AIDS in Asia and the Pacific in Bali, examines the issue of married or in long-term relationships women who are at risk of HIV infection due to their partners’ high-risk behaviours.

It is estimated that more than 90% of the 1.7 million living with HIV in the Asia became infected from their husbands and partners while in long-term relationships. These women are often percieved as ‘low risk’. At least 75 million men regularly buy sex from sex workers in Asia, and a further 20 million men have sex with other men or are injecting drug users. Many of these men are in steady relationships. As noted by the Report of the Commission on AID in Asia (2008), about 50 million women in Asia are at risk of infection from their partners who engage in risky sexual behaviours.

Dr Prasada Rao, Director, UNAIDS Regional Support Team Asia and the Pacific stressed, “HIV prevention programmes targetting the female partners of men with high-risk behaviours have yet to be developed in Asia, but are clearly essential”. It must be ensured that the health care infrastructure that many countries have built to take care of the reproductive health needs of women also provide information on sexual health and rights and render services to protect women from getting infected with HIV. The report calls for strong horizontal integration of reproductive health services and AIDS programmes at the grass roots level.

The report discusses the myriad issues that are at the root of the problem. The strong patriarchal culture in the countries of Asia, intimate partner violence, including sexual violence, delayed partner notification, disabling socio-cultural and gender norms, the large-scale migration and mobility of populations in Asia and HIV-related stigma and discrimination all play a role in the vulnerability of women to HIV.

Research from several Asian countries indicates that between 15% and 65% of women experience physical and/or sexual violence in intimate partner relationships, placing them at increased risk of HIV infection. According to studies in Bangladesh, India and Nepal, women exposed to intimate partner violence from husbands infected with HIV through unprotected sex with multiple partners were seven times more likely to acquire HIV compared to women not exposed to violence and whose husband did not have sex with multiple partners.

The strong patriarchal culture in Asian countries severely limits a woman’s ability to negotiate sex in intimate partner relationships, according to the report. While there is a societal toleration of extramarital sex and multiple partners for men, women are generally expected to refrain sex until marriage and remain monogamous thereafter.

“Discrimination and violence against women and girls, endemic to our social fabric, are both the cause and consequence of AIDS,” said Dr Jean D’Cunha, Regional Director, UNIFEM South Asia. “Striking at the root of gender inequalities and striving to transform male behaviors are key to effectively addressing the pandemic.”

To prevent HIV transmission among intimate partner relationships, the report outlines four key recommendations:

1. HIV prevention interventions must be scaled-up for men who have sex with men, injecting drug users, and clients of female sex workers and should emphasize the importance of protecting their regular female partners.

2. Structural interventions should be initiated to address the needs of vulnerable women and their male sexual partners. This includes expanding reproductive health programs to include services for male sexual health.

3. HIV prevention interventions among mobile populations and migrants must be scaled-up and include components to protect intimate partners.

4. Operational research must be conducted to obtain a better understanding of the dynamics of HIV transmission among intimate partners.

The report has been inspired by the ground breaking recommendations of the Commission on AIDS in Asia and developed through an extensive collaborative process between UNAIDS and it’s cosponsors UNDP, UNIFEM, UNFPA, WHO, WAPN+ and ICW.

Critical policy and programme action are urgently needed at scale to reduce intimate partner transmission. The challenge of addressing the vulnerability of the 50 million women at risk of intimate partner transmission of HIV calls for bold collective action. It calls for working with communities, joining the tremendous power of the women movements, need to rethink gender norms and engaging men in the response.

Ishdeep Kohli-CNS

Integrating Nutrition and Food Security into HIV Care Support and Treatment

Nutrition and food security are an integral part of the overall response to HIV at all levels. It is vital to address food security and nutrition in all settings to achieve the goal of universal access to HIV prevention, treatment, care and support by 2010, to which all Member States of the United Nations have committed themselves.

At a 9th ICAAP session, ‘Integrating Nutrition and Food Security into HIV Care Support and Treatment: Opportunities and Challenges’, Dr Martin W Bloem, Chief, Nutrition and HIV/AIDS Policy World Food Programme (WFP) discussed that, “Governments need to ensure the integration of food and nutritional support as part of the comprehensive care, support and treatment package for all people living with HIV ( PLHIV)”. Professor Praphan Phanuphak at the Thai-Australian Collaboration in HIV Nutrition (TACHIN) project, highlighted the impact of HIV on nutrition and food security in the Asia-Pacific region, he stated that “HIV affects metabolism and increases the need for nutrients and energy, good nutrition is of paramount importance for those with HIV, nutrition care should be a component of holistic care approach for PLHIV”. Nutrition and Food security form an integral part of Universal Access.

Food security refers to people's ability to access food, either by growing their own or buying food. HIV and AIDS have a significant impact on food security as HIV increases people's need to sell assets in return for food and medication. “Hunger can lead women to sell or exchange sex”, remarked Dr Angela Kelly, team leader Papua New Guinea Institute of Medical Research discussing the ‘Art of Living’ programme in PNG. Lack of food security constrains people’s choices about work and education, and child feeding and rearing, and can lead to increased mobility for work. Mobility and limited options for earning an income in turn can lead to high-risk behaviours such as engaging in sex for food or money.

Good nutrition plays an important role in maintaining the health of people living with HIV. Adequate nutrition is essential to maintain a person’s immune system, to sustain healthy levels of physical activity, and for quality of life. Adequate nutrition is also necessary for optimal benefits from antiretroviral therapy. Ms Kaniz Fatima, project officer WFP Bangladesh, “Large proportion of PLHIV are from the Most at Risk Populations (MARP), who also experience chronic malnutrition”. HIV impairs nutritional status by undermining the immune system, as well as nutrient intake, absorption and use. Malnutrition can exacerbate the effects of HIV and hasten AIDS-related illnesses in people living with HIV. Adults living with HIV have 10−30% higher energy requirements than a healthy adult without HIV, and children living with HIV 50−100% higher than normal requirements. Food availability and good nutrition are thus essential for keeping people living with HIV healthy for longer. A stronger, healthier body can better resist the opportunistic infections that affect people living with HIV.

Adequate dietary intake and absorption are essential for achieving the full benefits of antiretroviral therapy, and there is emerging evidence that patients who begin therapy without adequate nutrition have lower survival rates. Antiretroviral therapy itself may increase appetite and it is possible to reduce some side-effects and promote adherence if some of the medicines are taken with food.

Women are biologically, socially and economically more vulnerable than men to HIV. People without access to adequate food, income and land, especially women and girls, are more likely to be forced into situations that place them at risk of HIV infection such as mobility for work, transactional or commercial sex, or staying in abusive sexual relationships due to economic dependency. Women are usually involved in producing, purchasing and preparing food. Women are also primary caregivers. Most HIV positive children contract the virus from their mother during pregnancy, delivery or breastfeeding. Inadequate nutritional status may increase the risk of vertical HIV transmission. HIV positive mothers need access to appropriate information and replacement feeding options, in order to minimize the risk of transmission during breastfeeding.

Nutrition education and dietary counseling are currently underfunded; there is a current need for evidence to convince funding agencies like GFTAM and PEPFAR, that nutrition intervention can make a significant difference. It is important that issues of nutrition and food security are not trivialized and addressed immediately.

Nutrition should become an integral part of the countries response to HIV. It is recommended to strengthen the political commitment to nutrition and HIV within the national and global health agenda by reinforcing nutrition components in HIV policies and programmes. UNAIDS, WHO, WFP, FAO, World Bank, UNDP, GFTAM, PEPFAR, all these agencies need to collaborate and come up with an integrated Nutrition Food Security and HIV policy and programme applicable for all stages of HIV care support and treatment.

Ishdeep Kohli-CNS

ATS resorts to terror tactics

ATS resorts to terror tactics
Dr Sandeep Pandey

Rajasthan Police accompanied by Anti-Terrorist Squad (ATS) of Uttar Pradesh (UP) Police raided the house of Shahbaz Hussain, arrested in connection with blasts in Jaipur and now on Police remand there, in Molviganj, Lucknow for search past midnight on 29 August 2008 and house and office today, 30 August 2008, in the afternoon.

Shahbaz used to stay at his father-in-law Abdul Moid's house along with his wife and three little children. The police took away all literature present in the house including newspapers, a cheque for Rs 15,000 in the name of 'Zyna Computers' given by one the students and Rs 1000 cash from the purse of Shahbaz's wife Shadaf. Shahbaz used to run a computer training centre and a consultancy.

Today they took away a battery from the house and made Abdul Moid (father-in-law) sign on three blank papers. Upon receiving this information from Abdul Moid's son some of us rushed to the shop where the search was going on.

When we enquired from the Deputy Superintendent of Police (Dy SP) Sangram Singh, who had come for conducting the search operations from Rajasthan, about the purpose of getting Abdul Moid's signature on blank papers, he said they were going to draw the map of house and office on them. He didn't explain what the third paper will be used for. When we requested him to give a copy of what is written or drawn on these sheets of paper to Abdul Moid he told us to come to the ATS office after a couple of hours.

When Abdul Moid and myself reached ATS office, the officer from Rajasthan was gone. We insisted that we would like to speak to the officer in-charge. When we communicated the purpose of our being there to this officer, who came out to see us at the reception, he particularly got mad at the charge Rs 1000 being taken away from Abdul Moid's house. He raised his voice and said we were accusing him of theft. I suggested him not to raise his voice. He could have simply denied the charge. On this he ordered his men to throw us out of the office. I protested and said that he cannot take somebody's signature on blank piece of paper.

After this we were abused and pushed out of the premises of ATS office by his men. The ATS and Rajasthan Police are obviously busy concocting evidence and using their unlimited powers arrogantly. Whether Shahbaz was involved in the Jaipur blasts or not will be decided by the investigation and the judicial process but the high handed behaviour of police and ATS makes one suspect of how they implicate people.

Dr Sandeep Pandey

(The author is a Ramon Magsaysay Awardee (2002) for emergent leadership, heads the National Alliance of People's Movements (NAPM) and did his PhD from University of California, Berkeley in control theory which is applicable in missile technology. He taught at Indian Institute of Technology (IIT) Kanpur before devoting his life to strengthening people's movements. He can be contacted at: ashaashram@yahoo.com)

Contact Phone of Dr Sandeep Pandey: 0522 2347365, Mobile : 9415022772
Contact of Abdul Moid: 9792439090

Published in Tehelka

Universal Access – Challenges in the Asia Pacific Region

JVR Prasada Rao, Director of the UNAIDS Regional Support Team of the Asia and Pacific region, reiterated that “Universal Access is an achievable goal, and not just an aspirational goal”, all people should be able to access the services to live with health and dignity. Chairing the session on ‘Universal Access: What it takes to deliver in the Asia-Pacific Region’, Mr Rao stressed that countries in Asia need to think big and with confidence. Referring to the findings of the report ‘Redefining AIDS in Asia -- Crafting an Effective Response ‘, published by the Commission on AIDS in Asia, he stated that by pragmatically focusing prevention programmes on key populations – commercial sex workers and their clients, intravenous drug users (IDUs) and men having sex with other men (MSM), a considerable impact could be made by governments in halting and reversing the number of new infections across the Asia Pacific region.

At the UN high level meeting on AIDS in June 2006, the world committed itself to Universal Access to HIV prevention, treatment, care and support for all people in need by 2010. Following this, most countries organized consultations with key stakeholders, including civil society organizations, networks of people living with HIV, to agree on national universal access targets and on ways for overcoming the obstacles in achieving them. Since then, the commitment to universal access has galvanized AIDS responses around the world and reinforced the engagement to stand by those infected and affected by HIV. Specifically in the Asia-Pacific region, it is critical to make a breakthrough in prevention coverage among most at risk populations. In order to achieve this, countries will need to tackle legislative barriers and actively work with civil society organizations and people living with HIV to create an enabling environment and reach marginalized groups.

Michel Kazatchkine, Executive Director of the Global Fund for AIDS, TB and Malaria (GFATM), discussed the challenges to achieve Universal Access in the Asia Pacific. In the current scenario of global economic recession, resources are constrained even in the Asia Pacific region. But it is crucial that investment in the fight against HIV/AIDS continues. There is no excuse to decrease health spending, it is critical that gains made in the last eight years especially the progress made in scaling up prevention and treatment are not lost. Advocacy efforts are required at the national and global levels to continue the momentum and resource allocations for health. The Global Fund is currently providing support to 75 percent of those being treated for HIV in Asia. Asian economies even in this period of crisis are showing growth, and there is need for co-investment from multilateral organizations and the private sector.

Interventions have to be prioritized to reach high target groups, also protecting their human rights. More proposals that are dealing with vulnerable communities, IDU’s, MSM, Sex-workers needed to achieve Universal Access targets. Legal reforms are necessary in the region that truly protect PLHIV and work towards removing legislations that blocks universal access by criminalizing the lifestyles of vulnerable groups. Civil society partnerships are essential; communities need to be at the core of policy making, planning and programme delivery. It is vital that civil society organizations have support and funds.

HIV and TB co-infection and drug-resistant forms of tuberculosis present the greatest health challenges in the Asia Pacific. TB kills more people with HIV than any other disease. There is a growing emergence of Multidrug-resistance TB (MDR-TB) in this region; 10 of the 22 highest burden countries are in this region, and only a few cases are getting appropriate treatment. Need for urgent and aggressive scale up for effective interventions for the prevention, treatment and care of TB and MDR-TB in the Asia Pacific. Failure of Asian nations to combat MDR is a threat to global health.

One of the most significant barriers to achieving universal access to HIV-AIDS treatment and prevention is the lack of health infrastructure. In order to achieve universal access to comprehensive HIV prevention, treatment, care and support services; drastically cut maternal and child mortality; and achieve the other health-related Millennium Development Goals by 2010, strong health systems are essential. To strengthen and build sustainable health systems, long term commitments are required from all stakeholders in the Asia Pacific region. Ratu Joni Madraiwiwi, member of the Solomon Island Truth and Reconciliation Commission, believes that “to achieve universal access we must be rid of prejudice, engage civil society more, be culturally sensitive and have political commitment”.

Purnima Mane, Deputy Executive Director of the United Nations Populations Fund (UNFPA) stressed that the report of the independent Commission on AIDS in Asia published earlier this year found that it is vital that national responses are evidence-based and bring services to where it is most needed. Interventions are needed in marginalized groups – these include men who have sex with men, people who inject drugs, sex workers and their clients. Access to Sexual and Reproductive health services and information needs to be provided to youth and women living with HIV. Stating the slogan ‘Nothing About Us Without Us’, it is imperative that civil society be involved at each and every process in policy making and delivery on national programmes.

Ishdeep Kohli-CNS

Inequities are killing people on a "grand scale", reports WHO's Commission

Inequities are killing people
on a "grand scale"
reports WHO's Commission
World Health Organization (WHO)
28 August 2008

Press release

[To download the report, click here]

GENEVA -- A child born in a Glasgow, Scotland suburb can expect a life 28 years shorter than another living only 13 kilometres away. A girl in Lesotho is likely to live 42 years less than another in Japan. In Sweden, the risk of a woman dying during pregnancy and childbirth is 1 in 17 400; in Afghanistan, the odds are 1 in 8. Biology does not explain any of this. Instead, the differences between - and within - countries result from the social environment where people are born, live, grow, work and age.

These "social determinants of health" have been the focus of a three-year investigation by an eminent group of policy makers, academics, former heads of state and former ministers of health. Together, they comprise the World Health Organization's Commission on the Social Determinants of Health. Today, the Commission presents its findings to the WHO Director-General Dr Margaret Chan.

"(The) toxic combination of bad policies, economics, and politics is, in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible," the Commissioners write in Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. "Social injustice is killing people on a grand scale."

"Health inequity really is a matter of life and death," said Dr Chan today while welcoming the Report and congratulating the Commission. "But health systems will not naturally gravitate towards equity. Unprecedented leadership is needed that compels all actors, including those beyond the health sector, to examine their impact on health. Primary health care, which integrates health in all of government's policies, is the best framework for doing so."

Sir Michael Marmot, Commission Chair said: "Central to the Commission's recommendations is creating the conditions for people to be empowered, to have freedom to lead flourishing lives. Nowhere is lack of empowerment more obvious than in the plight of women in many parts of the world. Health suffers as a result. Following our recommendations would dramatically improve the health and life chances of billions of people."

Inequities within countries

Health inequities -- unfair, unjust and avoidable causes of ill health -- have long been measured between countries but the Commission documents "health gradients" within countries as well. For example:

* Life expectancy for Indigenous Australian males is shorter by 17 years than all other Australian males.
* Maternal mortality is 3--4 times higher among the poor compared to the rich in Indonesia. The difference in adult mortality between least and most deprived neighbourhoods in the UK is more than 2.5 times.
* Child mortality in the slums of Nairobi is 2.5 times higher than in other parts of the city. A baby born to a Bolivian mother with no education has 10% chance of dying, while one born to a woman with at least secondary education has a 0.4% chance.
* In the United States, 886 202 deaths would have been averted between 1991 and 2000 if mortality rates between white and African Americans were equalized. (This contrasts to 176 633 lives saved in the US by medical advances in the same period.)
* In Uganda the death rate of children under 5 years in the richest fifth of households is 106 per 1000 live births but in the poorest fifth of households in Uganda it is even worse -- 192 deaths per 1000 live births -- that is nearly a fifth of all babies born alive to the poorest households destined to die before they reach their fifth birthday. Set this against an average death rate for under fives in high income countries of 7 deaths per 1000.

The Commission found evidence that demonstrates in general the poor are worse off than those less deprived, but they also found that the less deprived are in turn worse than those with average incomes, and so on. This slope linking income and health is the social gradient, and is seen everywhere -- not just in developing countries, but all countries, including the richest. The slope may be more or less steep in different countries, but the phenomenon is universal.
Wealth is not necessarily a determinant

Economic growth is raising incomes in many countries but increasing national wealth alone does not necessarily increase national health. Without equitable distribution of benefits, national growth can even exacerbate inequities.

While there has been enormous increase in global wealth, technology and living standards in recent years, the key question is how it is used for fair distribution of services and institution-building especially in low-income countries. In 1980, the richest countries with 10% of the population had a gross national income 60 times that of the poorest countries with 10% of the world's population. After 25 years of globalization, this difference increased to 122, reports the Commission. Worse, in the last 15 years, the poorest quintile in many low-income countries have shown a declining share in national consumption.

Wealth alone does not have to determine the health of a nation's population. Some low-income countries such as Cuba, Costa Rica, China, state of Kerala in India and Sri Lanka have achieved levels of good health despite relatively low national incomes. But, the Commission points out, wealth can be wisely used. Nordic countries, for example, have followed policies that encouraged equality of benefits and services, full employment, gender equity and low levels of social exclusion. This, said the Commission, is an outstanding example of what needs to be done everywhere.

Solutions from beyond the health sector

Much of the work to redress health inequities lies beyond the health sector. According to the Commission's report, "Water-borne diseases are not caused by a lack of antibiotics but by dirty water, and by the political, social, and economic forces that fail to make clean water available to all; heart disease is caused not by a lack of coronary care units but by lives people lead, which are shaped by the environments in which they live; obesity is not caused by moral failure on the part of individuals but by the excess availability of high-fat and high-sugar foods." Consequently, the health sector -- globally and nationally -- needs to focus attention on addressing the root causes of inequities in health.

"We rely too much on medical interventions as a way of increasing life expectancy" explained Sir Michael. "A more effective way of increasing life expectancy and improving health would be for every government policy and programme to be assessed for its impact on health and health equity; to make health and health equity a marker for government performance."
Recommendations

Based on this compelling evidence, the Commission makes three overarching recommendations to tackle the "corrosive effects of inequality of life chances":

* Improve daily living conditions, including the circumstances in which people are born, grow, live, work and age.
* Tackle the inequitable distribution of power, money and resources -- the structural drivers of those conditions -- globally, nationally and locally.
* Measure and understand the problem and assess the impact of action.

Recommendations for daily living

Improving daily living conditions begins at the start of life. The Commission recommends that countries set up an interagency mechanism to ensure effective collaboration and coherent policy between all sectors for early childhood development, and aim to provide early childhood services to all of their young citizens. Investing in early childhood development provides one of the best ways to reduce health inequities. Evidence shows that investment in the education of women pays for itself many times over.

Billions of people live without adequate shelter and clean water. The Commission's report pays particular attention to the increasing numbers of people who live in urban slums, and the impact of urban governance on health. The Commission joins other voices in calling for a renewed effort to ensure water, sanitation and electricity for all, as well as better urban planning to address the epidemic of chronic disease.

Health systems also have an important role to play. While the Commission report shows how the health sector can not reduce health inequities on its own, providing universal coverage and ensuring a focus on equity throughout health systems are important steps.

The report also highlights how over 100 million people are impoverished due to paying for health care -- a key contributor to health inequity. The Commission thus calls for health systems to be based on principles of equity, disease prevention and health promotion with universal coverage, based on primary health care.

Distribution of resources

Enacting the recommendations of the Commission to improve daily living conditions will also require tackling the inequitable distribution of resources. This requires far-reaching and systematic action.

The report foregrounds a range of recommendations aimed at ensuring fair financing, corporate social responsibility, gender equity and better governance. These include using health equity as an indicator of government performance and overall social development, the widespread use of health equity impact assessments, ensuring that rich countries honour their commitment to provide 0.7% of their GNP as aid, strengthening legislation to prohibit discrimination by gender and improving the capacity for all groups in society to participate in policy-making with space for civil society to work unencumbered to promote and protect political and social rights. At the global level, the Commission recommends that health equity should be a core development goal and that a social determinants of health framework should be used to monitor progress.

The Commission also highlights how implementing any of the above recommendations requires measurement of the existing problem of health inequity (where in many countries adequate data does not exist) and then monitoring the impact on health equity of the proposed interventions. To do this will require firstly investing in basic vital registration systems which have seen limited progress in the last thirty years. There is also a great need for training of policy-makers, health workers and workers in other sectors to understand the need for and how to act on the social determinants of health.

While more research is needed, enough is known for policy makers to initiate action. The feasibility of action is indicated in the change that is already occurring. Egypt has shown a remarkable drop in child mortality from 235 to 33 per 1000 in 30 years. Greece and Portugal reduced their child mortality from 50 per 1000 births to levels nearly as low as Japan, Sweden, and Iceland. Cuba achieved more than 99% coverage of its child development services in 2000. But trends showing improved health are not foreordained. In fact, without attention health can decline rapidly.

Is this feasible?

The Commission has already inspired and supported action in many parts of the world. Brazil, Canada, Chile, Iran, Kenya, Mozambique, Sri Lanka, Sweden, and the UK have become 'country partners' on the basis of their commitment to make progress on the social determinants of health equity and are already developing policies across governments to tackle them. These examples show that change is possible through political will. There is a long way to go, but the direction is set, say the Commissioners, the path clear.

WHO will now make the report available to Member States which will determine how the health agency is to respond.

Comments from the Commissioners

Fran Baum, Head of Department and Professor of Public Health at Flinders University, Foundation Director of the South Australian Community Health Research Unit and Co-Chair of the Global Coordinating Council of the People's Health Movement: "It is wonderful to have global endorsement of the Australian Closing the Gap campaign from the CSDH established by the WHO. The CSDH sets Closing the Gap as a goal for the whole world and produces the evidence on how health inequities are a reflection of the way we organize society and distribute power and resources. The good news from the CSDH for Australia is that it provides plenty of ideas on how to set an agenda that will tackle the underlying determinants of health and create a healthier Australia for all of us"

Monique Begin, Professor at the School of Management, University of Ottawa, Canada, twice-appointed Minister of National Health and Welfare and the first woman from Quebec elected to the House of Commons: "Canada likes to brag that for seven years in a row the United Nations voted us "the best country in the world in which to live". Do all Canadians share equally in that great quality of life? No they don't. The truth is that our country is so wealthy that it manages to mask the reality of food banks in our cities, of unacceptable housing (1 in 5), of young Inuit adults very high suicide rates. This report is a wake up call for action towards truly living up to our reputation."

Giovanni Berlinguer, Member of the European Parliament, member of the International Bioethics Committee of UNESCO (2001--2007) and rapporteur of the project Universal Declaration on Bioethics: "A fairer world will be a healthier world. A health service and medical interventions are just one of the factors that influence population health. The growth of inequalities and the phenomena of increased injustice in health is present in low and middle income countries as well as across Europe. It would be a crime not to take every action possible to reduce them."

Mirai Chatterjee, Coordinator of Social Security for India's Self-Employed Women's Association, a trade union of over 900 000 self-employed women and recently appointed to the National Advisory Council and the National Commission for the Unorganised Sector: "The report suggests avenues for action from the local to national and global levels. It has been eagerly awaited by policy-makers, health officials, grassroot activists and their community-based organizations. Much of the research and evidence is of particular relevance to the South-East Asian region, where too many people struggle daily for justice and equity in health. The report will inspire the region to act and develop new policies and programmes."

Yan Guo, Professor of Public Health and Vice-President of the Peking University Health Science Centre, Vice-Chairman of the Chinese Rural Health Association and Vice-Director of the China Academy of Health Policy: "A man should not be concerned with whether he has enough possessions but whether possessions have been equally distributed", this is a time-honored teaching in China. Constructing a harmonious society is our shared aspiration, and equity, including health equity, composes the prerequisite for a harmonious development. Eliminating determinants that are adverse to health under the efforts from all of the society, promoting social justice, and advancing human health are our shared goals. Let's join our hands in this grand course!"

Kiyoshi Kurokawa, Professor at the National Graduate Institute for Policy Studies, Tokyo, Member of the Science and Technology Policy Committee of the Cabinet Office, formerly President of the Science Council of Japan and the Pacific Science Association: "The WHO Commission addresses one of the major issues of our global world - health inequity. The report's recommendations will be perceived, utilized and implemented as a major policy agenda at national and global levels. The issue will increase in importance as the general public become more engaged via civil society movements and multi-stakeholder involvement."

Alireza Marandi, Professor of Pediatrics at Shaheed Beheshti University, Islamic Republic of Iran, former two-term Minister of Health and Medical Education, former Deputy Minister and Advisor to the Minister and recently elected to be a member of the Iranian Parliament: "According to the Islamic ideology, social justice became a priority, when the Islamic revolution materialized in Iran. Establishing a solid Primary Health Care network in our country, not only improved our health statistics, but it was an excellent vehicle to move towards health equity. Now through the final report of the CSDH and implementing its recommendations we need to move much faster in our own country toward health equity."

Pascoal Mocumbi, High Representative of the European and Developing Countries Clinical Trials Partnership, former Prime Minister of the Republic of Mozambique, former head of the Ministry of Foreign Affairs and the Ministry of Health: "The Commission on Social Determinants of Health report will help African leaders adapt their national development strategies to address the challenges to health. These are derived from the current systemic changes taking place in the global economy that affects heavily on the poorest segments of Africa's population."

Amartya Sen, Lamont University Professor and Professor of Economics and Philosophy at Harvard University, awarded the Nobel Prize in Economics in 1998: "The primary object of development - for any country and for the world as a whole - is the elimination of 'unfreedoms' that reduce and impoverish the lives of people. Central to human deprivation is the failure of the capability to live long and healthy lives. This is much more than a medical problem. It relates to handicaps that have deep social roots. Under Michael Marmot's leadership, this WHO Commission has concentrated on the badly neglected causal linkages that have to be adequately understood and remedied. A fuller understanding is also a call for action."

David Satcher, Director of the Center of Excellence on Health Disparities and the Satcher Health Leadership Institute Initiative, formerly the United States Surgeon General and Assistant Secretary for Health and also Director of the Centers for Disease Control and Prevention: "The United States of America spends more on health care than any other country in the world, yet it ranks 41st in terms of life expectancy. New Orleans and its experience with Hurricane Katrina illustrate why we need to target social determinants of health (SDH) --- including housing, education, working and learning conditions, and whether people are exposed to toxins---better than any place I can think of right now. By targeting the SDH, we can rapidly move towards closing the gap that unfairly and avoidably separates the health status of groups of different socio-economic status, social exclusion experience, and educational background."

Anna Tibaijuka, Executive Director of UN-HABITAT and founding Chairperson of the independent Tanzanian National Women's Council: "Health delivery is not possible for people living in squalor, in dehumanizing pathetic conditions prevailing in the ever growing slum settlements of cities and towns in developing countries. Investment in basic services such as water and education will always remain constrained if not wasted unless accompanied by requisite investment in decent housing with basic sanitation."

Denny Vagero", Professor of Medical Sociology, Director of CHESS (Centre for Health Equity Studies) in Sweden, member of the Royal Swedish Academy of Sciences and of its Standing Committee on Health: "Countries of the world are presently growing apart in health terms. This is very worrying. In many countries in the world social differences in health are also growing, and this is true in Europe. We have been one-sidedly focused on economic growth, disregarding negative consequences for health and climate. We need to think differently about development."

Gail Wilensky, Senior Fellow at Project HOPE, an international health education foundation. Previously she directed the Medicare and Medicaid programmes in the United States and also chaired two commissions that advise the United States Congress on Medicare: "What this report makes clear is that improving health and health outcomes and reducing avoidable health differences---goals of all countries-- involves far more than just improving the health care system. Basic living conditions, employment, early childhood education, treatment of women and poverty all impact on health outcomes and incorporating their effects on health outcomes needs to become an important part of public policymaking. This is as true for wealthy countries like the United States as it is for many of the emerging countries of the world, where large numbers of people live on less than $2 per day."

For more information or interviews, please contact:

Sharad Agarwal
Communications Officer
WHO, Geneva
Tel.: +41 22 791 1905
Mob.: +41 79 621 5286
Email: agarwals@who.int

Felicity Porritt
Head, Communications
CSDH, UCL Secretariat
London
Mob.: +44 773 941 9219
Email: felicity.porritt@mac.com

Berlin Call to Action

Global Partners in Action:

NGO Forum on Sexual and Reproductive Health and Development

Berlin Call to Action

(The ‘Berlin Call to Action is the outcome document from the Berlin NGO forum appealing to governments, UN agencies, Donors, Parliamentarians, NGOs, Businesses, Religious communities to take the necessary steps to improve access to comprehensive sexual and reproductive health and rights. Organizers plan to push the Berlin Call to Action at the 2009 International Parliamentarians' Conference on the Implementation of the ICPD Programme of Action in Addis Ababa, Ethiopia, at the end of October.)

Berlin Call to Action: Now is the time for donors and government leaders at all levels to accelerate implementation of the International Conference on Population and Development (ICPD) Programme of Action (PoA) as fundamental to achieving equality and equity, human rights and social and economic development.

Leaders of non-governmental organisations (NGOs) from more than 130 countries have come together in Berlin to demand that the international community reinforce and strengthen their commitment to the vision of the ICPD PoA, and in particular, sexual and reproductive health and rights.

As urgent as the ICPD agenda was in 1994, it is even more so today as countries, communities, and individuals seek effective responses to financial, political, humanitarian and environmental crises, climate change, insufficient health resources, continuing high maternal mortality and morbidity and the spread of HIV, and inequality in ensuring human rights. It is important to recognize the social determinants of health and are responsible for a major part of health inequities between and within countries. Access to sexual and reproductive health and rights information and services is essential to addressing these issues. The ICPD created a visionary global consensus which confirmed that the best way to improve global health and population policies, support sustainable development, advance human rights and help end poverty is to:

    * Invest in health and rights for women and young people
    * Provide comprehensive sexual and reproductive health information, services and supplies for all people
    * Eradicate discrimination against girls and ensure access to all levels of education
    * Advance gender equality and equity and empower girls and women

ICPD’s core principles and priority actions have repeatedly been affirmed by governments as having links to other aspects of development, such as in the 21st session of the UN General Assembly in 1999, the UN Millennium Declaration in 2000 and Millennium Development Goals (MDGs), the World Summit Outcome in 2005, the inclusion of universal access to reproductive health as a target in the MDGs, in the 2009 resolution of the UN Commission on Population and Development and in recommendations issued by the UN Human Rights treaty monitoring bodies.

With five years left to implement the ICPD PoA and achieve the MDGs, which are integrally linked, we call on local, national and international decision-makers to join with non-governmental organisations (NGOs) to establish and implement concrete, practical, and fully funded actions for ensuring sexual and reproductive health and rights.

We urge the following actions to be taken immediately:

I. Guarantee that sexual and reproductive rights, as human rights, are fully recognized and fulfilled. Reform laws and policies to protect and promote sexual and reproductive rights, which are central to achieving the highest attainable level of health. Repeal restrictive and punitive laws and policies which deny access to information and services for sexual and reproductive health and rights, as well as those which criminalize the transmission of HIV and abortion. These laws and policies should at the minimum comply with international human rights standards, treaties and conventions. These rights enable free and informed decisions over marriage, pregnancy, childbirth, contraception, sexuality, sexual orientation, pleasure and livelihood. Eradicate sexual and reproductive coercion, stigma, discrimination, harmful traditional practices and gender-based violence, particularly against women and girls.

II. Invest in comprehensive sexual and reproductive health (SRH) information, supplies and services as a priority in health system strengthening. We are deeply concerned with the consequences of unsafe abortion and maternal mortality, and as a result call for governments to address these as public health and human rights issues. Ensure equitable and affordable access for contraception, safe and legal abortion, skilled maternity and newborn care, including access and referral to pregnancy and delivery complications; prevention, diagnosis, treatment and care of HIV and AIDS and all other sexually transmitted infections, including in humanitarian crisis. All of these services must be available and fully funded throughout the health system, particularly in the public sector and at the primary health care level as well as taking into consideration the important role that NGOs play in providing complementary health services. Provide these services for all, ensuring quality, gender and age-sensitive healthcare and non-discrimination for low income and other marginalised groups. Service providers need to be non-judgmental and respect diversity. Support innovation, including the development of new technologies and service models, and access to scientific progress. We call upon governments to include objectives and indicators in the national health planning and budgeting process that ensure positive sexual and reproductive health and rights outcomes.

III. Ensure the sexual and reproductive rights of adolescents and young people. Empower young people to make informed decisions about their life and livelihood in an environment that removes all barriers to accessing the full range of sexual and reproductive health information and services. Guarantee confidentiality and eliminate parental and spousal consent and age restrictions. Expand and allocate the resources needed to deliver effective, continuous, gender sensitive and youth-friendly services and evidence-based, timely, and comprehensive sexuality education. Acknowledge and respect the diversity of young people and collect age and gender disaggregated data.

IV. Create and implement formal mechanisms for meaningful civil society participation in programs, policy and budget decisions, monitoring and evaluation. Provide ongoing opportunities, especially for women and young people, to be full partners in the policy dialogue and decision-making processes. Increase funding and ensure autonomy for non-governmental organisations (NGOs), especially women’s organisations to expand and strengthen their work to inform, influence and advocate for sexual and reproductive health and rights. Repeal repressive laws regulating NGOs and enact and implement legislation that protects and facilitates their actions. Recognize and protect sexual and reproductive health and rights advocates as human rights defenders and foster meaningful leadership among women, young people and? groups of people living in situations? increasing their vulnerability.

V. Ensure that national governments and donors allocate sufficient resources and budgets that meet the needs of all people’s sexual and reproductive health and rights. Particularly in times of economic crisis, we strongly urge all donors to meet their commitments to overseas assistance and provide full funding that is predictable and long-term. Ensure funding mechanisms include sexual and reproductive health and rights policies and services. Establish and implement concrete, practical, and fully funded actions for ensuring sexual and reproductive health and rights. Strengthen and harmonise people-centered, economically and environmentally sustainable policies. Prioritise sexual and reproductive health and rights as a critical component of economic and social justice, health and development.

We ask you to adopt the following principles in taking action:

    * Equity and equality. The ICPD PoA and MDGs cannot be achieved without equity and equality,? therefore actions must always be designed and monitored to foster equity, participation and representation
    * Inclusiveness and transparency. All stakeholders, including the NG0s making this statement, will work in partnership to ensure that priority actions are taken and have an impact.
    * Accountability and sustainability. All stakeholders—policymakers, donors and civil society—are committed to achieving the ICPD PoA and to ensure sexual and reproductive health and rights.
    * Democratic processes and policies free from fundamentalisms and other doctrines that restrict human rights.

We, the NGOs participating in the Global Partners in Action NGO Forum urge governments to reaffirm their commitment to the ICPD PoA and as NGOs, we will promote this Berlin Call to Action in our own countries and communities. We will work in cooperation with governments, bilateral and multilateral agencies and policymakers and other sectors of the social movements? to ensure its timely implementation and hold governments accountable for the full realisation of the PoA.

Human beings cannot live in dignity without the full implementation of the ICPD PoA. We demand that all governments fulfill the commitments made to their own people and the international community at Cairo in 1994. As NGOs, we work daily to uphold the right to health and commit ourselves to this Call to Action and its dissemination among policymakers and stakeholders who are committed to shape the future. It is a matter of human rights, democracy, and equality for all. This mandate does not end in Berlin. We must intensify our efforts.

Ishdeep Kohli-CNS